Chapter 4; Patient Education – Flashcards

- Your role in teaching depends on the clinical setting in which you work. Never pass up an opportunity to teach. - Encourage patients to ask questions. - Periodically check to ensure that your teaching has been effective. - Do not overstep your role as a Medical Assistant. The teaching you provide should clarify and compliment information provided by the physician. - A well-planned patient education program helps ensure that patients receive high-quality health care they deserve.

an option or substitute to the standard medical treatment plan, e.g. herbal therapies, acupuncture, hypnosis

the process of gathering information about the patient and the presenting conditions

the process of distributing information on community resources

the process of recording patient information

the process of indicating how well the patient or person is processing toward a particular goal; to appraise; to determine the worth or quality of something or someone

the process of initiating or carrying out an action such as a teaching plan or patient treatment

steps that need to be achieved to accomplish a learning goal

the patient's inability or refusal to follow prescribed orders

an inert substance given as a medication for its suggestive effect; an inert compound identical in appearance to material being tested in experimental research, which may or may not be known to the physician and/or patient, administered to distinguish between drug action and suggested effect of the material under study

the process of using information gathered during the assessment phase to organize learning or patient care objectives in order to accomplish the specific learning or treatment goal

describes a physical task

a factor the induces body tension; can be positive or negative

Patient education is performed under the direction of the physician. Patient education involves more than just telling patients which medications they need to take or which lifestyle behaviors they need to change and expecting them to follow these instructions blindly. Patient education will be one of your most challenging and rewarding roles as a Medical Assistant. Of course, you will not be responsible for teaching patients everything they need to know about health care. The amount and type of education that you will be expected to do will vary greatly from office to office.

The process of patient education involves five major steps: 1. Assessment 2. Planning 3. Implementation 4. Evaluation 5. Documentation These five steps collectively produce the teaching plan. The plan may be formally written as the process is occurring or may be documented after the event. You must follow all these steps to achieve effective patient education.

Before you begin to teach, you must assess your feelings and attitude about the patient and the topic to be taught. Assessment requires gathering information about the patient's present health care needs and abilities. You must also look at these other areas: - Past medical and surgical conditions - Current understanding and acceptance of health problems - Needs for additional information - Feelings about their health care status - Factors that may hinder learning You may obtain this information from a number of sources. The most comprehensive source will be the medical record. When you have collected all of the assessment data, you are ready to start the next step of the patient education process: planning.

The purpose of the assessment step in teaching patients is to allow you to gather information about the patient's health care needs and abilities.

Planning involves using the information you have gathered during the assessment phase to determine how you will approach the patient's learning needs. Learning goals and objectives that are established with input from the patient are most meaningful. The patient's learning objectives include procedures or tasks that will be discussed or performed at various points in the program to help achieve the goal.

After you establish the need for patient teaching and agree on the goals and objectives, you begin implementation. Implementation is the process used to perform the actual teaching. Miscommunication or misinterpretation can lead to serious complications or injury. The implementation stage may occur once or over a longer period of time. The disease process and the patient's ability to comprehend information will dictate the length of teaching. After implementation of a given skill or knowledge, you must determine if your teaching was effective. This step is called evaluation.

Implementing the learning process should be individualized to the patient's best method of comprehension and retention. These may include: - Lecture and Demonstration: This method presents the information in the most basic form but requires no patient participation for reinforcement and retention. - Role Playing and Demonstration: The patient watches you perform a medical procedure, then performs it to ensure understanding. Information is more likely to be recalled if the patient actively participates in the process. - Discussion: This two-way exchange of information and ideas works well for lifestyle changes rather than for medical procedures. - Audiovisual Material: Audio and video material can often be taken home and reviewed by the patient and family members as needed. This allows for reinforcement of teachings and provides both visual and auditory stimulation. - Printed Material and Programmed Instructions: All information should be discussed with the patient to clarify points and to elicit questions before assuming that the instructions are understood.

Is the patient progressing? Did the teaching plan work? Does the teaching plan need any changes? These are a few of the questions you may ask yourself when you begin to evaluate. Evaluation is the process that indicates how well patients are adapting or applying new information to their lives. During the evaluation, you may discover noncompliance. Noncompliance is the patient's inability or refusal to follow a prescribed order. Remember that the patient has the right to refuse medical treatment unless the patient is determined to be mentally incompetent. The physician will determine the next appropriate action in these cases. Evaluation is an ongoing process, so you should expect to update and modify your plan periodically.

The purpose of the evaluation step in teaching is to allow you to determine how well patients are adapting or applying the new information to their lives.

