I am very excited about my research this week. First, I have expanded my annotated bibliography for another class to include appropriate literature that could apply to that class on research and this independent study. Two books that need to be included are Osbornes's Health Literacy from A to Z Practical Ways to Communicate Your Health Message and the other Polit's and Beck's book, Nursing Research Principles and Methods. Both offer great info for the nurse researcher and the staff nurse. Reading both of these books re enforce the belief that there should be no reason why a practicing staff nurse can not validate what that nurse has seen as effective nursing practice.
Next, this research shows me the value of the role of the nurse as an educator might occur daily in the practice of nursing, but the research literature often takes on the privileges of academia discounting the front line experiences.
This brings me to the issues of hierarchy within the hospital setting.When the evaluation of available patient teaching material is done, who has the power to investigate, suggest, and decide upon the materials to be utilized? How is any input by floor nurses utilized in the actual purchasing of information? Then to do to the post-use evaluation: how is the patient and the nurse approached? How flexible are the procedures and policies already in place?
On another note, Rima Rudd's work with Study Groups involving the Navigation of Health care is taking on a new note.
Parade Magazine, 3/29/09 Page 10 has a little blip "Helping you through the Medical Maze". In this section the new job category of Patient Navigator(PN) is designed to help people acquire the best medical care they can and " improve the lives of patients, especially those among the socially disadvantaged". In the growing world of complex medical care, the Patient Navigator addresses the multitude of reasons (not just health care literacy) that addresses why patients might not be compliant. Never to be removed from the mix is the responsibility of patients to assume some of the responsibility for successful medical treatment.
Monday, March 30, 2009
Tuesday, March 17, 2009
Re-invention of the Wheel
I have been involved with looking at many brochures, pamphlets, and other teaching materials lately given to patients for educational purposes. User-friendly and patient specific should be the goal of any information given when added to a face-to-face session with a medical professional. The timing of the written information should be appropriate with adequate time allowed for follow up. Patients should be encouraged to write questions as they think of them. Some facilities provide folders that include pens and paper as well as a place to collect all information given upon admission, during the stay, and at discharge. That folder can become the place to keep medical information such as history and current medications. The folder makes patients active in deciding on their health care.
A bad example of a brochure would be one that includes too much information on too many topics with confusing medical jargon that is inappropriate for a specific patient.
The question of availability of information and education of information will need to be addressed. What will constitute providing education that can be utalized by a specific patient and the documentation of that education?
A very user friendly web site for medical professionals and lay people can be found on the Centers for Disease Control and Prevention website www.CDC.gov. under the Dept of Health and Human Services. Access can be obtained @work, @home, @schools, and @ libraries. Of course, the recent PA cuts to library funding affect those looking for information that may not have daily access to a personal computer. The use of the computer also requuires skills. THE GAP then becomes not only between Patient and Physician but financial, age, education, and access ability.
Sometimes after 35 years of nursing, the impact of lacks of the gap seem to be re-discovered.
A bad example of a brochure would be one that includes too much information on too many topics with confusing medical jargon that is inappropriate for a specific patient.
The question of availability of information and education of information will need to be addressed. What will constitute providing education that can be utalized by a specific patient and the documentation of that education?
A very user friendly web site for medical professionals and lay people can be found on the Centers for Disease Control and Prevention website www.CDC.gov. under the Dept of Health and Human Services. Access can be obtained @work, @home, @schools, and @ libraries. Of course, the recent PA cuts to library funding affect those looking for information that may not have daily access to a personal computer. The use of the computer also requuires skills. THE GAP then becomes not only between Patient and Physician but financial, age, education, and access ability.
Sometimes after 35 years of nursing, the impact of lacks of the gap seem to be re-discovered.
Getting Through the Gobblydegok
My Mock Literacy Research survey "Addressing the Nurse to Patient Education in the Hospital Setting" has become quite an undertaking. The purpose was to address the comfort level of nursing staff in educating patients to allow the patient to have the information they want and need to participate in making informed choices regarding their health care.
First, I would like to comment on the comments of my non-nursing classmates who took on the role of criticising the survey. Their comments prove that "you can not tell a person's health care literacy by education level or profession. The jargon often gets in the way of the message.
Next, my nursing colleagues appeared to immediately see where the survey was headed. Some commented "who is doing this survey and what will I be required to do NOW?". Others thought the survey could be useful for in services (particularly with new Joint Commission and Nursing Board CEU requirement). Still others said, "there is just not enough time why do we nurses ALWAYS have to provide information?".
