Patient Education Strategies

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The following course content

Introduction   

As nurses, we wear many hats and take on numerous roles in our careers. The main part of our job is to educate our patients.

Have you ever walked into your patient’s room after the physician leaves, and are bombarded with questions from your patient? They are confused and scared, and this is when you come in.

Patient education is important in every type of nursing: inpatient, outpatient, acute care, long-term care, adults, or pediatrics. No matter the specialty of nursing, at some point in time you must educate your patients and their families.

This course’s goal is to provide resources to improve education for your patients, give strategies to prevent barriers to education and evaluate the effectiveness of the education we provide.

Definition- Patient Education 

What does patient education mean exactly? 

Education is knowledge that results from the process of being educated [10]. No matter what type of nursing you are in, you are constantly giving patients instruction on a topic.  

Whether it is regarding medications, diagnostic testing, or diagnoses we are the patient’s main point of contact. A physician or provider is with a patient for a short amount of time, and it is our job to explain the information that was given to them.  

Currently, there is information everywhere. We are almost overloaded with information. With the use of smartphones, we can search for almost anything.  

Our patients, for the most part, want to feel in control of their health, and this can come in the form of knowledge. As soon as they hear something, they want to search for information on the subject.  

This should not substitute our teaching. A lot of the information published may not be accurate or not pertain to their situation. We must be aware of this and make sure we are providing our patients with resources so they can find accurate information [2]. 

Who are we educating? 

The Healthcare Education Association has shared guidelines on patient education [8]. In some instances, we are educating family members, caregivers, friends, and sometimes an entire family [8].  

You might be caring for an elderly patient in an acute care setting and will be discharging this patient home to their adult child. They will now be the caregivers and they will require education. Or you are caring for a five-year-old, just diagnosed with type I diabetes in which multiple members of the family will need to be educated on carbohydrate counting and insulin administration.  

During this course, the term patient education may be used but it is meant to encompass anyone that we are providing teaching to.  

Importance 

At the end of the day, patient safety is our main goal. Patient education is a vital way to promote patient safety.  

After a new medication is prescribed, we must educate the patient on why they need to take this medication, how to take the medication appropriately, and the side effects of the medication. Our education can also push the importance of lifestyle changes after a diagnosis.  

It is easy to go through the motions of your job and forget why we became nurses. Our patients need their healthcare team to take the time to explain the importance of their treatment plan. Education helps patients be the center of their healthcare [12]. 

What is health literacy? 

Health literacy is described as the knowledge of health information and the ability to understand and find resources related to health information, to make decisions for their healthcare based on this information [1].  

This definition was changed in 2020 [1]. The change included being able to use health information and apply it to their life, not just having the ability to understand the information.  This new definition also states that organizations need to include health literacy in their mission statement [1].  

A study conducted by the National Assessment of Adult Literacy showed that only 12% of adult Americans have the appropriate health literacy to understand their care and make informed decisions [7]. With the average population, there is an extreme deficit of the ability to have the information to make autonomous decisions for their healthcare. 

How does health literacy play a role in education? 

With understanding what health literacy means, we want to give our patients the most accurate information, so they can make the most informed decisions about their healthcare. As nurses, we should be aware of our patients’ health literacy and want them to have the highest level of information available.  

Our goal should be that the patient understands and utilizes the information provided in their healthcare choices. Studies have shown that there is a correlation between low education and poor health status [4]. 

Role of Nursing 

Whose role is it to provide patient education? 

Sometimes education can be thought to fall under the physician’s scope of practice. However, every member of the healthcare team can play a part in educating our patients [8].  

As said earlier, nurses usually spend the bulk of their time with patients. It is our duty to reinforce and expand upon the teaching provided by other members of the healthcare team. We also must collaborate with other members of the healthcare team to not leave gaps in the education that is provided [12].

Opportunities for Teaching 

How should education be prioritized? 

In nursing, we are expected to perform a variety of tasks. It can get overwhelming at times trying to prioritize and complete each task. Adding any other task to that list can be daunting.  

Education should be incorporated into our work to place patient safety as the goal. Education should be prioritized over other tasks [13]. Many factors such as time and adequate staffing can result in insufficient education [13]. Simple tasks should be delegated if possible, so that you can focus on educating your patients.  

Learning Styles 

What are the main learning styles?  