As long as you are sure that your information is correct, you should share this with the patient. The patient then says he still does not want to take the medication, but he asks that you not tell the doctor because the doctor may get angry. Since the patient needs this medication for a serious condition, the physician must be notified. A physician cannot force the patient to take his medication, but he may be able to convince him to take the medication. Perhaps the patient could try another medication that may not have the same side effect. Remember to document the details of the encounter in the patient's chart.

Documentation includes the recordings of all teachings that have occurred. It should consist of the following information: - Date and time of teaching - What information was taught - How the information was taught - Evaluation of the teaching - Any additional teachings planned - Your signature, which implies that you performed the teaching Documentation is essential because, from a legal viewpoint, procedures are only considered to have been done if they are recorded. There is a common saying in health care: "If it is not in the chart, it did not happen." In a court of law, a medical record is a health care professional's best defense. Always take special care to succinctly and accurately record every interaction with a patient and to give patients their instructions in writing. When patients receive a new diagnosis, provide educational materials about their disorder and direct them to appropriate websites, if necessary. Document any instructions, information, or written materials given to the patient. Documentation should become second nature to you as you interact with patients each day. A complete and accurate medical record indicates good care and attention to detail.

Learning is the process of acquiring knowledge, wisdom, or skills through study or instruction. This process does not occur without certain conditions. Learning cannot occur without motivation or a perceived need to learn. For patient's to be taught, the following steps must occur: - The patient must accept that their condition must be controlled. - The patient must accept that there is a correlation between their lifestyle habits and their condition. - The patient must accept and be willing to make changes. Only if these steps have occurred, can teaching truly begin. In addition to patient motivation, basic human needs must be met first. The environment where you teach must be conducive to learning. For patients to acquire knowledge, they must feel relaxed and comfortable. A common type of education is teaching patients to perform a psychomotor skill. The steps to teach a psychomotor skill are as follows: - Demonstrate the entire skill - Demonstrate the skill step-by-step - Have the patient demonstrate the skill with your help - Have the patient demonstrate the skill without your help - Always provide written step-by-step instructions The person teaching the skill must have a solid knowledge of the material. Never guess or imply that you know something that you do not know. For patient education to be effective, it must consist of multiple techniques or approaches. The more techniques that are used, the more the patient will learn and retain. In addition to the conditions and factors already discussed, these factors will be necessary for the patient to learn: - Family or significant others should be present if the information is complex or if it will require their assistance. Family members are essential if the patient is confused or unreliable. - Patients should be wearing any sensory devices that they need. - Qualified instructions and materials should be prepared. - Written instructions and materials should be prepared.

Abraham Maslow, an American psychiatrist, recognized that people are motivated by needs and that certain basic needs must be met before people can progress to higher needs, such as taking personal responsibility for their heath (self-actualization). Maslow arranged human needs in the form of a pyramid, with basic needs at the bottom and the higher needs at the top. In your responsibility as an educator, you need to be aware that patients must have the basic needs satisfied before they are willing or able to learn to take care of their own health. Not everyone will start at the bottom of the pyramid. Some patients will never reach the top, while others may be at the top and slide backward as a result of unfortunate circumstances. Physiological Needs: include air, water, food, rest, and comfort. If these basic needs are unmet, the patient cannot begin the process. Safety and Security Needs: include a safe environment and freedom from fear and anxiety. Patients are susceptible to fear and anxiety that accompany many medical conditions. Affection Need: or the need for love and belonging, are essential for feeling connected and important to others. A sense of love or belonging can often be a powerful motivation for patients to try to regain good health. Esteem Needs: involve our need to feel self-worth. Esteem can be self-generated, or it can come from those who admire us. Self-Actualization: is the pinnacle of the pyramid, at which a person has satisfied all the other basic needs and feels personal responsibility and control over his or her own life.

The basic physiologic needs are air, food, water, rest, and comfort.

Many factors or circumstances can hinder learning. It is important to recognize these factors and intervene as appropriate. - Existing Illnesses: the type of illness that patients have will play a large role in their ability and willingness to learn. - Communication Barriers: effective communication skills are essential for patient education. Any barrier to communicate must be resolved before you can start teaching the patient. - Age: the age of the patient plays a very important part in the amount and type of education that you can do. - Educational Background: most initial health assessment forms ask patients what level of education they have obtained. This information may help you to determine the patient's ability to read. Patients who have completed some college courses, however, are more likely to be interested in preventative health care. - Physical Impairments: numerous physical impairments may hinder learning. Speak to the physician to obtain proper referrals, if necessary. - Other Factors: other factors may hinder your ability to teach patients. The patient's culture may affect willingness to learn or the family's involvement in learning. It is important that you assess the patient's readiness to learn and either try to remove or work around any obstacles that may be present.

These are six examples of illness or conditions that may affect learning: - Any illness in which the patient has moderate to severe pain. - Any illness or condition with a poor prognosis or limited rehabilitation potential. - Any illness or condition that results in weakness and general malaise as a primary symptom. - Any illness or condition that impairs the patient's mental health or cognitive abilities. - Any patient who has more than one chronic illness. Any illness or condition that results in respiratory distress or difficulty breathing.

As children mature at different speeds, you should assess what information this child can handle and what information should not be shared with the child. Communication with the parents is essential. Children require special communication skills and different teaching strategies. Here are a few tips to help you: - Encourage the child to be part of the teaching process. - Speak directly to the child. - Avoid confusing medical terms. - Avoid using baby language, or "baby talk". - Teach only age-appropriate information. - Discuss with the parents the child's knowledge base about the illness and any feelings the parents may have regarding what they want the child to know. (This should not be done in front of the child.) - Demonstrate skills on stuffed animals or dolls, if necessary.

The primary teaching focus for small children and their parents is safety and injury prevention.

Your role in patient education will vary greatly. The topics that you will teach will depend on the patient, type of medical office, and physician's preferences. - Preventative Medicine: preventing health problems is the key to living a long, healthy life. These are some commonly recommended preventative health care tips that you should teach all of your patients: - Regular physical examinations for all age groups. - Annual influenza and regular pneumonia vaccinations. - Adult immunizations for tetanus and hepatitis B. - Childhood immunizations. - Regular dental examinations. - Monthly breast self-examinations for women and regular gynecological examinations. - Cancer screenings, to include; Mammograms, Colonoscopy, Annual PAP tests, and Prostate-specific antigen blood test for all men, along with the need for regular digital rectal examinations. The frequency and age at which these procedures will be recommended to patients vary with the patient's medical history and genetics and the physician's preferences. your role as a Medical Assistant is to promote preventative screenings. The physician you work with will instruct you in his or her recommendations for these tests. Another large part of preventative medicine is teaching safety tips. According to the American Academy of Orthopaedic Surgeons (AAOS), falls cause 90% of the hip fractures that occur each year in the United States. Fall prevention tips should be taught to all older patients or any patient who has a problem with maintaining balance or uses an ambulation device (cane, walker). Here are some tips that you can use to teach fall prevention: - Encourage patients to remove all scatter rugs in their home. Remind patients to keep hallways clutter free. - Instruct the patient to ensure adequate lighting in all rooms and hallways. - Encourage the patient to avoid steps, if at all possible. Encourage one-floor living. - Ensure that the patient has well-soled shoes or sneakers. Advise the patient to avoid wearing heels. - Instruct the patient to place nonskid surfaces in bathtubs or purchase a shower chair. - Instruct the patient to install handrails or grab bars in hallways and stairwells. - Advise patients taking medications that lower their blood pressure to stand up slowly and get their balance, and then begin to walk. - Advise patients to get regular eye examinations and have their glasses adjusted, as needed. - Encourage patients to have a plan for power outages and severe storms. In addition to instructing patients, in many cases, you will be asking them to make changes in their lifestyle. Change is difficult for anyone.

Any patient who has trouble maintaining balance or uses an ambulation device should be taught fall prevention tips.

With the increasing number of medications available, the possibilities for teaching patients in this area are virtually endless. When preparing a medication therapy teaching tool, you must consider such factors as the patient's financial abilities, social or cultural demands, physical disabilities, and age. Be sure to include the following information in any teaching: - Medication name (generic or brand) - Dosage - Route - What the medication is for - Why the medication must be taken as prescribed - Possible changes in bodily functions (e.g., colored urine) - Possible side effects - Other medications, such as OTC drugs, herbal supplements, and so on, that might interfere with the action of the medication - Food or liquids to be avoided - Activities to be avoided - Telephone number to call for any questions or concerns Medication teaching should also include any OTC medications or herbal supplements the patient is taking. After assessing the patients' understanding of all of their medications, you may find that scheduling is a prime concern. Before developing a medication schedule, evaluate the patient's daily routine to see how adhering to the schedule may affect the patient's lifestyle. You may need to ask the patient: - What time do you typically get up for the day? - What time do you generally go to sleep? - When do you usually eat your meals? Once you have collected this information, you can create a scheduling tool to serve as a reminder to the patient about what medications to take and when. Another patient education area that falls under the category of medication therapy includes how to administer medications - orally, vaginally, rectally, and so on. This information will be taught in the clinical part of your curriculum. A patient's medication regimen should be reviewed at each visit to be sure the patient is taking the right medication in the right way.

