Patient education

Patients and caregivers can benefit from education about modifiable behaviors that are known to affect the risk for heart failure (HF). Information about the benefits of lifestyle change will enable some patients to reduce their risk for developing HF. Education covering hypertension management, treatment compliance, dietary modifications, smoking cessation, regular exercise, weight loss, and avoiding over-the-counter medications and foods that can potentially elevate blood pressure should be emphasized.

The process of patient education

There are several steps involved in effectively teaching what the patient and family need to know and coaching them about how to achieve their goals. 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

Adapted from The Joint Commission Comprehensive Accreditation and Certification Manual

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. In order 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 and
  3. Be motivated by the benefits of the new behavior.

Assessing knowledge of risks of developing heart failure

To know where a knowledge deficit exists, it is important to assess which of these above risk factors pertain to a specific patient. There are different approaches to carrying out this assessment. It is possible to leave a questionnaire given to the patient and/or family member. A good resource is the Stanford Patient Education Research Center. They have numerous questionnaires available free online.

It is also important also to know if any of the risks are currently being controlled with medication. This may be the case with hypertension, high cholesterol levels and high triglyceride levels. Avoid setting up instructions and giving out information on already controlled risks that do not meet the patient’s educational needs.

Assessing systems and adherence issues

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 preventative measures.

Ask the patient and/or family if there is anything blocking them from addressing any of the risk factors. These can be cultural, religious or financial. For example, the patient may need to walk 30 minutes a day. The patient and family know this so it is not a knowledge problem. However, they may not be able to afford the time or money to go to a gym. They may not live where they can walk safely – systems problems. The patient may have arthritis in his or her knees. That is an adherence problem. The nurse, patient and family need to agree to an exercise program that works within the family’s systems.

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 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 are as follows:

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

Once these objectives are agreed upon, a plan of instruction can be developed.

If the patient needs to modify eating habits, whomever does the cooking in the family can be referred to a nutritionist. Also interviews with the patient and/or family are recommended. It is important to not overwhelm them with many questions. General, 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?

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:

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.

For more information on learning styles see the patient education course.

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

Objective: List five hazards of smoking cigarettes.

Evaluation: Ask the patient to tell you or write out five hazards of smoking cigarettes

Objective: Give 3 examples of smoking cessation methods.

Evaluation: Ask the patient to tell you or describe 3 smoking cessation methods.

Objective: Develop a smoking cessation plan for you.

Evaluation: Ask the patient to describe his or her smoking cessation plan.

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 heart failure

There are many organizations that provide resource materials for patients and their families on cardiovascular disease prevention and management.

American Heart Association

The Center for Disease Control and Prevention

Heart Failure Society of America



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

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.