The gap between physician and patient often requires a nurse to intervene in health care knowledge. The Columbia University School of Nursing website is a stellar example of nurses taking control. The weakness in all of the assessment tools appears to be "the exceptions". Barriers such as willingness to learn, ESL, cognitive challenges (dementia, hearing, etc.), often seem to go hand in hand with compliance to a prescribed health care regime either through personal commitment or financial considerations. There is always THE TIME FACTOR.
Perhaps follow up phone calls by the facility would be beneficial for those who do not qualify for home health care follow through. The hospital could expand community out reach topics. Bottom line-nurses must be provided the skills, tools, and time to educate if financial re-reimbursement is to be considered tied into the discharge instruction mix. The other possibility is a return to the Primary Nurse responsibilities that offered a continuing education. Yet the weakness in that scenario is the present 23 hour observation status of many patients.
I return to the ASKme3 program that provides basic information while allowing for an expansion IF THE PATIENT DESIRES. A timely article is Safeer and Keenan's "Health Literacy: The Gap Between Physicians and Patients", American Academy of Family Physicians. 2005.
My bottom line as a nursing professional is that nurses (and hospitals) should not be penalized for patient non-compliance when the patient makes an active informed choice to not live with a prescribed health care regime.
First, I would like to comment on the comments of my non-nursing classmates who took on the role of criticising the survey. Their comments prove that "you can not tell a person's health care literacy by education level or profession. The jargon often gets in the way of the message.
Next, my nursing colleagues appeared to immediately see where the survey was headed. Some commented "who is doing this survey and what will I be required to do NOW?". Others thought the survey could be useful for in services (particularly with new Joint Commission and Nursing Board CEU requirement). Still others said, "there is just not enough time why do we nurses ALWAYS have to provide information?".
The gap between physician and patient often requires a nurse to intervene in health care knowledge. The Columbia University School of Nursing website is a stellar example of nurses taking control. The weakness in all of the assessment tools appears to be "the exceptions". Barriers such as willingness to learn, ESL, cognitive challenges (dementia, hearing, etc.), often seem to go hand in hand with compliance to a prescribed health care regime either through personal commitment or financial considerations. There is always THE TIME FACTOR.
Perhaps follow up phone calls by the facility would be beneficial for those who do not qualify for home health care follow through. The hospital could expand community out reach topics. Bottom line-nurses must be provided the skills, tools, and time to educate if financial re-reimbursement is to be considered tied into the discharge instruction mix. The other possibility is a return to the Primary Nurse responsibilities that offered a continuing education. Yet the weakness in that scenario is the present 23 hour observation status of many patients.
I return to the ASKme3 program that provides basic information while allowing for an expansion IF THE PATIENT DESIRES. A timely article is Safeer and Keenan's "Health Literacy: The Gap Between Physicians and Patients", American Academy of Family Physicians. 2005.
My bottom line as a nursing professional is that nurses (and hospitals) should not be penalized for patient non-compliance when the patient makes an active informed choice to not live with a prescribed health care regime.
Monday, March 2, 2009
Taking a Step Back...
After some discussion with co-workers (those front line nurses left responsible for co-ordinating and ensuring that patients have adequate knowledge of personal health care education); I needed to take a step back and evaluate methods of giving health care education. The bigger, first question became "what are the principles of adult education?".
So...I decided that I had to look at the key elements of andragogy. Looking at adult learning principles has been my quest over the past week.
As always I will be using the standard definition of health literacy that maintains providing individuals with the skills, resources, and motivation to obtain, process, and understand basic health information allowing the individual to make appropriate health care decisions relevant to the individual.
I am excited, The Facility-wide diabetes education committee has requested that I give a 15 min or so presentation regarding health care education and adult learning principles.
On another note: My question for the project has been refined: "How does the composition of health care patient educational materials affect health care conversations between nurses and patient?"
So...I decided that I had to look at the key elements of andragogy. Looking at adult learning principles has been my quest over the past week.
As always I will be using the standard definition of health literacy that maintains providing individuals with the skills, resources, and motivation to obtain, process, and understand basic health information allowing the individual to make appropriate health care decisions relevant to the individual.
I am excited, The Facility-wide diabetes education committee has requested that I give a 15 min or so presentation regarding health care education and adult learning principles.
On another note: My question for the project has been refined: "How does the composition of health care patient educational materials affect health care conversations between nurses and patient?"
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