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 7 th 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 or 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) Promotion of Successful Leadership Living Nurse-led Interprofessional Interventions Care Four Domains 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 Try to avoid by identifying ² Patient acuity early 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
What do Rehab Nurses teach? Bowel & Bladder Health and wellness Skin care Nutrition Prevention of secondary Medications 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, outcome, 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 5 th 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 7 th Ed.
Questions? Stephanie Davis Burnett stephanie.burnett2@stvhs.com 205.838.3582
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