Another Brick in the Wall
Helping people who are trying to help themselves, at what point is the most basic patient education slipping through the cracks, and how do we stop it?
I'm a nurse who is somewhat new to home health. Almost every patient I visit either has hypertension, diabetes, or both. What troubles me about these people is that they have usually been in the hospital within the past 3 months for something to do with their diagnosis, but they know absolutely nothing about it. The education I'm providing these people with is basic blood pressure and/or blood sugar parameters, and what symptoms to look for, so that they know they should be checking their blood pressure/blood sugar and when to get help for it. The people I'm talking about are in every different walk of life you can think of, ages 18-108, some in housing projects and some in gated communities, and all they are trying to do is help themselves, or help their loved ones. I feel that we need to find a way to bridge the gap that I am so frequently running into.
I find myself becoming more and more frustrated, not with the patients, but with the doctors offices, the hospital system, with the medical community. Patients listen to me, wide eyed, looking at me like what I'm telling them is some new cutting edge science that was discovered in the past week. I have had someone tell me that she's not concerned that her blood sugar is 600+ because she, "usually runs 300 or 400, so it didn't seem like that big of a deal". One person with a history of stroke told me that they had no idea high blood pressure can lead to a stroke. There are so, so many people who cannot tell me what is viewed as a high or low blood pressure, or when their blood sugar is to high or low.
While I do understand these people should know these things already, and that they most likely have been educated in the past, it obviously didn't stick. It would be easy to point fingers, to say "oh well ______ should be doing this education, these people should leave their PCP/hospital/clinic/whatever knowing what they need to know and it's their fault.
Maybe we all assume that the other providers have properly educated this person, maybe we are skimming through facts to quickly, or maybe we just aren't listening closely enough to the people we are supposed to be advocating for.
We can go down the patient blaming road as well, maybe they were provided this information time and time again and just don't care or just aren't listening. There are some people who you can educate and educate over and over and they just don't get it, they don't take those first steps to help themselves for whatever reason. While I'm sure there is a percentage of people like that, this article is not referring to them. There is a huge difference between a diabetic drinking multiple sodas a day knowing that it will cause her blood sugar to go up and doing it anyways, and a patient who had no idea that her blood sugar was so high because she's drinking 3+ sodas a day.
I'm talking about people who are asking me questions, hungry for knowledge, just trying to understand what is going on with their bodies. They look at me confused, hurt, and sometimes angry (mostly with themselves), trying to figure out how they did not know this before. I had a conversation with a friend of a friend who is on Synthroid and told me they take it every day right after their breakfast, and they truly thought this was the way they were supposed to be taking their medication.
My questions to you are, are you running into this problem as well? Do you work in a facility with people who have stories similar to the ones above, or maybe this is just me? Please comment and tell me how to bridge this gap, what do you do to better your education with patients? What can I do to help and what teaching tools do you use to improve patient education? What practices with education should become mandatory that already aren't, and what is it that isn't working? How are so many people slipping through the cracks? Is there someone that can be contacted to help get at least the basic information out there for the public?
Again what I'm referring to isn't a long list of things that should be taught, I'm saying there are people I'm seeing who do not know even the most basic things about their own disease. So many people can be helped, and help themselves if they only have the right tools, the right information, the right parameters. Thank you for taking the time to read this.
Apr 5, '17Teach. Repeat. Teach. Repeat. It is frustratingly true that of the 10 things we teach, patients often only grasp 1 or 2 and maybe remember those. I work as a parish nurse and sometimes struggle with feeling like I provide the same information over and over. But it is important work and it gradually chips away at the lack of knowledge. Hang in there! JoyApr 6, '17There is no education in the doctor's office because there is no TIME for education in the doctor's office. The doctor is most likely limited to a 15 or 20 minute visit with the patient. This is due to economic and other constraints. It would be ideal if there were a nurse in the office whose job was to do nothing but educate. and the patient did not leave the office until they had a visit with the nurse, but still, the patient might not absorb the information. Doctors have not yet come around to accepting the idea of having a nurse educator in the office either, and of course the idea of paying us to do that would probably be anathema to some of them, but I think it's an idea worth not only exploring, but promoting. It's not a job for LPNs, either, sorry to say. I think it requires at least an ASN with some experience in patient care and teaching. (My brother the internist agrees with me, FWIW, and has tried to get a nurse educator in offices where he's worked, with some success.)Apr 6, '17After many years of nursing I have learned that patients 1) do sometimes need multiple education/training sessions (for different reasons), 2) lie about previous education/training (for different reasons), 3) are very good actors, and 4) sometimes just do not care about themselves enough to even attempt to listen to education. Don't take any of the above personally. Your job is to assess what is needed and attempt to provide it to the best of your ability. Just do that and move on.Apr 6, '17I have family and friends who are educators. They all say that you need to teach something 3 times in 3 different ways (e.g. reading, hearing, doing) for the average person to get it.
