Find solutions to those gaps that break the continuum of education
Teaching plans, learning centers, and Intranet access all contribute to seamless education
Patient education managers describe education across the continuum of care in many ways. Yet all agree there are certain crucial components. To ensure a smooth continuum of education, your educational system should:
• provide a consistent message reinforced by providers in different settings;
• build on previous teaching, because teaching doesn’t always take place in optimal learning situations (for example, the patient might be in pain);
• be structured around a planned sequence of educational events consisting of integrated teaching components by multiple disciplines;
• provide for a patient’s ongoing educational needs at an appropriate level of education wherever that patient receives care, whether it is within different departments in a single facility or in separate facilities.
The only trouble with these recommendations is that they are easier said than done. However, that doesn’t mean they can’t be accomplished. There must be a written teaching plan in place, says Zeena Engelke, RN, MS, senior clinical nurse specialist at the University of Wisconsin Hospital and Clinics in Madison.
Engelke’s institution has set in place a method for teaching across the continuum for several surgeries, including hip and knee replacement, cardiac surgery, and mastectomy or lumpectomy surgery. The teaching is integrated with the learning center.
"The driving force is the teaching guidelines," says Engelke. Each guideline is designed with four columns. The first lists the outcomes the education is designed to provide; the second gives the content and time frame; the third lists the available resources and written materials for teaching; and the fourth identifies the disciplines responsible for teaching.
When a patient is scheduled for hip or knee replacement, the patient’s physician gives the patient a packet of information and asks the patient to read it. When the patient comes in for a pre-surgery work-up, the patient visits the learning center first to learn how to prepare for surgery and to receive some post-op information, such as what to expect when returning home after surgery.
During the work-up, the physician or nurse practitioner provides details about each patient’s particular surgery. The day before the surgery, a nurse from the work-up area telephones patients to see if they are prepared for surgery. In the post-op area, a nurse continues education using materials from the original packet.
Other surgeries would be slightly different. For example, mastectomy patients usually have same-day surgery, so the home care nurse continues the teaching. However, in each case, the educational sequence, the person who provides the education, and the appropriate time for teaching are all planned.
"We used the learning center to carry out certain components of the teaching guideline, and I think that helps the system. Without the learning center involved, not everyone would get the information at the same point in time, and there could be inconsistencies in the delivery of the message," says Engelke.
Time education along course of disease
There needs to be a plan regarding what is going to be taught across the continuum and when it’s appropriate to teach the information, agrees Kerry Harwood, RN, MSN, director of the cancer patient education program at Duke University Medical Center in Durham, NC. It’s important to understand when people are ready for certain kinds of teaching during the disease process. Some of the curriculum is determined by an individual patient assessment, but some is determined by listening to patients who have a similar condition and can therefore be fairly predictable, says Harwood.
For example, women with breast cancer receive intensive treatment and education for several months. As time goes on, women are scheduled for follow-up appointments less and less frequently. There isn’t a lot of time for education in the short follow-up sessions, but women have certain questions that need to be addressed at particular stages of cancer survivorship.
Therefore, Harwood and a social worker designed a patient education intervention to give these women the information they needed. "We noticed the same questions were being asked over and over again, and there wasn’t enough time within a 10- or 15-minute follow-up appointment to address the issues the patient had. So we designed a different way of meeting the patients’ needs," says Harwood.
The program featured a guest speaker who addressed a topic of concern for breast cancer survivors during a dinner meeting once a month. When it was learned that women were driving 250 miles to attend the meeting, the medical facility began to host an all-day annual conference instead. The program charge is $25, with scholarships available. The conference has many break-out sessions, so women can design their own education package. "This same model would work for any chronic illness. Just determine what people’s education needs are at any point in time," says Harwood.
Care team members must communicate
When there isn’t time for education, it’s important that health care providers don’t assume that someone else will do it, says Kathryn J. Conrad, RN, MSN, MA, AOCN, program leader, Cancer Education and Standards Integration for clinical support services at the University of Pittsburgh Cancer Institute. In today’s health care environment, patients are in and out of the treatment setting very quickly, whether inpatient or outpatient. This leaves little time for teaching.
"If you are dealing with a higher volume of patients coming in, it is harder to do the follow-up and get that information out to other members of your health care team. It’s also difficult to read everything other people have sent to you on the patient," Conrad explains.
To solve this problem, communication is key, says Conrad. All members of the health care team should meet to discuss the teaching process and discover where the gaps are. At the University of Pittsburgh, teams have created teaching plans on some of the common interventions that are consistent with clinical practice guidelines. For example, the guidelines for chemotherapy not only direct patients’ care; they also provide direction for the education and teaching resources.
