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Strategies for improving the quality of verbal patient and family education: A review of the literature and creation of the EDUCATE model


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Objective: Patient and family education includes print, audio-visual methods, demonstration, and verbal instruction. Our objective was to study verbal instruction as a component of patient and family education and make recommendations for best practices for healthcare providers who use this method. Methods: We conducted a literature review of articles from 1990 to 2014 about verbal education and collaborated on departmental presentations to determine best practices. A survey was sent to all nursing staff to determine perceptions of verbal education and barriers to learning. Results: Through our work, we were able to identify verbal education models, best practices, and needs. We then constructed the EDUCATE model of verbal education, which built upon our findings. Conclusion: Verbal education of patients and family members requires a multidisciplinary approach that takes into account learning styles, literacy, and culture to apply clear communication and methods for the assessment of learning. Providers need the skills, time, and training to effectively perform patient and family verbal education every time they care for patients. Further research needs to be performed on how to test, document, and quantify patients' comprehension and retention of verbal instructions.
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Strategies for improving the quality of verbal patient and family education:
a review of the literature and creation of the EDUCATE model
Cara Marcus
Director of Library Services, Brigham and Womens Faulkner Hospital, Boston, MA, USA
(Received 14 November 2013; accepted 28 February 2014)
Objective: Patient and family education includes print, audio-visual methods, demonstration, and
verbal instruction. Our objective was to study verbal instruction as a component of patient and
family education and make recommendations for best practices for healthcare providers who
use this method. Methods: We conducted a literature review of articles from 1990 to 2014
about verbal education and collaborated on departmental presentations to determine best
practices. A survey was sent to all nursing staff to determine perceptions of verbal education
and barriers to learning. Results: Through our work, we were able to identify verbal education
models, best practices, and needs. We then constructed the EDUCATE model of verbal
education, which built upon our ndings. Conclusion: Verbal education of patients and family
members requires a multidisciplinary approach that takes into account learning styles, literacy,
and culture to apply clear communication and methods for the assessment of learning.
Providers need the skills, time, and training to effectively perform patient and family verbal
education every time they care for patients. Further research needs to be performed on how to
test, document, and quantify patients comprehension and retention of verbal instructions.
Keywords: patient education; communication; interpersonal relations; health literacy;
communication barriers; health education; teach-back
1. Introduction
The need for patient education is widely recognized in the medical community (Behar-Horenstein
et al., 2005 ). Well-educated patients are better able to understand and manage their own health and
medical care throughout their lives. Patientprovider communication is a key element of patient
education and is often used in conjunc tion with other teaching practices. Communication is effec-
tive when patients receive accurate, timely, complete, and unambiguous messages from providers
in ways that enab le them to participate responsibly in their care. Patient understanding of infor-
mation communicated by healthcare providers can lead to enhanced patient satisfaction, better
compliance with treatment instructions, improved outcome s, and decreased treatment times
and costs (Behar-Horenstein et al., 2005; The Joint Commission, 2010). Patient education is
also a requirement for accreditation of healthcare facilities.
In a study of adult patients and visitors enrolled at four Boston-area emergency departments
(N = 1010), 24% of participants listed speaking with an expert as their preferred educational
modality. That metric was even higher for various demographic groups: 32% of Hispanic respon-
dents and those with less than a high school education preferred verbal education (Kit Delgado,
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Health Psychology & Behavioural Medicine, 2014
Vol. 2, No. 1, 482495,
Ginde, Pallin, & Camargo, 2010). Effective verbal patient education has been s hown to improve
the patients ability to care for him or herself post-discharge, thus reducing morbidity and
mortality. Patient education has also resulted in improvements in the patients hospitalization
experiences, including lessening of pain and anxiety (Montin, Johansson, Kettunen, Katajisto,
& Leino-Kilpi, 2010). If improved communication results in better self-care, future medical inter-
ventions may be needed less frequently (Kripalani & Weiss, 2006).
Not all patient education is successful. In reality, communication is often partially understood,
misunderstood, or misinterpreted. Even with the best of intentions, patient education that fails to
educate can lead to adverse events or poor outcomes. The Joint Commission studied patientpro-
vider communication as the root cause of sentinel events and found that poor oral communication
caused 10% of these events (The Joint Commission, 2010).
The Brigham and Womens Faulkner Hospital (BW FH) Patient/Family Education Committee
set out to explore literature on verbal education and barriers to effective education. Our goal was to
share our own internal methodologies and develop a new model of verbal education that included
recommendations for best practices for healthcare institutions and providers. While verbal edu-
cation should be just one part of an integrated, multimodal patient education session, it is vital
that it be delivered in a fashion that augments the patients learning, comprehension, and retention.
2. Methods
BWFH is a 150-bed non-prot, community teaching hospital located in Jamaica Plain, Massachusetts.
The BWFH Patient/Family Education Committee develops and implements standardized, easily
accessible patient education processes and resources in accordance with regulatory requirements.
The multidisciplinary committee includes members from nursing, medicine, administration, allied
health, nutrition, physical therapy, pharmacy, social work, library services, and the patient population.
In 2010, the committee prioritized initiatives through a brainstorming session, multi-voting
process, criteria grid, and impact matrix. Our brainstorming session identied the following pro-
jects that our committee saw as priorities at the time:
Brochure inventory
Cultural competency
Educational TV
Identication of learning styles
New employee orientation
Online resources
Patient education packets
Patient/Family Resource Center
Verbal education
Subcommittees were set up within the committee to present the three priority projects selected at
the rst meeting (inventory, educational TV, and verbal education). The verbal education subcom-
mittee consisted of a physician, a nurse, and a dietitian. The three projects were assessed through
an impact matrix for their feasibility, cost not to x (this includes monetary and public health
costs), and impact on the problem.
Verbal education became our initial priority project as the committee discussed that this method
was used in every patientprovider encounter and often was used in conjunction with additional
forms of education, such as written material. We would address the following focus areas: (1)
Health Psychology and Behavioral Medicine 483
identifying the learner, (2) assessment of comprehension, (3) continuous education, and (4) docu-
mentation of education. We planned to develop guidelines and staff training in these areas.
The committee conducted a literature review of articles from 1990 to present utilizing the fol-
lowing databases: EBSCO CINAHL, GALE InfoTrac Health Reference Center Academic, MD
Consult, OVID Journals Database, ProQuest Nursing and Allied Health, and PubMed. Search
terms included verbal education, oral education, patient education AND communication,
patient education AND oral, patient education AND verbal, physicianpatient communication,
and nursepatient communication. We included articles that addressed one or more of the four
focus areas identied by the committee. Committee members were asked to volunteer to read
one or more articles and report their ndings to the group. In addition to the literature review,
committee members presented their own approaches to delivery of verbal education within
their disciplines (Table 2). The summary of our own approaches was also used to help us formu-
late a model of best practices. We also conducted an online survey of the nursing staff on patient
education practices, which helped determine needs surrounding verbal instruction.
