The information given to the patient should be appropriate for the patient's age, literacy level, education, and language skills. Patient materials should be geared between sixth- and eight-grade reading levels. Use of medical terminology or jargon should be avoided. For example, the term's "myocardial infarction" and "MI" should not be used in place of "heart attack" unless they have already been defined for the patient.

With shorter lengths of stay and limited time for teaching, print and audiovisual materials are important adjuncts for any discharge teaching plan. They are, however, just adjuncts and should not replace individualized instruction. Printed materials are useful for reinforcing information provided to patients while in the hospital and also serve as a ready resource. Printed material is an important reminder of key points after patients return home.

Family members are the vital links in the transition from hospital to home care. Families must be included in discussions and demonstrations. Family is any person who plays an important role in the patient's life.

Every effort must be made to ensure that learning takes place in incremental steps and that patients are not overwhelmed with too much information at one time

"TEAM WORK"

Patient Assessment:

The FIRST STEP in patient education is the review the Admission Assessment for learning needs.
Then meet with the patient to determine what are specific needs for that patient.

Individualized Teaching:Is based on the patient assessment, readiness to learn, and patient and family needs.

Patient education is a team effort. Different members of the interdisciplinary health care team do the teaching, depending on what skills need to be learned.

Patient Education Should Cover:

Safe and Effective Use of Medications:
Patients need to know:
- How much to take, when to take it and for how long
- Possible food and drug interactions
- Expected action of the medication and possible side effects
- What to do if a dose is missed
- Special directions for mixing and administering the medications
- Proper storage and expiration and disposal.

Medical Equipment and Supplies:
Patient and/or family member(s) should know how to use any supplies and equipment that will be needed at home.

Diet and Nutrition:
Patient/family may need to know:
- What foods to avoid, especially to prevent food and drug interactions.
- Special diet instructions
- How to read food labels.

Rehabilitation:
Patient/family may need to know, depending on patient's physical needs:
- Rehabilitation techniques (example: special exercises, speech therapy, etc.)
- Safe and effective use of equipment.

Pain Management:
- Understanding pain and the risk of pain
- How to describe pain
- How pain will be managed

Personal Hygiene:
Instructions for bathing and toileting may be needed.

Psychosocial:
Information about possible emotional reactions, interpersonal functioning or normal feelings secondary to diagnosis or treatment.

Community Resources:
The patient/family may need helpful local resources:
- Transportation services
- Health clinic(s)
- Home health care agency
- Outpatient Dialysis
- Support Group(s) or Self-Help Group(s)

Patient Rights:
All patients or a family member must be informed of their rights with regard to:
- Informed consent
- Privacy
- Treatment options
- Advanced directives
- Respect

Patient Responsibilities:
Patient/family members must be informed of their responsibility to communicate:
- present complaints
- present illnesses
- prior hospitalizations
- types of medications/alternative treatments that the patient is using or has used
- other health related issues/concerns
- questions about the diagnosis or care plan.

Follow-up Care:
Instructions involved in discharge planning:
- Where to go for follow-up care
- When to get help (for example, side effects to report)
- Where to get medical equipment or medications.

LET'S START AT THE VERY BEGINNING: PATIENT ASSESSMENT

Start with patient assessment.

Consider the patient's:

PHYSICAL NEEDS:
- What kind of care does the patient will need at home (i.e., care for themselves, or if support is needed.
- Can the patient hear clearly or read small printed materials.

AGE:
- Choose language and teaching methods appropriate for the patient's age and education level.

SUPPORT SYSTEM:
- Assess not only the patient but also anyone involved in the patient's care. Especially if a family member/significant other is going to be the patient's caregiver after discharge.

FEELINGS:
- Assess if the patient is having difficulty accepting their condition.
They may feel: overwhelmed, afraid, angry, or depressed.
This may affect the patient's readiness or ability to learn.

CULTURAL AND RELIGIOUS PRACTICES that may influence the patient's:
- Beliefs about health and illness
- Response to health care recommendations

OTHER NEEDS:
- Patient's reading level and ability to learn
- Ability to understand English
- Financial and/or insurance coverage for durable medical equipment and supplies and medications.

THE BASICS OF THE PATIENT EDUCATION PROCESS

The Patient Education Process

Your goals as the patient educator are:
1. Provide support and information
2. Correct misconceptions
3. Assist patient in understanding their role
4. Identify learning needs

You need to:
1. Identify your learner's educational needs
2. Assess your patient and/or significant other's learning needs
3. Identify barriers to learning
4. Identify the best teaching plan for your patient
5. Set goals/priorities
6. Implement teaching
7. Evaluate teaching
8. Refer patient for further teaching
9. Document, Document, Document

Next, you want to set goals and priorities. Then, decide which ones you will teach to your learner to change his/her behavior.

