اللهم انی اعوذبک من علم لاینفع پروردگارا به تو پناه می برم از علمی که سود نبخشد.

Managerial challenges in patient Education Fatemeh Heshmati Nabavi Assistant Professor in Nursing management. Mashhad University of Medical Sciences 2014

Patient Misunderstandings Are Common… Among Patients Discharged from the Hospital… 41% able to state discharge diagnosis(es) 37% able to recount the purpose of all medications 28% able to list all their medications 14% able to state common side effects of meds Makaryus AN.Mayo Clin Proc.2005.

Managerial challenges  Time consuming and complex nature of teaching and learning process  Organizational culture  Interdisciplinary nature  Culture of clients and their family

Time consuming and complex nature of teaching and learning process Malcolm S. Knowles

Time consuming and complex nature of teaching and learning process Learning Objectives Skills Knowledge Attitude

Time consuming and complex nature of teaching and learning process Step 4: Go teach the patient. Step 3: Set educational goals with patient Step 2: Assess barriers to learning Step 1: Assess patient knowledge, learning styles, and motivation Step 5: Evaluate Learning Process Stromberg A. Eur. J. Heart Failure

Additional Barriers to Learning… Functional Visual Impairment Hearing Impairment Decreased mobili ty Illness-Related Pain Fatigue Cognitive Impairment Dementia Delirium Depression Stromberg.EurJCard.2005.

What is the solution? Setting Realistic Goals

What is organizational culture and how can it affect the quality of PE programmes?

What is Organizational culture Is the behavior of humans who are part of an organization and the meanings that the people attach to their actions.

Culture organizat ion values visionsnorms working language habitsBeliefs'

It is also the pattern of such collective behaviors and assumptions that are taught to new organizational members as a way of perceiving, and even thinking and feeling.

What is the Solution? Making information giving and patient involvement in decision making an integral part of the care delivery process.

Interdisciplinary nature of PE Program

Shared decision making is the key Patient education developed from the health care professional deciding what the patient needed to know to a shared decision making design where physician and patient are equally influential on the decision making process. The development of patient education is described for primary and secondary health care, as well as the impact of biomedical advances, an ageing population and cultural diversity on patient education. Some of the challenges for future patient education are identified: training health professionals as well as patients, involvement of the patient's social environment and application of e-Health techniques to patient education. A history of patient education by health professionals in Europe and North America: From authority to shared decision making education Ciska Hoving aCiska Hoving a, d Patient Education and Counseling Volume 78, Issue 3, March 2010, Pages 275– 281d Patient Education and CounselingVolume 78, Issue 3

In a review of palliative care teams four of the five randomized trials found that the co-coordinated specialist approach resulted in similar or improved outcomes in terms of patient and family satisfaction, anxiety, pain and symptom control. Those studies that examined costs showed a tendency to reduce hospital days and equal or lower costs.

46 A. Deccache, K. van Ballekom / Patient Education and Counseling 44 (2001) 43–48 Fig. 1. Factors facilitating the development of patient education (% answers).

Patient and family culture Preoperative patient education for open- heart patients: A source of anxiety? patient education should not be initiated before assessing the patient's cultural and social background

References Makaryus AN, Friedman EA. Patients' understanding of their treatment plans and diagnosis at discharge. Mayo Clin Proc. Aug 2005;80(8): Makaryus AN, Friedman EA. Patients' understanding of their treatment plans and diagnosis at discharge. Mayo Clin Proc. Aug 2005;80(8): Knowles MS, Holton EF, Swanson RA. The Adult Learner. 5th ed. Woburn, MA: Butterworth-Heinemann; Wehby D, Brenner PS. Perceived learning needs of patients with heart failure. Heart Lung. Jan-Feb 1999;28(1): Wehby D, Brenner PS. Perceived learning needs of patients with heart failure. Heart Lung. Jan-Feb 1999;28(1): Eshleman KY. Adapting teaching styles to accommodate learning preferences for effective hospital development. Prog Transplant. Dec 2008;18(4): Eshleman KY. Adapting teaching styles to accommodate learning preferences for effective hospital development. Prog Transplant. Dec 2008;18(4): Paradis V, Cossette S, Frasure-Smith N, Heppell S, Guertin MC. The efficacy of a motivational nursing intervention based on the stages of change on self-care in heart failure patients. J Cardiovasc Nurs. Mar-Apr 2010;25(2): Paradis V, Cossette S, Frasure-Smith N, Heppell S, Guertin MC. The efficacy of a motivational nursing intervention based on the stages of change on self-care in heart failure patients. J Cardiovasc Nurs. Mar-Apr 2010;25(2): Jeppesen KM, Coyle JD, Miser WF. Screening questions to predict limited health literacy: a cross-sectional study of patients with diabetes mellitus. Ann Fam Med. Jan-Feb 2009;7(1): Jeppesen KM, Coyle JD, Miser WF. Screening questions to predict limited health literacy: a cross-sectional study of patients with diabetes mellitus. Ann Fam Med. Jan-Feb 2009;7(1): Stromberg A. The crucial role of patient education in heart failure. Eur J Heart Fail. Mar ;7(3): Stromberg A. The crucial role of patient education in heart failure. Eur J Heart Fail. Mar ;7(3): Schillinger D, Piette J, Grumbach K, et al. Closing the loop: physician communication with diabetic patients who have low health literacy. Arch Intern Med. Jan ;163(1): Schillinger D, Piette J, Grumbach K, et al. Closing the loop: physician communication with diabetic patients who have low health literacy. Arch Intern Med. Jan ;163(1):83-90.

Dr. Fatemeh Heshmati Nabavi