Nursing News

The New, Well-informed Patient

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By Debra Wood, RN, contributor

November 22, 2010 - American health care has evolved from a paternalistic “doctor-knows-best” system of care to one that recognizes engaged and well-informed patients achieve better outcomes. Nurses play a huge role in teaching patients about their conditions, self-care and diagnostic or treatment procedures, and some are turning to electronic tools to enhance the process. 

Annette Moore-Mitchell, MSN, RN, CMSR
Annette Moore-Mitchell, MSN, RN, CMSRN, suggests removing distractions and assessing to be sure patients are ready to listen before beginning any teaching session related to their condition and care.

“When patients are fully informed, it helps relieve anxiety and uncertainty,” said Annette Moore-Mitchell, MSN, RN, CMSRN, clinical instructor of nursing at Oklahoma City University in Oklahoma.

Children require special attention to decrease stress levels. Not only must parents understand the plan of care, the patient and siblings also want to know what is happening. Child life specialists at Children’s Medical Center Dallas provide supportive care by using developmentally appropriate education, preparation and therapeutic activities to improve patients’ emotional well-being.

Child life
Child life specialists at Children’s Medical Center Dallas teach pediatric patients what to expect using play and other tools they can understand.

“Children want to know where a heart comes from for a heart transplant and how their sibling ‘caught’ cancer and if it's contagious,” said Renee Hunte, director of the child life department at Children’s Medical Center Dallas. “Our child life specialists explain medical procedures, tests and information in terms our patients and their siblings understand. Specialists engage children in medical play, showing them how to give a teddy bear an injection or listen to its heart with a play stethoscope.”

The medical center’s child life specialists often interact with children in the playrooms or help create an artistic masterpiece with syringes, glitter and glue. Older patients may enjoy group activities, a game of pool or individual bedside activities.

When Moore-Mitchell initiates a patient-teaching session with an adult, she will knock at the door, introduce herself, ask to turn off the television to avoid distractions and ascertain if that is an appropriate time for the session. For instance, a patient in a lot of pain will not learn as well as someone who is comfortable.

Joanne Turnier MS, RN, ACNS, BC, CNRN, CT, stroke coordinator at North Shore University Hospital in Manhasset, N.Y., recommends sitting down with the patient and family, using simple language and having what she describes as an interactive “living room conversation.”

“It’s nonjudgmental and a way of teaching them and teaching back,” Turnier said. “We’re developing a relationship and empowering.”

Turnier determines the patient’s current level of understanding, and then creates a dialogue, sharing information and asking the patient to verbalize their understanding of what she just taught. She advises nurses to assess how the patient likes to learn and tailoring the session to those needs. In addition, learning is enhanced when the patient feels relaxed and not threatened or bothered by anything and the nurse does not appear rushed.

Joanne Turnier MS, RN, ACNS, BC, CNRN, CT
Joanne Turnier MS, RN, ACNS, BC, CNRN, CT, engages the patient in an interactive “living room conversation” to discover what the patient knows and needs to further understand.

“No matter how frustrated and harried I might be, I remember the patient has the harder job, and it makes my job easier in comparison,” added Ann Levine, RN, CDE, MSN, a diabetes clinical nurse specialist at Montefiore Medical Center in the Bronx, N.Y.. “If you walk in the room and recognize all the patient and family have on the table, they respond favorably.”

The nurse must show respect and build a partnership based on trust, she advised. She always sits down to avoid hovering, asks permission to talk at that time and interviews, using open-ended, nonjudgmental questions to learn more about what the patient needs to know. She also suggests acknowledging different cultures, typically greeting the patient in his or her language.

“If I help them feel their culture is valued, they will trust me and what I have to say,” said Levine, who often uses written materials, available from Montifiore in English and Spanish.

“Handouts are wonderful, and the computer has brought that to a whole new level,” Levine said. “I can tailor it in a flash.”

Many hospital systems have incorporated patient education materials and protocols into their Intranet or electronic medical record system, which serve as a resource for nurses.

North Shore University Hospital developed its own patient teaching guides, considering health literacy and ensuring the tools are written in simple terms.

A nurse practitioner reviews important information from iMedConsent. Courtesy of Dialog Medical

“Most people don’t show you that they can’t read or don’t understand,” Turnier said. “Health literacy is a patient safety issue.”

Other systems use software tools, such as the Web-based iMedConsent system, from Dialog Medical of Atlanta, which allows health providers to prepare detailed information about procedures, anatomical images, pre- and post-procedure instructions, and informed consent forms, with an easy-to-understand description on the procedure, associated risks and benefits, alternatives and prognosis if the patient declines the treatment.

Dialog Medical’s software seamlessly will integrate with the health system’s electronic medical record. The provider can collect the patient’s signature with a digital capture pad, and the image is stored in the system, along with a note about what was discussed.

“Nurses love it, because of the patient education materials and the image library,” said Timothy Kelly, vice president of Dialog Medical.

Emmi Solutions
Emmi Solutions offers a Web-based interactive, multimedia patient education tool. Photo courtesy Emmi Solutions.

Emmi Solutions of Chicago offers online programs that use interactive multimedia to educate patients and empower them to take a more active role in their care. The provider can prescribe specific topics—disease process and procedures—for the patient to view online. Some facilities have installed it in the pre-admission testing area. As the patient completes the session, the software asks questions to track understanding.

“It’s a tool to educate and inform the patient and get them involved in their care,” said Cathryn DeGraff Crookston, RN, BSN, CCE, regional sales director of Emmi Solutions.

The health care provider can check electronically to verify the patient has watched the program and whether he or she completed it and answered the questions posed by the software correctly.

“Emmi can be used around the continuum of care,” Crookston said. “We lay a general framework for discussion and then the nurse goes over those points.”

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