PATIENT INSTRUCTION

. PATIENT INSTRUCTION





Adapting to Learner Needs176


Common Instruction Topics180


Follow-Up Care190


Locate Community Resources and Disseminate Information191


People learn in a holistic manner; this means that we respond to a variety of stimuli in any given situation, not merely to what is said or written. When learning, we internalize new information, ideas, emotions, and behaviors. Providing information is not enough; educators must stimulate learners and make sure they fully understand. Patients should be active participants in their treatment.

Each office should have a written policy and procedure brochure to give to patients when they first come to the provider. The brochure should include the following:


• Office hours and how to schedule an appointment


• How requests for prescription refills are handled (which medications can be refilled without the patient coming in for a visit and which medications cannot)


• Patient’s financial obligations (e.g., co-payments, self-payers), which insurance companies the office directly bills and which companies have the patient pay then file for reimbursement, and in which HMOs/PPOs the practice participates


• Provisions for after-hours emergencies and urgent telephone coverage



Six steps make up the teaching process:


1. Identify a need for teaching.


2. Assess the learner.


3. Plan activities to meet learning needs.


4. Implement teaching.


5. Evaluate the effectiveness of teaching and learning.


6. Document learning outcomes.


IDENTIFY A NEED FOR TEACHING

A patient newly diagnosed with a chronic disease needs to learn about the condition, the daily care of the condition, and the medical regimen for treatment. A few of the most common chronic illnesses about which you will need to teach patients include:


• Asthma (especially in children)


• Heart disease


• Hypertension


ASSESS THE LEARNER

Before planning and implementing education, you must assess not only what the patient knows about the subject but also how motivated the patient is to learn, what particular learning skills the patient has, and what barriers might inhibit learning.

After conducting this assessment, you can plan an educational program using tools that work well with the patient’s strong skills (e.g., learning by doing, learning from pictures) while downplaying the patient’s weaker learning skills (e.g., low reading comprehension).

At this point, ensuring that the patient understands the office’s policies and procedures is important. Each office should have a written policy and procedures brochure to give to patients when they first come to the provider.



IMPLEMENT TEACHING

Teaching sessions are most effective when they are short and focus on a discrete set of activities or tasks. Review the material from the last session before proceeding to the new material.

Use standardized materials whenever possible. Standardized materials reduce the amount of lesson development you need to do and ensure consistency and accuracy of the material presented. However, you should personalize the delivery of standard material for each patient.


EVALUATE THE EFFECTIVENESS OF TEACHING AND LEARNING

The goals and objectives for patient education need to be measurable to enable patients to be evaluated. In more complex learning situations, each discrete objective should be individually evaluated to determine whether the patient has mastered it and thus mastered the entire teaching goal.



ADAPTING TO LEARNER NEEDS

As people develop from young children to adults to elders, their learning styles often change. The following table describes in detail the various ways of learning most common to people at different stages of development and the most effective teaching methods for individuals at these stages.









































TEACHING AND LEARNING AT DIFFERENT STAGES OF DEVELOPMENT
Ways of Learning Effective Teaching Methods
Infant
Uses senses to Explore environment. Learns to trust when held securely.


Help infants learn to trust their environments by holding them securely, speaking softly, and allowing time for visual and tactile exploration.


Show love and acceptance.


Introduce changes slowly.
Toddler


Use simple words and brief explanations.


Use praise to reinforce desired behavir.


Use play to teach a procedure.


Allow for imitation and play.
Preschooler



Is still learning to use language correctly.


Still tends to express feelings through actions rather than words.


Asks questions to learn about the environment.


Use role playing, imitation, and play to teach. Use short sentences, but reinforce with demonstration.


Encourage questions.
School-Aged Child



Learns to think abstractly about information.


Can memorize facts, safety rules, and procedures.


Discussion can be reinforced by pamphlets, videos, and other visual aids, but the level of language must not be too complex.


Evaluate learning by having child summarize information or demonstrate skills.


Allow time for questions.
Adolescent



Analyzes, compares, makes decisions, and solves abstract problems.


Is emotionally challenged to adapt to body-image changes and to manage intense feelings.


Wants to be responsible for self, but judgment may need development.


Demonstrate problem-solving skills.


Help child learn about feelings.


Demonstrate acceptance of intense feelings.


Encourage responsible decision-making about health issues.


Provide privacy and autonomy.
Young and Middle-Aged Adult
Has reached full cognitive development, but may be overwhelmed by family, occupation, and social responsibilities. Allow participation in setting goals and in determining appropriate learning activities.
Older Adult

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