Who hasn’t heard the adage, “If it wasn’t documented, it wasn’t done”? Crickets in the audience, right?
I clearly remember learning how to document in nursing school. My nursing instructors said this at the beginning of our first lesson. It seemed silly at the time. When I envisioned nursing, I imagined spending time with my patients, teaching them to better their health, administering medications, helping them walk – not spending hours at the computer, documenting.
As it turns out, much of our time is spent documenting. Carefully. Every little detail about our patient assessment, our interactions. And yes, our patient education.
Patient Education… By the Numbers
A 2012 study indicated that patient education is not always absorbed, despite our best efforts. This study indicated that most patients older than 50 – 76%, to be exact – left their healthcare providers office or the hospital feeling confused about their plan of care. 50% of adults, in general, have a difficult time understanding health information that is provided by their providers. In addition, 40%-80% is forgotten by adult learners.
Frustrating, right? When I worked as a floor nurse, I painstakingly read through education materials until I was blue in the face, hoping my patient would understand, only for that heart failure patient to be readmitted because they had consumed too much salt or taken their diuretic incorrectly
And those patients are becoming the norm – approximately 20% of patients who are discharged from the hospital are readmitted within 30 days.
While many of these readmissions are unavoidable, such as their condition worsening, a large number can be avoided by improved patient education.
Improving Patient Education
As a brand-new floor nurse, I can readily admit – I did not provide the best patient education. Providing excellent patient education became a skill over years of practice. However, it doesn’t have to be that way.
Begin Discharge Planning at Admission
If you have a newly diagnosed heart failure patient admitted into room 412, chances are they’re going to be discharged on a diuretic. You can begin providing education on their new diuretic when you administer it – even if it is an intravenous medication!
For example, perhaps you’re ordered to administer Lasix 40mg IV:
“Hi Mr. Jones, I’m about to administer your first Lasix dose. This medication helps to reduce the extra fluid that you’re carrying, such as the swelling in your legs. It will help you breathe better. Likely you’ll go home on Lasix as a pill, although that could change. The most important side effect that you should be aware of is that the medication pulls the extra fluid from your tissues, and it causes you to urinate quite a bit. It is important that we weigh you daily to ensure that the fluid is being removed from your body appropriately – the dosage may need to be adjusted. I’ll also bring in a medication handout. Do you have any questions before I give it to you?”
Provide Education in Language that the Patient Understands
Occasionally, a healthcare provider comes into a patient room and describes a condition or a medication in very technical terms. A patient may be embarrassed to speak up because they do not want to look dumb.
When providing education, you should always provide education in language that the patient understands:
“Mr. Jones, it is important to check your weight daily. This helps you detect daily fluctuations, and when your weight goes up too quickly, your dosage likely needs to be adjusted by your doctor.”
Use Return Demonstration or Return Instruction
Return demonstration or return instruction enables you to assess whether the patient learned the material that you taught them.
For example, if you taught a patient about their new diuretic, Lasix, that is to be taken every morning, a patient stating the following indicates that they have not understood your teaching:
“I should only take my Lasix if I gain 5 pounds in one day.”
If teaching insulin injection technique, having your patient provide their own injections after instructing is a great way to ensure that education was retained.
Ensure That You’re Teaching at the Patient’s Level
Assess the patient’s level of literacy. Are they able to read? Write? Do they have any learning disabilities that prevent them from retaining information? Is English their second language or should you request an interpreter?
Teaching to your patient’s specific needs ensures that your patient will have the best possible outcomes.
If It Wasn’t Documented… It Wasn’t Done!
Document, document, document. Even if you feel as if you’re over-documenting (you’re probably not…), document every piece of education that you provide, even if it feels as if it is benign.
You discussed how to safely maneuver with a walker? Document! This may be useful if a patient has a fall.
You discussed appropriate peri-care during a bed bath? Document! This may be useful if a patient has a CAUTI.
You discussed the juice that you provided to a patient who had hypoglycemia? Expand and discuss treatment of hypoglycemia when they’re feeling better. This may be useful if a patient is readmitted for a significant hypoglycemic event.
The Bottom Line…
Patient education can be provided from various means, from reading from a handout (guilty!), to return demonstration, and to return instruction. Use your imagination.
The bottom line is that patient’s need us to teach them about their illnesses, their medications, general wellness, how to safely perform activities of daily living… you get the picture.
Oh, and document it…
Resources
Joros, T. (2017, September 19). How to evaluate patient education strategies. Retrieved August 22, 2019, from https://www.allscripts.com/2017/09/how-to-evaluate-patient-education-strategies/
Reducing hospital readmissions with enhanced patient education. (n.d.). Retrieved August 22, 2019, from https://www.bu.edu/fammed/projectred/publications/news/krames_dec_final.pdf
Tips to improve patient education. (n.d.). Retrieved August 22, 2019, from https://nursejournal.org/community/tips-to-improve-patient-education/
