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Presentation at International Conference on Patient and Family Centered Care describing content and program evaluation data using simulation to teach communication skills and partnering with patients as teachers.
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Partnering with Patient and Family Advisory Council Members to
Improve Patient Education Skills in Nurse Residents
Melissa Powell, MS, MHPE, RN-BC
Director of Education, Northside Hospital, St. Petersburg, FL
Mary Ann Peugeot, CPA
Past Chair, Vanderbilt Patient and Family Advisory Council, Nashville, TN
The International Conference on Patient- and Family-Centered Care:Partnerships for Quality & Safety, Vancouver, British Columbia, 2014
Presentation Objectives
Describe the education process for new nurses and opportunities for improvement
Illustrate innovative use of PFAC members in the education process for new nurses
Define benefits of collaboration between PFAC members and educators
The VanderbiltPromise
What did the patients say?
Survey question Percentage of patients reporting
“always”“Before giving you any new medicine, how often did hospital staff tell you what the medicine was for?”
84.83%
“Before giving you any new medicine, how often did hospital staff describe possible effects in a way you could understand?”
51.75%
How often did nurses explain things in a way you could understand?
79%
I clearly understood the purpose of taking all of my medication. 62%
Dr House asthma inhaler - YouTube
Vanderbilt Center for Effective Health Communication
Needs Identified
Call to action – Leadership at Vanderbilt was pushing for more patient and family engagement and improved readmission rates Leadership had initiated a Patient and Advisory
Council which delivered success in providing the patient perspective on the patient experience and improving processes and patient interactions.
Leadership began asking clinicians to improve patient education process to improve patient engagement in their own healthcare and readmission rates.
Improving patient-nurse communication at VUMC
Goal: Nurses will use “teach back” to ensure understanding when educating patients every patient every time.
Needs Assessment
GAP analysis: Observations for teach back during patient education events -- nurses targeted as a group who has multiple opportunities for patient education throughout hospital stay. Nurse residents are new nurses entering Vanderbilt system.
They attend a year long program of teaching and learning to become competent. The entry point training is the key for forming expectations. These were targeted for pilot intervention.
Observations of all nurses all levels as a whole in December (in this sample) was 35 out of 134 or 26%. This proportion is lower than the population proportion reported in the literature of 39% to a statistically significant degree.
Theoretical Basis for Question, Intervention and Evaluation
Experiential learning theory - We learn by doing and reflecting on the doing.
Social-Cognitive learning theory – We learn new behaviors through models and the consequences of doing the modeled behavior. Internal processes, the rewards given and perceived self-efficacy influence the learning outcomes. Communication skills are best learned in the setting, situational and
require role modeling, practice with feedback to be acquired.
Volunteer patients and learners attempt to come to shared understanding and potential for social consequences improves.
Commitment to use teach-back is key to internal motivation.
Perspectives from the patient
The Model
Content and Instructional Design Development
Constraints – financial and people resources
EBP – publications Sunil Kripalani. Demonstrated that non-actors can portray patients during patient education simulation. Thus providing a precedence.
Organizations – Institute for Patient and Family Centered care – Recognizes the
importance of the patent perspective in improving clinician performance and involvement in local improvement improves care.
Agency for Healthcare Research and Quality – the proven patient education strategies used during patient education sessions.
Subject Matter Expert – task analysis, checklist validation
Class Design Presentation of content.
The Hook.
AMA video demonstrating the identified gap between patients and clinicians when communicating and teaching.
Brief explanation (goal of less that 20 minutes) of patient education principles including an example:
Power point of the principles of teach back including a video of skill demonstrated.
Opportunity to practice with feedback
An opportunity to practice educating “patients as teachers” who are volunteers from the Patient and Family Advisory Council
Feedback received from “patients as teachers” and trained coaches.
Commitment to use teach back when educating patients.
Self Evaluation and Tracking Log to continue the deliberate practice in the clinical setting.
Practice &Homework
Perspective from the patient volunteer teacher eyes
Learning from patients
Level 2 & 3 – Satisfaction, learning I never realized how challenging discharge information can be to effectively
communicate and elicit patient understanding. I will take it much more seriously now.
The simulation was very nerve racking but effective in helping us communicate with patients and learning how to effectively teach.
I liked how outside sources/previous patients were brought in to give us a different perspective on our communication skills.
This was such a helpful topic and simulation. It's nice to hear feedback about communication skills that were done well and need improvement.
The patient-nurse simulation was a great way to learn. I enjoyed getting to practice!
It would be more of a benefit to have more time with the simulated patients.
So intimidating, but so informative!
The Committment
Commitment to change
Before and after
Yellow went up from winter to spring in all interactions
Winter Spring0
10
20
30
40
50
60
Teach-Back Use Winter/Spring Cohort
NoYes
Tell me – I forget.Show me – I remember.Involve me – I understand.Confucius 450 BC
Conclusions
More nurses who were trained used teach back than existing staff nurses.
More nurse residents who signed commitment and used self evaluation and tracking log used teach back with real patients.
The experience of simulated patients with patient advisory council members improved the attitudes and seemed to affect the value statements made during post class evaluations. This serves as a proxy for affective learning domain.
For additional information, please contact:
Melissa Powell
Director of Education
Northside Hospital, St. Petersburg, FL 33709
Mary Ann Peugeot
Past Chair, Vanderbilt Patient & Family Advisory Council
