Join a free phone conference, sponsored by the Health Care Education Association
on Thursday May 10, 2012
10 am Pacific time/1 pm Eastern time
Besides the printed page – alternative formats and technology for patient and family education

See the agenda and how to connect to the conference at:
http://www.hcea-info.org/html/unmeetings.html

Let’s move forward together!

Some factors that contribute to health outcomes are out of my control. For example, many studies correlate socioeconomic status and racial/ethnic disparities with poor health outcomes. Nice to know, but I can’t change those. Does that mean my goals need to be lower for those populations?

But now a study comes along that tells me no, we’re missing a root cause. Curtis and Wolf, et al. (2012) studied 353 adults aged 18-40 years with persistent asthma from 2004 to 2007. They assessed in person, at baseline: health literacy, socioeconomic status, and asthma outcomes including disease control, quality of life, emergency department visits, and hospitalizations. Then, every 3 months for 2 years they measured asthma outcomes by phone. They used multivariate analysis to assess racial and ethnic disparities in asthma outcomes, and looked at the effect of health literacy and socioeconomic status on these.

Compared with White participants, African American adults fared significantly worse in all asthma outcomes and Latino participants had lower quality of life and worse asthma control. Differences in socioeconomic status partially explained these disparities. Health literacy explained an additional 20.2% of differences in quality of life between Latinos and Whites, but differences in hospitalization rates between African American and White adults remained.

The authors concluded that health literacy appears to be an overlooked factor explaining racial and ethnic disparities in asthma. They proposed that comprehensive interventions should include evidence-based low literacy strategies for patient education and counseling.

This is good news. When you get that poor minority patient, you no longer have to sigh in resignation. Apply those interventions that address health literacy (Weiss, 2003), and you may have an impact on health outcomes:
• Slow down
• Use plain, non-medical language
• Show or draw pictures to enhance patient understanding and recall
• Limit the amount of information given at each visit — and repeat it
• Use the teach-back and show-me techniques
• Create a shame-free environment: Be respectful, caring, and sensitive
• Use patient-friendly written materials (consent forms and patient education handouts)

Sources:
Curtis, L. M., Wolf, M. S., Weiss, K. B., & Grammer, L. C. (2012). The impact of health literacy and socioeconomic status on asthma disparities. J Asthma, 49(2), 178-183.

Weiss, B. D. (2003). Health Literacy: A manual for clinicians Retrieved from http://www.ama-assn.org/ama1/pub/upload/mm/367/healthlitclinicians.pdf

©2012 Fran London, MS, RN

I continuously use free Internet tools to search for and send me the latest research and news relating to patient and family education. Then, whenever I get a chance, I can read a few of them in the limited time I have.

Recently, a systematic review appeared that looked at the most effective strategies for patient education for cardiovascular patients. Their findings were consistent with research findings in other patient populations:

1. Reinforcement: Programs that incorporate scheduled follow-up sessions as a core component are generally more effective than single-session interventions.
2. Focus on skills: Behavioral and clinical outcomes were better when interventions were designed to build skills: self-care, communication, and problem-solving skills, rather than those focusing on increasing knowledge.
3. Individualize: Compliance is best when teaching strategies are tailored to fit with the learner’s motivation, cognitive level, and learning style.

As I said in my book No Time to Teach, the research consistently boils down to involve and individualize. Involve the learner in the process, and individualize teaching methods and content to meet the needs of the learner.

Source: Commodore-Mensah, Y., Himmelfarg, C.R. (2012). Patient Education Strategies for Hospitalized Cardiovascular Patients: A Systematic Review. Journal of Cardiovascular Nursing, 27(2).

Well, MedlinePlus.gov offers free, reliable, up-to-date health information in English and Spanish, with no advertisements. It’s called MedlinePlus Connect. This service lets health organizations and health providers to link patient portals and electronic health record (EHR) systems to MedlinePlus, an authoritative up-to-date health information resource for patients, families, and health care providers. Upon receiving a problem code request, MedlinePlus Connect returns relevant MedlinePlus health information.

Content includes:
— Information on hundreds of diseases, conditions and wellness topics
— Interactive tutorials, videos and other multimedia
— An illustrated medical encyclopedia, dictionary definitions, and health news
— Links to health information in over 40 languages

MedlinePlus Connect can also link your EHR system to drug and supplement information written especially for patients. When an EHR system sends MedlinePlus Connect a request that includes a medication code, the service will return links to the most appropriate drug information.

Doesn’t this sound too good to be true?
Access to good, clear health information for free!
What a great use of tax dollars!

For more information, send your IT expert to: http://www.nlm.nih.gov/medlineplus/connect/overview.html

Like us on Facebook and you are automatically entered for your chance to win 1 of 5 copies of No Time to Teach, the AJN Book of the Year.
Winners will be chosen by December 21st.

https://www.facebook.com/permalink.php?story_fbid=10150519164913783&id=107911418782

Got the book already? Give it as a gift!

