when trying to convince them to teach patients. “As long as someone remembers something you have said you are immortal.” So many of my patients are immortal, for I remember something from everyone I have ever met.
My career has been, is, and will be an opportunity to do what I love best. I have been blessed!
1
Patient Education Defined
Here you will find not only my definition of patient education but also my approach to patient assessment.
Per Webster’s dictionary, a “patient” is “a person under Medical care” and to “educate” is “to supply with training or schooling: to supervise the mental or moral growth of.” Although I cannot argue that most of our patients are under the care of a primary care provider, I believe that education cannot be explained with the term training or schooling.
I define patient education as a person with a health care need. To meet this need requires clear, concise information. My role is to give that person all the information they need to make decisions about what they will or will not do. This implies that the patient has some control over their lives. In the past, patients were told what to do by physicians and nurses and were expected to do as they were told. The “white coat syndrome” was the result of this authoritarian model that made no allowances for partnership with the patient or discussions of their life choices.
Anderson and Funnell1 in their work on empowerment of patients talk about how for decades health care providers have taken over the role of manager in patient care and not allowed people to make decisions about their own lives. We also give them goals that are unachievable and get angry when they fail to achieve them. I have been in hundreds of patient care conferences where a group of professionals is judging the progress a patient is making or making decisions about future care without the patient being present. What is even worse is being in meetings where a family member is deciding what is best for his or her parent with mama nowhere in sight.
Bastable2 is much more realistic when she defines patient education as a “process of assisting people to learn health-related behaviors in order to incorporate them into everyday life with the purpose of achieving the goal of optimal health and independence in self-care.”3 I am somewhat concerned with that broad statement. What is optimal? Can a patient who has suffered a CVA and right-sided hemiplegia realistically achieve optimal health and independence, or will they set and meet a specific, achievable goal?
You may notice that although much of the focus of this book is about people with diabetes, the concepts are applicable for all people with chronic diseases who have to live or manage some kind of disease process. Managing a cardiac condition is certainly as difficult and demanding as type 2 diabetes, and the parallels are very similar because both conditions may exist in the same person. Interestingly, the mother going home with a new baby may require a lot more instruction and information than a person who has just had hernia surgery.
The person going home from cardiac surgery needs as much education as any chronic disease patient. The statement then holds true that acute care patients may require as much or more information than the chronic disease patient but you have a shorter time to educate them, and they may require the skills and knowledge for a short time and then discard the information. I call that pulling the plug on unnecessary knowledge.
Here is an example: A patient has a tracheostomy after throat surgery. He is going home for two weeks and must care for his trach during that period of time. You teach him wound care, self-suctioning, aseptic technique, and how to assess for infection. Don’t forget to teach him how to take his temperature and read a thermometer. You also, of course, make a referral for a visiting nurse to visit the patient and assist with the processes. Right? Right. Two weeks later the patient returns, the tracheostomy is closed, and the patient is breathing normally. Great. The patient no longer has to know or do some of those skills. There is nothing to suction. That plug is pulled, and they will very shortly forget that information. The mind doesn’t often remember what is unnecessary. He will, however, always know how to take a temperature and read a thermometer because it is a skill that will be helpful to him for the rest of his life. Talking about surgical patients makes me think of something that has been bothering me for years.
It is very interesting to me that most patients who have open-heart surgery are given a red heart-shaped pillow. It is used for splinting the chest while coughing or moving and is quite helpful during the drive home from the hospital. If you had someone open your chest, you might want something soft to hold against it when you move. It then becomes logical that pillows, perhaps shaped like a uterus, would be given out to patients posthysterectomy. Would it be helpful to hold a pillow against your abdomen when you cough or drive home over potholes after you have abdominal surgery? If you handle postoperative patients, think about all aspects of their patient education and not just what is routine or has “always been done.” After they recover from surgery, they will put the pillow aside—in essence, pull the plug—and never think of it again.
Several years ago, I was asked to see a patient in the critical care unit of my hospital who was recovering from open-heart surgery. The patient had been diagnosed with type 2 diabetes and was having some difficulty adjusting to the management plan the nurse in the unit had developed for him. When I visited him and asked how long he had diabetes, he told me that his physician had diagnosed him the year before. He had been informed that he had a “mild case,” and he and the doctor were going to concentrate on his cardiac condition first and then deal with his diabetes when his cardiac status was straightened out. After I finished my own cardiac arrest education, I assessed the patient to determine his health education needs. This person had to make major changes in his lifestyle to adjust to living with two major disease processes.
The educational concepts that educators use vary for each patient and are determined during the assessment process. Your first question must be, “What does this person need in order to safely live his life?”
Assessing Learning Needs
The first thing I find out is what the patient has been told and what he or she already knows. The easiest way to assess that is to ask.
What Has the Doctor Told You?
That is sometimes a difficult situation. If the physician was clear and concise and the patient was able to ask all the questions he or she needed to ask, we are in a much better place than we may be if the physician was vague or distracted.
In this case, I had to relate to a physician that people with diabetes have about four times greater risk of cardiac disease than people without diabetes and that diabetes and CVD interact. Sometimes, the education starts with the people who take care of patients.
Let’s be clear about our medical colleagues. Most of the physicians I have worked with are incredibly committed and dedicated professionals. They work hard, long hours and are determined to give our patients the best care possible, in often difficult circumstances. There are never enough hours, people, or resources to meet the needs of their patients.
A family practice physician has to take care of patients with over 200 different diagnoses and keep up on the disease management changes that occur constantly in our field. It is amazing what they have to continually learn. I salute these colleagues with all my heart and partner with them in all kinds of venues and circumstances.
Some physicians do not take the time or have the energy or interest to keep current and do not rely on the colleagues available to them. They sometimes avoid taking the time to answer questions and