Hank, a 65-year-old (details changed to ensure confidentiality) presented to the emergency department with progressive and increasing shortness of breath that began the day before.

He was diagnosed with hypertension three years ago and was started on both an ACE inhibitor and a beta blocker at that time. He stopped taking all his medications three months ago because he ran out and felt fine.

He was now in distress… diaphoretic and having difficulty breathing with bibasilar crackles. He had an initial BP of 240/140. A chest x-ray revealed that he was in acute pulmonary edema due to a hypertensive crisis.

He was stabilized in the ED with nitroglycerin subl. and a nitroglycerin IV gtt. that brought his BP down to 150/94 when he arrived to the floor and I assumed care.

As I was completing the admission and had time to discuss the events that led to this hypertensive and possibly life-threatening crisis, it became apparent that this crisis and admission could have been prevented.

He admitted that he did not have a clear understanding of hypertension and the importance of taking his medications.

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Patient education is an essential responsibility of the professional nurse.

As a clinical educator, I have observed that most students are reluctant to embrace this responsibility. Most students are all too aware of what they do and don’t know as a novice nursing student and need encouragement to integrate patient education into each clinical.

If patient education is done well, students can make a difference by improving patient outcomes by empowering patients and their families by helping them to understand their illness and take responsibility to do their part to promote and maintain their health.

But in order for patients to DEEPLY understand the primary problem that will require them to make needed change, they must know the simple essence of the PATHOPHYSIOLOGY of the primary problem presented at their level of understanding (see last weeks blog why patho must also be deeply understood by the nurse).

Why Patho Must Be Understood by Patients

Just as nurses must understand the WHY or rationale for everything that is done in clinical practice, the same is true for every patient or family member who has a new problem or nursing intervention to advance the plan of care.

Hank, who was a retired plumber, illustrated the importance of this point. I had a few minutes to provide a needed context and understanding of what was taking place with this unexpected hospital admission.

Using his frame of reference, I likened his arteries to pipes  The build up of pressure has no obvious symptoms until the pressure becomes too high and these pipes can burst.This can also literally happen with arterial pipes, especially in the brain which can result in a hemorrhagic stroke.

Though he fortunately did not have a stroke with debilitating consequences, it was a real possibility that he needed to understand.

I then likened his heart to a sump pump that was being overwhelmed with too much pressure to pump against and was unable to keep up. The back pressure and overload on the heart was causing fluid to fill up in his lungs causing the shortness of breath and current problem of pulmonary edema.

The light bulb went on and he remarked, “If someone had simply explained this to me three years ago, I would’ve understood what hypertension is and would have known why it is so important to take my medications!”

This is a timeless principle that effective teachers use in creative ways. For example, when Jesus was on the earth two thousand years ago and was recruiting his disciples, he approached Simon and Andrew who were fishermen and he said, “Follow me, and I will make you become fishers of men” (Mark 1:17).

He used their frame of reference as fisherman to ensure that they understood what he was calling them to by using a metaphor they could readily relate to.

As nurses we must also do the same with the patients and family members we teach (see past blog 4 Lessons from an Ancient Master Teacher that Can Transform Nursing Education Today).

I would like to share four additional principles that will strengthen patient education:

1. Individualize to Patient

Make it a priority to make all education INDIVIDUALIZED to the patient and family needs. Use metaphors or principles the patient readily understands is an application of this important concept.

Get inside the lived experience and story of your patient and family by determining:

• Education level and profession/career experience
• Age
• Mastery of English language, particularly if patients are immigrants

Once this relevant information is known, the nurse must then be able to communicate effectively in order to teach effectively. Keep all education as simple as possible to ensure that it will be understood.

2. Keep it Simple

Teach the simple concepts about a topic first, and then move to the more complex concepts.

Be sure to use language that your patient will find easy to understand and avoid medical terminology whenever possible (Freda, 2004)

3. Reinforce Everything Taught

Use the following principles to reinforce what is taught:

• Teach the one concept you want your patient to learn FIRST.
• Ask your patient to restate in their OWN words what you have taught, so you can be sure he understood. Engage in dialogue to determine effectiveness of education, not just yes or no answers. If any knowledge gaps are identified, address them immediately.
• Use visual aids for teaching; identify the preferred learning style of those you are teaching and adapt your teaching to accommodate.
• Always use written educational materials for the client to take home, if available (Freda, 2004)

4. Naturally Integrate While Providing Care

Make education a natural part of nursing practice. Clearly communicate everything that you are doing and why you are doing it throughout the shift.

This includes the plan of care simply stated and the rationale for nursing interventions, the data from vital signs, nursing assessment, and the administration of any medications or treatments.

For example, if your patient is postoperative and needs to use the incentive spirometer (IS), do not just tell the patient to do this 5 to 10 times an hour and a superficial reason for its use.

Go a little deeper into the rationale and the WHY. Explain that the alveoli are microscopic deflated balloons that need to be re-inflated after surgery to prevent pneumonia and other complications. Through proper and consistent use of the IS, these balloons can be reinflated and ensure a uneventful and timely discharge!

In Closing

Nurses can make a difference to improve patient outcomes!

When patients as well as families are educated well, this can reduce the number of readmissions for chronic health problems and promote patient health and outcomes.

Utilize these practical principles to ensure that each patient and their family not only have their immediate care needs met, but empower them through what has been taught to remain healthy and ensure long-term health stability and wellness.

What do you think?
Which principles of effective patient education do you currently emphasize? What could you include from this blog to strengthen patient education?
Comment below and let the conversation begin!

References

Freda, M. (2004). Issues in patient education. Journal of Midwifery & Woman’s Health, retrieved from http://www.medscape.com/viewarticle/478283_3