Many ancient remedies that were once considered voodoo and dismissed by Western medicine have proven to be beneficial. Billions are spent yearly on alternative medicine, and surveys have shown that about 51% of all Americans have used some form of unconventional medicine. The National Center for Complementary and Alternative Medicine (NCCAM), conducts clinical trials and training programs for practitioners of alternative medicine. There are numerous types of alternative medicine therapies. Following is a discussion of four of the most common therapies: - Acupuncture: is one of the oldest forms of Chinese medicine. Acupuncture works on the principle that there are 2,000 acupuncture points in the human body. Acupuncture is primarily used to treat addictions, fibromyalgia, osteoarthritis, asthma, and chronic back pain. - Acupressure: is similar to acupuncture, except that it does not use needles. - Hypnosis: is portrayed on television as a magical method for reaching the inner workings of the brain. There is proof, however, that when conducted properly, it may provide some health care benefits. - Yoga: has proved to be very beneficial for relieving stress and improving flexibility.

The use of herbal supplements is a multi-billion dollar business in the United States. The general public views herbal supplements as "natural" and hence safe. This is a misconception. Herbal supplements, vitamins, and similar substances are not regulated by the FDA. Furthermore, since the products are not regulated, there is not guarantee that what the label claims is in the bottle is actually there. In some cases, there is an element of placebo action involved. Your role as a Medical Assistant is to assess whether patients are using any alternative therapies. Patients should be advised to verify the training and credentials of the practitioner they are using and to ascertain that the practitioner is appropriately licensed. Here are a few general teaching points on herbal supplements: - Explain to patients the importance of always telling the physician or other health care professionals about any herbal supplements they are taking. - Explain to patients the fact that just because a product is "natural" does not mean it is safe. - Teach patients the importance of looking for the USP (United States Pharmacopeia) label. - Teach patients to look for expiration dates on all supplements. - Advise patients not to ask health store clerks for information on supplements but to speak to physicians or pharmacists instead. - Advise patients to distrust advertisements that use words like magical or breakthrough or that claim to detoxify the whole body. - Instruct patients to stop taking all herbal supplements at least 2 weeks prior to any surgeries and to tell their surgeons what supplements they have been using and for how long. (Some supplements can increase bleeding time.) - Warn diabetic patients that many supplements will interfere with blood sugar levels. - Advise parents to avoid giving herbal supplements to their children unless approved by a physician. - Advise pregnant or breast-feeding patients to consult with a physician or pharmacist before taking any herbal supplements.

Placebo is the power of believing that something will make you better when there is no chemical reaction that warrants such improvement.

Everyone is affected by an illness or injury at some time. Along with this often comes stress. Stress can come from forces such as fear, anger, anxiety, crisis, and joy. Stress may produce physiological changes as well as psychological effects. When faced with illness or injury, a patient usually must confront: - Physical pain - Inability to perform self-care - Stress of treatments, procedures, and possible hospitalization - Changes in role identity and self-image - Loss of control and independence - Changes in relationships with friends and family Patients with chronic conditions may need more time to adjust than patients with acute illnesses. Two types of stress affects all of us daily: positive stress and negative stress. Positive stress motivates individuals to work efficiently and perform to the best of their abilities. Negative stress is the inability to relax after a stressful encounter. Left unchecked, it can lead to such physiological responses: - Headache - Nausea, diarrhea - Sweating palms - Insomnia - Malaise - Rapid heart rate Long-term physical effects of unrelieved stress include increase in blood pressure, uncontrolled glucose levels, decreased metabolism, interocular pressure, and exhaustion. There is also an increased risk of heart attack, stroke, diabetes, certain cancers, and immune system failure. It may be difficult to escape completely from stress-causing factors, but management of them is possible. - Encourage patients to attempt to reduce stressors, but emphasize that it is not possible to remove all stressors. Warn them to avoid attempting to make everything perfect; perfectionism adds its own stress. - Encourage patients to organize and limit activities as needed. - Try to lessen patients' fear of failure so they just do the best they can. - When patients are feeling anxious, encourage them to talk to someone about their problems and let off steam. Any one of these tips may help patients to gain control over stressors. In addition, a number of relaxation techniques may be useful. Patients can use any of several types of relaxation techniques. To determine what works best for them, they must first consider how much time they have and what type of relaxation they need. - Breathing Technique: breathing exercises can be done anywhere. To perform these breathing exercises, the patient should sit up straight with hands placed on the stomach and take a deep breath in through the nose, feeling the hands being pushed away by the stomach. The patient holds the breath for a few seconds and then exhales thorough pursed lips as the hands are felt being puled in. - Visualization Technique: visualization is a relaxation technique that involves allowing the mind to wander and the imagination to run free and focus on positive and relaxing situations. - Physical Exercise: there is no better tranquilizer than physical exercise. Walking at least 30 minutes, three times a week is a great stress reliever.