3. Review
3.1. Effectiveness of verbal education
The literature review identi ed studies involving verbal education of various demographic groups
(children, the elderly, those with hearing impairment, etc.) In addition, studies were conducted
surrounding education of patients undergoing treatment for various conditions (cancer, cardiol-
ogy, orthopedics, etc.).
Posma, van Weert, Jansen, and Bensing (2009 ) studied 38 patients and found that they wanted
to receive concrete information about their disease and treatment, such as diagnosis, prognosis,
treatment side-effects, possible complications, and other practical information. This study
found that older patients beneted from a question list prepared to discuss subjects during
patient education sessions.
Johnson and Sandford (2005) conducted a systematic Cochrane review that compared written
with verbal information to verbal information only in a study of parents of children with health
problems. In the two trials selected by the study, ndings indicated that parents were more knowl-
edgeable and satised with the combination of written and verbal information than verbal edu-
cation alone. The combination of the information improved parents scores signicantly in
terms of knowledge of medications and how to recognize signs of improvement and concern.
In a study of 61 patients (Behar-Horenstein et al., 2005), cardiac patients provided more specic
information to their providers about their conditions than general medical patients, resulting in
better patient provider communication. Overall, the patients reported that they received most of
their information from verbal interactions they had with doctors and nurses. The majority of the
verbal education was perceived by the patients as effective. Nearly three-fourths of the patients
(n = 45) stated that they were satised with the information they received and the methods hospital
staff used to teach them. Only 5% of patients claimed that they received little or no information on
signs and symptoms, and only 5% of patients seemed uninformed about their medications.
In a prospective, blinded, randomized, controlled study of 605 patients (Liu et al., 2014), only 9%
of patients showed non-compliance with instructions after receiving telephone-based re-education on
the day before colonoscopy versus 32.6% of patients who did not receive the verbal re-education.
None of the articles we reviewed developed an approach to quantitatively measure the effec-
tiveness of verbal education; studies have focused on qualitative perceptions of its effectiveness
and/or patient satisfaction with education received. Research still needs to be performed on how
to test, document, and quantify patients comprehension and retention of verbal instructions
before and after various provider interventions.
484 C. Marcus
3.2. Identifying the learner
Patient education is a Joint Commission requirement for hospital accreditation. The hospital pro-
vides patient education and training based on each patients needs and abilities (PC.02.03.01).
The hospital performs a learning needs assessment for each patient, which includes the patients
cultural and religious beliefs, emotional barriers, desire and motivation to learn, physical or cog-
nitive limitations, and barriers to communication (EP 1). The hospital respects the patients right
to receive information in a manner he or she understands (RI.01.01.03) (The Joint Commission ,
To offer the highest quality verbal education, a healthcare provider must understand the
patients background, reading level, and how he or she learns best. Different people have different
abilities to learn, and providers need to understand what distinct learning preferences and needs
the patient may have (Anonymous, 2000; Montin et al., 2010; Posma et al., 2009). After the pro-
vider understands the patients optimal method of learning, he or she can adjust the teaching and
training strategy to incorporate many techniques, including demonstrations, diagrams, reinforce-
ment, review, teach-back, support, etc. (Anonymous, 2000).
Cultural, cognitive, and physical differences require different educational approaches (Goody &
Drago, 2009). For example, Lieu et al. (2007) recommended that providers communicating with deaf
patients should make eye contact, may need to write to communicate, but never assume that there is
an exact translation of medical terms into sign language. In another study focusing on hearing-
impaired patients, Tye-Murray (1992) empathized that it helps if the provider anticipates hearing
loss and the patient may be able to prepare for communication by reading or writing words that
he or she wants to know about. For patients whose preferred learning style is not verbal communi-
cation, Behar-Horenstein et al. (2005) recommended that providers broaden the use of alternative
instructional aids and methods of delivery that utilize auditory, visual, and kinesthetic modalities.
Pictures on paper or a screen may serve as simple visual aids to supplement verbal education.
Differences in communication and learning may stem from a variety of factors, including age,
gender, ethnicity, or level of education. Elderkin-Thompson and Waitzkin (1999) compared
research on communication by men and women as both providers and patients. This study ident-
ied a great many differences in communication styles among genders, such as providers com-
municating more with female patients by giving them more time and using easier terminology.
The authors also found that women generally use discussion to clarify explanations, while men
often present problems and expect to resolve them. The research also focused on socioeconomic
groups; for example, providers usually give more emotional support to poorer patients.
Articles in our review identied roadblocks to education, particularly low literacy
(Anonymous, 2000; Owen, 2005). Anyone, even highly literate people, may not be healthcare
literate. Providers need to assess patients for their level of literacy prior to providing education.
An assessment may include interviews with patient or family members, communication with
members of the medical team, or observations of patients (Behar-Horenstein et al., 2005). Provi-
ders may be able to assess poor literacy in verbal interactions if the patient asks questions about
what has already been explained, asks irrelevant questions, or provides unusual or irrelevant
answers to questions (Remshardt, 2011). Another method to identify patients learning styles is
asking what help is needed with understanding medical information (Posma et al., 2009).
3.3. Patientprovider communication
When patient education is delivered verbally as part of a multimodal patient education program,
the provider assumes the role of the teacher and the patient that of the learner. Richard and Lussier
(2007) found that providerpatient discussions have often been regarded as interactive in nature.
Health Psychology and Behavioral Medicine 485
However, this study found that resulting dialogue mainly consisted of separate monologues, with
insufcient real exchange in understanding of the other participants perspective. The authors
described how physicians often adopted the Information Provider role in discussions involving
medications, and patients the Listener role, often signicantly limiting their active input. When
patients did have some prior knowledge of medications related to their care, discussions with their
providers tended to be more interactive, resulting in improved outcomes. Further research is
needed to determine what ideal provider and patient communication roles should be. While
this may prove elusive, various art icles have focused on wa ys providers can improve communi-
cation. For example, Skorpen and Malterud (1997) described communication based on mutual
Talen, Grampp, Tucker, and Schultz (2008) addressed what providers needed from patients to
have positive verbal interactions. The patient should have knowledge of his or her medical history
and prescriptions and have an attitude that is focused on the treatment plan and the need for
follow-up care. Education can be improved by providing supportive staff to help patients and pre-
paring worksheets with questions for the patient to ask in advance. Talen et al. stressed that
patients can be trained to communicate more effectively with their providers, thus improving
their ability to have a conversation that results in better understanding.
3.4. Comprehension and retention
Patient education is ineffective if the patient fails to understand what is being taught. However,
patients may not even be aware that they do not understand what is being taught to them. In a
study of two teaching hospitals (Engel et al., 2009), the majority of patients with comprehension
decits failed to perceive that they had any deciencies. Only about 20% of patients in this study
reported comprehension difculties, but about 78% of the patients demonstrated a comprehen-
sion deciency in at least one domain of their visit. Many patients had poor comprehension of
multiple aspects of their emergency department care and discharge instructions in this study.
Another study by Margolis (2004) found that patients retained about 50% of information by
health care providers, and about half of that was remembered correctly.