The information may have been provided to the patient, but the patient is not capable of remembering. Memory is affected by a lot of diseases and by a lot of medications.
The information may have been provided, but because of a hearing deficit the patient didn't receive the information.
Stress affects memory. If the information was presented when the patient was diagnosed, the patient may have been too upset to be able to process the information. Just being in the Dr's office can be stressful to patients.
For patient education to be successful, the medical professional should utilize multiple modalities such as:
- Present the info verbally
- Provide Written material covering the same information.
- Provide links to reliable websites.
- Give the patient the opportunity to demonstrate what they have been taught.
- Ask the patient if they would like to include a family member or friend in the teaching.
- Provide a phone number or email where the patient can get answers to questions that occur to them after they go home.
- Repeat the education with each contact. Some patients will only retain a small fraction of the information each time it is presented, so you have to start small and build.
Unfortunately providers can't bill for education, so no effort is put into it.Apr 8, '17One physician I knew had online discussion groups similar to this for his patients with chronic conditions.
For example he might have one for diabetes. He gave his patients the URL and encouraged them to join.
Patients could use it to post questions or just get encouragement in managing their condition. Other patients could answer the questions.
His nurses followed the discussions and could answer questions or correct misinformation posted by other patients.
He had a part time dietician who posted tips and recipes as well.
A part time execise physiologist wrote articles on and answered questions about starting to excercise, staying motivated, etc.
The physician would respond to questions with encouragement and information.
Between the nurses, dietician, exercise physiologist, and physician following the board, none of the professionals had to spend much time doing it, but it really provided a tremendous amount of support to a lot of patients.
I was impressed by how he used technology to educate, motivate, and encourage his patients.Apr 10, '17To Anonymous - while it's nice that that physician used technology, his audience would have to be tech savvy and not everyone is.
Kind of like there's grocery store shop-from-home services, but you have to do it via computer (or else have someone else do it).
To OP - what's to say, that just after you've done all YOUR teaching, it hasn't just gone in one ear and out the other. Like it has for so many of us others who try to 'educate'.
To Daisy - I do like your reasons 2,3, and 4. Most likely it's accounting for what OP is experiencing.
To other posters - all very good info and insight. But still sad to those of us with beaucoup experience who have yet to see major NEW.
To Anonymous - I'm surprised that there isn't a CPT or ICD to bill for education. My PMP was able to charge for completing some paperwork needed for my NJ Disabled Motor Vehicle License Plate renewal.Apr 12, '17I think we need to start in theat every grade level every month... and have very simple classes in health based on our Anatomy and Physiology systems and how what we do or not do affects our bodies- incorporate "life choices and possible results" into all curriculum. We can educate till the cows come home but until we all have a responsible in our own health it will not change...there seems to be a pill for that or surgery for that with everything.
As a former prior DON I would briefly review chronic care education with the older inmates...they just did not care. With the new younger inmates I would try and really convey the importance of taking care of yourself. I remember one young inmate about 20 years old newly Dx with Diabetes, teaching him how to inject insulin. He was not interested, I asked if I could speak to him freely. I began my "mom" speech about taking care of your self...about the importance on checking blood sugars. He was and wasn't very interested and started down the you all will take care of me pathway....I told him look around and see this prison, see your life choices, that your mother did not want you here in prison and that by the time you are 30 you will be looking like your 50. It is not our job to take care of you alone you have a part to and it is the biggest part. More than likely I over stepped my boundaries as a nurse. 3 years later I received a post card from this inmate after he left prison...He thanked me for being so hard on him because no one else would, he thanked me for teaching him about his injections, foot checks, foods to eat, now he is a student at the local community college. There really is no good answer except to try and do your best without the fear of getting sued or losing your license when it comes to providing education to patients.Apr 18, '17My theory is that most of my patients understand their healthcare as well as I understand taxes - not very well. So we must explain, repeat, explain a different way, repeat, do teach backs. It's not their fault and I don't blame healthcare providers either. we just all have to do our best, then come back and do it again tomorrow.Apr 26, '17This is a large part of MY job (I also do follow up on ER visits and hospital discharges). Our practice group also has LPNs who do an absolutely fine job of educating the patients in their offices, as well.
Quote from CeciBeanThere is no education in the doctor's office because there is no TIME for education in the doctor's office. The doctor is most likely limited to a 15 or 20 minute visit with the patient. This is due to economic and other constraints. It would be ideal if there were a nurse in the office whose job was to do nothing but educate. and the patient did not leave the office until they had a visit with the nurse, but still, the patient might not absorb the information. Doctors have not yet come around to accepting the idea of having a nurse educator in the office either, and of course the idea of paying us to do that would probably be anathema to some of them, but I think it's an idea worth not only exploring, but promoting. It's not a job for LPNs, either, sorry to say. I think it requires at least an ASN with some experience in patient care and teaching. (My brother the internist agrees with me, FWIW, and has tried to get a nurse educator in offices where he's worked, with some success.)