Seize bedside opportunities to teach; education should be part of procedure

More than an afterthought; learn techniques for effective, timely instruction

Time, or the lack of it, should not be an excuse not to teach, says Yvonne Brookes, RN, patient education liaison at Baptist Health Systems in Miami. Teaching is part of patient care.

"The nursing shortage is there, and the nurses probably have more patients then they used to, but they don’t skip a medication because they have no time," says Brookes.

Nursing and other disciplines must learn how to fit teaching into patient care and not look at it as an extra task they have to find a lot of time to do, she says. At Baptist Health Systems, nurses are taught to use every opportunity to teach patients and avoid making it an extra task. They learn to integrate patient education into everything they do.

For example, when nurses are changing a dressing or taking a patient’s blood pressure, they devote an extra five minutes to asking the patient questions and providing information on things the patient needs to know for a safe discharge. Brookes advises nurses to evaluate learning needs by asking patients questions such as how they would take their medication at home or what they would do if they suddenly became short of breath. It’s an easy way to assess learning needs or determine if the patient has learned what has been taught.

"We teach nurses that education is part of the end-of-shift report. They should explain to the person taking over their shift what they have discussed with the patient and what needs to be reinforced," says Brookes. Just as a nurse reports what kind of IV a patient is on or whether the patient is on a special diet, he or she also should report patient education needs as well, she says.

Nurses within Baptist Health Systems also are taught to use observation as part of the assessment rather than asking questions from a long checklist. Things such as language barriers and cultural differences can be noted by careful observation during the initial assessment, says Brookes.

Techniques for effective teaching are part of the orientation process for new employees and provided on an ongoing basis via short seminars, tips sheets, and newsletters. It can’t be a one-time effort. Teaching skills must be covered time and time again, says Brookes.

A patient teaching competency project currently is in the implementation stage at M.D. Anderson Cancer Center in Houston.

"We did an institutionwide evaluation of patient education, and one of the things the staff nurses voiced was that they wanted to be better teachers," says Nita Pyle, MSN, RN, associate director of patient education. The competency project is a result of the survey.

A multidisciplinary group put together a list of behaviors that would demonstrate that a staff member was a competent teacher. The list includes three important elements:

1. Assess patients and caregivers for learning needs.

The staff member knows how to use the interdisciplinary patient teaching record as a guide for assessing the patient’s barriers to learning, learning needs, and preferred learning style. He or she provides an opportunity for the patient and caregiver to voice needs and concerns. Also, the staff member identifies the appropriate caregiver to teach.

Staff often will spend time teaching a family member who is with the patient at the hospital only to find out that he or she lives in another city and won’t be the caregiver when the patient is discharged, says Pyle.

2. Plan effective patient education.

Staff must know how to determine what is important to teach and select the teaching resources appropriate for the patient. At M.D. Anderson, the video-on-request system is available to assist with teaching, and an on-line patient education database from which to select from more than 1,000 instructional documents also is easily accessible. The Place of Wellness offers a variety of classes on integrative methods for coping and stress management.

"It is important as a part of the competency for the nurse, the pharmacist, or whomever is teaching the patient to know those resources," says Pyle. 

3. Assess effectiveness of teaching.

Teaching is not complete until patients have an opportunity to demonstrate their learning. It’s not enough to ask, "do you understand?" because the patient could answer yes without really comprehending what was taught. "It’s important that the patient demonstrate his or her knowledge or skill," says Pyle. This could be done by completing the task, such as changing a dressing, or by providing pertinent information such as the signs and symptoms that would prompt a call to the physician.

Several tools are being selected and designed at M.D. Anderson that will help staff build on strengths and increase competency in teaching. The tools include traditional classes, discussion group case scenarios, self-learning modules, and a video on effective teaching techniques.

The method for assessing competency also still is in the works. "We will work with the individual departments to develop what is useful for them and their staff. Different areas may need to evaluate competency in different ways," says Pyle. Currently the nutrition department evaluates teaching competency by peer observation. However, such an evaluation method might not work for a large staff.

In an era when patients are hospitalized for only a short period of time and nursing shortages are common, competent teachers are vital. "Making sure that staff know how to teach competently makes the patient education process more efficient," says Pyle.

Sources

For more information about teaching staff to teach, contact:

  • Yvonne Brookes, RN, Patient Education Liaison, Baptist Health Systems, 6200 S.W. 73rd St., Miami, FL 33143-4989. Telephone: (786) 662-4528. E-mail: YvonneB@bhssf.org.
  • Nita Pyle, MSN, RN, Associate Director of Patient Education, M.D. Anderson Cancer Center, 1515 Holcombe-Box 21, Houston, TX 77030. Telephone: (713) 792-7128. E-mail: ndpyle@mdanderson.org.