Читать книгу Patient Education: You Can Do It! - Ginger Kanzer-Lewis - Страница 13

I learn a lot by asking this question. People have amazing ideas. They have often been educated by their favorite sources—neighbors, friends, relatives, pulp fiction, and tabloid newspapers. I try to keep aware of this “valid” information so I can deal with the many calls I receive when there is an article published telling people that islet cells can now be eaten to cure diabetes. Just in case you are curious, I just made that up! Our ability to unteach myths and find the realities for patients is often the most important thing we do.

This does not only apply to people with diabetes. People are happy to get information from nonprofessionals because it is never threatening or fatal. If you don’t like what your neighbor tells you, go to another neighbor. This tactic often delays care or treatment and can be life-threatening. We need to create an environment that is neither frightening nor intimidating that allows the patient to ask questions without a fear of being thought stupid or naïve. Give the patient permission to disagree with you or argue about a concept. If you tell patients that they have the final say on their own life, then you are assuring them that you respect them as people.

The rest of the assessment is the process we utilize in health care constantly. In nursing, we call it “The Nursing Process,” but most health professionals follow a close proximity. Who is this patient as a person? What are her psychosocial needs? Does she have a support structure? Is there a significant other to help her through the learning process? Are there barriers to learning? Can she afford to live with this disease? What parts of the health care system will she utilize? What referrals will she require? Which members of the health care team are needed at this time or will be required at a later date?

The data you collect from the patient will give you a clear picture of this patient and how you can help him or her achieve his or her goals and objectives.

Collecting the physical data gives us a clear picture of what is happening to this patient and what changes need to be made in his or her physical picture overall. Part of this may be determining what data need to be collected in order to make clear decisions about treatments. One or two blood tests are not going to give me all the information I need to help the patient learn meal planning and make lifestyle changes. I cannot do pattern management without a pattern to analyze.

Compare this to an educational assessment. What does the person have to know, how does he learn, how ready is he to learn, and what are the barriers? In Chapter 4 on the Do-Know-Deficit, I will take you through the entire process of assessing learning needs.

Once you have assessed learning needs, you develop an education plan for that individual. The plan is developed in conjunction with the patient and, if possible, the significant other. Be realistic. What does this person need to know? There are three considerations: needs to know, wants to know, and nice to know.

The “needs to know” are the essential components. These are the survival skills, the basic things a patient needs to know to go home safely. In diabetes, I call them the four M’s: medication, meal planning, monitoring, and motivation. The patient needs this knowledge to leave your care safely.

The “wants to know” are the things that patients ask about. They may not be the most important things to you, but if the patient asks about something and you close the subject or shut them out, they will not hear anything else you say. For example, most of us divide our classes into several sessions. Perhaps the first class is “what is diabetes?” The second class is meal planning, and the third session is medications. Sound familiar?

Perhaps the first night you notice a patient looking very nervous and fidgety. When you go over the outline for the programs, the patient states that he was told he has to start on insulin “shots” next week and is worried about that. If you close him off by telling him that the subject will be covered in the medication class, three days later, he will be completely turned off. He may not even return for the rest of the classes and will absolutely not hear anything you say for the rest of the first class.

This is a teachable moment. These are so exciting, and when they occur, you have the best opportunity to get through to patients. They want to know something, so they have opened their minds to information and concepts. This is a wonderful chance to really get through to them and, if you miss that moment, you may never get it again. You can tell them that the subject will be covered later on, but that if they are really concerned you will discuss it with them after the class. That will show your concern but also let them know that the entire class is not there to meet their specific needs. In a large class, we have to create teachable moments. It is harder and a lot of work. I strive to create an atmosphere where people want to listen to me and learn. When I lead an all-day workshop, I ask an audience to give me the first two hours, and if I am not getting through to them, they have my permission to leave and we will give them back their money. I do not hold hostages!

Finally, there are the “nice to knows.” These are things that may be interesting and fun but no one needs them to survive. I remember teaching a section on “how to travel with insulin.” It was part of my medication class and was taught regularly. It was a long time before I realized that most of the people in my class had never been out of Nashua, New Hampshire, let alone to the Grand Canyon in 110° heat. Teach what the people need, not what you enjoy. You may have a great time in your favorite class, but it may be useless to your patients.

Patient educating can be exciting, inspiring, motivating, and wonderful. It can also be frustrating, exhausting, demanding, and frightening. It will be what you make it.

¹ Anderson B, Funnell M: The Art of Empowerment. See References.

² Bastable S: Nurse as Educator. See References.

³ Smith CE: Overview of patient education: opportunities and challenges for the twenty-first century. See References.

⁴ American Diabetes Association: Standards of medical care for patients with diabetes mellitus (Position Statement). Diabetes Care 26 (Suppl. 1):S33–S50, 2003.