The ability to comprehend and retain information may decline as patients and family members
age; Posma et al. (2009) studied 38 patients and found that older people had more difculties pro-
cessing and remembering information than younger ones. Barriers to information retention may
also include anxiety, denial, memory decits, pain, stress, or unfamiliarity (Anonymous, 2000;
Margolis, 2004). Talen et al. (2008) found that higher satisfaction with patientprovider com-
munication correlated to the patients ability to remember his or her providers recommendations
and comply with the instructions. These factors are some of many that may affect the individuals
ability to process and comprehend verbal education.
3.5. A multidisciplinary approach
Patient and family education should exist throughout the continuu m of care. A team of healthcare
providers should teach the patient and loved ones about disease management, medications, post-
discharge management, and advice on when and how to seek medical attention following
Nurses play a critical role in the education of patients. In a study of more than 400 orthopedic
operations, pati ents who preoperatively visited their nurse reported receipt of more knowledge
about their condition than other patients (Montin et al., 2010). A hospital instituted an effective
verbal education program where chemotherapy information was provided by oncology nurses
during a consultation lasting approximately one hour. A booklet was often used to supplement
486 C. Marcus
the verbal consultations. The consultation usually took place two weeks to one day before the rst
treatment started (Posma et al., 2009 ). Vreeland, Rea, and Montgomery (2011) conducted an evi-
dence-based review of the literature on heart failure and discharge education. They recommended
that the optimal patient education would be a structured, one-on-one session with a specialized
registered nurse and repetition of the information by the staff during care.
Physicians provide verbal education during every communication encounter. Richard and
Lussier (2007) conducted a descriptive study of medication-related exchanges during
1492 consultations between patients and general practitioners. The authors identied physicians
clinical expertise as technical knowledge that patients do not generally share to any great extent
and suggested that physicians can build on patients own knowledge and experience to increase
Many other providers and practitioners play a crucial part in patient education and counseling,
including social workers, rehabilitation therapists, home healthcare workers, educators, patient
advocates, librarians, etc. Each provider should work individually and collaboratively. Case man-
agers can become facilitators for recognizing gaps in patient education and putting an appropriate
plan in place given the patients needs (Owen, 2005). Behar-Horenstein et al. (2005) surveyed
patients about their education and found that about 12% received information from dietitians
or pharmacists, with slightly less reporting receiving information from physical therapists or
transplant coordinators. Cant and Aroni (2008) stressed that dietitians needed to display a high
level of communication competence because the purpose of their communication had the edu-
cation of a patient as a goal. A hospital developed a scripted patient education tool so that research
pharmacists could conduct 45 minute one-on-one patient education sessions (N = 528). Following
the patient education sessions, patients were given the opportunity to ask questions or voice con-
cerns. Medication adherence increased to 94.4%, compared to 89.9% in the pre-intervention
group (P < .0001) (Piazza et al., 2012).
Kruzik (2009) described a team-based initiative that offered a free preoperative program to
surgical patients and allowed patients a chance to meet team members, ask questions, and get
immediate feedback. This approach led to more positive educational experiences.
The literature als o discussed the patients role in the communication process. Avitzur (2011),
medical advisor to the Consumers Union, identied steps that patients could take to improve
communication with their doctor, such as not providing superuous information and using
clear, descriptive language to describe the patients main problem.
4. Models of verbal education
Three verbal education models were identied in our literature review. These models addressed
aspects of knowledge, communication competencies, educational methodologies, and communi-
cation assessment (Table 1).
Table 1. Models of verbal education identied in the literature review.
1. Six dimensions
of knowledge 2. Four main communication competencies 3. Suite of tools
Biophysiological Interpersonal communication Health information needs
Functional Nonverbal communication Health information behaviors
Experiential Professional values
Ethical Counseling skill
Health Psychology and Behavioral Medicine 487
Model 1 (Montin et al., 2010) followed a sample of 123 total joint arthroplasty patients and
found that perceived knowledge was highest in the area of biophysiological and functional.
Model 2 (Cant & Aroni, 2008) demonstrated that no single skill set operated alone; all were required
to be applied in concert to enable effective communication with patients. In their model, they devel-
oped specic performance indicators surrounding each competency, such as Introducing myself to
my clients is important as a component of the professional values competency. The Consumer
Health Education Institute (CHEDI) at the University of Virginia developed a model system to
create a suite of tools to assist practitioners (1) assess patients and consumers personal character-
istics and preferences for health information, (2) segment patients and consumers into groups that
minimize differences within groups and maximizes differences between groups, and (3) match
groups to the health information that most directly meets their needs and preferences (Cohn
et al., 2006). CHEDI identied segments of patients, such as those with low literacy, and then devel-
oped requirements for health education for those segments, such as avoiding medical jargon.
Table 2 is a summary of presentations given by various departments and services at our insti-
tution on their own best practices in verbal education.
Based on our literature review and presentations of best practices, the committee developed a
process-based model that leads the educator through ve stages of verbal education to reach
teaching and education goals: the EDUCATE model (Table 3).
5. Results
In our online survey of nursing staff (n = 46), 81% of the respondents felt that their experience and
knowledge were shared verbally as part of the patient and family educ ation process. The survey
asked the strengths of patient education at the hospital, the responses (n = 31) included nurses,
experienced multidisciplinary staff, knowledge base, experienced staff, the nursing staff,
nursing staffs expertise, and the experience of nurses.
The survey also identied barriers to verbal education (n = 30) that echoed our ndings in the
literature review:
Nurses need more time to listen to and teach patients and families.
Not all patients are alike.
Patients needs are not always known until they are on the unit.
The timing of education needs to be right.
When new issues arise, there needs to be a process so the nurse can teach that issue.
There needs to be communication between surgeons and the family on what to expect after
Teaching needs to begin in physiciansofce at the preoperative visit.
Caring for a patient alone can be difcult.
There needs to be a method to follow-up on whether patients really understood what they
were taught.
6. Discussion
While many articles in our literature review have focused on issues surrounding patient education
handouts, classes, video, and online information, we found less research addressing one-on-one
verbal education of patients. Verbal education is usually not, and should not, be delivered alone as
the only method of patient education. The articles our committee reviewed echoed common
themes addressing difculties encountered in providing and measuring this type of education.
While some articles studied specic populations and provided practice recommendations for
488 C. Marcus
Table 2. Summary of presentations on success strategies used in practice.
