Patient Educators are frustrated because there is significant pressure to do more and many patients don’t seem to care or want to know what to do to get better or improve. When you’re trying to teach someone and you find yourself getting frustrated because:
They don’t seem interested
They don’t seem to care
They don’t see the point
They don’t see how it affects them
They just want a pill or procedure to fix it
They’re just not getting it
Fran says frustration is a red flag as well as an indication that what you are doing isn’t working and means it’s time to stop and change your approach.
What are the key strategies nurses can use to overcome this problem?
Stop and step back.
Revisit your assessment/do it again. Listen carefully. What have you missed?
Do you know what motivates the patient or what their goals are?
Have you investigate their life experiences?
Do you know what they believe and what they don’t believe?
Are they physically able to perform necessary skills for their recuperation?
Is the patient exhibiting signs of discomfort, resistance, tension, misunderstanding or confusion?
Are you asking questions and really listening?
Have you really discovered the source of the problem?
The end goal is to find something the patient cares about and use that information to modify how you are educating the patient to improve engagement and results.
Too often we think of patient education as providing a handout and going over a list at discharge before sending the patient home. This is like giving every obese person the same diet advice: “eat less and move more”. It’s not likely to work because this advice does not address the patient’s individual circumstances or need.
Patient education must be individualized and specific to each patient in order to be successful. In talking with Fran London MS, RN, author of No Time to Teach, the right approach is to think about patient education as PRN.
What does PRN actually mean?
Pro re nata is a Latin phrase meaning in the circumstances or as the circumstance arises. It is commonly used in medicine to mean as needed or as the situation arises. It is generally abbreviated to p.r.n. in reference to dosage of prescribed medication that is not scheduled; instead, the decision of when to administer the drug is left to the nurse, caregiver or the patient’s prerogative. Such administration of medication is not meant to imply, and should never allow for, exceeding a given daily dosage.
Let’s change our focus on Patient Education and treat it as PRN meaning, “as needed” or “as circumstances dictate”. If approached this way we can relate it to something nurses do multiple times a day when administering pain medication as PRN. Before the nurse administers pain medication that is designated PRN he/she will determine whether or not the patient actually needs the medication by asking a few questions about their current pain situation as well as observe physical signs before deciding to provide or recommend withholding the medication.
Why does this makes sense for patient education?
Every situation is different.
Each patient is different
Each disease is different and often compounded when multiple chronic illnesses collide, i.e. diabetes and cancer or arthritis etc.
The only way to administer patient education is PRN or based on the circumstance and it can’t be administered unless the nurse or doctor has done an assessment to determine exactly what education is needed for each particular patient.
How would you administer patient education PRN?
Do an assessment first to find out where the patient is.
Individualize the intervention so its appropriate for that patient.
Listen, pay attention and take advantage of the “teachable moments” and do what’s right in that moment, right there.
How would you determine what patient knows and does not know or understand?
Ask them specific questions.
Observe the patient’s reactions and expressions to guide you.
Advantages or disadvantages to this approach.
Helps the educator better individualize teaching to each specific patient.
Helps the educator determine what the patient knows, what they don’t know and what they are ready for.
Keeps the educator and the patient in the same place.
Reminds the educator that they need to assess.
Helps the educator be more attuned to the patient.
This episode is about patient engagement and what it means. Prior to reading several articles I thought I had a clear understanding of what it meant and how to apply it to patient education but after reading a bit I discover that the health care world does not agree on what it means and how to include the patient, if at all. My obvious next step was to engage Fran London and get her perspective and she properly puts the focus where it is needed.
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