Improve teaching with tools, incentives
Improve teaching with tools, incentives
Evaluate skills on ability to tailor lessons to patient
Q: What steps can you take to make sure that staff are competent to provide adequate patient education? How do you help them acquire the skills they need, and how do you evaluate their competence?
A: Make patient education a priority, and staff will strive to meet your institution’s expectations, advises Jane Goetz, BSN, MS, director of education at San Bernardino County Medical Center in San Bernardino, CA.
The hospital’s administration made patient education one of its strategic goals and established a hospitalwide committee with representation at the management level. "The committee focuses on patient education and competencies," says Goetz. It wrote a policy on education which outlined the methods for patient education and developed a tracking tool to make sure all disciplines were complying.
To get staff to develop their teaching skills, you must be sure they value patient education, says Candace Stiklorius, MSN, RNC, staff development instructor and vice chairwoman of the patient education committee at the University of Pennsylvania Medical Center in Philadelphia. During orientation staff learn that patient education is a valued and expected behavior. They also learn how patient education is supported at the institution. "You have to start when people come into your system, explaining the value of patient education and the resources available," says Stiklorius. It’s also important to make sure employees understand that patient education is a part of their job by writing it into their job description, she says.
Once you have established the importance of patient education, staff may put more of a priority on learning how to be effective teachers. Following are several ways to help staff improve their teaching skills:
• Make money available.
At San Bernardino County Medical Center, each registered nurse is allotted $700 a year for continuing education. A class on how to teach patients is one option. Goetz recently met with the director of nursing to begin planning a course on how to teach because this type of continuing education class costs as much as $300 in her area.
• Explain adult learning often.
During orientation, Stiklorius discusses how to assess a patient’s learning needs and readiness to learn. She also goes over the teaching process. "I try to make the session interactive; for there will be some people in the audience who are fairly savvy at patient education," she says.
Teaching techniques can also be included in mandatory inservices to show people how to use a new form. Goetz included key issues of adult learning in the sessions she conducted to introduce to staff the hospitalwide policy on patient education and the tracking tool. "I tried to make it a group process by asking them what ways they liked to learn and then transferring that to the patient," she says.
• Provide opportunities to learn.
Several times a year, a lunch hour seminar that focuses on a particular patient education topic is offered to staff at the University of Pennsylvania Medical Center. One session addressed literacy and included a speaker and a short video that discussed the reading difficulties many people have. To help participants understand, they were asked to read a paragraph in mirror image. "Because you were concentrating on trying to decipher the words, you lost the meaning, which is what happens when people are only functionally literate," says Stiklorius.
• Make learning convenient.
To make it possible for staff to improve their teaching skills when they had the time to learn, members of the Patient Health Education Committee at Sinai Samaritan Medical Center created a self-learning packet titled Successfully Teaching on Borrowed Time.
The packet has three parts. The first part introduces characteristics of the adult learner through brief scenes of dialogue between a patient and a health professional. Part two discusses the challenges these characteristics pose for the patient educator. Part three brings the first two parts together using an acronym that represents key concepts to successful teaching.
"If the same information were given during an inservice many people in the audience would not be at their moment of readiness to learn. We are trying to use the same principles with the learning packet we want these people to use with their learners," says Marian Hansen, RN, BSN, editor of consumer information at Milwaukee Heart Institute of Sinai Samaritan Medical Center. Currently, the packet is a resource for staff and is not mandatory, although several department heads are considering making it part of their annual staff review process.
Once staff are made aware of their teaching responsibilities and given the tools to develop their skills, they need to be assessed to determine competency. This can be a difficult task, says Hansen. When the discussion of the self-learning packet for patient education took place in the committee, one department head thought it was not necessary. He had a thorough method of assessing patient education, he said, and his staff were competent. To assess staff, he videotaped them during a teaching session using an actor as the patient. When Hansen inquired, she found that the actor was always receptive and never burst into tears or refused to listen, as some patients do.
"Often, managers are looking at knowledge of content and delivery of content, which is great. But they aren’t looking at adjusting that content to the different types of adult learners and the different stages of readiness," says Hansen.
The same problem would exist if managers use the self-learning packet, Successfully Teaching on Borrowed Time. It would evaluate a staff member’s knowledge of adult learning principals, but the ideal evaluation is not just knowing that he or she knows the theory. Ideally, a manager would be able to ensure that the staff member could apply the principles, says Hansen.
At the University of Pennsylvania Medical Center nursing managers use three methods to evaluate teaching. They audit charts for documentation of patient education to verify that it is being done. They also look at the patient satisfaction survey all patients are asked to complete. A few questions on the survey are geared to patient education, for example, "Did you get enough information about your medications and how to take them safely?" That data can be traced to each unit but not each nurse, says Stiklorius. Nurses also are observed by their supervisor in actual teaching situations.
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