1. © 2009 The McGraw-Hill Companies, Inc. All rights reserved

2. Patient Education     دکتر لیلی یکه فلاح   دکتری تخصصی آموزش پرستاری   استادیار دانشگاه علوم پزشکی قزوین 14-2

3. © 2009 The McGraw-Hill Companies, Inc. All rights reserved Learning Outcomes 1 Identify the benefits of patient education. 2 Explain the role of the medical assistant in patient education. 3 Discuss factors that affect teaching and learning. 4 Describe patient education materials used in the medical office. 14-3

4. © 2009 The McGraw-Hill Companies, Inc. All rights reserved Learning Outcomes (cont.) 5 Explain how patient education can be used to promote good health habits. 6 Identify the types of information that should be included in the patient information packet. 7 Discuss techniques for educating patients with special needs. 14-4

5. © 2009 The McGraw-Hill Companies, Inc. All rights reserved Learning Outcomes (cont.) 8 Explain the benefits of patient education prior to surgery, and identify types of preoperative teaching. 9 List educational resources that are available outside the medical office. 14-5

6. © 2009 The McGraw-Hill Companies, Inc. All rights reserved  Patient Education: why?? 14-6

7. © 2009 The McGraw-Hill Companies, Inc. All rights reserved Patient Education Prior to Surgery EducationalLegal Informed Consent Preoperative Instructions Postoperative Instructions

8. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 14-8 The Educated Patient Takes a more active role in medical careIs often more compliant with treatment programs Is better informed about how to maintain a healthy state

9. © 2009 The McGraw-Hill Companies, Inc. All rights reserved The Educated Patient (cont.)   Benefits to the medical office Patients are more satisfied Patients are more likely to follow instructions so tests do not have to be rescheduled Patients are less likely to call the office with questions, so staff spends less time on the telephone   Medical assistant More interaction with the patient Assess educational needs at every visit 14-9

10. © 2009 The McGraw-Hill Companies, Inc. All rights reserved Benefits of Preoperative Education   Increases patients’ overall satisfaction   Reduces patient anxiety and fear   Reduces use of pain medication   Reduces complications following surgery   Reduces recovery time Patient Education Prior to Surgery (cont.)

11. © 2009 The McGraw-Hill Companies, Inc. All rights reserved Patient Education Rationale Model of Patient Education Outcomes PatientEducation  Print  Verbal  Multimedia  Combination PatientEducation  Print  Verbal  Multimedia  Combination Behavior Changes  Health services utilization  Compliance  Lifestyle  Self-care Behavior Changes  Health services utilization  Compliance  Lifestyle  Self-care Costs  Length of stay  Utilization  Provider image  Regulatory compliance Costs  Length of stay  Utilization  Provider image  Regulatory compliance Health Status  Physical health  Well-being  Symptoms  Complications Health Status  Physical health  Well-being  Symptoms  Complications Knowledge and Attitude Changes  Increased understanding  Increased confidence  Increased satisfaction  Improved emotional state Knowledge and Attitude Changes  Increased understanding  Increased confidence  Increased satisfaction  Improved emotional state

12. © 2009 The McGraw-Hill Companies, Inc. All rights reserved The Effective Educator ??????

13. © 2009 The McGraw-Hill Companies, Inc. All rights reserved  Effective Patient Educator skills include: Determining patient concerns Avoiding Assumptions Explaining things clearly The Effective Educator 14-13

14. © 2009 The McGraw-Hill Companies, Inc. All rights reserved Assess – Define patient and family needs and concerns; observe readiness to learn. Plan – Set objectives with your patient; select materials. Four Steps to Educating

15. © 2009 The McGraw-Hill Companies, Inc. All rights reserved Patient Education - Steps Implement – Put the plan in motion; help patients along the way to reach the objectives you’ve set together. Document – Create a written history and keep records.

16. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 14-16 FactualSensoryParticipatory Patient Education Prior to Surgery (cont.)

17. © 2009 The McGraw-Hill Companies, Inc. All rights reserved  Factual–Informs patients of specific details about a procedure and needed restrictions before and/or after surgery.  Sensory–Provides patients with descriptions of various sensations that may be felt during the procedure. Participatory–Includes explanations and demonstrations of certain techniques required after surgery and requires that patients perform a return demonstration of the technique to validate understanding and technique accuracy. types of patient education. 14-17

18. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 14-18 Brochures, Booklets, and Fact Sheets   Explain procedures that are performed in the medical office   Provide information about specific diseases and medical conditions   Provide information to help patients stay healthy Types of Patient Education: Printed Materials

19. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 14-19 Educational Newsletters Medical office newsletters :   Are written by the doctor or office staff   Contain practical health care tips   Offer updates on office policies   Provides information about new diagnostic tests and equipment Types of Patient Education: Printed Materials

20. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 14-20 Many physicians arrange classes and seminars for their patients Health information web sites for general consumer health information Videotapes and DVDs are used effectively to educate about complex subjects and procedures Types of Patient Education: Visual Materials

21. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 14-21  Using anatomical models A visual representation helps patients better understand what will take place  Helping patients relieve anxiety Allow extra time for patients to grasp information Use positive words when possible Have family members present Patient Education Prior to Surgery (cont.)

22. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 14-22  Verifying patient understanding Have patients explain to you in their own words their understanding of what has been taught Use return demonstrations to validate understanding of procedural instructions Patient Education Prior to Surgery (cont.)

23. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 14-23 Additional Educational Resources  Libraries Public libraries Hospital patient resource rooms  Computer resources Online services CD-ROMs

24. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 14-24 Additional Educational Resources (cont.)  Community resources Nursing home care Visiting nurses’ care Counseling Rehabilitation  Associations American Cancer Society American Diabetes Association American Heart Association Note: These outside resources may be used by office personnel or patients to obtain educational information.

25. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 14-25 The Patient Information Packet

26. © 2009 The McGraw-Hill Companies, Inc. All rights reserved   Benefits of the Information Packet Improves relationships between the office and the patients   Simple, inexpensive, and effective medium Provides important information about the office policies and staff roles Excellent marketing tool The Patient Information Packet 14-26

27. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 14-27 Contents Introduction to the office Physician’s qualifications Description of the practice Introduction to the office staff Office hours Appointment scheduling The Patient Information Packet (cont.)

28. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 14-28 Contents Telephone policy Payment policies Insurance policies Patient confidentiality statement Other information The Patient Information Packet (cont.)

29. © 2009 The McGraw-Hill Companies, Inc. All rights reserved Pre-Operative Nursing Interventions Client Teaching  Pre-operative progression & sensations  Preoperative experience  Description of Pre and Post operative events  Preoperative medication  Description of events in OR and PACU  Pain management  Coughing & Deep Breathing Exercises  Incentive Spirometry 14-29

30. © 2009 The McGraw-Hill Companies, Inc. All rights reserved  Turning & Positioning  Leg Exercises & Ambulation  Reducing anxiety and fear, support of coping  Special considerations related to outpatient surgery PREOPERATIVE TEACHING 14-30

31. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 14-31 Client Teaching Pain Management   Pre-operative assessment of individual pain perception on 1-10 scale   Reassurance that pain reports WILL be believed and acted upon   Use of PCA   Benefits of ATC versus PRN   Allaying of fears regarding addiction   Potential side-effects of narcotics   How pain management promotes recovery

32. © 2009 The McGraw-Hill Companies, Inc. All rights reserved Client Teaching Pulmonary Exercises  Method for diaphragmatic breathing: Hands on ribs, inhale thru nose allowing abdomen to expand, hold 3-5 sec, exhale thru pursed lips, 10X /hr while awake  Method for controlled coughing Deep breath X2, then inhale, hold breath 2-3 sec, cough forcefully 2-3X consecutively  Method for splinting 14-32

33. © 2009 The McGraw-Hill Companies, Inc. All rights reserved Client Teaching Pulmonary Exercises  Instruction on use of Incentive Spirometer: Take 2-3 normal breathes, close lips on mouthpiece, inhale to reach set goal, hold 3-5 sec, release mouthpiece & exhale, 10X/hr while awake. 14-33

34. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 14-34

35. © 2009 The McGraw-Hill Companies, Inc. All rights reserved تنفس دیافراگمی  در حالت نيمه نشسته قرارگيرد.  از بيمار بخواهيد تا دستها را بر روي دنده ها بگذارد به طوري كه بتواند بالارفتن و انبساط قفسه سينه را حس كند.  از بيمار بخواهيد بازدم را به طور عميق و آهسته انجام دهد.  از طريق بيني به طور آهسته و عميق عمل دم را انجام دهد.  تنفس را براي 5-3 ثانيه نگهداشته، تا حد امكان از راه دهان به طور كامل در حاليكه لبها غنچه است بازدم را در اين مرحله 3 مرتبه تكرار كنيد.  اين تمرينات را هر 2-1 ساعت در هنگام بيماري و در 48-24 ساعت بعد از جراحي انجام دهيد.

