Patient education is paramount during new employee orientation

A thorough program at the beginning makes the best impact

During orientation for new employees, patient education is just one of many topics covered. With so much new information taught, it is difficult to predict just how much is remembered. That’s why many patient education managers create methods that make learning about techniques for teaching patients and about hospital policy on education stand out.

Until recently, the patient education portion of orientation for newly hired nurses at Christiana Care Health System in Newark, DE, was fairly routine. A one-hour lecture on the patient education system was incorporated into the weeklong orientation. Those interested in a more hands-on lesson could enroll in a four-hour workshop on patient education referred to as an enhanced orientation option, says Susan Lewis, RN, BSN, a health education specialist at Christiana Care.

Now the four-hour workshop is the patient education portion of orientation. It includes information on tailoring education to the literacy of the patient, effective teaching strategies, and exercises in critical thinking through the use of case studies.

To develop the eight case studies used in orientation, Lewis looked for patient types that historically had been difficult to prepare for discharge. These included patients with diabetes, those with new ostomy appliances, and even mothers with new babies. "We wanted nurses to start thinking about these difficult cases as they began their orientation to Christiana Care and know that early discharge planning is valued at Christiana," says Lewis.

During the overall orientation process at the University of Colorado Hospital in Denver, the patient services department provides specifics on patient education for all disciplines involved in teaching patients. This includes nursing, social work, physical therapy, and pharmacy. During the session, the importance of patient education is emphasized, says Valerie Siml, RN, MSN, MA, an instructional development specialist at the health care facility.

"We try to get across the idea that patient education isn’t just sitting down and talking with the patient for 30 minutes, but anything that you do to help move them along the health continuum in a positive manner is really patient education," she says.

To teach basic patient education techniques such as barriers to learning and uncovering learning styles, a 15-minute videotape, "Patient and Family Education, Learning for Life," produced by Envision Inc. in Nashville, TN, is shown 

An educator on each unit provides details that are specific to the area in which the new employee will work. Using a checklist that helps ensure that all information is covered, the educator goes over documentation of patient education on the unit, where educational materials are stored, and the new employee’s responsibility in educating patients. The competency check- list also includes a section where the educator watches the new employee teaching a patient.

Documentation used to be covered in the general patient education orientation, however Colorado Hospital now is in the process of switching to computerized charting. About half the units now document patient education on the computer and the other half still use paper; therefore, it is easier to have documentation covered by the educator on the unit, says Siml.

Tiered orientation on education

A preceptor on each unit provides job-specific orientation for new employees at MeritCare Health System in Fargo, ND, as well. During this process, the preceptor signs off on a patient education intervention by the new employee.

The orientation system at MeritCare first focuses on the health system as a whole, then the employee’s role, and finally training in the area where each employee will work, says Roberta Young, BSN, RN, LCCE, coordinator of consumer health education.

All new employees receive an associate reference guide that includes a philosophy statement on patient education. This statement includes reasons MeritCare provides patient education, such as to decrease anxiety, create an atmosphere of informed decision making, and to form partnerships with patients and their families. Last year, MeritCare oriented 1,600 new employees.

Role-specific orientation for the nurses includes instruction on how to navigate the health system’s intranet where everything from policies to patient education manuals is kept. They learn about the strategic initiatives at MeritCare as well, which currently include patient safety and pain management.

"That may change depending on the initiative for improving patient care," says Young.

Nurses also are given a one-page description of the self-efficacy model used at MeritCare that includes information on how it relates to one-on-one or group patient education.

With this model, patient education strategies that increase a patient’s confidence in their ability to learn skills for self-care are interwoven throughout the education process, says Young. When programs or teaching strategies are evaluated, determining whether the format boosted confidence levels is critical. For example, in the childbirth classes, the evaluation is about how confident patients are in being able to use relaxation techniques during labor.

Young even uses the self-efficacy model developed by Kate Lorig, RN, DrPH, director of the Stanford Patient Education Research Center in Palo Alto, CA, when selecting patient-education materials. She looks to see if the materials have success stories that might bolster a patient’s confidence or photos of the people whom the material was written for.

"I look to see if the materials have problem-solving techniques for people rather than dos and don’ts," says Young.

To help those who teach patients understand the self-efficacy model better, two classes are offered on a quarterly basis at MeritCare. One is "Patient Education Getting the Bang for Your Buck," a class that lasts about an hour. The second is a more in-depth version of the topic titled, "A Tapestry of Patient Learning, Unraveling the Threads."

Patient education managers have found that carving out a distinct place for patient education in the orientation process has many benefits. Making the majority of the education unit-based at the University of Colorado Hospital helps new employees learn the specifics, such as the techniques for documentation, says Siml.

Removing pieces that are more unit-specific from the general patient education piece during the orientation allows for time to review the basics. "It gives us time to have some overview. I know that people supposedly learn how to do patient education in school, but the video we show is a very good overview and a good reminder for people," she says.

The videotape now is used in staff meetings for a general overview, and all staff take a computerized skills test based on the information as part of their competency testing. There are 13 questions on the test that cover such information as readiness to learn and assessing barriers to learning. Staff must get 80% of the questions correct to pass.

By including case scenarios as part of the patient education orientation at Christiana Care, patient care should improve.

"The benefit is that our service to our patients should improve, our patients should be ready for discharge, and hopefully we will have a staff of nurses that are able to educate and comfortable with educating," says Lewis.

[Editor’s note: To find out more about the videotape, "Patient and Family Education, Learning for Life," contact: Envision Inc., 1111 16th Ave. S., Nashville, TN 37212. Telephone: (615) 321-5066.]

Sources

For more information on incorporating patient education into new employee orientation, contact:

  • Susan Lewis, RN, BSN, Health Education Specialist, Christiana Care Health System, 200 Hygeia Dr., Suite 273, Newark, DE 19713. Telephone: (302) 623-0577. E-mail: SuLewis@Christianacare.org.
  • Valerie Siml, RN, MSN, MA, Instructional Development Specialist, University of Colorado Hospital, 4200 E. Ninth Ave., Mail Stop A021-565, Denver, CO 80262. Telephone: (303) 372-5635. E-mail: Valerie.Siml@UHColorado.edu.
  • Roberta Young, BSN, RN, LCCE, Coordinator of Consumer Health Education, MeritCare Health System, P.O. Box MC, Fargo, ND 58122. Telephone: (701) 234-5850. E-mail: ryoung@meritcare.com.