patient & family education: a multi-modal approach to improve the experience
DESCRIPTION
This session will describe educational concepts to enhance the orthopaedic patient experience. The elective nature of orthopedic surgery creates an opportunity to intervene with patients and family early and often throughout the episode of care. Multimodal teaching strategies (individual, group learning, written materials and web based tools) delivered prior to surgery and reinforced multiple times across care transitions can reduce anxiety, increase satisfaction, improve ability to manage pain and help patients feel more prepared for surgery. Improving the patient experience is increasingly important as quality and satisfaction metrics are becoming linked to reimbursement. Transitional care interventions, such as discharge planning, follow up calls with emphasis on participation in self care have shown to improve continuity of care, reduce readmissions and prevent poor health outcomes. About the Speaker: Jack Davis MSN, RN, ONC is the Manager of Patient Education Programs at Hospital for Special Surgery in NYC. Jack has over 30 years experience in orthopaedic nursing. He has been an active member of the National Association of Orthopaedic Nurses (NAON) since 1991. Jack currently serves as Director of the Orthopaedic Nurses Certification Board (ONCB). He is passionate about preparing patients and family for surgery and seeks to improve nursing practice through research, promoting specialty certification and nursing continuing education.TRANSCRIPT
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The Patient JourneyThe Guided CarePath, as part of a multi-modal strategy, helps create a single streamlined patient experience through the entire journey of a total joint replacement.
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Guided CarePath
Smart
Checklists for
Patients
Delivered online
and available 24/7
from home
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Patient & Family Education: A Multi-Modal Approach to
Improve the Experience
Jack Davis, MSN, RN, ONCManager, Patient Education Programs
Hospital for Special Surgery
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RS Laskin MD
HSS background
• Musculoskeletal Specialty hospital est 1863
• No. 1 ranking orthopaedics
• Magnet Recognition
• Academic center
• Research division
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RS Laskin MD
Conflict of Interest
• No financial affiliation with products discussed
• My current role as Manager Pt Education Programs for HSS influences my views on the subject on which I am presenting
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RS Laskin MD
Objectives
• Describe methods used to educate orthopaedic patients and families across the continuum
• Recognize factors that may improve the “experience”
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RS Laskin MD
Poll Question #1
• Do you routinely use a preopeducation class to teach patients?1. Yes
2. No
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RS Laskin MD
Educational Methods & Strategies
– Preop class group learning– Written materials
– Web-based
– Individual learning
– Use of technology
– Dedicated educator(s)
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RS Laskin MD
Poll Question #2
• Do you routinely use internet or web -based technology to teach patients?1. Yes
2. No
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RS Laskin MD
Organization’s Culture
• Identify models or theoretical frameworks
– Transpersonal Caring
– Relationship Centered Care
– Patient and Family Centered Care
– Transitional Care
– Magnet Model for Nursing Excellence
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RS Laskin MD
Poll Question #3
• Do you routinely include family in the education of patients?1. Yes
2. No
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RS Laskin MD
What metrics are used to evaluate the education
experience?
– Volume stats
– Cost to educate
– Outcomes associated?
– Knowledge
– Satisfaction
– HCAHPS?
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RS Laskin MD
Hospital Consumer Assessment of Healthcare Providers and Systems
(HCAHPS)
• Publicly reported survey of patients’ perceptions of hospital care
• Satisfaction with the Experience
• Failure to report=reduced reimbursement
• HCAHPS performance linked to Value-Based Purchasing incentive payments
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RS Laskin MD
Poll Question #4
• Are you modifying teaching strategies to improve HCAHPS scores?1. Yes
2. No
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RS Laskin MD
Is the education of Patient/Family relevant?
Patient education is critical to helping patients successfully cope with and recover from orthopaedic
conditions and surgery
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RS Laskin MD
Is education relevant to the organization?
• Sets expectations for experience– Nursing & MD Care
• Courtesy, listen, teach, respond
• Manage pain, new meds, toileting
– Environment• Clean, quiet
• Discharge disposition and transitions
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RS Laskin MD
So is preop class best practice?