36. © 2009 The McGraw-Hill Companies, Inc. All rights reserved Diaphragmatic Breathing and Splinting When Coughing 14-36

37. © 2009 The McGraw-Hill Companies, Inc. All rights reserved روش سرفه موثر:  در وضعیت نشسته قرار گیرید و مقداری به جلو خم شوید.  برای آرامش و کاهش کشش عضلات شکم حین سرفه ،مفاصل زانو وران راخم کنید  چند بار با لبهای غنچه از طریق بینی نفس بکشید و از دهان خارج کنید.  محل برش جراحی را با استفاده از دست یا بالش یا پتو برا ی جلوگیری از درد حمایت کنید.  درهنگام خارج کردن نفس ( بازدم ) دو بار سرفه عمیق انجام دهید طوری که عضلات شکم منقبض شوند. این کار رابلافاصله بعد از جراحی و به هوش آمدن چند بار در طول روز انجام دهید. 14-37

38. © 2009 The McGraw-Hill Companies, Inc. All rights reserved اسپیرومتری انگیزشی  به مددجو آموزش دهید در وضعیت نیمه نشسته یا نشسته قرارگیرد.  مقیاس ابزار را تنظیم و به مددجو نشان دهید  چگونگی قرار دادن قطعه دهانی اسپیرومتر به طوری که لبها کاملا آن را بپوشاند  آموزش دهید به طور آهسته عمل دم را انجام داده ، جریان هوا را ثابت نگهدارد تا به حجم هدف برسد وبعد تنفس را 2-3 ثانیه نگه دارد. مجددا تکرار کند. 14-38

39. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 14-39

40. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 14-40

41. © 2009 The McGraw-Hill Companies, Inc. All rights reserved Client Teaching Activity  LEG EXERCISES Dorsi/Plantar flexion, ankle rotation, knee/hip flexion, 5X each leg/hr w.a.  AMBULATION Discuss importance of early ambulation and method for getting out of bed  TURNING AND  POSITIONING Use of side rails 14-41

42. © 2009 The McGraw-Hill Companies, Inc. All rights reserved ورزشهای ساق پا مانند :  هر مچ پا را در یک دایره کامل بچرخاند. به مددجو آموزش دهید تا با شست پای خود یک دایره فرضی ترسیم کند. این کار را چند بار تکرار کند.  به طور متناوب هر دو پا را از ناحیه مچ به سمت بالا و پائین خم کنیدو باید احساس کند ماهیچه های پا منبسط و منقبض شوند.  تمرینات چهارسر ران را با سفت کردن ران و پایین آوردن زانو به سمت تشک انجام دهد. 14-42

43. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 14-43

44. © 2009 The McGraw-Hill Companies, Inc. All rights reserved Leg Exercises and Foot Exercises 14-44

45. © 2009 The McGraw-Hill Companies, Inc. All rights reserved چرخیدن در تخت  در وضعیت به پشت خوابیده به یک سمت تخت حرکت کند و سپس با خم کردن زانو و فشار دادن پاشنه های پا روی تشک باسن را بلند کند و به راست و چپ بغلتد. با گذاشتن بالش یا دست روی ناحیه عمل شده بخیه راحمایت و در تخت بچرخد.  به مددجو آموزش دهید در هنگام بیداری هر 2 ساعت در تخت بچرخد. 14-45

46. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 14-46 Educating Patients with Special Needs  Elderly patients Show respect Put information in writing Adjust procedures as needed when limitations are present

47. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 14-47 Educating Patients with Special Needs (cont.)  Patients with mental impairments Use tact and empathy Speak at the patient’s level of understanding Common conditions  Dementia  Alzheimer’s disease  Emotional problems  Drug addiction  Mental retardation

48. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 14-48  Patients with hearing impairments The ability to hear is not a measure of intelligence  Patients with visual impairments Use normal tone of voice Verify that all verbal instructions have been heard correctly  Multicultural issues Patients from diverse cultures may have different beliefs about the causes and treatments of their illness. Educating Patients with Special Needs (cont.)

49. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 14-49  Patients who cannot read well or cannot speak or understand English Use pictures and charts Translations Family or friends may be able to read it to them The Patient Information Packet: Special Concerns

50. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 14-50 Good Nutrition Regular Exercise Adequate Rest Healthful Habits Promoting Good Health Through Education: Healthful Habits

51. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 14-51 Balance Work Leisure No Smoking Limit Alcohol Intake Healthful Habits Promoting Good Health Through Education: Healthful Habits

52. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 14-52  Safety tips to prevent injuries At home At work At play  Proper use of medications Do not change dosage Do not mix medications Report unusual reactions Tell doctor about any OTC medications Protection from Injury Promoting Good Health Through Education: Protection from Injury

53. © 2009 The McGraw-Hill Companies, Inc. All rights reserved In Summary  Patient education is key to patient care  Knowledgeable patient Active in own medical care Aware of benefits of activities to promote and protect health  Reasons for patient education Understand condition Prepare for procedures Policies of office  Use resources available

54. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 14-54

55. © 2009 The McGraw-Hill Companies, Inc. All rights reserved 14-55

56. © 2009 The McGraw-Hill Companies, Inc. All rights reserved