Parent education to prevent abusive head trauma

The process of parent education

There are several steps involved in effectively teaching what the parent and other caregivers need to know and coaching them about how to prevent harming a child. The involvement of patients and family members in the process of patient education is promoted within the Joint Commission’s standard for patient education. According to the Joint Commission:

• The educational methods and instruction need to match the parent’s level of understanding and assessed needs.
• The learning assessment should include cultural and religious beliefs, emotional barriers, desire and motivation to learn, physical or cognitive limitations and barriers to communication.
• Basic health and safety information including risks.
• Evaluate the parent's understanding of the education and training.
• Instructions for self-care upon discharge. (Adapted from The Joint Commission Comprehensive Accreditation and Certification Manual) https://e-dition.jcrinc.com/Frame.aspx

Assessment of the learning needs

In Mager’s book (1997), Analyzing Performance Problems: Or, You Really Oughta Wanna--How to Figure out Why People Aren't Doing What They Should Be, he describes three issues that can lead to non-adherence to a prescribed plan of action: knowledge problems, system problems or compliance problems. For individuals to successfully adopt a positive mode of action they must

• Know what to do
• Be in a system that supports the action and
• Be motivated by the benefits of the new behavior.

Example with preventing Abusive Head trauma

An education program about Abusive head trauma can help clients know what not to do to a child, how to provide comfort for the infant, and how to keep an infant safe. Violence, substance abuse, unstable family situation and poverty can be precipitating factors for AHT. If the system the client lives in has violence, alcohol or substance abuse and/or poverty, it may be difficult for one person to keep a child safe in that environment. These issues can also be addressed, and assistance offered as part of the educational program.

Learning styles

When doing an education class, it is important to address a number of learning styles for effective teaching. One of the simplest yet effective tool is the VAK (Visual, auditory, kinesthetic) learning style from the field of neurolinguistics. In this tool individuals are visual, auditory or kinesthetic learners. If you are a visual learner you learn by reading, watching, or writing. You use the words and phrases that indicate vision, such as See what I mean. If you are an auditory learner, you listen, ask for information, like to discuss situations, talk on the phone. You use words and phrases that indicate sound, such as I hear what you said. If you are a kinesthetic learning, you learn through touching, demonstrating, handling objects. You use words and phrases that indicate feeling or doing, such as Let me try that.

A crucial concept about learning styles is our tendency to teach the way we learn. If as a teacher, you are visual, you will use handouts, visual aids, videos. However, if the learner is primarily auditory, they will ask for explanations and want the instructor to talk to them about the information. Teaching in one style that is not consistent with the learner’s is often the biggest disconnect between student and teacher. When teaching groups of individuals, it is best to use a variety of presentations to respond to any learning style.

Most individuals have a primary style in which they learn the best. Here is a website where you can access a VAC test to determine your style. https://www.businessballs.com/self-awareness/vak-learning-styles/

There are other learning style tests, many of which flow from the original work of Carl Jung. He was one of the first psychologists to identify inherit differences in personalities of individuals. In his framework, Jung described individuals as Extroverted or Introverted, Perceiving or Judging, Thinking or Feeling, Sensing or Intuiting. The Myers-Briggs Type Indicator, a very popular personality test, is based on Jung’s work as is the Keirsey Temperament Sorter. Here is a website that enables you to take the Myer-Briggs Type Indicator. http://www.truity.com/view/tests/personality-type

Reading levels of patient materials

The American Medical Association (AMA) and the National Institutes of Health (NIH) recommend patient education materials to not be higher than a sixth-grade reading level (Weiss et al., 2005). Several studies have shown patient education materials used in health care organizations and online are written at a much higher level, presenting a deterrent to the comprehension of important information. Most word processing systems have a readability analysis in their system. The most popular and well-validated is the Flesch-Kincaid formula to analyze grade level readability. When using Word, the spell check must be completed first then the statistics on the area being typed, including the Flesch-Kincaid reading level, will come up.

Developing goals and objectives

Blooms taxonomy is often used to develop educational objectives. Blooms taxonomy is described in different levels. Each level has specific words that describe in behavioral terms what the learner should be able to know or do.

Learning objectives should be specific, attainable, and measurable. Most objectives used in patient education are written from the bottom three levels. Here are some examples that relate to Abusive Head Trauma.

Upon completion of these instructions, the parent will be able to:

1. Remember
     List four dangers of shaking a baby
2. Understand
     Describe what happens to an infant’s brain when it is severely shaken.
3. Apply
     Demonstrate four comfort measures to soothe a crying baby.
4. Analyze
     Examine the precursor conditions that can lead to shaking an infant.
5. Evaluate
     Appraise a recommended approach to preventing AHT.
6. Create
     Develop a plan for what to do if they cannot cope with a crying infant.
   (For more information go to https://cft.vanderbilt.edu/guides-sub-pages/blooms-taxonomy/)

Content, time and presentation method

The next step is to decide on what information the client will need to achieve the objectives, as well as how much time to allot for that information, and how to present the information. The content in this course can be used to explain AHT. RnCeus Interactive is a free to view website.

This is an example of a typical instruction form for an educational activity that contains the connection between the objectives, content, time, teaching methods and evaluation.

Carrying out the teaching

Patients can listen to instruction, watch videos, read handouts at convenient times. Hospitals should have instructional materials available. All instruction should be noted in the patient’s record or in an educational folder if this is an outpatient course.

Examples of Methods and Materials

Teaching methods

• One-on-one sessions
• Small group discussions and support groups
• Demonstration and return demonstration
• Role-playing
• Games
• Programmed instruction

Teaching Materials

• Pamphlets and brochures
• Posters and flip charts
• Videos
• Computer – assisted instruction – Internet, CDs
• Audiocassettes
• Transparencies
• Models

Instruction evaluation

There should also be an evaluation the patient and/or family member complete about the instruction that was given. Typically questions about the quality of instruction, relevance and presentation are asked in a paper and pencil form. Providing resources is helpful for patients and family members.

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