• Pre-op program shows mixed results– Anxiety, LOS, Pain, Expectations
• Joint Commission Disease Specific Care Certification– Formalized program that provides theory &
skills to manage disease
• AHRQ National Guideline Clearinghouse– Pre op education program = moderate LOE
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RS Laskin MD
Patient Education Framework
• Provide health information
• Facilitate knowledge & understanding
• Engage patients to take an active role in care management
• Effect physical and mental health outcomes
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RS Laskin MD
Patient Education
“ …is more than just having the nurse review discharge instructions prior to leaving the hospital, it is a means for the nurse to assist the patient in the
enhancement and expansion of his ability to provide effective self-care”
(Bastable, 2006).
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RS Laskin MD
Increased responsibility to educate the patient’s family members and caregivers d/t shorter hospital stays and earlier transitions to home
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RS Laskin MD
Is there a best or most effective method to teach
orthopaedic patients?
• Combined teaching strategies
• Repeated/reinforced three times
• Patient/Family engagement
• Grounded in multiple theory
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RS Laskin MD
Transpersonal Caring
• Watson’s 10 Carative Factors
• Deep caring spiritual connection
• Provides comfort & Pain control
• Well being, Wholenss & Healing
(Gallagher-Lepak and Kubsch, 2007)
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RS Laskin MD
Watson’s 7th Carative Factor…
• Promotion of transpersonal teaching-learning– Interpersonal approach nurse to patient
and not information
– Assess readiness to learn
– Respect pre-existing knowledge
– Understand feelings about content, goals/desired outcome
(Gallagher-Lepak and Kubsch, 2007)
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RS Laskin MD
Relationship Centered Care
Respectful of and responsive to individual patient preferences, needs and values and ensuring that patient & family values guide all clinical decisions
(Epstein, Fiscella, Lesser & Stange, 2010)
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RS Laskin MD
Healing Relationships
• A two-way sharing of info patient & provider
• Explore values & preferences
• Help patient & family make decisions
• Facilitate appropriate care
• Follow through with behavioral change
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RS Laskin MD
Similar to self-management
• Model used in chronic disease
• Problem solving and decision making
• Patients engage in daily process to manage own care
• Use family, health team & community to manage consequences of health conditions
(Richard & Shea, 2011)
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RS Laskin MD
Poll Question #5
• Do you routinely use Clinical guidelines or pathways?1. Yes
2. No
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RS Laskin MD
Patient & Family Centered Care
• More popular approach
• Patient & Family Partnership
• Supports family presence and participation
• Enhance access to information
• Encourage shared decision-making
• Promote safety & well being
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RS Laskin MD
Outcomes?
• Better adherence to medications
• Improved disease management, problem solving and decision making
• Improve self-efficacy and ability to navigate health system
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RS Laskin MD
Transitional Care
• Ensure health care continuity
• Avoid preventable poor outcomes
• Promote safe and timely transfer– One level of care to another
– One type of setting to another
(Naylor et al. 2011)
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RS Laskin MD
Helps identify the best time to teach
• Before surgery
• Access to information after consults?
• During the hospital when taking medications?
• Reminders sent after discharge?
• Across all transitions of care?
• Who is the target audience?
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RS Laskin MD
Orthopaedic Transitions
•Patient Education
•Admission
•Nutrition
•Holding
•PACU
•In-patient
•Home
•Rehab
•Primary care
•Internist
•Anesthesia
•Other Consultant
•Out Patient office consult
•Operating Room
•Post op follow up
Surgical Service
Medical Service
Pre Surgery
Post Surgery
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RS Laskin MD
Transitional Care Interventions
• Discharge planning
• Patient and family teaching
• Home visits
• Calls or surveys after discharge
• Improve continuity of care & prevent readmission?
(Coleman et al,2006)
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RS Laskin MD
Magnet Model of Nursing Excellence
• Nurse as teacher concept
• Patient education program
• Interdisciplinary team input
• Other members of team?
• Address diverse patient/family needs
• Communicates across the organization
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RS Laskin MD
Written
MultimediaOutcomes
Classroom
Patient
Education
Office practice
Service lines
Revise content
Condition & process
Web-based
& other
Interactive
formats
Knowledge
retention
Press Ganey
Interdisciplinary Patient/Family Centered Education Committee
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RS Laskin MD
A Challenge
Research shows that patients remember and understand less than
half of what clinicians explain to them.
(Ley, 1988)
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RS Laskin MD
Barriers to learning
• Patient health status
• Medications
• Anxiety
• Teaching environment
• Learning styles
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RS Laskin MD
Individualistic learning & retention
• 10% of what is read
• 26% of what is heard
• 30% of what is seen
• 50% of what is seen & heard
• 70% of what they say
• 90% of what say as do something(Felder & Silverman, 2002)
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RS Laskin MD
Engagement and Evaluation of Learning
• Is content provided?
• Is it effective?
• Knowledge gained?
• Ability to manage self care?
• How long is information retained?
• Target patient & family
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RS Laskin MD
Teach-Back: Closing the Loop
Schillinger D, Piette J, Grumbach K, Wang F, Wilson C, Daher C, Leong-Grotz K, Castro C, Bindman A. Closing the Loop
Physician Communication With Diabetic Patients Who Have Low Health Literacy. Arch Intern Med/Vol 163, Jan 13, 2003
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RS Laskin MD
Teach-back – Using it Well:
Elements of Competence
● Responsibility is on the provider.
● Use a caring tone of voice & attitude.
● Use Plain Language.
● Ask patient to explain using their own words
(not yes/no).
● Use for all important patient education, specific
to the condition.
● Document use of & response to teach-back.
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RS Laskin MD
Even if teaching is good, will it influence behavior?
Education occurs if learning takes place with a resultant change in behavior,
skill or attitude.
(Falvo, 1994)
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RS Laskin MD
Providers should understand learning principles
• Active involvement
• Readiness to learn
• Conducive environment
• Perceived relevance
• Repetition
• Generalize info
• Pleasant experience
• Begin with known topics to unknown
• Present at appropriate rate
(DeYoung, 2009)
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RS Laskin MD
Ortho Patient Education Best Practice Summary
• Multi-modal approach
• Reinforced across practice settings
• Pre-op to discharge instructions & post-op calls
• Nurses to use teaching principles and evidence-based strategies
• Engage patients & family in the process
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RS Laskin MD
Identify & link to models
• Transpersonal Caring
• Relationship Centered Care
• Patient & Family Centered Care
• Transitional Care
• Magnet Model for Nursing Excellence
• Others?
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RS Laskin MD
More than the preop class
• It is about the nurse-patient relationship
• It is about how we include the family and convey messages
• It is about assessing individual learning needs and styles
• It is about reinforcing across transitions
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RS Laskin MD
Improving the experience
• Monitor HCAHPS & other metrics?
• Feed form focus groups?
• Engage the participants in process
• Make it convenient
• Expand access to info?
• Use technology?
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RS Laskin MD
Educational Methods & Strategies case study
– Written materials
– Web-based
– Classroom group learning
– Individual learning
– Use of technology
– www.hss.edu
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RS Laskin MD
Thank you!
Questions?
Jack Davis, MSN, RN, ONC
Manager, Patient Education Programs
Hospital for Special Surgery
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RS Laskin MD
References
• ANCC Commission on Magnet Recognition. (2008). Application manual magnet recognition program (2008th ed.)
• Bandura, A. (1977). Self-efficacy toward unifying theory of behavioral change. Psychological Review, 191-215.
• Kearney, M., Jennrich, M. K., Lyons, S., Robinson, R., & Berger, B. (2011). Effects of preoperative education on patient outcomes after joint replacement surgery. Orthopaedic Nursing / National Association of Orthopaedic Nurses, 30(6), 391-396
• Epstein, R. M., Franks, P., Fiscella, K., Shields, C. G., Meldrum, S. C., Kravitz, R. L., et al. (2005). Measuring patient-centered communication in patient-physician consultations: Theoretical and practical issues. Social Science & Medicine (1982), 61(7), 1516-1528.
• Naylor, M. D. (2009). Transitional care model. Retrieved December 12, 2009, from www.transitionalcare.info
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The Patient JourneyThe Guided CarePath, as part of a multi-modal strategy, helps create a single streamlined patient experience through the entire journey of a total joint replacement.
![Page 52: Patient & Family Education: A Multi-modal approach to improve the experience](https://reader034.vdocuments.site/reader034/viewer/2022051208/544f9558af7959070a8b4efc/html5/thumbnails/52.jpg)
Guided CarePath
Smart
Checklists for
Patients
Delivered online
and available 24/7
from home