Teach patients about venipuncture change
There may be little home care educators can do to stop the Medicare change that may force hundreds of thousands of venipuncture patients to seek help outside their homes. But education managers could at least educate these patients and their families about how to take care of themselves once the change goes into effect.
"We’ll have to be very aggressive in the amount of education and training we provide for the patient and family member," says Tammy J. Kelly, RN, staff development coordinator at Flowers Home Health Division, affiliated with Flowers Hospital in Dothan, AL.
"We’ll have to be more cost-effective and say to them, In three visits, we’ll have to teach you how to do 25 things. We’ll give you the tools to manage your care,’" Kelly says.
For home care agencies in some parts of the country, this is no problem since they’ve already learned how to speed up patient education because of managed care pressures. But Alabama has very low managed care penetration with only 6.7% of insured lives belonging to an HMO.1
Flowers Home Health nurses have told patients how the venipuncture change may affect them and their family members. "Sometimes people are willing to make the change, and in other cases, they are not physically able to do so," she adds.
So Flowers Home Health has been stepping up its teaching efforts to prepare patients for a drastic change in their care. Instead of having home health aides come into their homes to help them bathe and to provide other assistance, the patients’ family members will have to take over the care.
Here are some of Kelly’s suggestions about how to shift the focus from providing the patients with the care to teaching them and their families how to do it themselves:
• Teach nurses the difference between being a nurse and being a teacher.
Nurses will need to understand and assess a home’s whole environment, including cultural background, family interaction, and generational problems, Kelly says.
"We assess the individual’s ability to learn and willingness to learn, and we try to provide them with the information in whatever mode would be most effective for them," she explains.
The nurses are taught "to get on their level and try to talk with them in a way they will understand," Kelly says.
• Set patient teaching goals.
"We’ve been doing some studies on patient education, and our goal is two weeks or less," Kelly says. "It has to be patient specific, and everybody’s situation is different. But we feel like we could get all of this done in maybe 10 visits in two weeks."
Nurses need to know that not all patients will meet the goals, and some will end up in the hospital or a nursing home after being discharged, Kelly explains.
• Provide hands-on training.
Kelly suggests agencies have home health aides show patients and caregivers what needs to be done by providing hands-on training for a certain number of visits. The aides would do the initial teaching and training, and a nurse would come in and check-off the skills of the caregiver.
It could be set up where on the second day, the aide would perform the services while the caregiver watches. Then on the third day, the staff will provide demonstrations of how to provide the care.
Finally on the fourth, fifth, and sixth days, the family members will participate, and nurses will assess the caregivers’ skills.
Kelly says an agency could assess family members with the same forms it already uses for home health aides, covering the same areas, including home safety.
• Teach aides how to teach.
Education managers could use a variety of methods to train aides to become teachers, including using role-playing, Kelly suggests.
"Sometimes they have this knowledge and skills, and you have to show them how to put it all together," she says.
Aides could be asked to demonstrate teaching during the inservice, and the education manager could assess their teaching skills. Kelly figures it would take two or three inservices, totaling at least eight hours to train aides to become teachers.
Reference
1. Hoechst Marion Roussel, HLS Management Systems, The Business Word Inc., SMG Marketing Group Inc. HMO-PPO/Medicare-Medicaid Digest. Managed Care Digest Series 1997; p. 20.
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