Presented By: Dana M. Smith, MS, MCHES, CCE Patient Education Specialist UAMS Medical Center

By the end of this presentation, participants will be able to:  Verbalize what health literacy is and it’s importance to stroke education.  Verbalize the importance of stroke education to stroke survivors and their caregivers in the acute care setting.  Verbalize the key steps to providing effective stroke education.  Use the teach back method as an evaluation tool for stroke education.

Using printed and written information to function in society, achieve one’s goals, and develop one’s knowledge and potential. - Kirsch et al, 1993

“The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” - Ratzan and Parker, 2000 / Healthy People 2010

 A patient's ability to obtain, understand and act on health information.  A provider’s capacity to communicate clearly, educate about health and empower their patients.

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Access Safety Quality Outcomes

Health Literacy results from the National Assessment of Adult Literacy, US Dept of Education, 2003

 Reliance on the written word for patient instruction is increasing.  Increasingly complex healthcare system ▪ More medications ▪ More tests and procedures ▪ Growing self-care requirements ▪ Esoteric language

 Elderly  Ethnic and racial minorities  Limited education immigrants  Low socioeconomic status  People with chronic disease

 Making excuses  Perceived resistance  Has no questions  Frequently missed appointments, tests  Non-adherent with meds or treatment

 Helps patient and caregivers understand why quick access to care is important after stroke symptoms.  Identifies ways that the patient can reduce the risk of having another stroke.  Provides caregivers needed information on how to care for a stroke survivor.  Increases patient compliance and decreases re-admission rates.  After TIA – Within 2 days after a TIA, 5 percent of people will have a stroke. Within 3 months after a TIA, 10 to 15 percent of people will have a stroke. -National Stroke Association, 2012

Life Altering Event Short Admissions Large Amounts of Information + Limited Staff Time

 Assess patient for educational readiness  Plan what you will teach  Implement teaching  Evaluate teaching

 Who should education be targeted toward?  Are the learners emotionally ready?  Are there literacy issues?  What might be some potential barriers?  What are the learners preferred learning styles?  Are the learners motivated?

What does the patient NEED to know? “Get with the Guidelines - Stroke”: 1. Activation of emergency medical system 2. Need for follow-up after discharge 3. Medications prescribed at discharge 4. Risk factors for stroke 5. Warning signs for stroke

 Emotions after stroke  Avoiding complications: falls, UTI, aspiration pn, etc.  Managing ADLs  Help for the caregiver  Understanding deficits: memory, communication, motor skills, etc.  Rehab  Where to get further information – support groups, websites, organizations

 Physicians  Nurses  Patient Educators  Case Coordination  Speech Therapy  Occupational Therapy  Physical Therapy  And many others

 What Resources are Available?  Videos  Materials/Handouts  Other  Regarding Materials  Are handouts written in plain or common language?  Are materials written at a 6-8 th grade level?  Are materials free of medical jargon?

 Font should be at least 12 point  Use ample ‘white space’  Use 1.5 or double spaces between sentences and more space between bullets.  Organize information with the 3-5 most important “need to know” points.  Give the most important information first and last to enhance memory.  Use a conversational writing style and active voice.

 Use plain language and avoid acronyms.  Get the learner actively involved.  Don’t make assumptions.  Use a variety of teaching strategies, if able.  Ask questions during teaching to make sure the patient is understanding.  Always give written information as a back up to all teaching.

“The greatest impediment to communication is the illusion that it’s actually happening.” - George Bernard Shaw

 Research shows that patients remember and understand less than half of what clinicians explain to them. Ley, Communicating with patients: improving communication satisfaction, and compliance 1988 Rost, Predictors of recall of medication regimens and recommendations for lifestyle change in elderly patients  Use the Teach Back Method – aka: “Show Me” or “Closing the Loop”  Is a way to confirm that you have explained to the patient what they need to know in a manner that the patient understands.

● Asking patients to repeat in their own words what they need to know or do, in a non-shaming way. ● NOT a test of the patient, but of how well you explained a concept. ● A chance to check for understanding and, if necessary, re-teach the information.

● “Asking that patients recall and restate what they have been told” is one of 11 top patient safety practices based on the strength of scientific evidence.” AHRQ, 2001 Report, Making Health Care Safer ● “Physicians’ application of interactive communication to assess recall or comprehension was associated with better glycemic control for diabetic patients.” Schillinger, Arch Intern Med/Vol 163, Jan 13, 2003, “Closing the Loop”

● “I want to be sure I explained everything clearly. Can you please explain it back to me so I can be sure I did?” ● “What will you tell your husband about the changes the doctor made to your medicines today?” ● “Can you tell me some things you might do to reduce your risk of having a stroke?” ● “Can you tell me what you would do if you started to feel some of the symptoms of a stroke when you were at home?”

 On-Going Education after Discharge:  Newsletters  Follow up phone calls  Stroke support groups  Listservs  Social Media  Video-conferences, etc.  Education centered on staying healthy, reducing risks, adjusting to life after stroke,etc.

3 rd Thursday of Each Month 11 a.m. – Noon UAMS Family Home 4300 W. Markham Little Rock, Arkansas To Register:

 American Stroke Association ▪ Stroke Connection Magazine ▪ Stroke Handouts  American Heart Association ▪ Get With the Guidelines  National Stroke Association  National Institutes of Health