Stroke Education in the Acute Care Setting
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Transcript of Stroke Education in the Acute Care Setting
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Stroke Education in the
Acute Care Setting
Presented By:Dana M. Smith, MS, MCHES, CCE
Patient Education SpecialistUAMS Medical Center
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ObjectivesBy the end of this presentation, participants will be able
to: Verbalize what health literacy is and it’s importance to
stroke education.
Verbalize the importance of stroke education to stroke survivors and their caregivers in the acute care setting.
Verbalize the key steps to providing effective stroke education.
Use the teach back method as an evaluation tool for stroke education.
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What is Literacy?
Using printed and written
informationto function in society, achieve one’s goals, and develop one’s knowledge and potential.
- Kirsch et al, 1993
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What is Health Literacy?
“The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.”
- Ratzan and Parker, 2000 / Healthy People 2010
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Expanding the Definition
A patient's ability to obtain, understand and act on health information.
A provider’s capacity to communicate clearly, educate about health and empower their patients.
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What is it Like?
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GNINAELC – Ot erussa hgih ecnamrofrep, yllacidoirep naelc eht epat sdaeh dna natspac revenehw uoy eciton na noitalumucca fo tsud dna nworb-der edixo selcitrap. Esu a nottoc baws denetsiom htiw lyporposi lohocla. Eb erus on lohocla sehcuot eht rebbur strap, sa ti sdnet ot yrd dna yllautneve kcarc eht rebbur. Esu a pmad tholc ro egnops ot naelc eht tenibac. A dlim paos, ekil gnihsawhsid tnegreted, lliw pleh evomer esaergro lio.
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Health Literacy Impacts
AccessSafetyQuality
Outcomes
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Only 12% are Proficient
Health Literacy results from the National Assessment of Adult Literacy, US Dept of Education, 2003
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Why Are Patients at Risk?
Reliance on the written word for patient instruction is increasing.
Increasingly complex healthcare system▪ More medications▪ More tests and procedures▪ Growing self-care requirements▪ Esoteric language
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Who is Most at Risk?
ElderlyEthnic and racial
minoritiesLimited
education immigrants
Low socioeconomic status
People with chronic disease
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Red Flags
Making excusesPerceived resistanceHas no questionsFrequently missed appointments, tests
Non-adherent with meds or treatment
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So What Can We Do?
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Why is Stroke Education Important?
Helps patient and caregivers understand why quick access to care is important after stroke symptoms.
Identifies ways that the patient can reduce the risk of having another stroke.
Provides caregivers needed information on how to care for a stroke survivor.
Increases patient compliance and decreases re-admission rates.
After TIA –
Within 2 days after a TIA, 5 percent of people will have a stroke. Within 3 months after a TIA, 10 to 15 percent of people will have a stroke. -National Stroke Association, 2012
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The Problem
Life Altering Event
Short Admissions
Large Amounts of Information +Limited Staff Time
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Four Steps to Effective Teaching
Assess patient for educational readiness
Plan what you will teach
Implement teaching
Evaluate teaching
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Assessment Who should education be targeted toward?
Are the learners emotionally ready?
Are there literacy issues?
What might be some potential barriers?
What are the learners preferred learning styles?
Are the learners motivated?
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Planning for EducationWhat does the patient NEED to know?
“Get with the Guidelines - Stroke”:
1. Activation of emergency medical system2. Need for follow-up after discharge3. Medications prescribed at discharge4. Risk factors for stroke5. Warning signs for stroke
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And What Else Would Be NICE to Know?
Emotions after stroke Avoiding complications: falls, UTI,
aspiration pn, etc. Managing ADLs Help for the caregiver Understanding deficits: memory,
communication, motor skills, etc. Rehab Where to get further information –
support groups, websites, organizations
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Education is Best Using a Multi-Disciplinary Approach
Physicians Nurses Patient Educators Case Coordination Speech Therapy Occupational
Therapy Physical Therapy And many others
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Planning for Education
What Resources are Available? Videos Materials/Handouts Other
Regarding Materials Are handouts written in plain or common
language? Are materials written at a 6-8th grade level? Are materials free of medical jargon?
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Health Literacy Checklist for Stroke Materials
Font should be at least 12 point
Use ample ‘white space’
Use 1.5 or double spaces between sentences and more space between bullets.
Organize information with the 3-5 most important “need to know” points.
Give the most important information first and last to enhance memory.
Use a conversational writing style and active voice.
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Implement Teaching Use plain language and avoid acronyms.
Get the learner actively involved.
Don’t make assumptions.
Use a variety of teaching strategies, if able.
Ask questions during teaching to make sure the patient is understanding.
Always give written information as a back up to all teaching.
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Evaluate Learning
“The greatest impediment to communication is the illusion that it’s actually happening.”
-George Bernard Shaw
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Evaluate Learning Research shows that patients remember and
understand less than half of what clinicians explain to them. Ley, Communicating with patients: improving communication satisfaction, and compliance 1988
Rost, Predictors of recall of medication regimens and recommendationsfor lifestyle change in elderly patients 1987.
Use the Teach Back Method – aka: “Show Me” or “Closing the Loop”
Is a way to confirm that you have explained to the patient what they need to know in a manner that the patient understands.
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What Teach Back Is…● Asking patients to repeat in
their own words what they need to know or do, in a non-shaming way.
● NOT a test of the patient, but of how well you explained a concept.
● A chance to check for understanding and, if necessary, re-teach the information.
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Teach Back is Supported by Research
● “Asking that patients recall and restate what they have been told” is one of 11 top patient safety practices based on the strength of scientific evidence.”AHRQ, 2001 Report, Making Health Care Safer
● “Physicians’ application of interactive communication to assess recall or comprehension was associated with better glycemic control for diabetic patients.”Schillinger, Arch Intern Med/Vol 163, Jan 13, 2003, “Closing the Loop”
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Stroke Education TB Questions
●“I want to be sure I explained everything clearly. Can you please explain it back to me so I can be sure I did?”
●“What will you tell your husband about the changes the doctor made to your medicines today?”
●“Can you tell me some things you might do to reduce your risk of having a stroke?”
●“Can you tell me what you would do if you started to feel some of the symptoms of a stroke when you were at home?”
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On Going Education On-Going Education after Discharge:
Newsletters Follow up phone calls Stroke support groups Listservs Social Media Video-conferences, etc.
Education centered on staying healthy, reducing risks, adjusting to life after stroke,etc.
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UAMS Stroke Support Group
3rd Thursday of Each Month11 a.m. – Noon
UAMS Family Home 4300 W. Markham
Little Rock, Arkansas 72205
To Register: 501-686-7791
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Resources American Stroke Association
▪ Stroke Connection Magazine▪ Stroke Handouts
www.strokeassociation.org
American Heart Association▪ Get With the Guidelineswww.heart.org
National Stroke Associationwww.stroke.org
National Institutes of Healthwww.stroke.nih.gov