Home healthcare Library services Nutrition
E Give patients information in small increments, so that
the patient can build on each block of information
D Teach the patient problem solving skills
Try to motivate the patient to gain information, skills,
and condence so that they can make informed
decisions about their health
U Consumer health library staff can play a role in patient education
through the reference interview to nd out the patients
information needs and learning abilities in order to provide
them with resources that they can learn from and share with
their providers
C Professional tools like conversation maps may be helpful in
aiding communication
A Address the patients current living situation, barriers the
patient may be facing in complying with instructions
and the patients motivation and level of condence
Rehabilitation Social work Surgery
E Patients are instructed how to perform exercises and
each time they come, the exercise is reviewed and
changes are demonstrated
A nurse discusses the surgery with the patient at least one week
before. It is also recommended that there should be verbal
education early on by the patients physician. Patients are asked
to call in the day before surgery to review the information
Face-to-face is the best way to communicate because a provider
can assess if the patient really understands
D Try to get an understanding of the patient how they connect with
family, what support systems are in place, and how their
environment impacts their care
Try to assess if the person is taking in the information presented to
them and what stressors are in the way. If they are anxious, try
to nd out what the source of the anxiety is
Try to get the person engaged in conversation and nd topics that
the patient feels comfortable talking about
Try to establish a relationship with the patient
C Patients have the opportunity to ask many questions and
are given expectations throughout treatment
A Visual tools usually supplement verbal education
Notes: (E) Enhance comprehension and retention; (D) deliver patient-centered education; (U) understand the learner; (C) communicate clearly and effectively; (A) address health literacy
and cultural competence.
Health Psychology and Behavioral Medicine 489
Table 3. EDUCATE model for verbal education.
Enhance comprehension
and retention
Deliver patient-centered
education Understand the learner
Communicate clearly and
Address health literacy and
cultural competence
Teaching and
education goals
Use a question list so that
patients can ask
questions and providers
can answer them
(Posma et al., 2009)
Talk to NOT AT
people (Anonymous,
2008; Behar-
Horenstein et al.,
Find out what the patient
already knows before
providing information;
ask, What do you
already know about high
blood pressure?
(Kripalani & Weiss,
New communication skills
require practice to use
them effectively and
structured skill
development exercises
may be helpful for
providers. (Kripalani &
Weiss, 2006)
Ask patients, Do you need
help understanding
health information?
(The Joint Commission,
for teaching
and learning
Repeat the most important
information (Margolis,
2004) and increase the
frequency of the
message exposure
through several
repetitions (Ronco,
Iona, Fabbro, Bulfone,
& Palese, 2012;
Takemura et al., 2011)
Practice empathetic skills
especially when the
view of the patient is
different from that of
the provider (Cant &
Aroni, 2008; Posma
et al., 2009; Skorpen &
Malterud, 1997)
Be aware of nonverbal
messages when
delivering verbal
including gestures, body
language, and dress
(Cant & Aroni, 2008)
Present the most important
information rst
(Margolis, 2004).
Emphasize one to three
key points (Kripalani &
eiss, 2006). Focus on
one issue at a time
(Avitzur, 2011). Present
the information in
logical blocks
(Remshardt, 2011). Use
concrete instructions
(Margolis, 2004)
Supplement verbal
education with simple
written and visual
materials (Anonymous,
2008; Behar-Horenstein
et al., 2005; Margolis,
2004); however, the
materials should be used
for reinforcement and not
to replace verbal
instruction or direct
interaction (Anonymous,
Good teaching
Ask patients to repeat
information in their own
words (Engel et al.,
Ask patients about their
life experiences and
use to teach (Montin
et al., 2010). Use
metaphors comparing
the patients care to
their life situation
(Anonymous, 2008;
et al., 2005)
Determine the patients
barriers to health literacy
(Paasche-Orlow, 2011).
Assessing the ability to
learn may include
interview or observation
(Behar-Horenstein et al.,
Use easy to understand
language (Kripalani &
Weiss, 2006; Margolis,
2004; Posma et al.,
Use an interpreter if a
patient requires one due
to language or disability
(Dreger, 2001; Lieu et al.,
2007). Avoid using
technical terminology or
medical jargon (The Joint
Commission, 2010)
barriers to
490 C. Marcus
Provide information in
several different ways to
make sure the patient
understands (Skorpen &
Malterud, 1997).
Audiotapes of patient
consultations can be
effective for patient
recall of verbal
education (Friedman,
Cosby, Boyko, Hatton-
Bauer, & Turnbull,
Pay attention to the
patients worries and
fears and try to dispel
them (Posma et al.,
On many occasions family
members also need to be
educated (e.g. pain
management) (Behar-
Horenstein et al., 2005)
Patients must be given an
opportunity to ask
questions prior to
discharge. Give them
time to speak
(Anonymous, 2008;
Behar-Horenstein et al.,
A scripted tool may help
providers verbalize
clearer and more
understandable patient
education (Piazza et al.,
Teaching as an
Use the teach-back method
(Anonymous, 2008;
Kripalani & Weiss,
2006; The Joint
Commission, 2010)
Ask patients to state their
goals of medical care
to begin a discussion
(Paasche-Orlow, 2011)
Realize that patients may
not even be aware that
they do not understand
what is being
communicated to them
(Engel et al., 2009)
Audiotapes of patient
consultations can be
effective for patient
recall of verbal
education (Friedman
et al., 2011)
Do not just ask the patient,
Do you understand?.
Regardless of their
ability to understand,
many patients may still
answer Yes (The Joint
Commission, 2010)
Assessment of
Note: The last column of the EDUCATE model stands for T and E, Teaching and Education goals, which outlines principles of the model as they relate to the models individual
Health Psychology and Behavioral Medicine 491
verbal education to those groups, we found a lack of literature on the ideal verbal education
encounter. Measurement of effective verbal education focused mainly on obtaining qualitative
patient satisfaction feedback with the instructions received.
The best practices we identied suggest goals providers should strive for when educating
patients verbally. Providers should be empathetic and pay attention to patients fears. Practices
like using concrete instructions may be considered common sense, but may be difcult to
achieve unless one focuses on doing s o. Effective patient education practices need to be
learned and reinforced by staff educators in order to become part of the everyday provider care
environment. There is a well-known marketing adage called The Rule of Seven, which
states that someone needs to see or hear your marketing message at least seven times before
they take action and buy from you (Hammer & Stanton, 1995).
In their study, Richard and Lussier (2007) concluded that there is no ideal patient education
conversation. Medical terminology itself is a huge challenge; many of the words that describe
medical conditions and treatments are long and multisyllabic and there are no short synonyms.
Even seemingly normal words, like diet may be interpreted differently (e.g. all the calories
a person consumes, an organized effort to lose weight, etc.) (Paasche-Orlow, 2011). However,
providers can make a dedicated effort to avoid lingo, which may be so ingrained in speech
that this will require concentration and willpower.
Two of the more challenging aspects of verbal education are nding out what the patient needs
to know (understand the learner) and, after the education has been completed, determini ng if the
patient understood it (enhance comprehension and retention). Providers should conduct health lit-
eracy assessments. Certain patients are extremely knowledgeable about their conditions and the
consultation can build upon that. An assessment is also a way to nd out if there are going to be
literacy, disability, or cultural issues. The same education will obviously not apply to every
patient. Teach-back tools, such as the Ask-Me-3 program, are recommended for assessing
whether the education has been effective. Teach-back includes asking questions to assess what
the patient has learned from their education, offering feedback to focus on aspects not understood,
and then reevaluating with additional questions to determine if the patient has learned the infor-
mation (Paasche-Orlow, 2011).