- Denial: refusing to acknowledge an unpleasant fact of life in order to delay facing it; allowing yourself to believe that the problem does not exist. Example: A parent of a teen ignores or trivializes physical signs of drug abuse. - Displacement: taking out your anger and frustrations on someone other than the person responsible for the bad feelings. Example: A Medical Assistant is angry with his/her physician-employer. Later, he/she yells at their spouse when they ask about dinner. - Intellectualization: analyzing a difficult situation to try to make sense of it. Example: A daughter spends hours researching Alzheimer's disease after her mother's diagnosis. - Projection: blaming others for your unacceptable qualities. Example: A Medical Assistant graduate blames his/her teachers when they have trouble finding a job because of poor personal work history. - Rationalization: using excuses for unacceptable behavior. Example: A patient says it is alright for him/her to smoke because he/she has a high-stress job. - Regression: behaving in an immature way when faced with a stressful situation. Example: A patient puts when he/she has to wait because the physician has been called away for an emergency. - Repression: blocking out bad memories. Example: An abused wife remembers only "the good times" when she thinks about leaving her abuser. - Sublimation: changing unwanted aggressive or sexual drives by finding an outlet through creative mental work. Example: A recovering abuser volunteers at a shelter and counsels abused spouses. - Withdrawal: physically or emotionally pulling away from difficult or stressful situations. Example: A little boy sits alone on the playground because he is not as good at kickball as the other children.

Because Medical Assistants are usually allotted only minimal time for patient teaching, you may often find yourself teaching without a written plan. To ensure that teaching is done logically, always use the education process to help you formulate a plan in your mind. All teaching plans, no matter what the design, should contain the following elements: - Learning goal - a description of what the patent should learn from implementation of the teaching plan. - Material to be covered - all major topics to be discussed. - Learning objectives - steps or procedures the patient must understand or demonstrate to accomplish the learning goal. - Evaluation - appraisal of the patient's progress. - Comments - remarks concerning circumstances that may be preventing successful completion of the objectives. Teaching plans must also include an area for documenting when the information was presented to the patient and when the patient successfully completed each objective.

An enormous amount of teaching material is available. Although the physician or institution may select much of the material you may use, you may be responsible for selecting some teaching aids. A good rule of thumb is to use commercial material only from nationally recognized organizations or government agencies. Sometimes, you may need to create your own teaching materials. When developing teaching materials, remember to do the following: - Indicate the objective of the information. - Personalize the information so the patient wants to learn. - Make sure information is clear and well-organized. - Use lists and outlines, which are easier to read and remember than paragraphs. - Avoid medical jargon as much as possible. - Focus on the key points. - Select appropriate printing types. - Use diagrams that are simple, clear, and well-labeled. - Include the names and telephone numbers of people or organizations that patients can call with further questions or concerns.

The elements necessary for a written teaching plan are: - Learning goals - The material to be covered - Learning objectives - Evaluation - Comments - Documentation

Patients have access to many services that sometimes they do not even realize are available. Many communities have a central agency that coordinates and disseminates or distributes information about many or all community resources. Most local telephone directories include a section that outlines the agencies and resources available through the city and state. The Internet is an excellent source for local, state, and national agencies that provide information, support, and services to patients. Some common community resources are: - Council on Aging; www.ncoa.org - American Red Cross; www.redcross.org - Hospice; www.hospicefoundation.org - American Cancer Society; www.acscsn.org - American Heart Association; www.americanheart.org - Civic organizations - Public health departments - Social services - Home health agencies

assessment, planning, implementation, evaluation, documentation

self-actualization

all of these options

withdrawal

all of the above

ask the physician or nurse for clarification

all of the above

have motivation and a perceived need to learn

all of the above

ask the physician or nurse for clarification

displacement

noncompliance

all of the above

Herbal supplements are natural; therefore, they are safe.

All patients should be involved in some form of exercise plan.

self-esteem

all of these options

The patient will demonstrate how to change the dressing on her leg.

Young children should never be taught about a terminal illness.

reading a diet plan