Professional Rehabilitation Nursing Client/Caregiver Education - - PowerPoint PPT Presentation

Professional Rehabilitation Nursing Client/Caregiver Education Successful Discharge

Stephanie Davis Burnett, RN DNP ACNS-BC CRRN

Disclosure

Information is based on publication by author

Burnett, S. D. & Miller, E. L.

(2015 anticipated). Patient Education Across the Lifespan. In The Specialty Practice of Rehabilitation Nursing: A Core Curriculum 7th Ed., Chapter 8.

Patient Education Challenges

WHY? HOW? WHAT? WHEN? WHO?

Objectives

Participants will be able to: u Identify appropriate teaching & learning strategies to consider with the chronically ill and disabled population u Discuss key evidence related to effective teaching

Teaching and Learning

• Pedagogy, the art & science of

teaching

• Learning is a change of behavior
• r potential that results from

experience and not attributed to temporary body states (Olson & Hergenhahn 2012)

Patient Education

• Central role of the professional rehabilitation

nurse Ø Promotes maximum patient independence Ø Prevents secondary patient complications Ø Enhances patient health status Ø Essential nurse task in all settings

Ø Successful Community Re-integration

ARN Competency Model for Professional Rehabilitation Nursing

(ARN, 2014)

Four Domains

Nurse-led Interventions Promotion of Successful Living Leadership Interprofessional Care

2 related to patient education

ARN Competency Model for Professional Rehabilitation Nursing

Domain 1

§ Nurse-Led, Evidence-based Interventions

§ Promotes function and health management § In persons with disability and/or chronic illness § Identifies the provision of patient and caregiver education R/T Disability, Chronic illness, Health management (DCIHM) § Dynamic and family-centered § Includes needs, health, and welfare of primary caregiver

Domain 2

§ Promotion of Health and Successful Living

§ In persons with disability and chronic illness across life span § Self-management fostered and safe and effective care transitions promoted and facilitated

§ Providing education in relation to Disability, Chronic illness, Health management (DCIHM) § Promotes highest quality of life while living with DCIHM § Population-specific competence necessary of the rehab nurse

Population-specific competences to meet the needs of the rehabilitation patient

• Age specific
• Life span
• Growth & Development
• Ethnicity
• Cultural differences and beliefs
• Health beliefs
• Dietary & religious practices
• Language
• Care transitions

Overview: Teaching

• A deliberate, purposeful act of communicating

information that focuses on patient/family education needs with measureable outcomes

• Requires educator to be aware of learning

styles, needs, and capabilities of the patient/ family

Overview: Learning

• Time and repeated contact required for

individual to acquire new knowledge, skills, and attitudes that are meaningful and significant

• Facilitated if provided in a manner that moves

from simple to complex, concrete to abstract and known to what is not yet known

• Increased if information is provided on personal

and individualized basis and relevant to the learner’s needs and problems

Overview of Learning

• Enhanced if individual is attentive and feedback

is timely

• Takes place in an environment where

communication is collaborative, cooperative, supportive & creative

• Improved with active participation and

involvement of the learner

Initial step for patient education

ASSESSMENT

Assessment of the Learner(s)

• Use of a tool helps focus the assessment
• Identify the primary caregiver
• Assess learner’s developmental stage
• Assess learning needs and skills

– Health Literacy – Baseline knowledge – Readiness to learn – Ability to learn – Barriers

Assessment

• Formal Tools

– Health Literacy Management Scale (HeLMS)

• Test use of health info in healthcare setting

– Test of Functional Health Literacy in Adults

• Comprehensive test consisting of:

– Reading comprehension of health-related materials – Test understanding of numbers, such as prescriptions, appointment times, etc.

• Informal

– “Teach Back”

• Learner repeats or demonstrates what they know or

understand

Learning Theory

• 40 evidence-based learning theories to assess

learning

• Classics

Behavioral learning theories: Pavlov - conditioned stimulus evokes a response Skinner-desirable behavior is more likely repeated when it is reinforced or strengthened by reward

Learning Theory

Cognitive learning theories: Lewin- 3 stage ‘change theory’; unfreezing- change-refreezing Piaget- developmental stage theory of learning Maslow-hierarchy of needs Erickson-8 stage theory of identity and psychosocial development

Health Literacy

The ability to obtain, process, and understand the basic health information and services needed to make appropriate health decisions

(Burnett & Miller, 2015)

Four levels: below basic/basic/intermediate/proficient

Health Literacy

ü Involves more than ability to read-write ü Associated with poor patient-healthcare provider communications and outcomes ü Instructions difficult to comprehend ü Effects all socioeconomic levels ü Poor and minorities are disproportionately affected

Readiness to Learn

• Emotional state
• Cognitive status
• Resources available
• Past health issues
• Memory and recall ability
• Energy and health status

Ability to Learn

• Patient’s acuity
• Patient’s identification of need
• Sensory & motor deficits (vision, hearing,

mobility, function)

• Medical status/diagnosis

– Brain injury, confusion, psychiatric

• Stressors

Learning Style

• Educational level
• Reading ability
• Computer skills and access
• Available resources
• Auditory, visual learning preferences

Barriers

² Patient acuity ² Short LOS ² Skills of the educator ² Available teaching resources ² Stress of caregiver ² Cultural differences ² Health beliefs ² Sensory deficits ² Cognitive status

Try to avoid by identifying early

What do Rehab Nurses teach?

Bowel & Bladder Health and wellness Skin care Nutrition Medications Prevention of secondary complications Self-care and mobility Available resources Diagnosis/Outcomes Safety

Strategies

• Develop plan and attainable goals with the

patient and family

• Develop good communication & rapport with

patient/family

• Include team in the goal
• Use available technology
• Consider generational differences
• Timing is everything
• Creativity and flexibility

Strategies

• Engage patient/caregiver to participate & stay

motivated

• Document promptly what was taught, when,

measureable outcomes, how, to whom,

• utcome, and need for follow up
• Use evidence-based strategies involving the

specific population, desired outcome

• Use Mnemonic strategies to assist with

memorization

Strategies

• Hands on learning & activity learning with return

demonstration

• Peer group learning (when possible),

encourages learning from each other

• Computer applications
• Visuals-charts, notebooks, boards
• Every opportunity is a teaching moment

Strategies

• Use short words and sentences
• Written materials should be at 5th grade level

and culturally appropriate

• Avoid use of technical terms; clearly define

terms (hyperglycemia>high blood sugar)

• Teach most important info first
• “Teach-back” method to ensure understanding

– Don’t ask “do you understand” – Rather, ask “describe the signs of a stroke”

Summary

• The professional rehabilitation nurse has

many roles

• Teacher/Educator is one of its most

important

• Prepares the patient/caregiver for

successful discharge resulting in successful community living

• Reduces readmissions, secondary

complications

• Improved health outcomes and quality of

life for both patient and caregiver

Reference

Burnett, S. D. & Miller, E. L. (2015 anticipated). Patient Education Across the Lifespan, Chapter 8. In The Specialty Practice of Rehabilitation Nursing: A Core Curriculum 7th Ed.

Questions? Stephanie Davis Burnett

stephanie.burnett2@stvhs.com 205.838.3582