Making resource centers an extension of bedside and clinic education process

Assemble collection of resources and work to reach people

Most bedside education in hospitals provides patients and family members with what is frequently referred to as "survival skills" for a safe discharge.

However, there is much to learn about diseases and conditions that resource centers can provide. "We have some very educated clients that are interested in a lot more information than a preprinted pamphlet on heart disease, for example," says Susi Frederick Miller, MLIS, director of the medical library at Riverside Hospital in Columbus, OH.

Patient and family resource centers can complement bedside teaching in many ways. In addition to allowing patients to explore a topic in as great a depth as they desire, patients can learn on their own time and at their own pace not when staff have the time to answer their questions, Miller says.

The information patients and their family members get at The Learning Center at M.D. Anderson Cancer Center in Houston supplements the teaching received at bedside or at clinics, says manager Elaina J. Cundiff, MPH. Often patients have questions about their disease and treatment options — questions they need answers to in order to make an informed decision.

"Patients receive customized service. The information is customized to their learning ability, their learning needs, and where they are in their disease continuum," Cundiff explains.

For example, a newly diagnosed cancer patient would need different information than a patient who has had a recurrence of cancer after 25 years.

Resource centers are comfortable places to learn, says Patsy Rann, CRTT, RCP, CHIS, family library coordinator at Children's Healthcare of Atlanta Max Brown Family Library at Scottish Rite. Often, parents are scared or intimidated yet try to put on a good face in front of their child. Going to the library is a normal experience during a stressful time, Rann explains.

In addition, families often feel they aren't being heard at the bedside, and rather than being told what they want to know they are being told what they need to know. In the resource center they can ask their own questions. And knowledge, Rann says, empowers parents to advocate for their child.

Resource centers provide more teaching tools than those that would be presented at bedside, says Magdalyn Patyk, MS, RN, BC, patient education program manager at Northwestern Memorial Hospital in Chicago. For example, while there are many educational videos on the patient TV station it is impossible to include everything there is to show on closed-circuit television.

At consumer libraries, there can be many other resources that aren't available at bedside.

Gear resources to patient population

The selection of resources will depend on the amount budgeted and the patient population served. The majority of resources at M.D. Anderson are on cancer topics; however, because it is promoted as a consumer health library about a third of the collection relates to chronic conditions such as heart disease, says Cundiff.

The resource center at the Scottish Rite campus of Children's Healthcare of Atlanta has materials for all age levels and reading comprehension levels including material for children, says Rann.

It's important to deliver information in a variety of formats to adequately address various learning styles, says Cundiff.

Staff members at the M.D. Anderson consumer library have access to everything from basic print materials from the National Cancer Institute to 4,000 medical journals and about 80 medical databases.

"We are fortunate to piggyback with our research medical library on site and we belong to a consortium of libraries. Therefore, we are able to provide more sophisticated levels of information than an average consumer health library," explains Cundiff.

Rann says the Max Brown Family Library has models, posters, and a color copier to print pictures from books, which parents can use to gain a greater understanding of their child's health condition. Also, there are books and videos that can be checked out for use during the hospital stay.

Parents receive bookmarks on which to write information and the library staff will make single copies of pages from the book if parents ask. Rann says she encourages parents to start a notebook if their child has been diagnosed with a chronic illness as their knowledge base will grow. There are also interactive tutorials on-line for children to learn about their disease.

Providing access to various databases is important, says Miller. At the medical library at Riverside Hospital consumers can obtain information from consumer health-oriented databases, such as the Mayo Clinic Resource Center, and medical research databases such as MD Consult.

With Internet access it is wise to post information at each computer that explains how to evaluate a web site to determine if it is reputable, says Rann. Also post disclaimers, she advises.

"Everything that comes out of my hand that I research is stamped with a disclaimer that says: This is for your information only and does not reflect the opinions or policies of Children's Healthcare of Atlanta. Please consult your doctor or staff if you have any further questions," Rann says.

Whatever resources are offered, it is important to do your homework before making the purchase, says Mary L. Gillaspy, MLS, MS, manager of the Health Learning Center at Northwestern Memorial Hospital in Chicago.

When purchasing books that are not standard text or reference works find two positive reviews before adding them to your collection, she advises. "If you don't have time to do that you can go with one really solid review from a reputable source such as the New England Journal of Medicine," says Gillaspy.

To find basic resources, she suggests patient education managers purchase "Introduction to Reference Sources in the Health Sciences," published by Neal-Schuman.

In addition to reference materials, many resource centers offer recreational materials, such as novels, magazines, and movies, to help families ease the stress of having a loved one hospitalized.

Other important resources include trained staff and a private place to talk with people about their information needs should they have a sensitive health issue.

Assessing patient needs

Whether patients and family members are willing to discuss their needs at the information desk or require a secluded area, with so many choices available at most resource centers some guidance is usually required.

