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Look for community allies to help teach
Patient education managers don’t need a crystal ball to see into the future, because many of the issues they are beginning to struggle with now are escalating and will therefore shape the future, say the experts.
As health care facilities continue to drown in red-ink services that aren’t generating revenue, services are being cut, such as wellness programs, says Karen Stallings, RN, MEd, associate director of the North Carolina Area Health Education Centers Program at the University of North Carolina at Chapel Hill.
With the continuing decline in resources, patient education managers must be efficient in their job and focus on outcomes that are rooted in the place where they work, says Leah Kinnaird, EdD, RN, a consultant with Creative HealthCare Management in Minneapolis. It isn’t so much about helping people stay healthy in general, but keeping them out of the hospital. When designing a program ask: "What is the benefit to the organization, rather than what is the benefit to society?" she advises.
What’s needed to help meet the budget crisis are more mechanisms for reimbursement for patient education as a part of regular health care, says Donna Flavo, PhD, RN, coordinator of rehabilitation counseling at the Rehabilitation Institute at Southern Illinois University in Carbondale. This will happen only if patient education managers set up systems to collect data that prove their programs work.
It’s not enough when patients say they like the program; administrators want to know if the teaching decreased the hospital stay or benefited the institution in some other way. "Reimbursement for diabetic patient education came about because people were able to show decreased morbidity in people who were better educated," says Flavo.
Finding funds will be paramount
Patient education managers will be put in a position to try to find money to subsidize their patient education programs, whether through grants or some other means, predicts Sandra Cornett, RN, PhD, program manager for consumer health education at The Ohio State University Medical Center in Columbus.
While hospitals still will provide the needed information following a procedure, much of patient education will be done in a community setting, says Patricia A. Mathews, RN, MA, FHCE, president of Mathews Associates, a consulting firm in Chambersburg, PA. "The job of patient education coordinators within health care systems will be to provide technical support, to provide resources, and to coordinate making sure people are connected," she explains.
For example, the patient education coordinator would find out if the patient belongs to a church with a Parish nurse program that might help him or her manage their chronic health problem. There are many community-based disease prevention and disease management programs, such as a pediatric asthma program implemented through school systems, or the Parish nurse programs in churches that teach people how to manage diabetes and other health problems.
In addition, payers are beginning to shift some of the cost back to the patient, says Mathews. Therefore, patient education managers will need to help patients make informed decisions. "There will be more questions to be answered because patients will want to make the right choice. Cost will be a factor in those decisions, so people will need more guidance so cost won’t be the deciding factor," explains Mathews.
Unfortunately, as money becomes tighter, community outreach programs aimed at high-risk groups often are discontinued. In turn, these patients begin to use the emergency department (ED) as their primary source of care. "We had great hopes with the onset of managed care that there would be incentives to creating alternative sources of health care to keep people out of the ED, but we are now seeing folks back again," says Stallings.
For the ED, that means more emphasis needs to be placed on the discharge planning needs of the patients with chronic health problems who don’t manage their disease well at home, she explains.
Effective teaching essential
Too much to teach in too little time has been a common complaint for a long time as the length of hospital stays has plummeted. Now with a nursing shortage, the problem is more severe. "Nurses are the best-prepared providers of patient education across the board, and with the nursing shortages we are staffing fewer RNs per patient," says Stallings. As a result, staff development is essential. Staff need continuing education not only on teaching approaches, but also current information about chronic illnesses or new drugs, she says.
Research shows that patient education is effective when patient and practitioner interact in a one-to-one relationship working in a partnership, says Flavo. "The reason we do patient education is to help patients incorporate the recommendations into their life to benefit their health. Just getting people information doesn’t do that," she says. Therefore, as time for teaching in both the inpatient and outpatient setting continues to shrink, staff education becomes more and more important.
In one study Flavo conducted, she looked at how much time physicians spent on patient education when they were with patients. What she found was that their delivery of education was inefficient. "If they know how to do it in an efficient and effective way, they would cut down on the amount of time they had to spend with the patient," she says.
While there’s less time for teaching patients, there’s also less time for teaching staff, says Cornett. To remedy this situation, patient education should be a part of clinical care inservices and other ongoing staff education initiatives, she advises. "It would support our belief system that patient education is an integral part of patient care," says Cornett. Also, more staff education programs need to go on-line. Health care professionals could be given a password to access the curriculum, complete the work at home, and receive credit, she says.
Computers already impact patient education in several ways. People who are computer-savvy and have access to the Internet are getting a lot of the health care information they need. Due to computer technology, the nature of the questions families are bringing to the nurses who staff the health library at Phoenix Children’s Hospital has changed dramatically in recent years.
"They are bringing in harder questions because they are getting the easy answers themselves. The questions are difficult to research outside the medical literature," says Fran London, MS, RN, a health education specialist at the hospital. (For more information on how technology is shaping patient education, see article on p. 53.)
Helping patients decipher all the information they gather through the Internet and media will be a bigger and bigger role for patient education managers, says Mathews. "They will do less development of informational pieces and more interpretation of what’s out there and helping people figure out what is helpful to them," she says.
