Do patients read your educational tools?

To have success in getting your patients to read discharge instructions and educational materials, it isn’t enough to make sure the material is accurate and up-to-date, says Jean Proehl, RN, MN, CEN, CCRN, immediate past president of the Emergency Nurses Association, based in Des Plaines, IL.

"Reading level, font size, appearance, and illustrations all need to be considered," she stresses. (See sample patient education sheets on fractures, injury prevention for older adults, abdominal pain, domestic violence, grief, congestive heart failure, and ED discharge instructions, inserted in this issue).

Here are ways to make your patient educational materials more effective:

• Avoid pages of solid print. Include white space in the materials you develop, so patients aren’t overwhelmed by pages of text, recommends Jean R. Moss, PhD, RN, PNP, patient education specialist at Dartmouth-Hitchcock Medical Center in Lebanon, NH. "Illustrations and personal stories are also recommended, because they are more interesting than just the facts,’" she says.

• Gather materials from organizations. There is a wealth of material available on injury prevention and management of specific diseases, says Proehl. "Almost all of the associations have patient information pertinent to their mission," she notes. (See sources and resources box for more information, p. 156.)

Some vendors also supply written patient education materials and videotapes specific to their products, notes Proehl. For example, Dermabond, a topical skin adhesive manufactured by Ethicon in Somerville, NJ, has a discharge sheet. Lovenox (enoxaparin sodium) manufactured by Aventis Pharmaceuticals, based in Collegeville, PA, has a patient video. And EpiPen, an autoinjector drug delivery system to treat anaphylaxis manufactured by Dey Laboratories in Napa, CA, has a video and training pens for practice.

"However, I always evaluate this material before we put it into place," Proehl says.

• Address needs of non-English-speaking patients. First, translate your most commonly used information sheets into the prevalent languages for your area, says Proehl. "However, in some ethnic groups, literacy in their own language is not the norm," she cautions. "The original Hmong refugees did not even have a written language when they came over in the early 1980s."

Translating the sheets is the easy part, says Proehl. "The tough part is verifying that the patient understands the information on the sheet," she explains. "You frequently need a translator for this."

Language Line Services, based in Monterey, CA, is an excellent resource if you don’t have ready access to appropriate translators, Proehl recommends. The line provides 24-hour access to translators in 144 languages, she notes. [To subscribe or use the service periodically, call (800) 752-0093.]

Cultural assessment is also important when deciding on the discharge plan of care, says Proehl. "Maybe there is something from their native culture that can be integrated with the Western plan of treatment. That will increase the likelihood of compliance," she suggests.

If patients seem uncomfortable with a treatment or discharge plan, find out why, recommends Proehl. "Perhaps there is something in the Western plan of care that is unacceptable to the patient/family, so you’ll need to come up with an alternative."

• Consider your patient population. When developing materials for education, consider the reading level of your "audience," says Moss. "You would use different materials for an inner-city hospital with a predominantly low-income population than the population for a medical center in a college town."

Members of your target audience should be on the committee that develops those materials, Moss urges. "Also, use another group of the same audience to review the final draft before the pamphlet or videotape is produced."

Members of the target audience should also be on the committee that approves purchased materials, says Moss.

• Provide verbal explanations. It’s ineffective to hand a patient a pamphlet or have them view a videotape without any explanation, says Moss. "All materials should have someone who can evaluate the patient’s understanding and answer questions," she advises. "A human contact is necessary for the best teaching."

• Direct patients to the Internet. There is a wealth of free material on the World Wide Web, says Moss. "But you have to know the best resources," she notes. Here are three consumer education sites she recommends: This comprehensive collection of health and disease information is endorsed by former Surgeon General C. Everett Koop, MD. This gateway to selected consumer health information is provided by local, state, and federal government agencies; not-for-profit organizations; and universities. The Web site is a service of the Department of Health and Human Services. This collection of on-line pamphlets and other information is from reputable sources such as health advocacy organizations and federal agencies.

