Obstacles to teaching diminish when dedicated staff accept the challenge
Obstacles to teaching diminish when dedicated staff accept the challenge
Learning centers provide a means for reducing readmissions, complications
Although not as prevalent as patient and family resource centers, learning centers or labs are becoming more common within health care institutions.
One of the oldest in the United States is The Patient Learning Center at the University of Minnesota Medical Center, Fairview in Minneapolis. It was implemented in 1987 as patients began to be discharged earlier with more acute learning needs. After a short hospital stay and a couple of home care visits, patients were expected to do difficult self-care techniques such as trach care; therefore, it was determined that a skills lab might be beneficial.
"Our purpose is to help prepare patients and their family members to take care of themselves after they leave the hospital — to really promote independence and help them achieve the highest health goal they could possibly achieve," says Nancy Goldstein, MPH, patient education program manager.
Studies over the years evaluating the effectiveness of the learning center have shown it reduces readmission rates, reduces complications, and improves discharge time. Quality improvement studies have shown that services at the learning center increase patient satisfaction.
This learning center has become well established because the studies have helped to prove it is cost-effective. "If we can discharge patients in a timely way, that does save the hospital dollars, and I think we play a key role in that," says Goldstein.
In addition, without the learning center, more staff nurses would be needed to complete difficult teaching at the unit level.
The first six months of 2005 show a 30% increase in patients served by the learning center compared to the same time period last year. Goldstein expects to see 4,000 patients this year and is submitting a proposal for increasing staff hours.
Customer surveys prompted the implementation of the family learning center at The Child-ren’s Hospital of Philadelphia. Parents stated it was difficult to learn at the bedside with interruptions and that it would be helpful to practice on the equipment.
Yet in the beginning it was a struggle to get referrals to the learning center because nurses did not want to give up teaching at the bedside. However, as parents learned about the facility through conversations with one another they would ask to go, and soon there was staff buy-in, says Linda S. Kocent, RN, MSN, coordinator of patient-family education at the pediatric hospital.
Almost 10 years later, it takes at least 24 hours to get an appointment at the Family Learning Center, which has two classrooms and one learning lab and is open 12 hours a day, from 8 a.m. to 8 p.m.
Learning centers are implemented for different reasons, yet each fills a unique niche or purpose within an organization.
While the idea for a learning center at the University of Wisconsin Hospital and Clinics in Madison was to augment the teaching that was occurring in the hospitals and clinics by providing a quiet place without distractions in which to learn, it was determined that in some cases it was best to take the teacher to the patients rather than the patients to the teachers.
Therefore, nurses from the learning center teach patients at the bedside self-care skills, mainly in the area of diabetes. These are time-intensive learning sessions with patients who have significant learning barriers, says Zeena Engelke, RN, MS, patient education manager.
"In the inpatient setting, it is a lot more practical for us to go to the bedside because of the fragile nature of the patients we see," she explains.
Also, various satellite locations serve patients having operations who need pre-op teaching and are part of the sequential scheduling process. As clinics schedule the pre-surgery lab work, they automatically arrange for teaching at a learning center site.
There are six sites or areas from which staff work. These include the surgery clinic, which sees 10 to 12 patients a day; the West clinic, which is primarily pediatric and sees seven to eight patients a day; the sports medicine site, which has seven to eight clients a day; and the inpatient setting, which works with 12-15 patients a day. Although the other two sites are more variable, it has become a robust program.
"I think as patients have experienced the value of having someone sit down with them and talk with them about what to expect, the clinicians have learned to appreciate that more and more, so we have gotten busier and busier," Engelke says.
When large numbers of patients need pre-op teaching, the clarity of the information and consistency of the delivery is much greater when there is a process, she notes.
Also, when there is complex teaching with patients who have difficulties, it is more efficient to use a nurse with lots of expertise in the area. "They have good resources to draw from and can think out of the box for solutions because they see those patient scenarios over and over," Engelke says.
The learning center at Rainbow Babies & Children’s Hospital in Cleveland operates on a consulting basis like many centers with referrals made by staff nurses and physicians. Its purpose is to provide discharge education.
"We are very strong in the philosophy of family-centered care, and this truly adds to the philosophy by empowering the family to make the decisions about their child and being able to provide them with the knowledge and the skills to care for their child," says Patricia Beam, MSN, RN, BC, pediatric nursing staff development coordinator.
When the learning center gets a request, the initial teaching begins at the bedside and then family members are brought to the center to practice on the equipment.
"Some of the teaching can be completed right at the bedside, but if it is extensive, they need to be brought downstairs," says Beam.
In the case when learning center staff cannot see a patient, the nurse or physician on the inpatient unit or in the clinic completes the teaching.
Engleke warns that one of the pitfalls of an effective learning center is to have staff become too dependent on it and expect certain teaching to be completed by center staff.
She advises learning center managers to make sure hospital and clinic staff understand what the programs are and how they can access them, as well as how these programs augment basic practice.
Most learning centers have a menu from which to select. The group classes offered by the learning center at the University of Minnesota Medical Center, Fairview as well as the choices for one-on-one teaching are based on requests from clinicians. "That works well for us because then I know I will get referrals instead of me deciding on my own," says Goldstein. Currently, there are seven group classes offered and a long menu of individually taught skills classes.
In addition to a set menu of classes, the teaching is formal with standards, guidelines, and patient education materials for each class.
"Having the guidelines promotes consistency, because with eight different people doing the teaching, a person could come back the next day and have a different nurse teaching, and we don’t want to have any deviation in how we teach so we have the written guidelines," says Goldstein.
Learning center staff check with clinicians periodically for changes in practice to update curriculum, but most often the center is contacted if something new has occurred. In addition, clinicians come to present at each staff meeting to keep learning center staff abreast of practices.
Goldstein says patients are always taught with the equipment they will go home with; therefore, there may be protocols for 10 different central lines.
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At the Children’s Hospital of Philadelphia, a representative from a company with a new product, such as a feeding pump or glucose meter, inservices learning center staff before the product is introduced. He or she watches staff members do a return demonstration and signs them off on a competency record.
Learning centers can never be cookie-cutter facilities, and each must be tailored to fit the needs of the patients served. These needs may change over time.
"You have to adapt to your clinical environment as you go, so the programs you may start with may look differently in a few months or years as your patient populations and your organization changes," says Engelke.
Surveys are a regular monitoring device at Rainbow Babies & Children’s Hospital. Physicians and other staff members are asked if the patient educators are meeting their needs and if any additional topics need to be added to the menu of classes.
| Two organizations celebrate patient education this fall
Two health care organizations sponsor health education weeks in the fall. The Washington, DC-based Society for Public Health Education has dedicated the third week in October to health education, and the Health Care Education Association based in Amarillo, TX, in partnership with Atlanta-based Pritchett & Hull Inc. the first full week of November. These observances have prompted two health care systems to promote educational efforts by rewarding those staff members who go above and beyond their job duties. In the following two articles, we describe the details of their awards. |
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