Simple tools fit most needs
Simple tools fit most needs
The sheer size of the institution seemed intimidating to many relatives of patients. "We looked at a range of their learning needs simply by putting ourselves in their shoes," Vlasak adds. What resulted was a series of simple learning tools that answered most needs.
Patients and their families are now more receptive to nurses and accepting of care plans because they understand exactly what to expect and how it will be rendered, Vlasak says. In turn, the process of health care delivery has run smoother and with fewer delays.
The strategy began with determining the group’s needs. In making a needs assessment, Vlasak and her colleagues discovered fundamental concerns: What happens now? What should we expect? What will we see in the ICU? What are all the equipment and lights in the unit for? How long will our patient/relative be there? Where are the bathrooms and the waiting areas for family members? How will things turn out?
The concerns ran the gamut of obvious possibilities but were important to anyone new and unfamiliar with the health care system, Vlasak says.
First goal: Reduce fear, anxiety
When creating a learning program for patients and families, the first assumption to make is that everything about the hospital and the ICU is unusual and sometimes intimidating, says Teresa Neuzil, RN, CCRN, a staff nurse in the thoracic ICU at 1,100-bed Mayo Medical Center-St. Mary’s Hospital. The facility is one of the two Mayo Foundation hospitals. The other is Rochester Methodist Hospital.
Both nurses worked on developing an education program for families of thoracic surgery patients. The program was similar to the one Vlasak helped design for other critical care units, but was more focused on thoracic surgery.
One of the primary objectives of both projects was to reduce fear and anxiety in both families and patients, Neuzil recalls. The following are key elements of each project:
• Material aids. Nurses felt that relatives should have something tangible that they could employ as a reference guide. After determining that the ICU’s physical surroundings represented a big anxiety factor, Vlasak and her team developed an equipment booklet with photographs of heart monitors and mechanical ventilators.
The booklet also describes the equipment and its importance in patient care. In the thoracic surgery unit, a similar booklet formed part of an information packet that included an eight-minute videotape about the unit. It explained what occurs in general terms from admission to discharge or transfer, Neuzil states. "We filmed it in the unit, so it gives them a chance too see what that looks like," she says. The packet also contains booklets on pain management, other types of surgeries, and a map to the hospital. Families are able to take the packet home to study it and can bring it with them on future visits.
• Set protocol. By design, the learning process was begun at the point of admission or during the family’s first encounter with the ICU, Vlasak explains. When visitors arrived at the unit and signed in, someone was always there to greet them with a caring, supportive attitude. Typical questions posed to the family included: "Are you OK?" "Do you know what to do?"
The purpose of these questions was to determine where relatives needed guidance, but they were also intended to build trust and reduce anxiety in the visitors, Vlasak notes. After being admitted to a waiting room, the family is shown a short video of the ICU, along with a sample of the equipment booklet with snapshots of the ICU itself. "Seeing the unit for the first time can be shocking to some people," she says.
• Designated functions. Key to the process was assigning one individual to be the primary contact person for the family. A staff nurse from the unit is considered the best choice over a social worker or other hospital employee because of the nurse’s direct affiliation with the ICU and patient care, Vlasak indicates.
The same staff nurse would initiate the family’s needs assessment and recommend the specific elements of the learning plan. The plan itself would include a discussion with the patient’s physicians and nursing staff members and a tour of the ICU in some cases. "It doesn’t help just to have a video or booklet without a specific implementation plan," Vlasak says.
• Quick study. In the thoracic surgery unit, family members and patients are given the learning tools the day prior to surgery. Due to the shortening length of time spent in hospitalization, patients have hardly any time at all to absorb the meaning of what is about to happen to them, says Neuzil.
An evening admission prior to the day of surgery was felt to be the best time to begin the learning process, Vlasak adds. At the same time, a nurse works with the patient and family members on key issues. The information includes an explanation of what is about to take place during surgery, details on preparation such as necessary pre-operative testing, and aspects of follow-up, the ICU stay, and discharge planning.
While the emphasis on patient learning is communication, teamwork also matters, says Vlasak. Learning can occur at every point of contact within the hospital from physicians to nurses to receptionists.
"Reminding your nursing staff that opportunities to teach patients and families can occur in anything, from a brief exchange of words to the touch of a comforting hand, can be a significant contribution to the process," Vlasak concludes.
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