• Use highlighters to emphasize important points. If you give patients four pages of information, use highlighter pens for the points they must know, recommends Margaret M. Duffy, RN, EdD, CNN, former clinical educator at Medical University of South Carolina Medical Center. Those points may include how many pills to take, when to take them, and what symptoms should prompt a call to the ED, she says.

• Include the patient’s name. Leave a space on
the front page of educational materials for the patient’s name, suggests Duffy. "If you put their name on the material, they are not as likely to throw it away," she says.

For more information about patient education materials, contact:

Margaret M. Duffy, RN, EdD, CNN, 304 Stratford Drive, Summerville, SC 29485. Telephone: (843) 871-7052.

Jean Proehl, RN, MN, CEN, CCRN, Dartmouth-Hitchcock Medical Center, Emergency Department, One Medical Center Drive, Lebanon, NH 03756. Telephone: (603) 650-6049. Fax: (603) 650-4516. E-mail:

Jean R. Moss, PhD, RN, PNP, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756. Telephone: (603) 650-8095. Fax: (603) 650-4900. E-mail:

Patient Education Management, a monthly newsletter from American Health Consultants, publisher of ED Nursing, is a source for concrete, "how-to," hands-on management information on patient education. Each month, readers receive usable tips from patient education managers across the country detailing how they created and implemented successful education programs — and detailing their mistakes, so you don’t have to learn the hard way. With every monthly issue, you’ll receive a sample patient education protocol, policy, checklist, or other valuable document that you can tailor to your program without reinventing the wheel. The cost is $365. To order, contact:

American Health Consultants, Customer Service, P.O. Box 740056, Atlanta, GA 30374. Telephone: (800) 688-2421. Fax: (800) 284-3291. E-mail: Web site:

Patient education brochures are available from the National Heart Lung and Blood Institute. The publications can be downloaded at no charge from the Web site ( Or to order, contact:

National Heart, Lung, and Blood Institute Information Center, P.O. Box 30105, Bethesda, MD 20824-0105. Telephone: (301) 592-8573. Fax: (301) 592-8563. E-mail:


Mosby’s Emergency Department Patient Teaching Guide 1 and Guide 2 are a compilation of more than 200 patient teaching handouts in a binder organized by body system. The handouts are designed for the health care provider to copy and give to the patient and/or family. The product is $74.95. To order, contact:

Mosby, 11830 Westline Industrial Drive, St. Louis, MO 63146-3318. Telephone: (800) 426-4545 or (314) 545-2522. Fax: (800) 535-9935 or (314) 579-3357. E-mail: Web site:

The National Highway Traffic Safety Administration has age-specific injury prevention sheets that deal with motor vehicle, bicycle, and pedestrian safety. All fact sheets and brochures can be accessed from the Web site ( Single copies are free and can be duplicated for distribution. For more information, contact:

National Highway Traffic Safety Administration, 400 Seventh St. S.W., Room 5119, Washington, DC 20590. Telephone: (202) 366-5399. Fax: (202) 493-2062. E-mail:

The American Academy of Pediatrics has a comprehensive, age-based program of injury prevention information. Also, the Academy has public education brochures are available in pads of 100. The cost is $34.95 plus $7.50 shipping and handling. Topics include febrile seizures, poisonings, prevention of shaken baby syndrome, and allergies. A patient education CD-ROM resource has 100 pediatric health care brochures. The cost is $295 plus $29.50 for shipping and handling. For more information, contact:

American Academy of Pediatrics, P.O. Box 747, Elk Grove Village, IL 60009-0747. Telephone: (888) 227-1770 or (847) 434-4000. Fax: (847) 228-1281. E-mail: Web site:

Helios Health provides Internet "e-stations" free of charge to hospitals for placement in their waiting rooms. Each station has a live Internet connection with video, audio, and animation clips to give patients health-related on-line information. For more information, contact:

Helios Health, 4151 Ashford Dunwoody Road N.E., Suite 610, Atlanta, GA 30319. Telephone: (877) 9HELIOS or (404) 303-2300. Fax: (404) 303-2323. E-mail: Web site: