Have your teaching session and test it, too

Roll staff education, competency testing into one

Two factors triggered the development of a program to teach staff at York (PA) Health System to teach patients effectively. One was the fact that management had not developed a good way to evaluate the competency of staff in teaching patients. They used a self-learning packet followed by a multiple-choice test. Also, the health care system had no clearly defined expectations for patient education, nor were tools provided to accomplish it in a short time period.

To remedy the situation, the patient education committee created a subcommittee to design a pilot program for staff education. This team consisted of the patient education coordinator, director of community health, an education specialist, and a nurse from the cardiovascular service line, which was the area that would pilot the program.

"We decided the theme of the program would be teaching patients in the amount of time you have and also the importance of patient participation in teaching," says Donette Lasher, MAT, patient education coordinator at York Health System. To design the curriculum, each team member looked through resources at hand, such as books and conference materials. They selected three techniques that either saved time, required patient participation, or both. The curriculum included the following:

• Agenda setting and assessing importance and confidence in the agenda.

This technique helps health care providers identify an agenda or topic of discussion, to which the patient agrees, and assesses its importance to the patient and the patient’s confidence in achieving the teaching objective. For example, cardiovascular patients would be shown a card with graphics representing lifestyle changes like losing weight, modifying diet, exercising or managing stress. Patients then are asked to choose the behavior they are ready to address. Then they would be asked how important making the change is to them on a scale of one to 10 and how confident they are in making the change.

Ask open-ended questions about content

• Content, participate, and review (CPR) cycle.

Using this technique, the content is the portion of the teaching that provides information to the patient such as a medication schedule. During the participation phase, the nurse asks the patient open-ended questions about the content. For example, the nurse might ask, "What problems do you anticipate with following the medication schedule?"

"The more actively patients participate in the planning, the more likely they will follow through, because it’s their solution, not the nurse’s," says Lasher. The review is a simple statement to wrap up the teaching. For example, the nurse might say: "So let’s review. You have agreed to set your watch alarm at noon so you remember to take your med icine on time."

• Documentation and patient teaching tools.

Documentation was included in the curriculum because it is a communication tool that saves time by preventing duplication of teaching. Education materials provide written follow-up to teaching.

Once the curriculum was determined, the team decided on the format to deliver the information and evaluate the competency of the learner. They considered many different methods, including a workshop, the self-learning module, and a video accompanied by an information packet.

They modeled their program after the competency evaluation format, where nurses are checked off as they go from station to station, demonstrating their competency. "We had three stations, which took about 15 minutes each because we were doing some education and not just evaluating the competency," explains Lasher. There were two to three nurses at each station at every session. This meant that only three nurses from each unit were at the station at any one time, so no area in the cardiovascular services line was strained.

At station one, two presenters demonstrated the agenda-setting tool and explained how to assess for importance and confidence in the selected topic. This was followed with a role-playing session in which one person represented the nurse and another the patient. Through conversation with the nurses, the presenters would assess their understanding of the benefits of using the tools.

At station two, one presenter gave a PowerPoint presentation of the CPR cycle and provided an example of how to use the CPR cycle to teach a patient about discharge medications. Participants then picked another topic, such as a low-sodium diet or monitoring daily weight, and demonstrated the use of the cycle in teaching a patient.

The third station covered documentation and the use of patient education materials. At this station, all standardized patient education materials pertaining to cardiovascular problems were displayed in order to raise awareness. Also, the presenter reviewed the documentation form and gave examples of how to document patient education in each session. "This station was really an opportunity to clarify their misunderstandings and answer questions about the form," says Lasher.

The 125 staff who participated in the pilot program that ran in November and December 1999 were asked to evaluate whether or not the presenters met the objectives set for each station and comment on the format. Staff found the mandatory sessions helped them improve their teaching skills. However, the team that created the program found that it was not a very efficient use of the presenters’ time. The stations were scheduled over a two-month period on five separate days with four groups attending each day.

"The conclusions we made were that it is an effective format, but it needs to be condensed into one or two days and made larger so we accommodate more people," says Lasher. They are considering having a cafeteria-style format with 20 stations available and staff being required to select five of the stations. This would help meet the patient teaching needs of a variety of disciplines. For example, outpatient surgery would have different teaching needs from the cardiovascular service line.

For more information on creating a competency-based teaching program, contact:

Donette Lasher, MAT, Patient Education Coordinator, York Health System, 1001 South George St., York, PA 17405. Telephone: (717) 851-3081. Fax: (717) 851-3049. E-mail: dlash01@yorkhospital.edu.