• Visual- A visual learner requires seeing what they are learning right in front of them [9]. They benefit from graphs and examples for them to look at. Not only going over the education but also providing them with a copy of the teaching is useful. 
• Auditory- An auditory learner thrives on hearing the information [9]. This type of learner would not benefit from just receiving a pamphlet. 
• Reading- This example of a learning style would be providing material for the learner to read on their own [9]. 
• Kinesthetic- This type of learner would be described as a “hands-on” learner [9]. This learner would benefit by tangibly holding material. When providing education about  

changing an ostomy bag and giving them an ostomy bag to hold would be useful during the teaching. 

How do we as nurses identify a patient’s learning style?  

A barrier to education can be that we sometimes treat each patient the same. We build standardized educational pamphlets to provide to our patients, teach group classes, and provide similar, if not identical, resources.  

While this can be helpful and save time, it can also be a barrier. Not all people learn the same way. Completing a learning assessment for each patient could help identify their preferred learning style to in turn make the teaching more effective [8].  

How can we use learning styles in our teaching? 

Each person may not be a single type of learner and may be responsive to a variety of learning styles. Prior to providing the actual education, it is important to determine which learning style the patient would be most receptive to.  

Also factoring the subject matter into which style you use can be beneficial in teaching [9]. If you need to educate on how to change a dressing on a wound, a demonstration would be appropriate.  

If you need to educate on dietary modifications for a low-cholesterol diet, a handout that can be referenced makes sense.  The subject matter should be considered when determining which type of learning style should be used.  

Case Study: 

A patient is being discharged home with a diagnosis of asthma and a new prescription for an albuterol MDI as needed for wheezing. You are the nurse providing discharge teaching.  

Prior to providing education you ask if the patient has a preferred learning style. The patient states they are a hands-on learner and are receptive to reading material.  

When providing the teaching you give them a spacer with the inhaler to hold and demonstrate how to attach them together. You demonstrate how to administer the ordered number of puffs. You review and provide them with a printout of triggers that could exacerbate their asthma. 

Teaching Strategies 

What to include in your education plan? 

Before beginning your education with the patient or family member you must set a plan. In your plan, you should include realistic information [2]. Stick to the need to know and not all the information you would like your patient to know [2].  

Information overload can be a barrier to helping the patient understand what you are teaching them. In some specialties, nurses have multiple interactions with their patients, where they can build a rapport with them [12].  

Use this to your advantage. It might take several visits with your patients to help them understand a certain topic. While other specialties such as acute care, the emergency department, or outpatient surgery centers need to provide concise information and additional resources so the patient can review the information at a later time [2].  

Set an attainable goal for yourself and your patient. If you have a short amount of time, it is not realistic to expect to educate on an entire topic such as COPD and expect the patient to verbalize understanding. With specific attainable goals, this will help in your planning and execution of the teaching.  

What to ask patients at the beginning of the teaching?  

At the start of your teaching, it is crucial to ask the patient about their concerns [8]. A patient might be more receptive to the education if they feel like they are heard. Patient education should be patient-centered, which means focusing on their needs [8].  

This can be useful information so you can include what they are most concerned about in the teaching. The patient will then feel valued and will be open to learning. 

How does a learner’s demographic become a factor in their understanding of information? 

A review was conducted regarding older adults and their preferred style of information [3]. This review concluded that older adults benefit more from written articles presented by healthcare professionals and were not as receptive to group classes, online apps, or videos [3].  

Statistics from the CDC states that by 2030, 71.5 million people will be over the age of 65 living in the United States [6].  Which means, in order for them to lead healthy lives, it is our responsibility as healthcare workers to play our part in providing accurate information for them to implement in their lives [6].  

On the other end of the spectrum, you might be educating a patient on the other end of the spectrum, a child. Pediatric nursing requires lots of education for the families and the patients themselves.  

Children can learn and understand topics when they are presented with developmentally appropriate material. With pediatric patients props and hands-on learning can be beneficial.  Age should be considered when planning education materials for patients or their families.  

Language can also be a barrier to communication. It is important to ask a patient their preferred language for healthcare information. A patient may speak English however they might be more comfortable in their first language if it is something other than language.  

Prior to teaching, a learning assessment is beneficial for you and the patient [8]. Asking the learner their preferred language should take place first.  

A patient’s culture can also impact their learning abilities [5][8]. As health care providers we must not shy away from cultural differences but rather incorporate this in our practice [8]. The information we provide should be standardized with our patients, however the way we communicate can vary.  