However, even if the patient appears to understand the teaching during a verbal consultation,
this does not assure the ability for self-care when the patient goes home. Patients must be able to
manage and commit to their own healthcare for the education to be effective (Committee on
Patient Safety and Quality Improvement, Committee on Health Care for Underserved Women,
American College of Obstetricians and Gynecologists, & Committee Opinion Number 585,
2014). Throughout the patients medical care, there will be numerous providers teaching the
patient, all with different approaches and areas of expertise. Patients need time to understand
and absorb the messages their doctors, nurses, and other caregivers provide.
Education also does not necessarily lead to behavioral change. Questions for further research
include how one should relate learning to behavioral compliance, and what educators long-term
roles should be in the spectrum of health and wellness.
The ongoing challenge to healthcare organizations is training the frontline staff responsible for
educating patients. Programs like the American Medical Associations Health Literacy Train-the-
Trainer Program teaches health care professionals how to conduct health literacy programs, which
may in turn improve provider education and communication (Maniaci, Heckman, & Dawson, 2008).
7. Conclusion
What verbal patient and family education depends upon is the approach and content of patient
provider communication. Our research indicates that there are many complex parameters that
492 C. Marcus
inuence this communication, such as the patients learning style, literacy level, culture, environ-
ment, etc. By incorporating our simple EDUCATE model into staff education and professional
practice, healthcare providers can help guide verbal education to be more patient and family cen-
tered. It will be a modication to the providers current communication styles to incorporate the
models teaching and learning goals into their everyday conversations.
Not all areas of the tool need to be used in all encounters. The EDUCATE model is structured
so that providers can apply modules applicable to the individual teaching situation. In its entirety,
the model addresses the commonly encountered impediments and obstacles we have identied, as
well as provides specic recommendations for modication.
To raise awareness of our ndings and educate the hospital staff about our committees
project, we sponsored a presentation on verbal education at a meeting of department heads of
our organization and published an article in the hospital newslette r Faulkner Nurse (Marcus,
2011). We also piloted a modied Ask-Me-3 handout and poster in our Rehabilitation Department
to raise awareness of this type of tool. Ask-Me-3 is a tool developed by the National Patient Safety
Foundation that asks three questions: (1) What is my main problem? (2) What do I need to do?,
and (3) Why is it important for m e to do this? (National Patient Safety Foundation, 2013 ). After
educating patients, providers teach-back by asking patients the same questions to test if the
learning occurred.
The next steps for our committee are to develop methods of determining whether provider
education is comprehended by patients and their families. While our Ask-Me-3 pilot wa s well
received by patients, we realized that we would need a way to document receipt of patient edu-
cation and change brought about by teach-back tools. We are investigating ways to best document
patient education encounters, which will enhance patient care and outcomes beyond the initial
encounter and throughout the spectrum of the patients healthcare continuum.
The author thanks the members of the Brigham and Womens Faulkner Hospital Patient/Family Education
Committee who worked on this project for their time, presentations, literature and manuscript review, and
thoughtful recommendations: Christi Barney, Lisa Cole, Noreen Connolly (Committee Co-Chair),
Maureen Fischer, Jean Flanagan Jay (Ask-Me-3 pilot), Kimberlee Frasso, Ellen Fusfeld, Georgette
Hurrell (developer of nurse survey), Kerstin Palm (Ask-Me-3 pilot), Kitty Rafferty, Peggy Tomasini,
Shannon Vukosa, and John Wright. Christi Barney and Noreen Connollys thorough review and suggestions
for this article were greatly appreciated.
The author gratefully acknowledges contributions and assistance from the following individuals and
departments: BWFH Information Systems, Rebecca Blair, Kathy Duckett (presenter at department head
meeting), Carolyn Geoghegan, Sally Gore, Paula Knotts, Megan McAlpine, Pat McCarthy, Bruce Mattus,
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... Nursing care for children with OSA may require creative and interactive methods for educating them on the importance of treatment adherence as wel as involving family members more heavily than in care for adults. On the other hand adults may require a different and maybe more straightforward explanation of OSA and its treatment [78,79]. The symptoms and treatment of OSA in paediatric and adult patients are unique. ...
... Nursing care for children with OSA may require creative and interactive methods for educating them on the importance of treatment adherence as well as involving family members more heavily than in care for adults. On the other hand, adults may require a different and maybe more straightforward explanation of OSA and its treatment [78,79]. ...
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Citation: El Arab, R.A.; Sánchez-de-la-Torre, M.; Valenzuela-Pascual, F.; Rubinat-Arnaldo, E.; Blanco-Blanco, J.; Rubí-Carnacea, F.; Martinez-Navarro, O.; Mediano, O.; Gea-Sánchez, M. Nursing Professionals' Role in the Comprehensive Management of Obstructive Sleep Apnoea: A Literature Review. Appl. Sci. 2023, 13, 3516. https://doi. Abstract: Background: obstructive sleep apnoea is a common and burdensome condition, char-acterised by obstruction of the airway during sleep at the level of the pharynx, which may occur with symptoms or without any symptoms. The most common place for obstructive sleep apnoea management is in specialised sleep units. Aim: to identify what is known about nurses' role in comprehensive management of obstructive sleep apnoea, and to determine the effectiveness of nurse-led interventions as well as the cost effectiveness of management of obstructive sleep apnoea in primary care settings. Methods: a scoping review was carried out by searching PubMed/Medline, CINAHL, Scopus, Cochrane Database of Systematic Reviews and ScienceDirect. The study findings were synthesised using a thematic analysis approach. Results: In this review, 12 articles were included, and three key themes emerged, namely the role of nurses in the diagnosis of obstructive sleep apnoea, role of nurses in the follow up and support of obstructive sleep apnoea patients, and role of nurses in the management of obstructive sleep apnoea in primary care and the cost-effectiveness. Conclusion: Nurses can play a critical role in obstructive sleep apnoea. There are many ways in which nurses can contribute, including screening, assessment, diagnosis, promotion of therapy adherence, and following up with patients, including monitoring for any side effects associated with the CPAP machine, such as irritation of the face. Additionally, nurses can provide patient education and coordinate with other health care providers. Nursing interventions such as patient education have been demonstrated to be highly effective in promoting adherence to PAP therapy in both sleep units and primary care settings. Based on the findings of this review, the primary care model is more cost-effective than the sleep unit model in the management of obstructive sleep apnoea patients. The role of nurses in managing Obstructive Sleep Apnoea in both paediatric and adult populations shares similarities, but also includes differences that should be carefully considered and explored. In this review, one article only explored the role of nurses in paediatric OSA care. Thus, there is a need to identify the potential role of nursing in the comprehensive management of paediatric obstructive sleep apnoea, as well as to explore alternative cost-effective approaches that include primary care settings.
... Another issue is that families often do not return for their education appointment following hospital discharge. Providing education during an acute care visit to the hospital, is attractive in terms of capitalizing on a captive audience, but is often unsuccessful due to the anxiety and fatigue of parents who are actively supporting a sick child [7] . Virtual asthma education can overcome many of these barriers but has not been well studied for its e cacy or family/patient acceptance. ...