"It's important for library staff to be very aware of the different levels of interest and education and not to overwhelm folks but really gauge the amount of information they want by asking direct questions and looking for indirect cues," says Miller.

Consumers are asked if they would like to look at medical textbooks, read current research articles, or search medical databases. Find out what questions people have, Rann says, and then work with them to find the answer.

While Sacred Heart Medical Center in Spokane, WA, does not have a resource center specifically for patients, the staff medical library is open to the public. Sandy Keno, MEd, the librarian, encourages staff members to ask patients and family members if they already have basic information and then probe further about more in-depth details.

It's also important to find out how much time they have to spend researching the topic. When information is given let people know that what is described in the material may not exactly mirror the diagnosis and should be discussed with the patient's physician. It's important that patients don't jump to conclusions about worst-case scenarios, explains Keno.

Cundiff recommends that staff initiate conversation by asking people how they can be of help. Often people will ask for specific information, such as details about a cancer treatment. Sometimes the request is for everything available on breast cancer, which would be an overwhelming amount of information.

To accommodate this staff members must help the patient determine exactly what information might be helpful. For example, they might ask what the specific diagnosis is and follow this answer with a question about the treatment options the physician discussed with the patient.

A helpful tool developed at M.D. Anderson is the pathfinder, which is available via the cancer center's web site. These pathfinders list books, pamphlets, audio-visual materials, and evaluated web sites that provide information on certain topics such as breast cancer.

"Pathfinders give patients an opportunity to look at what we have and pick and choose from the list what medium would work best for them," says Cundiff.

At Northwestern Memorial Hospital a referral system makes the educational needs of patients clear. They show up with a paper script from their physician or an advance practice nurse and when possible are referred via an electronic patient record.

"What really makes our program work is that we close the loop and give the provider documentation of the patient visit within five working days. We send a paper letter if the patient is referred on paper or an electronic e-mail through the electronic medical record. Whether paper or electronic it is put directly into the patient's chart," says Gillaspy.

While patients and family members who walk through the doors of a resource center can be provided with information to complement what is taught at the bedside, one of the limiting factors of this method of education is that people must show up.

Many centers look for ways to distribute information to people who cannot physically make it to the site.

Volunteers at Children's Healthcare of Atlanta take book carts to patients. At Riverside Hospital the resource center will send staff to a patient's room to discuss what information they are interested in receiving. They also will mail material to patients' homes at no charge.

M.D. Anderson recently began an e-mail reference service. People can send questions to the resource center staff electronically. The e-mail is on the health care system's web site — www.mdanderson.org/departments/tlc.

It is equally important to publicize the center to patients, family members, and the public so they will know about the resource.

Miller sends physicians throughout the community library brochures and bookmarks and also sends these promotional materials to the hospital units. She also works with public libraries, encouraging them to send patrons to the medical library when they need information that is not available at the community site.

Cundiff invites nurses to come to the learning center for a scavenger hunt. She provides them with a set of questions about their patient population; for example, if the nurse works at the prostate cancer clinic the questions would pertain to prostate cancer. Learning center staff guide each nurse through the process of identifying the resources available.

"Nurses get hands-on experience and see what we have available for teaching patients and that raises their awareness level," Cundiff says.

Rann says she has announcements on the overhead public address system throughout the day at Children's Healthcare of Atlanta and also advertises on the closed-circuit TV and in the information guide to services at each bedside. She also presents at various staff meetings and has many advocates in the chaplain's, social work, and child life specialist departments.

Miller says resource centers have an important place in the community helping people find detailed, reputable medical information.

Sources

To learn more about how resource centers might complement bedside teaching, contact:

  • Elaina J. Cundiff, MPH, manager, The Learning Center, M.D. Anderson Cancer Center, 1515 Holcombe Blvd-Unit 312, Houston, TX 77030-4009. Phone: (713) 745-8064. E-mail: ecundiff@mdanderson.org.
  • Mary L. Gillaspy, MLS, MS, manager, Health Learning Center, Galter 3-304, Northwestern Memorial Hospital, 251 East Huron St., Chicago, IL 60611-2908. Phone: (312) 926-9693. E-mail: mgillasp@nmh.org.
  • Sandy Keno, MEd, librarian, Sacred Heart Medical Center, 101 W. Eighth Ave., Spokane, WA 99220-2555. Phone: (509) 474-3094. E-mail: kenos@shmc.org.
  • Susi Frederick Miller, MLIS, director, medical library, Riverside Hospital, Columbus, OH. Phone: (614) 566-5740. E-mail: SMILLER5@OhioHealth.com.
  • Patsy Rann, CRTT, RCP, CHIS, family library coordinator, Children's Healthcare of Atlanta Max Brown Family Library at Scottish Rite. Phone: (404) 785-2166. E-mail: patsy.rann@choa.org.