Formal or informal patient education plan?

Cincinnati Children’s Hospital reviews the research in specific areas, and comes up with Best Evidence Statements, which they share freely with the world on the Internet. One of the questions they asked is:
“Among pediatric nurses engaged in the patient discharge process does the use of a formal education plan versus an informal education plan improve the patient/family satisfaction, safety, and timely discharge?”

The outcome they measured was:
Improve patient/family satisfaction, safety, and timely discharge.

They defined the two variables as:
Informal Education Plan: The unstructured, unscheduled, random bedside opportunity for education, used to teach patients and caregivers the patient’s needs.
Formal Education Plan: Structured, scheduled education, with tool or check off, at bedside or other location used to teach patients and caregivers the patient’s needs.

I think they confused a teaching plan with a teaching method.

A plan is “a detailed proposal for doing or achieving something.” What you intend to do. A teaching plan would list what to teach, how to teach it, when to teach it.

However, whenever research compares two teaching methods, the most effective in improving outcomes is the method that either involves the learner better, or individualizes teaching to the needs of the learner. Consequently, a totally structured formal education plan that is not modified to the needs of the learner would be less effective. Teaching from a checklist ignores the learner and the learner’s needs. It is not patient-centered. It is provider-centered.

One of the definitions of “formal” is “having the form or appearance without the spirit.” When patient education disregards the patient, it lacks the spirit of relationship. And relationship provides the trust and confidence that enhances learning.

They define an informal education plan as random. Ideally, informal education would occur at teachable moments, not randomly. Personally, I would find it difficult to teach something randomly (“without method or conscious decision”). It would be hard for me to teach about the dressing change when giving a medication.

They concluded that, “Methods to support formal education included in structured learning are: multi-media methods of education, oral & written instruction, demonstration, and reinforcement.” These methods could be just as easily used when teaching spontaneously. In fact, what exactly would informal teaching be, if it didn’t even include oral instruction?

So what do I propose?

Based on the research — all the research — I propose:

Separate the teaching plan from the teaching method.

The patient education plan should always be: the learner teaches back or demonstrates:
— informed consent
— basic knowledge and skills for self-care
— how to recognize problems and how to respond, and
— who to call for concerns and follow-up.
You can have a checklist that lists components of each of these for a specific medical problem.

But the method these are taught should be individualized to the needs of the learner. Your assessment should determine what needs to be taught first. What is the learner most anxious about? Don’t wait until you get to that on the checklist. Teach it now. The learner is ready to listen!

Use your teaching tools as appropriate. Is the learner having trouble visualizing that body organ? Get a picture or a model. How will the learner review steps in the procedure at home? Get a handout, or take photos. Whatever will help.

Use each teachable moment and make teaching relevant to the learner. When you assess the patient’s condition, describe what you are looking for and what it means. When you give a med, explain what it is for. When you do a treatment, prepare the learner for doing this at home.

And as the learner teaches back or return demonstrates each item, check it off that task list. As you get closer to discharge, review the list. Intentionally discuss with the learner any items that are left uncovered. You can create a teachable moment by asking, “What would you do if . . .”

So have a plan for what needs to be addressed before discharge. But use your assessments and interactions with the learner to prioritize learning needs and determine teaching methods. And always, always, ask the learner to teach it back to you. A head nod is not evidence of learning.

Resources:

Best Evidence Statements
http://www.cincinnatichildrens.org/svc/alpha/h/health-policy/best.htm

Formal education plan versus an informal education plan
http://www.cincinnatichildrens.org/assets/0/78/1067/2709/2777/2793/9198/5f964aa6-733b-428c-bc11-92e39c40e619.pdf

London, F. (2009). No Time To Teach: The Essence of Patient and Family Education for Health Care Providers. Atlanta: Pritchett & Hull. www.notimetoteach.com

©(2010) Fran London, MS, RN

3 Responses to “Formal or informal patient education plan?”

  1. Chuck Jones says:

    Fran:

    I think you raise some great points. One thing that struck me is that when I think of random and informal I also think it raises the potential that the teacher will randomly “omit” something.

  2. Thanks, Chuck. So the plan can be formal, to make sure all the important points are covered. This should include self-care skills and potential problems, as well as Joint Commission’s specific requirements. But research shows the most effective and efficient teaching methods are individualized, based on your assessments of the learner. This makes sense. If your learner can’t read, what good is a standardized plan that insists the learner read a booklet?

  3. shimaa.roman says:

    nice topic, the unstructured patient education is very important issue that needs more clarification and emphasis on its documentation.

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