... Small classroom sizes pose an infection control/safety risk, even pre-pandemic, and have restricted the access of the virally-triggered hospitalized adolescent patient and symptomatic caregivers to attend group education. However, there is limited capacity for one on one bedside education and many caregivers nd it di cult to concentrate and absorb bedside teaching while also tending to their sick child [7] . Providing adequate supervision of preschool patients while their parent attends a classroom education session is an ongoing challenge, and further limits access to education during the hospital stay. ...
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Background We compared patient and caregiver knowledge and confidence for managing asthma, and participant experiences when comprehensive asthma education was delivered in person versus in the virtual setting. Methods We performed a multi-methods study using structured surveys and qualitative interviews to solicit feedback from patients and caregivers following participation in a comprehensive asthma education session between April 2018 to October 2021. We compared participant knowledge and confidence for managing asthma as well as user experience when the education was attended in-person or virtually. Quantitative responses were summarized descriptively, and qualitative feedback was analyzed for major themes. Results Of 100 caregivers/patients who completed post education satisfaction surveys and interviews, 52 attended in person and 48 virtually, with the mean age of patients being 6.7 years (range: 1.2–17.0). Participant reported gains in knowledge and confidence for asthma management were not different between groups and 65.2% preferred attending virtual asthma education. The majority of participants described virtual education as a safer modality that was more convenient and accessible. Conclusions We demonstrated the successful implementation of a novel, virtual asthma education program for patients and caregivers of children with asthma. Both virtual and in-person delivered asthma education were equally effective for improving perceived knowledge and confidence for asthma self-management and virtual education was considered safer, more convenient and accessible. Virtual asthma education offers an attractive and effective option for improving the reach of quality asthma education programs and may allow more children/patients to benefit.
... A high proportion of surgeons integrated some universal measures of support for health literacy to their clinical encounters and recognized several possible barriers faced by their patients in accessing and using the healthcare system. Improved awareness of the concept of health literacy among some surgeons may have also contributed to longer patient counselling sessions or targeting a lower grade level in language used; practices which are known to improve understanding and retention (Marcus, 2014). ...
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Adequate health literacy is essential to navigate the healthcare system and has a major role in peri-operative care and outcomes. Minimal information exists regarding surgeons’ understanding of health literacy, clinical implications, and awareness of universal measures of support. This study assessed Canadian surgeons’ perceptions of patients’ health literacy and their knowledge of available supportive resources. We conducted a cross-sectional study using an electronic survey distributed to surgeons at academic institutions. Data collected included sociodemographics, health literacy knowledge, and practice surrounding the use of supportive measures. Across four Canadian academic institutions (University of Toronto, McMaster University, University of Alberta, and University of Calgary), 35 surgeons from various surgical specialties, including general, plastic, and orthopedic surgery, completed the survey. Approximately 74% of surgeons reported familiarity with the concept “health literacy”, but they used general impressions to estimate their patients’ health literacy levels. Surgeons’ perceptions were that patients who had proficient health literacy represented 50% or less of their practice. However, knowledge of supportive tools for measuring patient health literacy was variable. Surgeons familiar with health literacy spent significantly more time (>15 minutes) counselling patients (38%, p=0.02) and used language at a 10th grade level or less (92%, p=0.04). Common supportive measures included using simple, non-medical terms (97%, n=34), repetition (83%, n=29), and drawing pictures/diagrams (83%, n=29). This study highlights the importance of surgeon awareness of health literacy and how improved awareness may guide patient-surgeon interactions and improve the quality of care.
... Bunlar; sözel eğitim, yazılı eğitim/ materyal/ broşür ve görsel-işitsel multimedya tabanlı eğitimdir (Abed, 2014;Yıldız, 2015). Sözel eğitim modelinde, hasta ile iletişime girilerek öğrenim gereksinimleri belirlenebilmektedir. Hasta ve ailesini dinlemek ve bilgilendirmek için yeterli sürenin olmaması, eğitim için uygun zamanlamanın yapılamaması, verilen eğitimin hasta tarafından doğru algılanıp algılanmadığının kontrolü için farklı metoda ihtiyaç duyulması sözel eğitimin olumsuz yönleridir(Marcus, 2014). Yazılı eğitim modelinde, broşürler ve materyaller uzun süredir hasta ve ailesini bilgilendirmek ve rehberlik etmek amacıyla verilmektedir. ...
Conference Paper
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Background: To investigate the usability of Mixed-Reality (MR) during patient education in patients scheduled for abdominal aortic aneurysm (AAA) repair. Patients and methods: Consecutive patients scheduled for elective AAA repair were block-randomized in either the Mixed-Reality group (MR group) or the conventional group (control group). Patients of both groups were educated about open and endovascular repair of their respective AAA. The MR group was educated using a head-mounted display (HMD) demonstrating a three-dimensional virtual reconstruction of the respective patient's vascular anatomy. The control group was educated using a conventional two-dimensional monitor to display the patient's vasculature. Outcomes were informational gain as well as patient satisfaction with the educational process. (DRKS-ID: DRKS00025174). Results: 50 patients were included with 25 patients in either group. Both groups demonstrated improvements in scores in the Informational Gain Questionnaire (IGQ) when comparing pre- and post-education scores. (MR group: 6.5 points (±1.8) versus 7.9 points (±1.5); Control group: 6.2 points (±1.8) versus 7.6 points (±1.6); p<0.01) There was no significant difference between the MR group and the control group either in informational gain (MR group: 1.4±1.8; Control group: 1.4±1.8; p=0.5) nor in patient satisfaction scores (MR group: mean 18.3 of maximum 21 points (±3.7); Control group: mean 17 of 21 points (±3.6); p=0.1) Multiple regression revealed no correlation between the use of MR and informational gain or patient satisfaction. Usability of the system was rated high, and patients' subjective assessment of MR was positive. Conclusions: The use of MR in patient education of AAA patients scheduled for elective repair is feasible. While patients reported positively on the use of MR in education, similar levels of informational gain and patient satisfaction can be achieved with MR and conventional methods.
