How do you find time for assessment?

The most efficient way to provide patient education is to individualize teaching to the needs of the patient, so you’re not wasting time on unnecessary content or inappropriate methods.  The most efficient way to individualize teaching is to begin with a good assessment.  Then you know what the learner:
— knows already
— misunderstands
— wants to know
and how to best present the information so the learner understands and can use it.

A colleague asked me the other day how to find the time to ask all the assessment questions we find on our forms and in the literature, including those relating to:
—  self-care knowledge and skills
—  language
—  literacy
—  learning style
—  health beliefs
—  self-efficacy
—  socio-economic status
—  emotional status
—  physical limitations
—  the Kleinman questions to reveal the patient’s explanatory model.

Good question.

Let’s go back to the goal:  You need to know what the patient understands and believes in order to individualize teaching.

To meet this goal, don’t have to ask about everything.  Some things you can learn by listening and observation.  Assessment happens during every conversation, integrated with the flow.

Every bit you learn about the patient helps you decide which questions you need to ask, and when.  If you notice an accent, you might want to ask what language is spoken at home.  If it is not your language, then using an interpreter will improve the chances that complex medical information will be understood.

Notice what questions the patient asks.  What do they reveal?  What are the patient’s concerns?  These provide cues to areas that may need further assessment.

There isn’t a set number of questions.  Sometimes the answers to a few key questions can give you a good sense of where the learner is.  Sometimes you have no idea what is going on, and you have to keep asking more.

Learn how to pick up on learner’s cues of discomfort, resistance, misunderstanding, or confusion.  Notice when you feel the learner isn’t listening or isn’t getting it.  Notice when you start to feel frustrated.  This frustration means you are not individualizing your teaching enough to meet the learner’s needs, and is a cue that you need to go back to assessment.  Go back to questions relating to the topic that created the tension.  For example, if there was resistance to taking medication, what was it related to?  A belief that one should be able to heal oneself through prayer alone?  A lack of money to pay for prescription meds?  A lack of transportation to access a pharmacy?  Find out.

Assessment is never completely done.  There’s always more to learn about the patient.  If you think of assessment as a process, not a task, it will be easier.  It’s getting to know the patient, so you can involve him or her in care, and individualize teaching to be most efficient and effective.  Be patient with yourself.  It’s a skill that takes time to perfect.  But that’s the difference between novice and expert health care providers.

© Fran London, 2009

One Response to “How do you find time for assessment?”

1. Chuck Jones says:

   November 2, 2009 at 8:08 am

   Fran:

   I must tell you this is one of the most thoughtful, logical approaches I’ve seen as it relates to this topic. I’ve talked with lots of healthcare providers and too many look for a one-size fits all approach rather than a patient-centered one like this.