Health Education | FINALS

document

Not only do health professionals need to be excellent teachers, they must also be attentive to how they ? what they have taught.

Patient education

? is more than just teaching facts and demonstrating skills.

Documentation

It is a two-way conversation in which patients and clinicians learn from each other and is an essential component of good patient care.

documentation

An important step in patient education is good ?

Careful documentation

? can also save time and avoid unnecessary repetition.

Careful documentation

? can also minimize professional liability.

Anne Marie Haber

Who said that documentation should not only include specifics about what topics were taught, but also include the patients' responses to education

use a standardized form
document formal and informal teaching
describe the response of the learners
when possible, put copies of education materials in the chart
update the teaching plan

Enumerate the Five Steps for Effective Documentation: (USF-DFIT-DRL-CEMC-UTP)

teaching tools (use a standardized form)

(1) Standardized forms, sometimes called "?" have designated areas for specific information and can be an efficient way to quickly find important information.

forms (use a standardized form)

(1) In addition to providing an easy way to scan for information, ? also have designated areas to highlight key concepts, such as learning preferences, communication barriers, curriculum, responses, and further teaching needed.

forms (use a standardized form)

(1) Making use of these areas will help ensure continuity in the education process.

Formal teaching (document formal and informal teaching)

(2) ? is often thought of as curriculum that is taught at a designated time, perhaps prefaced by a clinician saying "Now I'm going to teach you about…."

Informal teaching (document formal and informal teaching)

(2) On the other hand, is teaching that happens on an on-going basis

learns (describe the response of the learners)

(3) Patient education is more than what the clinician says or does; patient education is what the learner ? and this should be carefully noted in the medical chart.

interaction/response (describe the response of the learners)

(3) In addition to a brief description of the topics covered, documentation should include a note about the ? of the learner.

open-ended (describe the response of the learners)

(3) Patient education documentation should include information about the learner's reactions and feelings as well as responses to ? questions.

copies (when possible, put copies of educational materials in the chart)

(4) Ideally, ? of the actual teaching materials should be included in the medical chart (Haber)

materials (when possible, put copies of educational materials in the chart)

(4) If it is not possible to put in the actual documents, describe the ? that were given out and encourage the patient or family to show them to their other clinicians.

teaching materials (when possible, put copies of educational materials in the chart)

(4) Detailed information about the ? helps with the continuity of care, avoids unnecessary repetition, and helps to build on lessons already learned

update (update the teaching plan)

(5) As patient education is an ongoing process of learning and teaching, the patient's medical chart should include space to ? the teaching plan and include information about further learning needs, effective teaching techniques, and recommendations for the next steps.

updated (update the teaching plan)

(5) With this ? teaching plan, clinicians have the tools they need to educate patients, and patients remain stimulated and challenged by learning new information they most need to know

evidence-based practice (ebp)

? based the integration of best research evidence with clinical expertise and patient values' which when applied by practitioners will ultimately lead to improved patient outcome.

a. best evidence which is usually found in clinically relevant research that has been conducted using sound methodology
b. clinical expertise refers to the clinician's cumulated education, experience and clinical skills
c. patient values which are the unique preferences, concerns and expectations each patient brings to a clinical encounter

Enumerate 3 fundamental concepts of EBP: (BEV-CE-PV)

best evidence

(1) ? which is usually found in clinically relevant research that has been conducted using sound methodology

clinical expertise

(2) ? refers to the clinician's cumulated education, experience and clinical skills

patient values

(3) ? which are the unique preferences, concerns and expectations each patient brings to a clinical encounter

Individual Clinical Expertise + Patient Values & Expectations + Best External Evidence = EBM

It is the integration of these three components that defines a clinical decision evidence-based. This integration can be effectively achieved by carrying out the five following steps of evidence based practice.

formulate an answerable question
find the best available evidence
appraise the evidence
implement evidence
evaluate outcome

Enumerate the 5 steps of EBP: (FAQ-FBE-AE-IE-EO)

clinical (formulate an answerable question)

(1) One of the fundamental skills required for EBP is the asking of well-built ? questions.

question (formulate an answerable question)

(1) By formulating an answerable ?, you to focus your efforts specifically on what matters.

patient encounters (formulate an answerable question)

(1) These questions are usually triggered by ? which generate questions about the diagnosis, therapy, prognosis or etiology

evidence (find the best available evidence)

(2) The second step is to find the relevant ?

search terms (find the best available evidence)

(2) This step involves identifying ? which will be found in your carefully constructed question from step one; selecting resources in which to perform your search such as PubMed and Cochrane Library; and formulating an effective search strategy using a combination of MESH terms and limitations of the results.

critical appraisal (appraise the evidence)

(3) It is important to be skilled in ? so that you can further filter out studies that may seem interesting but are weak.

simple critical appraisal questions (appraise the evidence)

(3)
What question did the study address?
Were the methods valid? What are the results?
How do the results apply to your practice?

clinical decisions (implement the evidence)

(4) Individual ? can then be made by combining the best available evidence with your clinical expertise and your patients values.

