Guidelines trigger teaching points, use of resources
Guidelines trigger teaching points, use of resources
Experts get input from disciplines on committee
To remind clinicians of teaching points to cover on various diagnoses and health care issues, the patient education committee at Mid Coast Hospital in Brunswick, ME, initiated the creation of teaching guidelines.
Currently 35 can be found on the hospital Intranet with most of the major diagnoses, such as diabetes and stroke, covered. It is an ongoing process.
"Because there are so many different diseases, procedures, medications, and symptoms for which you can use a patient teaching guideline it is a never-ending project," says Janice Reynolds, RN,C, BSN, OCN, a staff nurse and chair of the patient education committee at Mid Coast Hospital.
However, it is a process that has been refined at this small hospital with fewer than 100 beds and therefore can be done fairly quickly.
One person with expertise on a topic writes a rough draft. For example, the community health nurse who teaches tobacco cessation wrote the tobacco cessation teaching guidelines.
The behavioral health nurse wrote several guidelines on different aspects of psychology care including a teaching sheet for use when a patient is diagnosed as bipolar. The teaching guideline on total hip repair was created by a physical therapist in the rehabilitation department.
Members of the interdisciplinary patient education committee have written most of the guidelines, but authorship is not limited to this group. However all committee members review the rough draft to determine if they have any teaching instructions that might be added.
"Copies are given to the whole group and they look to see if there is anything they want to add from their discipline because we want the guidelines to be interdisciplinary," says Reynolds.
Committee members also review the finished draft before it is placed on the hospital Intranet.
The guidelines contain teaching tips and a list of educational materials that can be used to teach the patient. Yet they are not based on a cookbook formula with each one containing similar instructions, says Reynolds. (For examples of the teaching guidelines, see article.)
Also guidelines are not meant to be used as a checklist type of educational tool but rather to refresh people's memory on what contents might be covered. Often they trigger teaching on an aspect that might otherwise be overlooked.
Reynolds who specializes in pain management wrote the guidelines for this topic. Part of the teaching for pain management should include the harmful effects of pain and many nurses forget to teach this until they see the point listed on the guideline.
"No one should refuse pain management or pain medication unless they know the harmful effects of pain. If you teach them the consequences it is informed consent," says Reynolds.
In most cases, whether or not a teaching point is covered depends on the patient's learning needs assessment.
For example the diabetic teaching sheet may be inserted into the patient's chart but he or she would only be taught the information that pertains to his or her illness. If the patient is not on insulin the topic may be touched upon but not covered in-depth.
The guidelines are meant to trigger teaching but they also trigger consults with experts when nurses and other clinicians realize they do not have the expertise to teach a particular topic, says Reynolds.
Educational resources named, too
In addition to teaching points, the guidelines list resources available on the topic and where these videos and handouts are located. Often the expert writing the guideline is not aware of all the teaching materials, therefore Reynolds will review a master list she keeps and insert the names of the resources that have been overlooked by the guideline's author.
To pull the appropriate guideline from the Intranet clinicians simply click on the clinical resource icon. Within this section patient teaching guidelines are divided into four categories that include diagnoses, procedures, medications, and symptoms.
"I ask people to stick the guideline in the patient's chart so others can see it; however, it is not a saved page and it gets tossed when the chart goes to records. It is there for people to see and use," says Reynolds.
Basically guidelines are not part of the permanent record because if they were incorporated into the record and staff did not insert an available guideline in a patient's chart the medical center might be held accountable in a legal case, explains Reynolds. Therefore it is better to keep their use informal.
"Essentially it is a resource for the nurse as opposed to something that is part of the permanent record," says Reynolds.
To make sure that staff members remember to use the guidelines the patient education committee continually reminds them. They do this by printing information about guidelines in the hospital-wide newsletter. During patient education week a display table was set up in the hallway with a selection of patient education materials including a couple of samples of the patient teaching guidelines.
"If people are being reminded they will tend to use them," says Reynolds.
They are a worthwhile resource and very helpful when implemented. Reynolds says they work particularly well when a nurse on the medical/surgical unit or the intensive care unit is confronted with a teaching requirement with which he or she is unfamiliar. For example, pre-op teaching is usually done before a patient is admitted to the hospital. However once in a while surgery is ordered for an inpatient and at that time the pre-op teaching takes place on the unit.
"A lot of the teaching is probably just common sense but then again if you are not doing something on a regular basis it is nice to have a reminder of what needs to be taught," says Reynolds.
Sources
For more information on teaching guidelines at Mid Coast Hospital, contact:
- Janice Reynolds, RN,C, BSN, OCN, chair of patient education committee, Mid Coast Hospital, Brunswick, ME. Phone: (207) 729-5932. E-mail: [email protected].
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