This role will be particularly beneficial as scientific research uncovers new medical information such as the genes that make a person susceptible to a particular type of cancer. The psychological aspects of screening will be significant, says Stallings. She sees the need for advance practice nurses to help people with genetic risk assessments, prevention, and treatment strategies.
People who have a predisposition to a particular disease will need help deciding what it means to them and what they should do about it if anything, says Flavo. Advances in medicine could bring about the need for intense patient education programs just as the ability to do heart and lung transplants did several years ago, she says.
Scientific advances can cause moral dilemmas as well. "I think there will be many more ethical questions patient education coordinators are going to help people navigate. We already have selective abortion, stem cell testing, and conceiving a child to be a bone marrow donor," says Mathews.
Patient education needs not only are changing due to scientific and technological advances, they are being altered by population changes as well. Health care providers are treating people from diverse cultural backgrounds, and the diversity is increasing. Patient education managers will need to continue to develop educational materials in other languages and help staff learn as much as they can about the cultures they serve. However, that is not enough, says Stallings.
"Almost family by family, our culture, and beliefs affect the way we learn and the way we practice health behavior; so what we need are providers who are open to learning from their patients," adds Stallings. (For more information on breaking down cultural barriers to patient education, see article on p. 57.)
The elderly population also is on the rise, and as the baby boomers age, new retirement communities are springing up that include assisted living arrangements. "There is a real opportunity to improve the delivery of patient education by thinking of the health care team in a bigger way than before," says Stallings.
In addition, the sheer numbers of people, especially in metropolitan areas, are sure to have an impact on health care, says Kinnaird. As it becomes more and more difficult to get an appointment with a physician, education on the appropriate use of the health care system becomes more relevant. Right now, there are informal triage systems in place such as "Ask a Nurse," but in the future, those systems may be formalized, says Kinnaird.
The mobility of the world’s population also is impacting patient education. "Some of the health problems that other countries experience, we never really thought we would have to deal with, but in this age when people are so mobile, anything can be anywhere," says Flavo. A good example is tuberculosis, which Americans thought they had under control, she adds.
Another health threat that is on the horizon due to the shrinking travel time is bioterrorism. Most health care facilities are preparing for the possibility of such an attack, and part of the preparation is to anticipate the information needs of the public, says Stallings. This might include discharge instructions with isolation procedures, emotional support systems, and providing accurate information quickly.
"Health care agencies would need to do public information announcements as well as teaching with patients and families. They would need to be prepared to do group teaching if lots of people needed to be taught," she says.
As patient education managers prepare for the future by embracing technology and the opportunities it provides to improve teaching, London worries that patients who don’t have access to computers will be left behind. More needs to be done to educate low-literacy patients, not less, she contends.
"People who can’t fend for themselves in the health care system will have a harder time. We don’t have the resources, the time, or the tools to teach them as effectively as we do the people who are educated or are resourceful," says London.
The health literacy problem is growing, agrees Cornett. Patient education managers should not only look to technology as a means for distributing health information but other venues as well. "We need to continue to provide learning materials in a way that people can understand," she says.
Many people are overwhelmed by the language of medicine; therefore, an advocate system similar to the interpreter setup in many health care facilities might work well, says Kinnaird. "I would like to think people in the hospital could ask for that service. Someone would be available to help them phrase their questions when the doctor is in their room," she says.
For more information about the future of patient education management, contact:
• Sandra Cornett, RN, PhD, Program Manager Consumer Health Education, Department of Consumer & Corporate Health Education & Wellness, 1375 Perry St., 5th floor, Columbus, OH 43210. Telephone: (614) 293-3191. E-mail: firstname.lastname@example.org.
• Donna Flavo, PhD, RN, Coordinator of Rehabilitation Counseling, Rehabilitation Counselor Training Program, Rehabilitation Institute, Suite 308, Southern Illinois University, Carbondale, IL 62901-4609. Telephone: (618) 453-8262. E-mail: dflavo@ siu.edu. Author of Patient Education: A Guide to Increased Compliance, published by Aspen.
• Leah Kinnaird, Consultant, Creative HealthCare Management in Minneapolis. Telephone: (800) 728-7766. E-mail: email@example.com.
• Fran London, MS, RN, Health Education Specialist, The Emily Center, Phoenix Children’s Hospital, 909 E. Brill St., Phoenix, AZ 85006. Telephone: (602) 239-2820. Fax: (602) 239-4670. E-mail: firstname.lastname@example.org. Author of No Time To Teach? A Nurse’s Guide to Patient and Family Education, published by Lippincott, Williams & Wilkins.
• Patricia Mathews, RN, MA, FHCE, President, Mathews Associates, 1020 Leidig Drive, Chambersburg, PA 17201-2816. Telephone: (717) 264-1143. E-mail: email@example.com.
• Karen Stallings, RN, MEd, Associate Director, North Carolina Area Health Education Centers (NC AHEC) Program, University of North Carolina at Chapel Hill, CB 7175, 101 Medical Drive, Chapel Hill, NC 27599-7165. Telephone: (919) 966-0802. E-mail: Karen_Stallings@med.unc.edu. Co-author with Sally H. Rankin of Patient Education: Principles and Practice, published by Lippincott, Williams & Wilkins.