Conquering time - the formidable teaching foe
Conquering time - the formidable teaching foe
Speed teaching with prompts for quick instruction
Question: "Staff always complain that there is not enough time to teach during the hospital stay. What steps have you taken to solve this problem? Have you uncovered any ways to streamline the patient education process?"
Answer: In today's health care climate, people who are admitted to the hospital are very ill and often cannot absorb a lot of information. Yet, with short hospital stays it is not possible to wait for the patient to get well enough to learn, says Jane Goetz, director of education at San Bernardino County Medical Center in San Bernardino, CA.
To remedy this problem, patients are given a few basic facts as an inpatient, then staff build on that foundation during post-hospitalization visits. Visits are often scheduled within one week of hospitalization, explains Goetz. In the meantime, patients have written materials to review at home that help reinforce what was taught in the hospital or refresh their memory.
Searching for ways to help nurses beat the clock and find the time to teach has become a top priority at many health care facilities. Here are a few suggestions from your colleagues:
· Provide easy access to resources.
Put together a directory of patient and family education resources, advises Alison Reid, MS, RNC, educator/clinical nurse specialist for St. Francis Hospital & Health Center in Blue Island, IL. "We know that if nurses have materials available at their fingertips, it helps save some time," she explains. The directory lists all the videos and brochures available on each unit so staff can share resources.
Also, create a place for materials on each unit, says Nadia Evans, RN, CDE, patient educator at Nash General Hospital in Rocky Mount, NC. Evans has placed a box of patient education pamphlets on each unit so they are easily accessible. Other facilities use a file cabinet or closet to store materials.
· Use closed circuit television (CCTV) to teach.
The videos on the hospital's CCTV system can be used to begin the education process. While nurses need to take time to review the information, the patient already is familiar with the material so less teaching is required, explains Evans. The CCTV schedule for Nash General is printed on laminated cards so they can be sterilized and left in the rooms after each patient is discharged.
· Have other disciplines share the teaching.
Incorporating other disciplines into the teaching process can save time. When a patient needs dietary information, a dietitian can be called, says Beatrice Wolf, RN, CS, MSN, CDE, clinical educator at Sacred Heart Medical Center in Spokane, WA. However, nurses must reinforce the teaching throughout the hospital stay, she says. (For more information on interdisciplinary teaching, see article on p. 106. See also Patient Education Management, June 1998, pp. 75-78; July 1998, pp. 89-91.)
Teaching checklists for several conditions are used to prompt nurses to contact the appropriate discipline for educating patients at St. Francis, says Reid. For example, the pharmacist would be contacted to teach about insulin and oral medications. (See example of diabetic teaching checklist, inserted in this issue.)
· Teach patients in groups when possible.
When several inpatients need to hear the same information, deliver it in a group setting, advises Wolf. Before discharge, cardiac patients at Sacred Heart attend group classes on low-cholesterol and low-sodium diets taught by a dietitian.
· Show nurses how to streamline education.
New nurses are taught how to complete a good learning assessment and focus on the patient's specific learning needs when teaching. "During orientation, we teach nurses to determine what the patient already knows and what the patient needs to know because it's impossible to teach a patient everything," says Reid. Both presentations and self-learning packets are used to teach nurses. (For teaching tips that streamline patient teaching, see article above.)
· Create streamlined forms for quick teaching and documentation.
At Nash General, critical pathways provide cues on what nurses must teach the patient on a daily basis. Much of the information comes directly from booklets. Nurses are encouraged to go over the information with the patient and then leave the booklet so the patient can review the information. This simplifies the patient education process, explains Evans. (See example of critical pathway and accompanying teaching checklist, inserted in this issue.)
At Sacred Heart, teaching sheets for some diagnoses have been created, such as diabetes. These sheets list what the nurse needs to teach and provide areas for quick documentation of the teaching. A sheet that prompts nurses to quickly identify preferred learning methods, educational barriers, and learning needs helps streamline patient education as well, says Wolf.
· Generate teaching materials electronically.
St. Francis Hospital recently implemented a software program, called CareNotes, to generate patient education materials. (For a list of delivery systems, see Patient Education Management, April 1998, p. 48.) To generate a teaching sheet, a nurse simply has to type the topic into the computer. "The resource is right at the desk so nurses don't have to find a booklet or make copies. They just go to a computer and pull it up," says Reid. CareNotes is manufactured by Micromedex, based in Englewood, CO.
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