When is the appropriate time to educate your patient?  

The patient may be in the middle of a life-changing event or managing a chronic disease and they may have a hard time focusing. When planning to educate a patient it is important to factor in the time of the education.  

Did the patient just get out of surgery? Was the patient up all night? Involving the patient in the education will help the patient be more receptive and give them some control [2].  

If the patient is being discharged and requires education set a time with them to go over the information. This can prevent barriers that might occur. 

How can technology influence education? 

In this day in age, technology has influenced all aspects of our lives. Technology can be incorporated into our education as well [2]. Many hospitals are using programs on patient televisions to provide education.  

When planning to teach our patients we should explore these methods to help the patient and ourselves as the educator. Some videos can be used that explain procedures, skills, and medications to our patients [8]. It is also important to know our patients and see how receptive they are to this means of education.  

An elderly patient may not be interested in a link for more education regarding dietary changes [3]. A person in their 30s may like education they can look at on their computer at home. 

Evaluating Effectiveness  

What does it mean to evaluate your teaching? 

Teaching is not complete until it is evaluated. As healthcare professionals, we must gauge if our teaching was understood or if further teaching is indicated [8].  

If further teaching is needed, it does not mean we failed at our job. It means that we have our patient’s best interest, and we want them to succeed and need to change our education to fit their needs.  

Studies in the past have shown that 40-80% of medical teaching done at an outpatient visit was not remembered by the patient and almost half of the information that was retained was not accurate [11].  

What are some strategies to evaluate the patient’s understanding of the education provided? 

• Demonstration- Often nurses must teach a patient to perform a skill, for example, check blood pressure with a blood pressure cuff, perform a blood glucose check, and administer a subcutaneous injection.  

In this type of instruction, the nurse should begin by stating the objective to the patient, which is the skill that needs to be performed, and explain that the patient should return to demonstrate that skill to the nurse [8]. By stating this at the beginning, the patient will know they need to perform the skill at the end of teaching and not be caught off guard. This is also a way to evaluate the teaching [8].  

When the patient returns and demonstrates this skill, the nurse can discuss ways they can improve the skill [8].  

• Teach-back method- This is a strategy that includes teaching and then allows the learner/patient to demonstrate what they learned back to you [11].  

This is an example of how to evaluate the level of the patient’s understanding [11]. Giving the patient time to verbalize what you are educating is a measurable way to evaluate the education that was provided.  

A strategy to use the teach-back method is to teach in sections and then allow the patient to state in their own words what they learned in that section [11]. This helps break up the teaching and allows the patient to process the information [11]. 

Case Study 

You are set to discharge a patient home that was hospitalized due to anaphylactic shock from a food allergy. They are overwhelmed by the amount of information they are receiving.  

They are prescribed an Epi-pen in case of future reactions. To implement the teach-back method you can use a training Epi-pen to demonstrate how it works.  

Then give the practice Epi-pen to the patient so they can hold the Epi-pen and apply the Epi-pen to themselves. Now the patient can feel more comfortable after practice, and you can evaluate if the teaching was understood.  

Case Study 

A patient is diagnosed with hypertension and high cholesterol. As the nurse at an outpatient clinic, you are responsible for going over some lifestyle changes with the patient. You have listed some changes they should make in their diet.  

In the middle of the teaching, you ask, “What are 3 dietary modifications you can implement into your daily life?” This helps the patient process the information and turn it into their own words.  

When to allow questions during teaching? 

Sometimes it might feel easier for us to instruct the learner to save their questions till the end of the instruction. However, allowing the learner to ask questions throughout the education can help prevent information overload and be helpful for you to evaluate your teaching [8].  

Questions can allow you to tailor your education to focus on areas that the patient might need more information on [8]. The patient can emphasize their concerns by asking to hear more information on a certain aspect of what you have taught.  

When preparing for education make sure that you insert breaks so the patient or family member can ask questions. This will help with their learning and can help you determine the effectiveness.  

Conclusion

To summarize the content of this course: Patient education should be specific, concise, tailored to your patient’s needs, and measurable.

You should present your patients with objectives at the beginning of your education so they will know what to expect to understand by the end of the teaching. Address any questions that the patient might have and allow the patient to provide you with feedback.

By providing intentional patient-centered education we can give our patients the tools they need to make informed decisions about their healthcare.

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