Reader Questions

Give patients skills for responsible self-care

Patients must understand the role they play

Question: The Joint Commission requires that hospitals "make clear to patients and families what their responsibilities are regarding the patient’s ongoing health care needs, and gives them the knowledge and skills they need to carry out their responsibilities." What do you teach patients about their responsibilities as far as their ongoing health care needs? What steps do you take to teach the skills they need to carry out these responsibilities?

Answer: Upon hospital admission, each patient receives a handbook consisting of information that is mandated by law, says Megan Finch, RNC, MS, patient education coordinator at Union Hospital in Terre Haute, IN. The Patient Handbook contains legal materials only, such as advance directives and the patient’s rights and responsibilities. Information on hospital operations, such as cafeteria hours or parking, is kept in a separate guest service book. "We keep all the legally important materials that patients need access to in a separate piece," says Finch.

In addition to handing patients and family members the information in writing, a nurse reviews the materials with them, explaining that it is their responsibility to provide accurate information, participate in teaching sessions, and let health care workers know when they don’t understand something, says Finch.

In the outpatient areas, patient rights and responsibilities are available in handouts in the waiting areas, says Finch. The information also is posted.

At Memorial Hospital of Sheridan (WY) County, patients will find a list of global rights and responsibilities in a folder next to their beds. The responsibilities they have for their ongoing health care needs specific to their diagnosis are given to them in writing.

Also, a letter is included explaining that the patient and his or her family are the most important members of the care team. (See example of letter and instructions, inserted in this issue.)

It is important to solicit patients’ aid in their own care, rather than simply telling them it is their responsibility to follow instructions that can be adversarial, says Janet Swift, RN, BSN, patient education coordinator at Sheridan. "We tell them how to get the best out of their treatment, the best out of their stay," she explains.

Provide the proper tools

It’s important to make sure patients have the knowledge and skills to carry out their responsibilities and set goals with the patient and or family, depending on who is going to be providing care at home, says Jean Wadnik, MA, RNC, director of staff development and health education at Warren Hospital in Phillipsburg, NJ. "What we try to do is give them the tools to carry out their responsibilities," she says.

A teaching record prompts staff to cover all areas that must be addressed, and written materials reinforce teaching. For example, for each medication patients are taking, they receive a fact sheet and a small card on which to track the medications. They also receive information sheets on their diagnosis and a diagnosis-specific community resource sheet that lists agencies they can contact for additional information or to meet ongoing needs such as financial aid for equipment and supplies.

"In some cases, such as diabetes, we do outpatient follow-up because we can’t complete the teaching in the short time they are in the hospital," says Wadnik.

An interdisciplinary teaching checklist also is used to prompt education at St. Francis Hospital and Health Center in Blue Island, IL. Yet rather than relying solely on each discipline’s assessment of learning needs, the patient is brought into the teaching process upon admission when asked to identify learning needs on a questionnaire, says Allison Reid, MS, RNC, an educator at St. Francis.

Patients are asked whether they need information related to their current illness, treatment plan, medication, medical equipment, nutrition, diet, rehabilitation, community resources, personal hygiene, grooming, or other information. They also are asked how they best learn, such as reading, by demonstration, verbally, by practice, or visually by watching a video. "Our policy states that education includes instruction of specific knowledge or skills needed to meet the patient’s ongoing health care needs," says Reid.

At Union Hospital, preparation for discharge is a part of the daily teaching strategy so patients will be capable of self-care when they go home. Patients are taught something new each day so they will be able to take responsibility for their care upon discharge.

Each patient should be re-evaluated on discharge by asking him or her to either perform a task or verbally explain a concept such as how to take their medication, advises Finch. "If patients can’t demonstrate a skill, it is our responsibility to point out that we think they need some additional follow-up by a home care agency, visiting nurse association, or other community resource and offer to set it up," says Finch.

Sources

For information on teaching patients the responsibilities they have for their ongoing health care needs, contact:

Megan Finch, RNC, MS, Patient Education Coordinator, Union Hospital, 1606 North 7th St., Terre Haute, IN 47804-2780. Telephone: (812) 238-7535. Fax: (812) 238-4528. E-mail: edmof@uhhg.org.

Allison Reid, MS, RNC, Educator, St. Francis Hospital & Health Center, 12935 S. Gregory Ave., Blue Island, IL 60406. Telephone: (708) 597-2000, ext. 5854. Fax: (708) 597-1381. E-mail: areid@ssmhcs.com.

Janet Swift, RN, BSN, Patient Education Coordinator, Memorial Hospital of Sheridan County, 1401 West Fifth St., Sheridan, WY 82801. Telephone: (307) 672-1193. Fax: (307) 672-1111. E-mail: mhscpc@wave.sheridan.wy.us.

Jean Wadnik, MA, RNC, Director of Staff Development and Health Education, Warren Hospital, 185 Roseberry St., Phillipsburg, NJ 08865. Telephone: (908) 859-6777. Fax: (908) 859-6848.