Background: There is some evidence to suggest that discharge education may reduce the risk of postoperative complications, however, a critical evaluation of the body of evidence is needed. Objective: To assess the effect of discharge education interventions versus standard education given to general surgery patients prior to, or up to 30-days of hospital discharge on clinical and patient-reported outcomes. Design: Systematic review and meta-analysis. Clinical outcomes were 30-day surgical site infection incidence and re-admission up to 28 days. Patient-reported outcomes included patient knowledge, self-confidence, satisfaction, and quality of life. Setting: Participants were recruited from hospitals. Participants: Adult general surgical patients. Methods: MEDLINE (Pubmed), CINAHL (EBSCO), EMBASE (Elsevier) and the Cochrane Library were searched in February 2022. Randomised controlled trials and non-randomised studies of interventions published between 2010 and 2022, with adults undergoing general surgical procedures receiving discharge education on surgical recovery, including wound management, were eligible for inclusion. Quality appraisal was undertaken using the Cochrane Risk of Bias 2 and the Risk of Bias Assessment Tool for Nonrandomised Studies. The Grading of Assessment, Development, Recommendations, and Evaluation was used to assess the certainty of the body of evidence based on the outcomes of interest. Results: Ten eligible studies (eight randomised control trials and two non-randomised studies of interventions) with 965 patients were included. Six randomised control trials assessed the effect of discharge education interventions on 28-day readmission (Odds ratio 0.88, 95 % confidence interval 0.56-1.38). Two randomised control trials assessed the effect of discharge education interventions on surgical site infection incidence (Odds ratio = 0.84, 95 % confidence interval 0.39-1.82). The results of the non-randomised studies of interventions were not pooled due to heterogeneity in outcome measures. The risk of bias was either moderate or high for all outcomes, and the body of evidence using GRADE was judged as very low for all outcomes studied. Conclusions: The impact of discharge education on the clinical and patient-reported outcomes of patients undergoing general surgery cannot be determined due to the uncertainty of the evidence base. Despite the increased use of web-based interventions to deliver discharge education to general surgery patients, larger samples in more rigorous multicentre randomised control trials with parallel process evaluations are needed to better understand the effect of discharge education on clinical and patient-reported outcomes. Registration: PROSPERO CRD42021285392. Tweetable abstract: Discharge education may reduce the likelihood of surgical site infection and hospital readmission but the body of evidence is inconclusive.
Introduction While occupational therapy home assessments are effective to identify environmental falls risk factors, patients may not receive these services due to workforce distribution and geographical distances. Technology may offer a new way for occupational therapists to conduct home assessments to identify environmental fall risks. Objectives To (i) explore the feasability of identifying environmental risk factors using smartphone technology, (ii) develop and pilot a suite of procedures for taking smartphone images and (iii) examine the inter-rater reliability and content validity between occupational therapists when assessing smartphone images using a standardised assessment tool. Method Following ethical approval a procedure was developed and participants recruited to submit smartphone images of their bedroom, bathroom and toilet. Two independent occupational therapists then assessed these images using a home safety checklist. Findings were analysed using inferential and descriptive statistics. Results Of 100 volunteers screened, 20 individuals participated. A guideline for instructing patients to take home images was developed and tested. Participants averaged 9.00 minutes (SD 4.401) to complete the task, whilst occupational therapists took approximately 8 minutes to review the images. The inter-rater reliability between the two therapists was 0.740 (95% CI: 0.452–0.888). Conclusion The study found that use of smartphones was to a large extent feasible and conclude that the use of smartphone technologies is a potential complimentary service to traditional home visits. The effective prescription of equipment in this trial was identified as a challenge. The impact on costs and potential falls incidents remains uncertain and more research is warranted in representative populations.
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Background Coronavirus disease 2019 (COVID-19) was first reported in December 2019 and on March 2020, the World Health Organization declared it as pandemic. Patients with Severe Mental Illness (SMI) are the most susceptible population during the pandemic with their impaired cognitive ability, altered insight and judgment and lower awareness of risk resulting incapable of practicing preventive measures. Methods This is a retrospective cross-sectional study employing the quantitative approach to measure the patient satisfaction on COVID-19 psychoeducation. COVID-19 psychoeducation was given by the nurses who were trained to every patient who has been receiving care under the wings of community mental health services, Hamad Medical Corporation (HMC), Qatar. This is the quality improvement project in Mental Health Services (MHS), HMC. At the end of the education session, patients were offered a 11 items questionnaire to assess their satisfaction on COVID-19 psychoeducation provided. Results The patient’s (n = 165) overall satisfaction on the COVID-19 psychoeducation is 91.5%. The educational session was delivered on an individual basis by the nurses could be considered for high satisfaction. Patients who were satisfied with the attitude of education facilitating nurses, found satisfaction with the content and mode of delivery of COVID-19 psychoeducation and satisfaction on the impact of the COVID-19 psychoeducation. Conclusion COVID-19 psychoeducation sessions found to be effective among patients with SMI. It is delivered in Arabic language which could have caused majority of them to identify the contents interested and found satisfied with psychoeducational session. It is recommended to have an online survey to avoid any influences. Keywords:COVID-19; Psychoeducation; Mental illness; Community mental health services; Patient satisfaction
Waiting rooms provide an ideal location to disseminate health information. In this mixed-methods study, we evaluated waiting room–based health education talks at two clinics in the Dominican Republic and explored recommendations for implementing this intervention in similar settings. The talks addressed noncommunicable diseases, sexually transmitted infections, family planning and gender-based violence. We conducted pre- and posttests to assess attendees’ change in knowledge and conducted semi-structured interviews with a subset of them. We conducted a semi-structured focus group with educators. Analyses included Wilcox Signed Rank Tests and McNemar tests for pre- and posttests, conventional content analysis for individual interviews and transcript coding for the focus group. Patient participants were 69.3% female aged 39.6 years (SD = 13.5) on average at one clinic (n = 127) and 100% female aged 17.4 (SD = 1.3) on average at the second clinic (n = 24). Focus group participants (n = 5) had 4.8 years (SD = 3.3) of health educator experience on average. Pre- and posttests showed significant improvement (P < 0.05) across all talks. Qualitative interviews emphasized engaging, clear and brief content delivery with visual aids. The focus group highlighted the importance of patient-centered design with culturally concordant delivery and identified implementation challenges. Findings demonstrate that waiting room–based education talks improve knowledge and provide suggestions for similar interventions.
Acute care therapists routinely screen body systems, activity tolerance, safe mobility, activities of daily living/instrumental activities of daily living performance, cognition, caregiver support, home environment, and risk factors for hospital readmission. Despite most elective procedures, such as joint replacement and spine surgery, which receive automatic orders for acute care therapy, individuals who elect to give birth in a hospital are typically not offered rehabilitation services to optimize their recovery. Across hospitals in the United States, individuals receiving obstetric care have limited access to acute care therapy despite increasing postpartum readmission rates, severe maternal morbidity, and disproportionate levels of maternal mortality. Cardiovascular conditions, infection, and hemorrhage remain the leading causes of death in the obstetric population during the first 6 weeks postpartum. However, individuals are frequently discharged from the hospital after birth without a formal assessment by an acute care occupational or physical therapist. Extensive education to maternal care providers on obstetric rehabilitation is needed to improve outcomes after hospital birth with inpatient occupational and physical therapy. Supplemental video abstract available at
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The author's purpose of this study was to investigate patients' beliefs about the effectiveness of a patient education program. The authors interviewed general medicine and cardiac patients and their families at a large teaching hospital. They asked participants to describe the kind of information the hospital provided about patients' illnesses, pain management, and self-care following discharge and asked participants if they were satisfied with the information provided. The findings revealed that cardiac patients had greater access to information about their illnesses than general medicine patients. Overall, patients received verbal communication from doctors and nurses about their condition. All of the patients relied on pharmacological interventions for managing their pain and were unclear about how to manage their care following discharge. The authors describe recommendations for developing a written patient education curriculum, including information that addresses pain management options and discharge protocols.
