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© 2009 The McGraw-Hill Companies, Inc. All rights reserved

Patient Education

فالح یکه لیلی دکتر

آموزش تخصصی دکتریپرستاری

پزشکی علوم دانشگاه استادیارقزوین

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Learning Outcomes1 Identify the benefits of patient education.

2 Explain the role of the medical assistant in patienteducation.

3 Discuss factors that affect teaching and learning.

4 Describe patient education materials used in the medical office.

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Learning Outcomes (cont.)

5 Explain how patient education can be used to promote good health habits.

6 Identify the types of information that should be included in the patient information packet.

7 Discuss techniques for educating patients with special needs.

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Learning Outcomes (cont.)

8 Explain the benefits of patient education prior tosurgery, and identify types of preoperative teaching.

9 List educational resources that are available outside the medical office.

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Patient Education: why??

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Patient Education Prior to Surgery

Educational Legal

Informed ConsentPreoperative Instructions

Postoperative Instructions

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The Educated Patient

Takes a more active role in medical care

Is often more compliant with treatment programs

Is better informed about how to maintain a healthy state

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The Educated Patient (cont.) Benefits to the medical office

Patients are more satisfied Patients are more likely to follow instructions so tests do

not have to be rescheduled Patients are less likely to call the office with questions, so

staff spends less time on the telephone

Medical assistant More interaction with the patient Assess educational needs at every visit

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Benefits of Preoperative Education

Increases patients’ overall satisfaction

Reduces patient anxiety and fear

Reduces use of pain medication

Reduces complications following surgery

Reduces recovery time

Patient Education Prior to Surgery (cont.)

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Patient Education RationaleModel of Patient Education Outcomes

Patient Patient EducationEducation

PrintPrint VerbalVerbal

MultimediaMultimedia CombinationCombination

Patient Patient EducationEducation

PrintPrint VerbalVerbal

MultimediaMultimedia CombinationCombination

Behavior ChangesBehavior Changes Health services utilizationHealth services utilization

Compliance Compliance LifestyleLifestyle Self-careSelf-care

Behavior ChangesBehavior Changes Health services utilizationHealth services utilization

Compliance Compliance LifestyleLifestyle Self-careSelf-care

CostsCosts Length of stayLength of stay

UtilizationUtilization Provider imageProvider image Regulatory Regulatory compliance compliance

CostsCosts Length of stayLength of stay

UtilizationUtilization Provider imageProvider image Regulatory Regulatory compliance compliance

Health StatusHealth Status Physical healthPhysical health

Well-beingWell-being SymptomsSymptoms

ComplicationsComplications

Health StatusHealth Status Physical healthPhysical health

Well-beingWell-being SymptomsSymptoms

ComplicationsComplications

Knowledge and Knowledge and Attitude ChangesAttitude Changes

Increased understandingIncreased understanding Increased confidenceIncreased confidence Increased satisfactionIncreased satisfaction

Improved emotional stateImproved emotional state

Knowledge and Knowledge and Attitude ChangesAttitude Changes

Increased understandingIncreased understanding Increased confidenceIncreased confidence Increased satisfactionIncreased satisfaction

Improved emotional stateImproved emotional state

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• The Effective Educator

• ??????

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Effective Patient Educator skills include: Determining patient concerns Avoiding Assumptions Explaining things clearly

The Effective EducatorThe Effective Educator

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• Assess – Define patient and family needs and concerns; observe readiness to learn.

• Plan – Set objectives with your patient; select materials.

Four Steps to Educating

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Patient Education - Steps

• Implement – Put the plan in motion; help patients along the way to reach the objectives you’ve set together.

• Document – Create a written history and keep records.

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Factual Sensory Participatory

Patient Education Prior to Surgery (cont.)

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Factual–Informs patients of specific details about a procedure and needed restrictions before and/or after surgery.

Sensory–Provides patients with descriptions of various sensations that may be felt during the procedure.

Participatory–Includes explanations and demonstrations of certain techniques required after surgery and requires that patients perform a return demonstration of the technique to validate understanding and technique accuracy.

types of patient education.

