What is scope of practice in patient education?
Question:
Discuss about the Patient Education.
Patient education is the procedure by which healthcare professionals and others impart health related information to patients and their caregivers. This is helpful in altering the health behaviors of the patients and family members that thereby help in improving their health status. Patient education is an individualized, structured and systematic process that helps in proper assessment and imparting of knowledge regarding health of the patients[1]. This helps the patient in being careful about their activities and help in development of skills that will help to modify the incorrect habits and bring out changes in behaviors. The main goal of patient education is to increase comprehension as well as participation in proper self-management strategies and health care needs[2]. The following assignment will show how patient education is important in ensuring good health of patients. It will also show the procedure by which healthcare education is given to patients.
An old woman was admitted to the hospital after she faced a fall. She was not hurt as she had the fall on her bed. She was lying on the bed after her meal. She was about to step off the bed when she felt uneasy and fell on the bed with her back. Immediately, her son and daughter in law admitted her to the healthcare center. It was diagnosed that she had an insulin shock. Although, she was safe in the healthcare center after treatment, it could have resulted her more suffering if she had this fall elsewhere like in garden, stairs or floors. It was also noticed that she had no knowledge about her disorder and did not know why he she was taking medicines and insulin injections. She had grown old and tends to forget her medicines or takes them more than once. For these reasons, on the day of the accident, the patient had taken insulin twice – once before and once after the meal. This had resulted in overdose of insulin and excessive decrease in sugar level in blood. This affected her physiological systems. Therefore, it was necessary to teach her and her family caregiver about the disorder, ways it affects human beings, issues it may cause and ways to overcome the issues with proper medication. Dosing is very important which is not followed properly, can lead to detrimental errors[3]. Therefore, the main aim of the health education plan is to make the patient understand the disorder in details and teach her the correct medication intake so that insulin shock or high blood sugar level due to forgetting of medication do not take place.
How to assess patient’s learning needs?
Scope of practice can be defined as the procedure, processes as well as actions that every health care professional are permitted to undertake for the safety care of patients. This should follow the proper guidelines, laws, and boundaries of their professional license. Every healthcare professional should follow a particular procedure that in order to provide proper patient education [4].
The first step is called the proper assessment of the learning needs of the patient. It is important for the healthcare professionals to assess the learning needs, style of learning and readiness of the patient to learn. This would include what the patient already knows what they want to or need to learn. They should also have the idea about what the patients are capable of learning. The nurse should also develop the knowledge about the best ways by which they can educate the patients. Proper open-ended questions can be asked in the interviews. This will help the caregiver to know the lifestyle of the patient and would help in assessing her needs[5]. Moreover, the nurse should also ask question to identify the patient’s learning style so that she can correctly develop the teaching strategies as closely as possible for the patient’s preferred style. Questions for patient’s readiness to learn should be also known.
The next step would be developing the learning objectives. The healthcare professionals should be able to define the outcomes that she herself and the patient are expecting from the teaching learning procedures. Learning objectives are very different from learning goals, as they are not general and long-term. Rather they are specific, attainable, measurable and short term. In case of the patient noted, an example can be provided[6]. The learning goal of the patient would be to make her learn how to maintain the blood sugar levels between 70 and 150 mg/dl at all times of the day. However, reaching to such goals will never be successful until the patient develops learning objectives that will help him to achieve the goal. The patient in such situation should set objectives like where she would be able to state five symptoms of hypoglycemia after the completion of program by the time of discharge. She should understand linking her medications with her physical conditions by the need of education proper discharge and similar others.
The next important step would be planning and implementing teaching. The teaching plan will have a number of aspects. The teaching plan will be based on when the teaching would be conducted. This would include the length of hospital stay or the number of home health visits available in the patient’s account[7]. The plan will also state when the teaching will be conducted which would be based on the patient’s comfort and her privacy. The healthcare professional would also plan the ways by which she would teach. This would involve different teaching methods like one on one sessions, small group discussions, and demonstrations and return demonstrations, role playing, programmed instruction and games. The different teaching materials would be using of models, pamphlets and brochures, posters and flip charts, transparencies, audiocassettes, computer assisted instructions and internet CDS, videos and closed circuit televisions and many others[8]. These are the best resources and tools which will bring put positive outcomes.
Developing learning objectives
The next step would be evaluating teaching and learning procedures adapted by the professional and the patient. This is the last phase of the teaching procedures. This is mainly an ongoing appraisal of the learning progress of the patient during and after the education. This step mainly helps to evaluate if the patient has successfully learnt what had been taught to them. This would be done by maintaining a proper checklist which the healthcare sector had prepared for evaluating the patients health literacy skills. This may vary from one to another healthcare center. The nurse will need to observe return demonstrations of what the patients had learnt regarding the necessary skills[9]. The patient can be asked to restate the instructions in their own words. The patient should be confirmed whether she needs more training in any area. Simple questionnaires of education on diabetes can be asked to the patient to develop ideas about her knowledge. The patient can be also taken in practical sessions where the professional can review her own record of self-monitored glucose levels in blood, how she injects insulin, how she schedules her timings for medication and others. If any reminder apps are advised, the educator would also check whether she is able to use the app successfully or not.
Some of the important points that should be inculcated in the teaching sessions should be jotted down prior to the development of education tools and resources for the patient. The patient was seen not to have any ideas about the entire disorder of diabetes and therefore large amount of information should be provided to patients[10]. The content should contain material that would help the students to understand exactly about the disorder of diabetes and the procedure by which this disorder affects the physiological system of the body. Secondly, it should contain information about the ways of working o medicines for diabetes. The education plan would also contain ways by which the patient would be able to educate themselves about the types of food he would take and how meals should be planned. It would also contain suggestion charts, apps as well as other tools that would help in providing reminders and helping in tracking progress. It would also provide ways about how the patient could handle stress and solve different problems arising from diabetes treatment. She should be educated about oral medication like metformin and insulin injections as she is to pursue combined dose of oral medication and insulin.
- Social care worker helping her with her daily activities until she gets fit
- Weekly monitoring sessions held by communities where overall health can be checked
- Community workshops for lifestyle management [11]
- Weight and diet management sessions as obesity has associations with diabetes
- Regular checkups by GP
Planning and implementing teaching
Documentation is very important as it helps in meeting purposes like communicating patients’ progress across all team members, maintain continuity of care, prevent duplication of teaching, serving of evidences of fulfillment of teaching requirement according to policies and procedures and others. It can be done in flowcharts, checklists, care plans, traditional progress notes and many others. The document would contain:
- Readiness of the patient to learn and patient’s preferred learning style.
- Learning needs of the patient
- Information and skills that are taught
- Patient’s current idea and knowledge about her condition and healthcare managements
- Learning objectives and goals set by the patient and professional [12]
- Teaching methods that had been used
- Evaluation results.
Conclusion:
When a nurse follows these procedures of educating patients in a planned manner, she or he can provide the safest care to the patients ensuring that the patient leads better quality life. Every nursing professional should try to learn and apply proper steps for educating patients. Patients with health literacy show better quality lives than those who do not have proper health literacy.
References:
Bell, K.J., Smart, C.E., Steil, G.M., Brand-Miller, J.C., King, B. and Wolpert, H.A., 2015. Impact of fat, protein, and glycemic index on postprandial glucose control in type 1 diabetes: implications for intensive diabetes management in the continuous glucose monitoring era. Diabetes Care, 38(6), pp.1008-1015.
Chrvala, C.A., Sherr, D. and Lipman, R.D., 2016. Diabetes self-management education for adults with type 2 diabetes mellitus: a systematic review of the effect on glycemic control. Patient education and counseling, 99(6), pp.926-943.
Coppola, A., Sasso, L., Bagnasco, A., Giustina, A. and Gazzaruso, C., 2016. The role of patient education in the prevention and management of type 2 diabetes: an overview. Endocrine, 53(1), pp.18-27.
Cryer, P.E., 2016. Management of hypoglycemia during treatment of diabetes mellitus. UpToDate, Waltham, MA.(Accessed on March 25th, 2014.) Retrieved from https://www. uptodate. com/contents/management-of-hypoglycemia-during-treatment-of-diabetes-mellitus.
Devchand, R., Nicols, C., Gallivan, J.M., Tiktin, M., Krause?Steinrauf, H., Larkin, M. and Tuncer, D.M., 2017. Assessment of a National Diabetes Education Program diabetes management booklet: The GRADE experience. Journal of the American Association of Nurse Practitioners, 29(5), pp.255-263.
Inzucchi, S.E., Bergenstal, R.M., Buse, J.B., Diamant, M., Ferrannini, E., Nauck, M., Peters, A.L., Tsapas, A., Wender, R. and Matthews, D.R., 2015. Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes care, 38(1), pp.140-149.
Inzucchi, S.E., Bergenstal, R.M., Buse, J.B., Diamant, M., Ferrannini, E., Nauck, M., Peters, A.L., Tsapas, A., Wender, R. and Matthews, D.R., 2015. Management of hyperglycaemia in type 2 diabetes, 2015: a patient-centred approach. Update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetologia, 58(3), pp.429-442.
Pal, K., Dack, C., Ross, J., Michie, S., May, C., Stevenson, F., Farmer, A., Yardley, L., Barnard, M. and Murray, E., 2018. Digital Health Interventions for Adults With Type 2 Diabetes: Qualitative Study of Patient Perspectives on Diabetes Self-Management Education and Support. Journal of Medical Internet Research, 20(2), p.e40.
Powers, M.A., Bardsley, J., Cypress, M., Duker, P., Funnell, M.M., Fischl, A.H., Maryniuk, M.D., Siminerio, L. and Vivian, E., 2015. Diabetes self-management education and support in type 2 diabetes: a joint position statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. Journal of the Academy of Nutrition and Dietetics, 115(8), pp.1323-1334.
Rosland, A.M., Kieffer, E., Spencer, M., Sinco, B., Palmisano, G., Valerio, M., Nicklett, E. and Heisler, M., 2015. Do pre-existing diabetes social support or depressive symptoms influence the effectiveness of a diabetes management intervention?. Patient education and counseling, 98(11), pp.1402-1409.
Sohal, T., Sohal, P., King-Shier, K.M. and Khan, N.A., 2015. Barriers and facilitators for type-2 diabetes management in South Asians: a systematic review. PloS one, 10(9), p.e0136202.
Xiang, Y., Luo, P., Cai, X., Tang, Y. and Wu, Z., 2017. results of a pilot study of patient-to-patient education strategy on self-management among glycemic uncontrolled patients with diabetes. Patient preference and adherence, 11, p.787.
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