Family education improves care, reduces follow-ups
In crisis situations, family members typically process only a small portion of the overwhelming volume of information presented to them. Providing written information can go a long way to answering after-the-fact questions. "It should be available in the primary languages of the communities served by the hospital and written at approximately a fifth-grade reading level," says Beverley H. Johnson, president of the Institute for Family-Centered Care in Bethesda, MD. Information should be available through another medium for families who cannot read, she adds.
Cincinnati Children’s Hospital uses an "education cart" with a TV and VCR for children and parents. Tapes include the ABCs of surgery for children going to the OR, STDs for boys and girls, asthma, and bicycle safety. A patient education pamphlet (PEP) drawer is filled with informational brochures about various conditions. "We also have an anatomy book to teach kids about the specific area of the body they’re having a problem with," says Crabtree.
Some pamphlets explain follow-up care, such as how to take a rectal temperature, while others inform parents about procedures done in the ED. "When we do a septic workup, we’ll still explain it to them verbally, but we also give a PEP to them so they can look at it," says Crabtree. "We also have laminated PEPs in bathrooms so kids can see the instructions when they’re doing a urine catch."
The pamphlets are approved by the hospital’s PEP committee. "If we see a need and don’t have a PEP, we’ll create one," says Crabtree. A nursing discharge summary sheet is filled out and given to the patient along with the appropriate PEP. "An information sheet tells girls having pelvic exams what to expect," she says. The sheets are written at a fourth-grade level so older children can read and understand them.
At Phoenix Children’s Hospital, patient education materials are an integral part of the ED’s operations. After PEPs are written, they are reviewed by families to make sure they’re understandable and meaningful. Families are contacted by mail, given a form to complete and make revisions and suggestions. The PEPs are given to patients upon discharge.
Often the information is basic. "For nurses it’s mundane stuff, but to parents it may be a crisis, and learning in a crisis mode is very limited," says Mark Burns, RN, a clinical nurse in the ED at Good Samaritan, which houses the Phoenix Children’s Hospital ED. "So many times we’re encouraged to do cattle care, with large quantities of patients in and out, and it’s important to take the time to explain about follow-up care."
Patients who aren’t educated about a health condition may come back to the ED unnecessarily, says Burns. "Insurance companies may refuse to pay if they come back over and over, and it might just be because we’re not taking the time to educate that patient," he says. "Sometimes today it’s kids raising kids," he adds. "Parents are worried, and they want something tangible to hold onto, so discharge instruction sheets can really help."
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