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Brochures, Booklets, and Fact Sheets

Explain procedures that are performed in the medical office

Provide information about specific diseases and medical conditions

Provide information to help patients stay healthy

Types of Patient Education: Printed Materials

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Educational Newsletters

Medical office newsletters : Are written by the doctor or office staff

Contain practical health care tips

Offer updates on office policies

Provides information about new diagnostic tests and equipment

Types of Patient Education: Printed Materials

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Many physicians arrange classes and seminars for their patients

Health information web sites for general consumer health information

Videotapes and DVDs are used effectively to educate about complex subjects and procedures

Types of Patient Education: Visual Materials

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Using anatomical models A visual representation helps

patients better understand what will take place

Helping patients relieve anxiety Allow extra time for patients to

grasp information Use positive words when possible Have family members present

Patient Education Prior to Surgery (cont.)

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Verifying patient understanding

Have patients explain to you in their own words their understanding of what has been taught

Use return demonstrations to validate understanding of procedural instructions

Patient Education Prior to Surgery (cont.)

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Additional Educational Resources Libraries

Public libraries Hospital patient

resource rooms

Computer resources Online services CD-ROMs

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Additional Educational Resources (cont.)

Community resources Nursing home care Visiting nurses’ care Counseling Rehabilitation

Associations American Cancer

Society American Diabetes

Association American Heart

Association

Note: These outside resources may be used by office personnel or patients to obtain educational information.

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The Patient Information

Packet

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Benefits of the Information Packet Improves relationships between the office and the patients

Simple, inexpensive, and effective medium

Provides important information about the office policies and staff roles

Excellent marketing tool

The Patient Information Packet

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Contents• Introduction to the office• Physician’s qualifications• Description of the practice• Introduction to the office staff• Office hours• Appointment scheduling

The Patient Information Packet (cont.)

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Contents• Telephone policy • Payment policies• Insurance policies• Patient confidentiality statement• Other information

The Patient Information Packet (cont.)

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Pre-Operative Nursing InterventionsClient Teaching

Pre-operative progression & sensations Preoperative experience Description of Pre and Post operative events Preoperative medication Description of events in OR and PACU Pain management Coughing & Deep Breathing Exercises Incentive Spirometry

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Turning & Positioning Leg Exercises & Ambulation Reducing anxiety and fear, support of

coping Special considerations related to outpatient

surgery

PREOPERATIVE TEACHING

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Client TeachingPain Management

Pre-operative assessment of individual pain perception on 1-10 scale

Reassurance that pain reports WILL bebelieved and acted upon

Use of PCA Benefits of ATC versus PRN Allaying of fears regarding addiction Potential side-effects of narcotics How pain management promotes recovery

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Client TeachingPulmonary Exercises

Method for diaphragmatic breathing:Hands on ribs, inhale thru nose allowing abdomen to expand, hold 3-5 sec, exhale thru pursed lips, 10X /hr while awake

Method for controlled coughingDeep breath X2 , then inhale,hold breath 2-3 sec, coughforcefully 2-3X consecutively

Method for splinting

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Client TeachingPulmonary Exercises

Instruction on use of Incentive Spirometer:Take 2-3 normal breathes, close lips on mouthpiece, inhale to reach set goal, hold 3-5 sec, release mouthpiece & exhale, 10X/hr while awake.

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دیافراگمی تنفس.در حالت نيمه نشسته قرارگيرد از بيمار بخواهيد تا دستها را بر روي دنده ها بگذارد به طوري

كه بتواند باالرفتن و انبساط قفسه سينه را حس كند..از بيمار بخواهيد بازدم را به طور عميق و آهسته انجام دهد.از طريق بيني به طور آهسته و عميق عمل دم را انجام دهد ثانيه نگهداشته، تا حد امكان از راه دهان 3-5تنفس را براي

به طور كامل در حاليكه لبها غنچه است بازدم را در اين مرتبه تكرار كنيد.3مرحله

24-48 ساعت در هنگام بيماري و در 1-2اين تمرينات را هر ساعت بعد از جراحي انجام دهيد.

