Create a solid foundation for patient education

Build an infrastructure to support teaching

Although Zeena Engelke, RN, MS, has multiple job duties as patient education manager of the University of Wisconsin Hospital and Clinics in Madison, she has managed to incorporate direct teaching into her position as well.

The teaching is done at one of five learning centers she oversees, and the patients frequently are in need of pre-surgical instruction or self-care management. For example, the patients learning self-care may be newly diagnosed with diabetes.

Engelke supervises nine registered nurses at the learning centers, one of whom is a clinical nurse specialist, and three program assistants. She also oversees student help.

However, patient and family education is not limited to the learning centers and neither is Engelke’s oversight. She is responsible for helping nurses and other disciplines meet the standards related to patient and family education and ensuring they have the tools to teach, such as written materials and videos.

The academic medical center has 471 beds and includes an adult and pediatric hospital as well as several clinics. Four clinics are off-site.

Engelke has been in her role as manager of patient education for about 10 years; however, she has been with the University of Wisconsin Hospital and Clinics since 1986.

Her original clinical experience was in perinatal nursing. Also, she worked in staff development for about 10 years with part of that time shared with patient education. She has a bachelor’s and master’s in nursing.

The position of patient and family education manager is within the department of nursing at the University of Wisconsin Hospital and Clinics. Engelke reports to the senior vice president of nursing and patient care services.

In a recent interview with Patient Education Management, she discussed her job, her philosophy on patient education, the challenges she has met, and the skills she has developed that helps her to do her job well.

Question: What is your best success story?

Answer: "The emergence of the learning centers. I think they started as a bit of an illusive idea and have emerged into a very strong, vibrant service at five different sites with nurses practicing daily at those sites and modeling best practices in patient and family education."

It took a lot of work with a variety of disciplines to make the learning centers successful. The first center opened in 1995.

The working relationship between the learning centers and each clinic varies. Many have incorporated pre-op teaching into the work-up template for surgery along with lab tests.

Nurses and physicians also contact the learning center when patients have complex, time-intensive, learning needs. Often these patients have lots of learning barriers.

In addition to direct teaching, the learning centers provide resources for teaching patients and families.

Creating a strong infrastructure

Question: What is your area of strength?

Answer: "We have developed a fine infrastructure to support patient and family education. We have a significant number of health facts available on-line for staff to print out on a variety of topics. Also, we have a lot of videotapes that match those health facts. We have set the stage for a good solid patient education effort."

Question: What lesson did you learn the hard way?

Answer: "You can never reach all the people you need to reach to let them know of all the resources and tools that are available. In huge organizations, it is hard to help people at so many different levels and locations understand what is available to support their teaching. Communication is nonstop. You can do it 24 hours a day and never reach everyone."

Question: What is your greatest challenge?

Answer: "The greatest challenge everywhere is documentation. It’s helping nurses and other clinicians capture all the teaching they do and get it on paper."

It’s important because it is a vital communication tool as well as a regulatory requirement, Engelke says. Effective communication will save a lot of time. Without effective communication, people always are reassessing before a teaching session and starting fresh rather than building on what the prior clinicians accomplished.

"A constant complaint is that there is no time to teach yet without communicating what has been assessed and taught more time is lost in the long run."

What’s next?

Question: What is your vision for patient education for the future?

Answer: "A much cleaner continuous path to learning would be incredibly helpful. Not just continuity from one site to the next but also consistency of information with documentation to support teaching."

Communication on patient educational efforts between inpatient areas, outpatient clinics, and home health often is fragmented, Engelke reports. Information on not only what the patients were taught but also how they responded to the teaching and what the priorities are for the next step of the learning process needs to be transferred from setting to setting so that there is a seamless delivery of patient education.

"Links and a crystal-clear message need to be in place so that teaching is constant from one location to the next. In some areas of the academic medical center, good models exist, but not in all areas."

Question: What have you done differently since your last Joint Commission on Accreditation of Health Care Organizations’ (JCAHO) visit?

Answer: "We are more vigilant in tracking documentation. Learning preferences was a red flag for our organization, so I audit that. The managers need to work with their staff to get 100% compliance within 24 hours."

Rather than giving a 58% or 84% rating, managers receive specific data so that they can take corrective action to obtain 100% compliance on this issue. Assessing for learning preferences is a battle because staff not only have trouble asking people how they prefer to learn but also in the timing of the question. During a crisis situation, it is an awkward question, Engelke says.

JCAHO, based in Oakbrook Terrace, IL, surveyed the University of Wisconsin Hospital and Clinics in the fall of 2002.

Question: When trying to create and implement a new form, patient education materials, or program, where do you go to get information/ideas from which to work?

Answer: "To get the best implementation, you have to work within the group that is implementing it. However, the group may or may not have all the latest ideas that are out there, so sometimes you feed in other models from across the nation."

Networking with colleagues via listservs or at conferences is one way to obtain best-practice ideas to bring to the group, but it has to be up to the core group working on the project to include the information. Without buy-in from this group, it wouldn’t work anyway, Engelke advises.