Reader Question: Are your staff competent teachers?

Evaluate through observation

Question: How do you determine if your staff are competent teachers? What criteria do you use to evaluate them and what method? Is this part of their evaluation for job competency? Do you provide inservices that train staff to teach?

Answer: Staff competency related to educating patients is evaluated by the manager’s observations, says Diane Moyer, MS, RN, CDE, program manager for consumer health education at The Ohio State University Medical Center in Columbus. Opportunities for staff to gain information on teaching are provided through inservices and continuing education opportunities related to particular disease processes. Patient education also is part of orientation.

"There are teaching guides available on the intranet system so staff can review and refresh their knowledge about key aspects to be taught on a particular topic or area," says Moyer.

Patient education competencies are part of nursing staff, nutrition, and pharmacy staff competencies, and are evaluated by managers each year as part of the annual performance review process at the University of Washington Medical Center in Seattle. Observation is the typical method of evaluation; however, some staff members are very active in resource, committee, or systems development for the medical center. These activities may also be included in their performance review, says Cezanne Garcia, MPH, CHES, manager of patient and family education services.

Tip cards designed help new staff

"Our RN1 orientation includes a session on patient education, but it focuses more on accessing resources. However, it underscores some of the key teaching principles," says Garcia. Clinical staff also are given tip cards that have optimal strategies for patient education effectiveness in one-on-one encounters.

These tip cards are distributed to new staff when they receive their ID badge for the hospital. They are laminated cards the same size as the ID badge and punched so they can be worn with it. One side of the card has documentation tips that include:

  • Baseline learning needs assessment.
  • What was taught and why.
  • How teaching was done.
  • Outcome.

Documentation tips also advise staff to use action verbs to document how the patient demonstrated:

  • Knowledge — identifies; defines; lists.
  • Comprehension — describes; explains; gives examples.
  • Skill — demonstrates; uses; practices.

The other side of the card has tips for quality education. They instruct staff to:

Determine what information is most relevant to your patient.

  • Limit your main points to three or less.
  • Get the patient to talk about what you said.
  • Make sure written materials provide an opportunity for interaction, such as questions or checklists.
  • Be sure your visuals/pictures are clear and simple.

The effectiveness of the card has not yet been evaluated, but tip cards used for other types of services haven’t been shown to be effective, notes Garcia.

During nursing orientation at Great Plains Regional Medical Center in North Platte, NE, the patient education coordinator gives an overview of Joint Commission standards, explains why staff teach, and provides tips on how and what to teach.

"I am not part of all-employee orientation yet, but foresee this in the near future with the development of some new programs," says Barbara Petersen, RN, patient education coordinator. Patient education is included in many job descriptions at the medical center, although there is not a competency per se for patient education.

The patient education committee decided to assess the education needs of staff because they were hearing feedback from clinical areas that staff did not know how to teach and had no training, although it was something they did each day. The assessment was informal with committee representatives asking staff in their area questions about patient education, says Petersen.

The committee found that staff wanted to know how to build rapport with patients, how to verbally teach from a handout rather than just giving the patient the information, how to determine patient learning styles, and how to document better.

To address the concerns of the employees, a speaker was brought in to teach on patient education. There was a fair response to the speaker, but with staff shortages, it’s difficult for people to get away for a half- or full-day conference. Petersen is considering using e-mail to distribute teaching tips to staff. "Our facility relies heavily on e-mail, so I feel this may be a good avenue to pursue," she says. She also is considering learning packets on teaching that staff could complete for continuing education units.

On-line education is an effective way to get information to staff about patient teaching, says Virginia Forbes, MSN, RNC, program director for patient and family education at New York-Presbyterian Hospital in New York City. The hospital’s intranet, referred to as "Infonet," serves as the cornerstone of the patient and family education program. "It provides an avenue for communicating with the thousands of employees in this 2,200-bed hospital. Regular updates, articles, and patient education resources are placed on the Patient Education Webzine, an on-line magazine," she says.

Currently an on-line continuing education program is being developed to increase staff knowledge and competency. Staff will be able to access the interactive program through the Infonet, and upon satisfactory completion of the program, obtain continuing education credit.

More traditional methods also are used to educate staff on teaching techniques. A handbook for patient and family education is available in each department, which has guidelines for assessing learning needs, teaching patients, and other subjects. Unit-based conferences are provided as needed and guidelines for effective patient and family teaching are covered during orientation, says Forbes.

Knowing how to teach is important, because professional staff are annually evaluated regarding their competency in patient/family education as part of their performance appraisal at New York-Presbyterian Hospital. In nursing, it is the responsibility of the nurse manager in collaboration with the nursing education instructor to determine if the staff member meets the standard.

An appraisal form helps managers consider and measure areas relative to patient teaching such as nurses’ collaboration in the plan of care, meeting age-specific competency requirements, assessing patient needs and establishing priorities, communicating information, and providing education to staff on patient and family care-related problems. The overall criterion is: "Provides continuity of care through patient/family education and planning."

Dietitians, physical therapy, and social work departments evaluate competency on an ongoing basis. "This competency evaluates the staff’s ability to assess educational needs, barriers, learning-style preferences; provide needed teaching; and assess learning outcomes," says Forbes.

Sources

For more information on evaluating staff patient education, contact:

  • Virginia Forbes, MSN, RNC, Program Director, Patient and Family Education, New York-Presbyterian Hospital, 525 E. 68th St. Whitney 102, New York, NY 10021. Telephone: (212) 746-4094. E-mail: vforbes@nyp.org.
  • Cezanne Garcia, MPH, CHES, Manager, Patient and Family Education Services, University of Washington Medical Center, 1959 Pacific St., N.E., Box 358126, Seattle, WA 98195. Telephone: (206) 598-8424. E-mail: ccgarcia@u.washington.edu.
  • Diane Moyer, MS, RN, CDE, Program Manager, Consumer Health Education and Wellness, The Ohio State University Medical Center, Department of Consumer & Corporate Health Education & Wellness, 1375 Perry St., 5th FL, Columbus, OH 43210. Telephone: (614) 293-3191. E-mail: moyer-1@medctr.osu.edu.
  • Barbara Petersen, RN, Patient Education Coordinator, Great Plains Regional Medical Center, 601 W. Leota, North Platte, NE 69101. Telephone: (308) 535-8640. E-mail: petersenb@mail.gprmc.com.