Policy, tools, training and expectation prompt assessment of learning needs
Teach staff to individualize teaching based on information from an assessment
Policy is in place at the University of Washington Medical Center in Seattle that translates The Joint Commission Standard PC.6.10 into a statement about assessing the learning needs of patients and families, as well as tailoring education to their specific care, treatment and services.
This health care institution is not unusual. It is common for policy to be written addressing this standard in the Patient Care Chapter which reads: "The patient receives education and training specific to the patient's needs and as appropriate to the care, treatment, and services provided."
Yet with or without a policy, one of the most common RFIs (requirement for improvement) issued during a survey by The Joint Commission pertains to this standard.
So how do you ensure that your staff conduct learning needs assessments and use the information to create an individualized plan of teaching for each patient? The first step is to make sure the tools are in place.
A learning needs assessment is the first computer screen for the online documentation system for patient education at Children's Healthcare of Atlanta. The assessment tool has questions to ask the parent and/or child in order to tailor the education appropriately.
The questions cover ways the learner likes to be taught, such as watching a video or reading a booklet, as well as the information he or she wants covered. In addition, questions determine physical problems, such as a hearing impairment, as well as psychosocial, emotional, religious and cultural factors that need to be addressed in order for the patient to learn. For example, to determine whether or not to involve social work or some other department, staff might ask: "Are there any kinds of emotional or family stressors going on in your life now that may impact your ability to care for your child at home or to learn the information we are going to be teaching?"
According to Kathy Ordelt, RN-CPN, CRRN, patient and family education coordinator at Children's Healthcare of Atlanta, the learning needs assessment addresses anything staff may need to be aware of to alter their teaching so that the patient or parent may actually learn. There is also space to document the interventions used to address the factors, such as calling in an interpreter or child life specialist or arranging a consult with a financial counselor or social worker.
A learning needs assessment is part of the intake process for hospitalization at the University of Washington Medical Center, and the assessment is on the new electronic medical record.
In outpatient clinics patients are given a questionnaire to complete or if preferred a staff member helps them fill out the form.
The questions on the form are written according to The Joint Commission Standards as well as the philosophy of patient-and family-centered care, says Cezanne Garcia, MPH, CHES, the associate director of Patient & Family Centered Care and Education Services at the University of Washington Medical Center.
Tools make assessment complete
Many factors impact the approach used for communication, says Garcia. That is why the outpatient assessment covers many areas not always considered important to learning, such as those with whom patients live and whether or not they have help with transportation. The ability to eat nutritious meals could depend on whether or not the patient has help with food preparation and the ability to get to a store, not just education on nutrition.
The variety of questions on the outpatient learning needs assessment include the following:
- Do you have a main concern or question about your health care that you would like to talk about today?
- My illness or condition has made me change the kind and/or amount of food I eat.
- Do you have any values or beliefs we should consider when planning your care?
- How often during the last four weeks have you felt so down it has affected your ability to do your daily activities?
Check boxes are provided to indicate how a patient learns best, such as listening, reading, viewing a video, or doing something hands-on. People are also asked about their ability to physically function, pain concerns, and physical impairments.
With information in hand, such things as exercise to help patients with hypertension could be tailored to their physical ability to enable them to put into practice what is taught.
At Phoenix (AZ) Children's Hospital, staff are given patient education tip cards that can be inserted into a badge holder for quick reference. The cards give specific questions to ask in order to best individualize teaching to the needs of the learner, says Fran London, MS, RN, a health education specialist at Phoenix Children's. Also, the cards have questions to ask to evaluate understanding of teaching.
Assessment questions include:
- What concerns you most about this illness?
- What do you think caused the problem?
- What do you need to know to take care of yourself at home?
- What do you want to learn more about?
In addition, the documentation form used at Phoenix Children's Hospital prompts the person doing the teaching to ask the patient what he or she knows about the subject before proceeding with the lesson. The degree of knowledge includes "no understanding," "able to state general concept," and "understands."
While a teaching plan is often informal, at the University of Texas M.D. Anderson Cancer Center in Houston, an interdisciplinary plan of care teaching record has been created on a multitude of topics, such as subcutaneous medications or lymphedema of the arm.
This gives staff a standardized template from which to work, prompting a learning needs assessment and a written plan for teaching that can be individualized.
"It really keeps staff from missing any specific teaching content and reminds them of the available resources," explains Louise Villejo, MPH, CHES, executive director of the M.D. Anderson Cancer Center patient education office.
The plan has sections pertaining to learning preference, barriers affecting learning ability and readiness, learning needs, education provided, teaching method, and the response to teaching.
There is also a section on the teaching goal, as well as content that needs to be covered. For example, content for subcutaneous medications would include instructions on the type, dosage, actions, and side effects of the medication, as well as information on when a patient needs to call the doctor or health care team. The goal of the teaching would be that the patient/parent/caregiver verbalizes understanding of medication actions, side effects and adverse reactions to report. Also, he or she verbalizes proper storage of medication.
Formal teaching sheets are not unique to cancer centers, says Villejo. An institution would simply need to determine areas in which instruction is most frequently offered, such as prenatal care, heart conditions, or diabetes.
Following policy
Although tools are beneficial, providing assessment questions and templates for teaching plans are usually not enough to secure high compliance. That's why patient education managers make sure staff training is part of the equation.
Ordelt says staff often thinks there is no time for a learning needs assessment. However, it allows them to tailor the information to patients and families and make it meaningful for the learner. She explains in staff orientation that tailoring education to the learner based on an assessment not only results in quality education, but also the teaching process is quicker.
Garcia says a staff development workgroup, which is part of the patient and family education committee at the University of Washington Medical Center, developed training modules for all the new nurses on various education issues, including the learning needs assessment. In addition, there are periodic training sessions on patient and family education.
Also important for compliance is staff accountability, says Villejo. A few years ago during a performance improvement project at M.D. Anderson, staff members said they knew that conducting a learning needs assessment and using the information to individualize the teaching was important, but because it was not part of their job performance evaluation, when pressed for time it might be dropped.
Now managers have a notebook with guidelines on making staff accountable for conducting a learning needs assessment and creating a teaching plan based on the information gathered. Each manager must make sure it is part of an employee's job description when appropriate and job evaluation as well. Managers also must ensure that staff members are educated about the process during orientation and as part of ongoing training.
"We regularly monitor the medical record and specifically look to make sure staff have evaluated for the learning preference and looked at barriers and learning needs. It is an ongoing evaluation," says Villejo.
SOURCES
For more information about creating tools and staff teaching methods for conducting a learning needs assessment, contact:
- Cezanne Garcia, MPH, CHES, Associate Director, Patient & Family Centered Care and Education Services, University of Washington Medical Center,1959 N.E. Pacific St. Box 356052 Seattle, WA 98195-6052. Telephone: (206) 598-8424. E-mail: [email protected].
- Fran London, MS, RN, Health Education Specialist, The Emily Center, Phoenix Children's Hospital, 1919 East Thomas Road, Phoenix, AZ 85016-7710. Telephone: (602) 546-1408. E-mail: [email protected].
- Kathy Ordelt, RN-CPN, CRRN, Patient and Family Education Coordinator, Children's Healthcare of Atlanta, 1600 Tullie Circle, Atlanta, GA 30329. Telephone: (404) 785-7839. Fax: (404) 785-7017. E-mail: [email protected].
- Louise Villejo, MPH, CHES, Executive Director, UT M. D. Anderson Cancer Center, Patient Education Office, 1515 Holcombe – 21 Houston, TX 77030. Telephone: (713) 792-7128. E-mail: [email protected].
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