Читать книгу Patient Education: You Can Do It! - Ginger Kanzer-Lewis - Страница 14

2

Why Do Patient Education?

Here are my thoughts on the importance of patient education and how to approach the legal, moral, ethical, and professional issues of patient education.

In these times of nursing shortages and time constraints created by managed care companies, how dare I suggest that you need to educate patients? When health care providers of all disciplines are being asked to do more with less each day, how can patient education really be done?

When only the most acutely ill are allowed to be admitted as inpatients in hospitals and the outpatient departments are overflowing with needy people, when patients may wait three or four months to get appointments for outpatient clinics and the waiting list is continually growing, how dare I insist that patients have a right to be taught?

There are critical issues to be addressed. Why should patients be taught at all?

It Is the Legal Thing to Do

Think about it. If you are a nurse, this situation will ring true: All of us have given a patient a drug that requires that you take a pulse before administration of that medication. We would never consider giving that one pill without personally taking a pulse. Some of us even take apical radial pulses. An example would be a digitalis tablet. Now think about this. Have you handed a patient a prescription for 100 digitalis tablets and not asked him whether he knew how to take a pulse? Have you asked him to show you how to take a pulse and validated that he was doing it correctly? You would not give the patient one pill without taking that pulse, and yet you would send the patient home with a lethal dose of medication without making sure he had instructions to keep him safe?

I can think of another example: A patient has a simple fracture and cast but requires crutches for non–weight-bearing walking. If the patient is not taught to walk correctly with the crutches and falls, refracturing the leg, you are legally responsible. These patients trust you to administer medications, teach them treatments, and make sure they are leaving the facility no worse than when they entered.

My cousin had a total hip replacement while in his early 40s. He left the hospital and was told to avoid soft seats and make sure to always sit on a hard surface. He went home and sat on a solid leather sofa that happened to be too low. He dislodged his hip and had to be returned to the hospital that day for additional surgery. No one had said anything about chair height.

My son went to college in Florida and worked part-time as a lifeguard. He developed a sore throat and went to the infirmary for care. The physician prescribed tetracycline. Think about that: tetracycline—Florida—lifeguard. Every person who administers that drug knows to tell the person to stay out of the sun. The sun can cause a severe burn to that person on that drug. Would you have wanted to be the nurse on the other end of the phone when I called to question the care?

It Is the Moral Thing to Do

We have a responsibility to advocate for our patients and protect them from any harm, especially from our colleagues and us. People in our care are entitled to know that we will do right by them. We will be honest and protect them whenever we can. Each of us has stepped in when circumstance put us in the position of patient advocate. I have had to step into a code situation where CPR is being done incorrectly and take over. If someone is tactfully told to let me, a CPR Instructor Trainer, handle it and refuses, I need to be more assertive and deal with the consequences later on.

I have spoken to many people with diabetes, and they come to us with a lot of “garbage” about the health care industry. Some of them have been dealt with very badly and incorrectly by professionals and come to us with fear, concern, and a history of poor care. We often have to prove that we are competent and capable. They don’t know who we are. Are you wonderful? Are you the best you can be? Did you graduate at the top of your class or at the bottom? They are entrusting themselves to people whom they did not know an hour earlier and giving them major decision-making power over their lives.

That is a lot of responsibility. We are the only professionals responsible for the intimate care of strangers. We ask them to do all kinds of things and tell us about their most personal issues, and we are therefore responsible not to betray that trust. In Chapter 14 on the patient’s perspective, I give you actual examples of the poor health care experiences of people I have met or with whom I have worked.

It Is the Ethical Thing to Do

Ethics are the guiding principles of human behavior. How do we behave toward people? Are they important human beings who have needs and specific concerns? I have a cartoon in my office of a patient sitting up in bed, talking to his wife. He tells her that yesterday he was the chairman of the board and today he is the gallbladder in 254. Are your patients people, or just patients? People have expectations about us, and unfortunately, many of them have been disappointed in the past. We cannot send people out of our care unprepared for self-care or without turning them over to another appropriate health care professional.

It Is the Professional Thing to Do

The Nurse Practice Act of each state says that the registered nurse will do patient education. If you examine the expectations of each of the other professionals, dietitians, physicians, social workers, and physical therapists, they are expected to do the same. You must adhere to these legal expectations of your profession. It does not say, do it when you have the time. Nowhere is it written that only educators are held accountable.

The Joint Commission for Accreditation of Healthcare Organizations, JCAHO, says that all patients are entitled to patient education and hold health care facilities accountable for having policies and procedures that explain how this is done and by whom. It is a wonderful mandate for us and really helps convince people that what we do is important and of value.

There is no need for patient education to be a burden. There is no expectation for unit personnel, be they nurses, dietitians, or pharmacists, to conduct formal classes on the units. If you give patients a medication, teach them about it. If you discuss a special “diet” with patients, talk to them about meal planning at home. If you change a dressing, explain the follow-up care required at home. This should become part of all care for people in any health care facility. I know that patients are taught when we get a free minute, extra staff, or a lapse in urgent activity. Everything else gets caught up in the routines of our day and is put aside. It can be even worse in a clinic where patients are in and out so quickly that you miss them and the opportunities to teach them. Can patients use waiting room time more effectively? Can a video be shown in the area to reinforce your teaching? Can an awareness tape on smoking cessation be part of the “background noise” in the clinic area? Maybe they will find themselves watching despite feeling bored. The TV is often on in waiting areas, so show something educational.

I met a pharmacist once who works in a large hospital in Chicago and was a participant in my patient education workshop. He raised his hand at this point in the discussion and told me that he teaches people every day and was indeed the “discharge pharmacist.” When I asked for clarification, he explained that he had an office at the front door of the hospital and that every patient would stop at his office on the way out, where he would teach them about their medications. Picture this: the patient is on his way out, he has his coat on and his luggage in hand, and his wife is waiting outside with the car or a cab with the meter running. This is when he is taught about an important medication.

I suggested that he get out of his office and go to the units to teach the patients while they would be interested in hearing from him. I also asked him how often he did medication reviews and updates for the staff members on the units who were administering medications. People do not do things outside of their comfort zone, and if the staff is unsure or uncertain about something, they certainly will not teach about that subject.