Plain language is important for clear communications. There are many PDF booklets and books offering you step-by-step instructions on how to edit your materials for clarity. Best of all, they are free to download from the Internet. Here are links to a few:

America’s Health Insurance Plans (AHIP). (2010). Health Literacy: A Toolkit for Communicators Retrieved from http://www.ahip.org/healthliteracy/toolkit

Centers for medicare and Medicaid Services (CMS). (2010). Toolkit for Making Written Material Clear and Effective. Retrieved from https://www.cms.gov/WrittenMaterialsToolkit/.

Children’s Hospital & Regional Medical Center. (2005). Family Education Materials Development Kit Retrieved 3/4, 2006, from www.seattlechildrens.org/pdf/PEMatDevKit.pdf

Covering Kids & Families National Program Office. (2005). The Health Literacy Style Manual, from http://www.coveringkidsandfamilies.org/resources/docs/stylemanual.pdf

Doak, C. C., Doak, L. G., & Root, J. H. (1996). Teaching patients with low literacy skills (2nd ed.). Philadelphia: J. B. Lippincott Company. Retrieved from http://www.hsph.harvard.edu/healthliteracy/resources/doak-book/

Ridpath, J. R., Greene, S. M., & Wiese, C. J. (2007). PRISM Readability Toolkit Retrieved from http://www.grouphealthresearch.org/capabilities/readability/ghchs_readability_toolkit.pdf

Weiss, B. D. (2003). Health Literacy: A manual for clinicians Retrieved from http://www.ama-assn.org/ama1/pub/upload/mm/367/healthlitclinicians.pdf

So stop wasting resources by giving your patients printed information they cannot understand. Apply evidence to practice, edit your patient education materials to optimize readability, and observe the differences in health outcomes.

Happy teaching!

Nurse case managers can improve outcomes of patients with diabetes. http://www.physiciansbriefing.com/Article.asp?AID=655594

Patient decision aid: should your female patient with signs of a simple UTI take antibiotics? http://bit.ly/o1pBLK

Patient decision aid: should your patient without symptoms be screened for prostate cancer? http://bit.ly/nlagFt

What do patients want to know? Focus groups help to better target patient education. http://bit.ly/p2nyGA

Do your patients use health-related gadgets that track physical activity, measure blood pressure, and more? http://nyti.ms/nyruCm

Do you assume your patients self-administered each prescribed medication as directed? http://bit.ly/pRcDTl

Low health literacy is associated with poorer health outcomes and poorer use of health care services. http://1.usa.gov/mY1G9n

Vocabulary self-test for health literacy. http://nyti.ms/pz6pBf

Did you know the NIH has an Adherence Network? http://bit.ly/qhnVPN

We are developing systems that better manage chronic illnesses. Asthma is an example. http://bit.ly/qNZ4pd

Four intervention strategies to promote adherence achieve marked reduction in morbidity and cost. http://1.usa.gov/mUnAGY

So much information, so little time!

- Fran.

The reviewer, Judy McDaniel, MSN, RN, pointed out that chapters were able to “focus on the key points in a short and concise manner without the additional detail found in many references on patient education.” Yet, “If the nurse wants to find the in-depth rationale behind what method was used, there are many references. . . that can be reviewed when time permits.”

Yes, that was the point. No Time to Teach offers the evidence boiled down to the essence of patient and family education.

Thank you, Ms. McDaniel and JNSD.

To read the review:
Journal for Nurses in Staff Development – JNSD: May/June 2011, Volume 27, Issue 3, page 151.

So here’s a way to reach those colleagues on an affective level: Show them this 5 minute video produced by the American Medical Association.

And they thought those patients understood, just because they nodded their heads.

Maybe it’s not intentional non-compliance. Maybe the patient just didn’t know what to do . . .

Here’s the link: http://youtu.be/BgTuD7l7LG8
Once again, the link to this video is: http://www.youtube.com/watch?v=BgTuD7l7LG8

95% of nurses surveyed want to use their skills and time to educate individuals about the threat and prevention of non-communicable diseases (NCDs). You know, things like heart and kidney disease, cancer, stroke, and diabetes.

“Nurses think they should be spending significantly more time, almost twice the amount they are able to devote, on preventing the development or escalation of [non-communicable diseases] NCDs. However, nearly all nurses surveyed (95%) are experiencing daily time pressures that they almost unanimously (98%) believe are having negative effects on patient health,” said Paula DeCola, RN, MSc., Pfizer External Medical Affairs.

“If nurses get the resources and time they need, they can arm people with the knowledge to help them make the critical lifestyle changes that will ultimately help combat the NCD crisis and improve global health.”

Pfizer concluded: “We must provide maximum support to nurses so we unleash their power to fight these debilitating and deadly diseases.”

Cool. When do we start?

Resource:
Survey Shows Nurses Can Use More Help in Battle Against NCDs from http://bit.ly/l1PEGc