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Diaphragmatic Breathing and Splinting When Coughing

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موثر سرفه :روش در وضعیت نشسته قرار گیرید و مقداری به جلو خم

شوید . برای آرامش و کاهش کشش عضالت شکم حین

سرفه ،مفاصل زانو وران راخم کنید چند بار با لبهای غنچه از طریق بینی نفس بکشید و

از دهان خارج کنید . محل برش جراحی را با استفاده از دست یا بالش یا

پتو برا ی جلوگیری از درد حمایت کنید. درهنگام خارج کردن نفس )بازدم (دو بار سرفه

عمیق انجام دهید طوری که عضالت شکم منقبض شوند .این کار رابالفاصله بعد از جراحی و به هوش

آمدن چند بار در طول روز انجام دهید.

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انگیزشی اسپیرومتری به مددجو آموزش دهید در وضعیت نیمه نشسته

یا نشسته قرارگیرد. مقیاس ابزار را تنظیم و به مددجو نشان دهید چگونگی قرار دادن قطعه دهانی اسپیرومتر به

طوری که لبها کامال آن را بپوشاند آموزش دهید به طور آهسته عمل دم را انجام

داده ، جریان هوا را ثابت نگهدارد تا به حجم ثانیه نگه دارد . 3-2هدف برسد وبعد تنفس را

مجددا تکرار کند.

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Client TeachingActivity

LEG EXERCISESDorsi/Plantar flexion, ankle rotation, knee/hip flexion, 5X each leg/hr w.a.

AMBULATIONDiscuss importance of early ambulation and method for getting out of bed

TURNING AND POSITIONING

Use of side rails

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:ورزشهای ساق پا مانند هر مچ پا را در یک دایره کامل بچرخاند . به

مددجو آموزش دهید تا با شست پای خود یک دایره فرضی ترسیم کند . این کار را چند بار

تکرار کند.

به طور متناوب هر دو پا را از ناحیه مچ بهسمت باال و پائین خم کنیدو باید احساس کند

ماهیچه های پا منبسط و منقبض شوند .

تمرینات چهارسر ران را با سفت کردن ران و.پایین آوردن زانو به سمت تشک انجام دهد

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Leg Exercises and Foot Exercises

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تخت در چرخیدن در وضعیت به پشت خوابیده به یک سمت تخت

حرکت کند و سپس با خم کردن زانو و فشار دادن پاشنه های پا روی تشک باسن را بلند کند و به راست و چپ بغلتد.با گذاشتن بالش یا دست روی ناحیه عمل شده بخیه راحمایت و در تخت

بچرخد.

2به مددجو آموزش دهید در هنگام بیداری هر ساعت در تخت بچرخد.

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Educating Patients with Special Needs

Elderly patients

Show respect

Put information in writing

Adjust procedures as needed when limitations are present

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Educating Patients with Special Needs(cont.)

Patients with mental impairments Use tact and empathy Speak at the patient’s level of understanding Common conditions

Dementia Alzheimer’s disease Emotional problems Drug addiction Mental retardation

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Patients with hearing impairments The ability to hear is not a measure of intelligence

Patients with visual impairments Use normal tone of voice Verify that all verbal instructions have been heard correctly

Multicultural issues Patients from diverse cultures may have different beliefs

about the causes and treatments of their illness.

Educating Patients with Special Needs(cont.)

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Patients who cannot read well or cannot speak or understand English Use pictures and charts Translations Family or friends may be

able to read it to them

The Patient Information Packet: Special Concerns

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Good Nutrition Regular Exercise

Adequate Rest

Promoting Good Health ThroughEducation: Healthful HabitsHealthful Habits

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Balance

Work Leisure

No Smoking

Limit Alcohol Intake

Promoting Good Health ThroughEducation: Healthful HabitsHealthful Habits

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Safety tips to prevent injuries At home At work At play

Proper use of medications Do not change dosage Do not mix medications Report unusual

reactions Tell doctor about any

OTC medications

Promoting Good Health ThroughEducation: Protection from InjuryProtection from Injury

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In Summary Patient education is

key to patient care

Knowledgeable patient Active in own medical

care Aware of benefits of

activities to promote and protect health

Reasons for patient education Understand condition Prepare for

procedures Policies of office

Use resources available

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