At Southern Arizona Veterans Affairs Health Care System in Tucson, patient education guidelines and handouts were developed to help standardize educational objectives and content in different areas. Also, standardized discharge forms were created to assist in comprehensive discharge instructions, says Connie S. Wilkinson, PhD, RN, MPH, program director for staff development. In addition, forms were created to support each educational guideline so documentation would be easier for providers.
It’s important to know what patients receive at every stage of the education process, says Engelke. At the University of Wisconsin, the clinics are part of the health care system, but even when hospitals work with several clinics outside their system, patient education managers need to find out what information is given, she says.
Health resource centers being developed at many health care institutions have great potential when it comes to filling gaps in education, says Magdalyn Patyk, MS, RN, advanced practice nurse, patient education at Northwestern Memorial Hospital in Chicago. "We can reinforce the information the physician provided or clarify it. We can also provide information on treatment modalities that the patient can discuss with his or her physician," she says.
Patyk recently kicked off a new program for Type II diabetes to fill the gap between when patients are diagnosed and when they are able to see a diabetes nurse clinician and dietitian for detailed teaching. Patients often are just given a prescription and a few guidelines at the physician’s office, so they come to the learning center.
At the center, Patyk has an hour-long patient education intervention that teaches the basics of Type II diabetes. The session includes a video and one-on-one teaching. She worked with the diabetes nurse clinician and dietitian to make sure she was only giving patients the basics. "I have 14 videos and lots of information on diabetes, but when you are newly diagnosed, you don’t need all that information at one time," says Patyk.
Making sure patients have the information they need without being overwhelmed can be a problem when there isn’t always a designated time in which a patient can be taught. Duke University Medical Center faced this problem with cancer patients who live a three- or four-hour drive away from the hospital. These patients often are treated by telephone triage. The nurse practitioner or physician might change a medication or order a test following a phone assessment, for example. At these times, there was no opportunity to properly educate the patient about the test or medication.
To remedy this problem, a patient education notebook was created that is customized for each type of cancer and also for each patient, because materials can be added as needed. Information on medications and tests that the patient might have is included, and the patient is told this when given the book. Then, during telephone triage, patients are asked to get their notebook and turn to a certain page.
No matter where education is delivered, it is important that patients get a consistent message, says Patyk. To aid in this process, she included copies of all the videos found in the hospital’s closed-circuit TV system in the learning center video collection. "In this way, they have access to them again on an outpatient basis, and we are providing that consistent message across the continuum," she explains.
It’s even possible to deliver consistent information between different health care institutions, says Harwood. For example, a statewide asthma program with consistent information was designed by a coalition in North Carolina with representatives from hospitals, health departments, and clinics. "Primary care providers will be using these consistent asthma patient education materials on a statewide level," she says.
Technology is making it easier to deliver a consistent message. More and more institutions are putting educational materials on an Intranet so standardized materials are always available, says Harwood. "The Duke Intranet gives our affiliates access to our materials. They may be located two or three hours away, but if they are seeing our patients in follow-up, they can access our materials," she says.
For more information on creating a system of education across the continuum of care, contact:
• Kathryn J. Conrad, RN, MSN, MA, AOCN, Program Leader, Cancer Education and Standards Integration, University of Pittsburgh Cancer Institute Clinical Support Services, 206 Iroquois Building, 3600 Forbes Ave., Pittsburgh, PA 15213. Telephone: (412) 624-5254. Fax: (412) 624-1936. E-mail: [email protected].
• Zeena Engelke, RN, MS, Senior Clinical Nurse Specialist, University of Wisconsin Hospital and Clinics, 3330 University Ave., Suite 300, Madison, WI 53705. Telephone: (608) 263-8734. Fax: (608) 265-5444. E-mail: [email protected].
• Kerry Harwood, RN, MSN, Director, Cancer Patient Education Program, Duke University Medical Center, DUMC Box 3677, Durham, NC 27710. Telephone: (919) 681-5288. Fax: (919) 681-7473. E-mail: [email protected].
• Magdalyn Patyk, MS, RN, Advanced Practice Nurse, Patient Education, Nursing Development, Northwestern Memorial Hospital, 251 East Huron, Suite 4-708, Chicago, IL 60611-2908. Telephone: (312) 926-2173. Fax: (312) 926-1741. E-mail: [email protected].
• Connie S. Wilkinson, PhD, RN, MPH, Program Director, Staff Development, Southern Arizona Veterans Affairs Health Care System, 3601 S. 6th Ave. (7-14B), Tucson, AZ 85723. Telephone: (520) 629-4673. Fax: (520) 629-4972. E-mail: [email protected]. gov.
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