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Learning center point of pride for educator
Manager reflects on 25 years of change
The patient education program Nancy Goldstein, MPH, now manages at Fairview-University Medical Center in Minneapolis, is the program she put in place 25 years ago. However, it’s not quite the same program, nor is her job the same.
"My job responsibilities grew as patient education expanded," she notes.
Those duties now include coordinating and maintaining the patient education resources at two hospital campuses that are one mile apart; managing the patient learning center; and developing standards, conducting research and evaluation studies, and integrating new information, trends and regulatory requirements into existing programs and systems. Goldstein also is responsible for developing and monitoring the budget for patient education.
The University campus, at which she originally was employed, merged with the Riverside campus several years ago to form an 1,800-bed medical center. Both are part of the Fairview Health Care System.
Patient education is within the department of nursing, and Goldstein’s supervisor is the director of nursing practice, research, and innovation. She oversees 10 employees. They include eight registered nurses who work at the learning center, a facility for one-on-one patient teaching operated seven days a week at the university campus and two days a week at the Riverside campus. Two are program administrative assistants. One assists the Learning Center crew with such administrative duties as scheduling appointments for teaching and the other distributes and maintains more than 1,200 booklets in the patient education resource collection.
Goldstein, who has her undergraduate degree in psychology and a master’s degree in public health, was hired to develop and oversee a patient education program a year after graduate school.
In a recent interview with Patient Education Management, Goldstein discussed her job, her philosophy on patient education, the challenges she has met, and the skills she has developed that helps her to do her job well. The following are excerpts from the interview:
Question: What is your best success story?
Answer: We set up the Learning Center in December 1987, just about the time we began to notice that patients were being expected to do more of their own care management at home. We would tell them their diagnosis and then hand them tubes, syringes, and things they had never touched before. They were to become experts with a couple of home care visits, yet when staff first learned some of these skills they practiced on models.
The Learning Center is a skills lab for patients similar to those that staff members use to learn new techniques. When patients need to learn such skills as administering antibiotics intravenously or how to care for a trach, they schedule an appointment with a nurse at the Learning Center. The patients use models to simulate exactly what they will do at home.
Basic diabetes teaching also is covered at the Learning Center as well as education on cancer symptom management for the caregiver. The class on symptom management is tailored to the specific symptoms the caregiver is trying to manage. A lot of referrals to social workers, chaplains, and other resources are made during the teaching session.
Also taught at the Learning Center are group classes for transplant patients. These include an overview of the transplant process before surgery is scheduled and a class on medications before discharge. Transplant patients are taught as a group because research shows that this patient population wants to meet others who are having transplants.
To make sure that the classes at the Learning Center are meeting patients’ needs, 10 random phone calls are made to patients each month. If a program is new, all patients are called for the first couple of months to make sure it is working smoothly. The data are complied into a report each month.
Question: What is your strongest area?
Answer: My staff would say I am very organized. Also, I am a good writer, and that has helped me with the development of materials.
Every patient education project begun at Fairview-University Medical Center has a list of clear objectives, target dates for each task that needs to be completed and the name of the person who is accountable. This keeps projects on target, moving forward fairly quickly to the end point.
Question: What lesson did you learn the hard way?
Answer: I have perfectionist tendencies, and over the years I have had to learn to work on that. Everything cannot be textbook perfect. Sometimes you have to move a lot faster then you would like, let go of projects sooner and move on to the next one letting some of the kinks work themselves out. It may not be absolutely perfect, but it is adequate.
Question: What is your weakest link?
Answer: For an institution this size, we still do not have a resource center or library for patients.
Two years ago, an oncology resource center was established, but it was lost when the oncology clinic expanded. It was not producing revenue, so it was let go. On other occasions a resource center has almost become a reality, but always plans have been terminated.
In this day and age, a library is a needed service because people are so much more involved in making decisions about what they want for their health care. They are active participants, and there is a lot of easy to access information. When the service was available for oncology patients, it was well used.
Questions: What is your vision for patient education for the future?
Answer: Although Fairview-University Medical Center is part of the large Fairview system, we are the only entity that has a patient education program, and I am working to get a systemwide program.
The medical center provides a lot of materials for other hospitals in the Fairview network but can’t support the entire system adequately unless a systemwide process is initiated at the corporate level. A systemwide patient education program would be more efficient, cost-effective, and it would provide a better service for all patients.
Question: What have you done differently since your last JCAHO visit?
Answer: We were surveyed in October 2003, and I was very concerned about our documentation but we did just fine. As we get closer to the actual visit our scores on our audits do climb considerably and I will have to remember that trend. We have a good system of patient education, so I don’t worry as much about that part it is just the unit documentation that has always been a struggle.
I like the changes in 2004. Following a patient throughout the system to look at the continuity of care and education is good. For example, following a patient from the clinic to the lab for tests to surgery and then to the unit will reveal how the system supports the patient and will show whether or not he or she is prepared for discharge.
Question: When trying to create and implement a new form, patient education materials, or program, where do you go to get information/ ideas from which to work?
Answer: About 95% of the time, staff call to say they have a need. For example, they may be seeing more patients for a particular procedure and they need additional teaching materials.
They are the ones who are the direct caregivers on the unit or in the clinic and are in the best position to identify a need. While most projects come from the direct caregivers who recognize the need and call, there are others that are top-down initiatives.
For example, currently there is a hospital performance improvement project that will combine the two classes for joint replacement patients taught on each campus into one class.
Once a need is recognized, a team of experts in the organization is put together to research the problem and find a solution. Often the members of the team make phone calls to colleagues at other institutions to find out how they have addressed the problem.
For more information about patient education at Fairview-University Medical Center, contact: