Patient education

Patient and/or family education is promoted by the Joint Commissions within their standards for patient education. According to the Joint Commission

• The organization needs to assess the patient’s learning needs
• The educational methods and instruction need to match the patient’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, medications, and equipment.
• Evaluate the patient'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

What to teach

Patients and caregivers can benefit from education about the following aspects of West Nile Virus (WNV):

• What is the risk of being infected with the West Nile Virus in their specific area?
• What human factors increase their risk of being infected with the WNV?
• What can be done to reduce the risk of being infected with the WNV?
• While only 20% of those infected with the WNV will exhibit symptoms, what are those symptoms?
• Other content as needed should be also included.

The process of patient education

There are several steps involved in effectively teaching and coaching patients and family members about West Nile Virus (WNV). Once a nurse has identified what information needs to be discussed with patients and caregivers, it is important to know the how of transmitting that information.

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 none 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

1. Know what to do
2. Be in a system that supports the action
3. Be motivated by the benefits of the new behavior.

Assessing knowledge of risks of being infected with the WVN

To know where a knowledge deficit exists, it is important to assess which risk factors pertain to a specific patient. There are different approaches to carrying out this assessment. For example, it is possible to leave a questionnaire for the patient and/or family member to complete. If time permits, an interview provides an opportunity to collect data and answers questions.

The following risks factors are described in this course. Asking which pertain to the patient and/or family members should be identified.

Environmental risk factors - mosquito habitats

Swamp areas, sewer systems, septic ditches, septic tanks.

Container Sources - generally man-made sources that will catch and hold water, such as waste tires, buckets, pool covers and rain barrels.

Drainage Systems - catch basins, channels, roadside ditches, and underground storm water/drainage systems.

Open Habitats - Surface-water habitats that become stagnant and enriched to support larval development, such as swamps, marshes, bogs, rice fields, and pastures.

Hot humid environments are most amenable to mosquito growth and survival.

Individuals with increased susceptibility

Age 50+

Certain medical conditions, such as cancer, diabetes, hypertension, kidney disease, and individuals who are receiving drugs that reduce the immune response, such as organ transplant patients

Assessing systems and adherence issues to preventing WNV infections

To prevent being infected with the WNV, individuals are asked to avoid the above mosquito habitats as well as eliminating any standing water places in their environment.

In addition, the following precautions are recommended

Check that all window and door screens are intact

Wear long sleeves and pants when outdoors

Use mosquito repellent

Systems that enhance or detract education

We all live within various systems including our families, work and social systems. As the instructor before writing learning objectives with the patient and family, it is also important to assess systems and adherence issues that might interfere with accomplishing these preventative measures.

Ask the patient and/or family if there is anything blocking them from addressing any of the above risk factors. These can be cultural, physical, psychological or financial. For example, the patient and/or family may not have the financial resources to fix all window screens. The nurse, patient and family can discuss how to cover up holes in the window screens. We cannot assume the resources available to us are available to all patients and their family members.

Developing goals and objectives

To develop an active learning program the patient and/or family should be involved in developing objectives. Blooms taxonomy is often used to develop these objectives. (For more information go to http://www.nwlink.com/~donclark/hrd/bloom.html and the patient education and coaching course)

The learning objectives should reflect the time these risks will be addressed and by whom.

Sample learning objectives for WNV are as follows:

Upon completion of these instructions, (the patient) will be able to

Assess own risk factors

Identify mosquito habitats

Identify which protective clothing to wear when outside

List recommended mosquito repellents

Recognize symptoms of WNV infection

Talking with patients and family members

We in health care are enthusiastic about individuals carrying out instructions that provide better health. Patients need to make their own goals and describe the benefits they see in changing. Patients and family members sometimes see a down side to what will be changing in their lives. This perception can create a block to changing behavior.

• Other questions that can be asked of clients are the following:
• What is your goal related to …..?
• What do you see are the benefits to achieving this goal?
• What are obstacles that can stand in the way of achieving this goal?
• If you were to draw a picture of you now related to this goal, what would it look like?
• If you were to draw a picture of you achieving your goal, what would that look like?
• When would you like to achieve this goal?

Assessing learning styles

It is important also to determine the patients learning style 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. Visual learners learn by reading, watching, or writing. Auditory learners listen, ask for information, like to discuss situations, talk on the phone. Kinesthetic learners, learn through touching, demonstrating, handling objects. Most individuals have a primary style in which they learn the best. Here is a website where you can access a VAK test to determine your style. http://www.businessballs.com/vaklearningstylestest.htm

It is key to not overwhelm patients and family members with questions. Open ended questions can be asked with opportunity to delve deeper into the answers.

The following are suggestions:

1. What concerns do you have?
2. How do you prefer to receive information: hearing someone explain information, reading information or hands on learning?

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 than the statistics on the area being typed, including the Flesch-Kincaid reading level, will come up.

Carrying out the teaching

How teaching is carried out will vary based on the patient’s learning style and the time available by staff to do the education. Usually any instruction is limited to 30 minutes. 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. Some institutions provide education after the patient is discharged. Group instruction can be helpful to prevent isolation and to hear questions individuals may have but are reluctant to express.

Evaluation

There are three levels of evaluation of learning that we can apply to patient education:

1. Can they teach back the information?
2. Can they apply the information they have learned?
3. Has the information helped prevent WNV infection?

Evaluation should be based on the objectives decided with the patient. Using our objectives, the nurse would do the following

Objective: Assess own risk factors
Evaluation: Ask the patient to tell you or write out their risk factors for WNV infection.

Objective: Identify mosquito habitats
Evaluation: Ask the patient to tell you or describe 4 mosquito habitats they are exposed to

Objective: List recommended mosquito repellents
Evaluation: Ask the patient to describe which mosquito repellent he or she will buy

Instruction evaluation

There should also be an evaluation the patient and/or family member completes about the instruction that was given. Typically questions about the quality of instruction, relevance and presentation are asked in a paper and pencil form.

Resources for preventing WNV infections

There are many public and private organizations that provide resource materials for patients and their families on mosquito suppression and arbovirus disease prevention.
https://www.ucsfhealth.org/education/west_nile_virus/

CDC. West Nile Virus. Home. For Health Care Providers. Clinical Evaluation & Disease. Diagnosis & Reporting. https://www.cdc.gov/westnile/healthcareproviders/healthCareProviders-ClinLabEval.html

World Health Organization. Media centre. West Nile virus. Fact sheet No.354. Oct. 2017 https://www.who.int/en/news-room/fact-sheets/detail/west-nile-virus

References

Mager, R. & Pipe, P. (1997). Analyzing Performance Problems: Or, You Really Oughta Wanna--How to Figure out Why People Aren't Doing What They Should Be, and What to do About It. Atlanta: Center for Effective Performance.

The Joint Commission Comprehensive Accreditation and Certification Manual https://e-dition.jcrinc.com/Frame.aspx

Weiss, B., Mays, M. Z., Martz, W., Castro, K. M., DeWalt, D. A., Pignone, M. P., Mockbee, J., & Hale, F. A. (2005). Quick assessment of literacy in primary care: the newest vital sign. Annals of Family Medicine, 3, 514-522.

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