To Review:
1. Identify your learner's educational needs
2. Assess your patient and/or significant other's learning needs
3. Identify barriers to learning
4. Identify the best teaching plan for your patient
5. Set goals/priorities

Actual Teaching:
At this point you are ready to "fill in the gaps" of your learner's knowledge and skills. You may need to "correct" wrong ideas about care of self at home.

You teach any time you talk to your patient and/or significant other(s).

Teaching and learning take place until the day your patient leaves the hospital.

All health care providers - physicians, nurses, social worker, dietitian, rehab therapist, respiratory therapist, and others who provide direct patient care - supplement teaching.

Referring Your Patient:
How to Obtain Further Treatment
Educating the patient and/or significant other is never complete because your patient does not stay long in the hospital.

This is why you want to refer your patient to outside agencies or support groups. These places can be good sources of education.

The different programs that UMDNJ-The University Hospital has, such as outpatient clinics and consultations, are good sources, too.

REVIEW:

First, you identify who your learner(s) is/are. If you see that your patient is not able to receive any teaching, you then identify the patient's significant other. This significant other will be your learner.

Second, you want to know if there are things that make it difficult for your patient and/or significant other to learn (barriers to learning). You can ask questions like:
- What circumstances make it difficult for the patient and/or significant other to learn?
- How can I help the patient and/or significant other overcome these difficulties?

Third, you plan your teaching. Ask yourself the following questions to choose the best teaching plan:
- What does the patient already know about his/her health condition?
- What else does this patient need to know about his/her health condition?
- What does the patient know that needs reinforcement?

Make the teaching process interactive.
Ask questions that require more than a "yes" or "no" answer. For example, ask, "How was your
morning? Tell me a little about your morning." rather than "Are you feeling OK?" This can help give
you a clearer understanding of the patient's condition.

Set goals together.
Involving the patient in decisions about their care can help build motivation. It can also help you get
to know the patient better.

Agree on responsibilities.
The patient's responsibilities may include:
- Giving you accurate health information
- Following instructions
- Asking questions when something isn't clear
The health care provider's responsibilities include:
- Explaining the care you provide
- Answering questions
- Treating the patient with respect

Evaluating your learner. Ask for feedback.
To ensure that your patient understands the instructions you provide.
- Encourage the patient to ask questions and share any concerns
- Have the patient repeat instructions to be sure he/she understands them

Practice skills together.
After you demonstrate a technique to the patient and family/significant other, have them
re-demonstrate and/or verbalize it.

Offer feedback.
Inform the patient on how they are progressing. Give praise and encouragement when patient
shows effort or progress.

Document patient education.
When teaching takes place, all instructions should be documented as soon as they are given.
Include who the learner was - the patient and/or a family member.

CHECKLIST FOR PATIENT EDUCATION DOCUMENTATION

Diet/Nutrition
Document the type of diet the patient is on.

Self-Care
Any activity/behavior that needs to be taught to the patient, to be initiated at home for health
maintenance and self-management.
- S/S which signal a relapse
- S/S to expect during an exacerbation of chronic condition(s)
- How to record duration, location, severity of S/S
- Calling MD immediately when S/S occur
- Use of (name of equipment) at home
- Other: BP check, Limit or quit smoking/drinking, Importance of diet/rest/ or exercise

Equipment/Rehabilitation
For example:
For Dx of Asthma:
- Nebulizer/Inhaler
- Peak flow meters
- Spacers

For Dx of Diabetes:
- Needles & Syringes
- Alcohol wipes
- Glucometer
- Strips
- Lancets

For Dx of CVA:
- Canes
- Walkers
- Wheelchair

For Dx with Surgical Patient:
- Wound dressing
- Bandage

How To Obtain Further Treatment
- Informed importance or need to follow up care with MD or clinic
- Referred to (name of agency, clinic, SNF, etc.)
- Encouraged/counseled to call MD when S/S occur
- Encouraged/counseled to join support group

Food and Drug Interaction: Examples
- Erythromycin: Take one or two hours before or after food intake/meals
- Levodopa: Avoid protein-rich diet (decreases effectiveness)
- Propulsid: Avoid grapefruit juice
- Coumadin: Avoid Vitamin K rich foods
- Demeclocycline HCl: Avoid water, dairy products (milk), any food, iron pills
- Phenytoin (Dilantin):
Interacts with enteral feedings (drug level drops);
­ Folic acid, ­ Vitamin D, ­ Calcium in diet
- Indinavir (Crixivan): Avoid high calorie, high fat, high protein diet
- Isoniazid: ­ Calcium, ­ Phosphate, ­ Vitamin D, ­ Pyridoxine in diet
- Lasix: Best taken without food
- MAOI: Avoid aged cheese, alcohol
- Nelfinavir (Viracept): Always take with food (improves absorption)
- Saquinavir: Avoid high fat, low calorie foods

This section provides guidelines for documentation of patient education on the Interdisciplinary Patient Education Record.

Choose one (1) of the three (3) case scenarios and document patient education on the
Interdisciplinary Patient Education Record.

GUIDELINES FOR COMPLETION OF THE INTERDISCIPLINARY PATIENT EDUCATION RECORD

Interdisciplinary Patient Education Record will be stamped and placed in medical record as FIRST
page in the Progress Note section.

Each discipline that provides patient education/instruction during the delivery of patient care is
responsible for documenting on this form.

The health care provider/educator should review the Admission Assessment for learning needs.

INTERDISCIPLINARY PATIENT EDUCATION RECORD
Column 1 Each entry will be dated and timed.
Instructions given to:
Columns 2 to 4 Indicate(s) who was taught (patient, family, other)
Column 5 Name the person(s) being taught, exclude if patient

Readiness assessment
Columns 6 to 8 Indicate your judgement of the patient's/caregiver's readiness to learn.
If the patient is uncooperative and you do not have another family member to teach, indicate this
and make another attempt later.
Example of a patient that denies need for learning:
An insulin dependent diabetic patient denies need for learning, ask the patient if you can return to
observe him giving his next injection and document findings in outcome section.
Focus
Columns 9 to 27 These columns indicate the subject matter being taught.
Some subjects may be taught repeatedly and by different
disciplines.
The subject headings provide a quick glance at the patient's educational activities.

Barriers
Contains the checklist of potential barriers to learning that need to be considered when providing the education.
Content
Column 28 Leaves enough room to state the teaching content, name of literature, or video.
Documentation may be continued on the back of the form.
For example: Diabetic patient - content signs/symptoms of hyperglycemia and hypoglycemia; blood
glucose monitoring; insulin administration; safety and personal hygiene issues - stressed dental,
foot, and skin care; diet; activity; given BD Home Care Kit/Literature; referral to local diabetes
support groups, the ADA; etc.

It is not always possible to capture the essence of the teaching in a single entry.

If you have documented your teaching in another location in the chart, use this box to indicate where
it may be found (e.g. nursing progress note of date of entry). You may also use the back of the form
to further describe your teaching activities.

Methods
Columns 29-32 Indicate which method was used to communicate the information.
The method selected should be appropriate to the age, culture, and language of your patient.

Outcome
Column 33 to 35 Indicate the results of your teaching/patient's learning.
If the patient is unable to verbalize or give a return demonstration, the column "needs review" is
checked. When this column is checked teaching must be repeated and reinforced.
If the patient verbalized understanding and/or gave a return demonstration, check the
corresponding column, and then move onto another topic/area of instruction.

Initials
Column 36 The health care provide initials in this column each time an entry is made.
The first time the initials are used on the form, the signature key on the bottom of the form must be
legibly completed.
Initial, sign your full name and add your title/department.

Frequently Asked Questions (FAQ):

1. I believe that I am teaching every time I interact with a patient. I can't write all that down. Where does it all end? Which of the many areas of teaching should I document?

Some teaching merits special attention and documentation because the patient and/or caregiver
will be able to influence the outcome of care by applying this knowledge.

Examples of teaching are preparations for tests and procedures, safe and effective use of
medications, safe and effective use of equipment, understanding potential food and drug
interactions, signs and symptoms of complications, dietary restrictions, and how to contact
community services.

2. When should I teach?

Teaching is incorporated into routine care as you explain what you are doing, ask and answer
questions and demonstrate techniques.

3. When should I document?

Summarize what you covered during your shift as you complete your shift notes.

4. Teaching is an on-going process, how often must I document?

Repetitive teaching of information that has been understood and return demonstration does not
have to be documented once the learning has been achieved and documented.

However, if your patient is having difficulty learning and needs continual reinforcement, each
session should be recorded until learning is achieved.

This might be achieved by giving instruction to other family members or caregivers, bringing in a
interpreter, using a telephonic interpreting services such as Language Line or CyraCom, or creating a discharge plan that will supplement the lack
of learning (e.g. visiting nurse referral).

If the treatment plan or condition changes, the educational needs of the patient must be
reassessed.

5. What if my patient is too young or too ill to teach?

The caregiver needs to be taught.

You need to call the caregiver in or ask the social worker to help to identify the family
member(s)/caregiver(s).

If the caregiver is going to be another institution (e.g. nursing home), the patient care needs are
communicated in the transfer form or discharge instructions.

6. What if my patient or the caregiver does not speak English or cannot hear?

Communication obstacles must be overcome.

Utilize the Volunteer Interpreter List or call one of the telephonic interpreter services such as Language Line or CyraCom or call Social Work Services to schedule an interpreter for the hearing impaired and other language interpreters.

If the teaching can be done through demonstration or drawing pictures and the return demonstration
indicates comprehension and learning, you have completed your task.

7. What if the topic that I just reviewed with the patient was already documented as being taught by someone else?

The idea of this form is to document the collaboration of the interdisciplinary health care team.
Many of our teaching materials are reviewed or developed with input from an interdisciplinary group
so that a single educator can provide all the teaching. However, if you assess a learning need and
provide instruction, you should document it.