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Background: Despite advances in bowel preparation methods, the quality of bowel preparation in some patients undergoing colonoscopy remains unsatisfactory. The effect of telephone re-education (TRE) on the day before colonoscopy on the quality of bowel preparation and other outcome measures had not been studied. Methods: A prospective colonoscopist-blinded study was conducted. All patients received regular instructions during a visit to discuss colonoscopy. Those scheduled for colonoscopy were randomly assigned to receive TRE on the day before colonoscopy (TRE group) for bowel preparation or no TRE (control group). The primary outcome was the rate of adequate bowel preparation. The secondary outcomes included polyp detection rate (PDR), non-compliance with instructions, and willingness to repeat bowel preparation. Results: A total of 605 patients were randomised, 305 to the TRE group and 300 to the control group. In an intention-to-treat analysis of the primary outcome, adequate preparation was found in 81.6% vs 70.3% of TRE and control patients, respectively (p=0.001). PDR was 38.0% vs 24.7% in the TRE and control group, respectively (p<0.001). Among patients with successful colonoscopy, the Ottawa scores were 3.0±2.3 in the TRE group and 4.9±3.2 in the control group (p<0.001). Fewer patients who showed non-compliance with instructions were found in the TRE group (9.4% vs 32.6%, p<0.001). No significant differences were observed between the two groups with regard to willingness to have a repeat bowel preparation (p=0.409). Conclusions: TRE about the details of bowel preparation on the day before colonoscopy significantly improved the quality of bowel preparation and PDR.
According to the Institute of Medicine of the National Academies, health literacy is defined as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. The American College of Obstetricians and Gynecologists is committed to the promotion of health literacy for all. Responsibility for recognizing and addressing the problem of limited health literacy lies with all entities in the health care arena—from the system level to the health care professional.
Some people with hearing impairment may use anticipatory strategies to prepare for an upcoming communication interaction, such as a doctor's appointment. They may consider vocabulary and statements that might occur, and they may practice speechreading a partner saying the items. Experiment 1 evaluated the effectiveness of two types of anticipatory strategies: workbook activities and situation-specific lipreading practice. Two groups of normalhearing subjects were asked to prepare for a communication interaction in a bank setting where they would be required to recognize speech using only the visual signal. Each group was assigned to one type of anticipatory strategy. A third group served as a control group. Experiment 2 evaluated whether multifaceted anticipatory practice improved cochlear implant users' ability to recognize statements and words audiovisually that might occur in a doctor's office, bank, movie theater, and gas station. One group of implanted subjects received 4 days of training, 1 day for each setting, and a second group served as a control group. In both experiments, subjects who used anticipatory strategies did not improve their performance on situation-specific sentence tests more than the control subjects.
By 2050, > 50% of the U.S. population will consist of people from different cultural backgrounds. The dynamic, growing population shifts in the United States and the changing health status of various cultural, ethnic, and racial groups create exciting challenges for health care professionals. Increasing evidence about culture and health emphasizes the importance of understanding and applying cultural constructs as a part of diabetes care and education. To understand the connections between cultural food practices and diabetes among ethnic and racial groups, cultural competence first must be gained. This article presents a discussion about applying the Campinha-Bacote Model of cultural competency to the task of understanding the relationship between cultural food practices and diabetes.
Rationale and objectives: In 2004, Johansson and colleagues, in their systematic review covering the years 1990-2003, documented education interventions and their effectiveness in the treatment of surgical patients. While they provide a review of the state of knowledge until 2003, recent trends in preoperative education and its effects on postoperative patients' outcomes have not been documented in a systematic review. The aim of this study was to describe preoperative educational interventions (including content and delivery time) and postoperative outcomes as considered in studies evaluating the effectiveness for patients undergoing major surgery published from 2004 to 2010. Methods: A systematic review of preoperative education and its effects on postoperative patient outcomes was undertaken. A search was conducted of the PubMed, CINAHL and EBMR databases, including the Cochrane Central Register of Controlled Trials. Randomised controlled trials, or at least clinical trials including pre-/post-test evaluations, with educational interventions performed by nurses preoperatively and outcomes evaluated postoperatively, and written in English, were included. Results: A total of 19 studies involving 3944 patients were retrieved. Of these, 12 were randomised controlled trials. Interventions were based on verbal education, on written/visual education, or both. The content of interventions varied widely. Frequent outcomes evaluated were anxiety, knowledge, pain and length of stay. Objective knowledge (what a patient retains from education) was the only positive outcome influenced by education. Conclusions: Current trends in preoperative education are: scheduling education early; increased frequency of message exposure through several interventions and/or reinforcements; content frequently addressing postoperative management; the measurement of outcomes such as patients' cognitive, experiential and biophysiological aspects. Both the clinical and research implications that emerged from the findings are discussed.
Many training curricula, research efforts, and resources have been focused on what makes competent doctor communication. However, few studies have identified what makes good patient communication. This project was designed to explore physicians' perspective on patient communication. Forty-one primary care physicians participated in focus group discussions on what constitutes competent patient communication. The results of these discussions pointed to three areas of competent patient communication: (1) patients' knowledge of their own health, diagnosis and medications, (2) communication skills in organizing and prioritizing, and presenting clear, concise descriptions of symptoms, and (3) personal attitudes of ownership, trust, and honesty. Focusing on teaching patients these specific skill areas will facilitate a more effective medical visit. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Up to 15% of clinician-ordered doses of injectable pharmacological prophylaxis to prevent venous thromboembolism are not administered. Patient refusal accounts for nearly 50% of these omitted doses. We conducted a prospective cohort study to determine whether a patient education program would improve medication adherence to clinician-ordered injectable prophylactic anticoagulation. We identified 528 hospitalized patients ordered to receive injectable pharmacological venous thromboembolism prophylaxis. We evaluated the impact of pharmacist-led patient education sessions on medication adherence (defined as the ratio of doses administered to doses scheduled) compared with our historical cohort. Individualized patient education sessions were conducted within 24 hours of the initial order for prophylactic anticoagulation in 99% of patients. Adherence to clinician-ordered pharmacological venous thromboembolism prophylaxis was higher after the patient education program than in our historical cohort (94.4% vs 89.9%, P <.0001). The proportion of patients receiving 100% of scheduled doses of injectable pharmacological venous thromboembolism prophylaxis was higher after our novel patient education program than in our historical cohort (73.7% vs 62.4%, P=.001). Patient refusal as a reason for omitted doses was less frequent after the patient education program (29.3% vs 43.7%, P=.001). Pharmacist-led individualized patient education sessions were associated with higher medication adherence to clinician-ordered injectable pharmacological venous thromboembolism prophylaxis and a reduction in patient refusal as a reason for omitted doses. A randomized controlled trial to evaluate the impact of a patient education program on medication adherence to pharmacological venous thromboembolism prophylaxis is warranted.