clinical decisions (implement the evidence)

(4) These ? should then be implemented into your practice which can then be justified as evidence based.

evaluate (evaluate the outcome)

(5) The final step in the process is to ? the effectiveness and efficacy of your decision indirect relation to your patient.

evaluation questions (evaluate the outcome)

(5)
Was the application of the new information effective?
Should this new information continue to be applied to practice?
How could any of the 5 processes involved in the clinical decision-making process be improved the next time a question is asked?

evidence (best-evidence medical education)

Healthcare professionals are trained to make clinical decisions that are based on ?

tradition/intuition (best-evidence medical education)

However, when it comes to teaching, many abandon this approach and base everything on ?and ?

new ideas (best-evidence medical education)

When ? are introduced, very little real, reliable or valid evidence may be available, and these ideas may subsequently be found to be unhelpful and wasteful of time, effort and resources.

evidence (best-evidence medical education)

Even when ? exists, integrating best-evidence medical education into teaching programs may be problematic

framing the question
developing a search strategy
producing the raw data
evaluating the evidence
implementing change
evaluating that change

Enumerate the 6 steps of EBT: (FQ-DSS-PRD-EE-IC-EC)

search strategy

Health professionals have limited time in which to search the literature, but a carefully planned '?' should result in quick identification of important publications.

search strategy

A good ? will have a well-framed question relating to the purpose of the inquiry, and key words chosen specifically to reflect the dimensions of the question to use with appropriate databases.

evidence

You must seek and grade the power of ? to find out what works and what does not work.

appraise

Critically ? the literature to identify gaps, flaws and the need for further studies.

preparation of systematic reviews of suitable rigor and merit

dissemination of the results of this work

nurturing a culture of respect and value for medical teaching equal to that of other aspects of professional practice

Seeking out the best evidence for medical education involves three key tasks: (PSRRM-DRW-NCRV)

communication skills

Best-evidence medical education (some examples):
? can be taught they are learned

communication skills

Best-evidence medical education (some examples):
? are best maintained by practice

teaching

Best-evidence medical education (some examples):
? should be experiential, not instructional

contents

Best-evidence medical education (some examples):
? should be problem defining

least

Best-evidence medical education (some examples):
the ? competent students improve the most

men/women

Best-evidence medical education (some examples):
? take longer to learn than ? do

the 'distance' between the input (the teaching strategy) and the output (the change in healthcare)

external factors such as learners' prior knowledge, motivation, opportunity, access to materials, time constraints, emotional and even financial pressures can affect learning

not all learning results from your teaching

Enumerate 3 challenges for EBT: (DIO-EF-NAL)

the teaching strategy
the change in healthcare

the 'distance' between the input (?) and the output (?)

external factors

? such as learners' prior knowledge, motivation, opportunity, access to materials, time constraints, emotional and even financial pressures can affect learning

learning

not all ? results from your teaching

establish where learners are in their learning

decide on appropriate teaching strategies and interventions

monitor leaners' progress and evaluate teaching effectiveness

Evidence-based teaching involves the use of evidence to: (EWL-DATSI-MLPETE)

learners

establish where ? are in their learning

strategies/interventions

decide on appropriate teaching ? and ?

progress/evaluate

monitor learners' ? and ?teaching effectiveness

medicine

The concept of evidence-based practice has its origins in ?

best available evidence

The essential idea is that decisions made by medical practitioners should be based on the ? collected through rigorous research - ideally, through randomized controlled trials.

controlled

Research studies in the form of carefully ?experiments are seen as providing the strongest and most dependable forms of evidence to guide practice.

evidence

However, everyday medical practice uses multiple forms of ?

conditions/symptoms

In addition to evidence from external research studies, medical practitioners gather and use evidence relating to patients' presenting ? and ?

gathering evidence regarding patient's presenting conditions/symptoms

for example, by taking patient histories and ordering diagnostic tests.

Evidence

? plays a crucial role in monitoring a patient's progress and evaluating the impact of treatments and interventions.

evidence-based medicine

Most definitions of ? recognize the role and importance of these different forms of evidence.

evidence-based practice

One of the earliest and most cited definitions (Sacket et al, 1996) describes ? as 'integrating individual clinical expertise with the best available external evidence from systematic research.'

Evidence-based teaching

? similarly involves more than the implementation of practices that have been shown to be effective in controlled research studies.

first essential form of evidence for teaching is

information about the points individual learners have reached in their learning.

first essential form of evidence for teaching

This usually means establishing what they know, understand and can do as starting points for teaching and to ensure that individuals are provided with well-targeted learning opportunities and appropriately challenging learning goals.

Ethics

? as a branch of classical philosophy has been studied throughout the centuries by and large these studies were left to the domains of philosophical and religious thinkers.

ethical

More recently, due to the complexities of modern day living and the heightened awareness of and educated public, ? issues related to healthcare have surfaced as a major concern of both healthcare providers and recipients of these services.

client

Thus, it is a widely held belief that the ? has the right to know his or her medical diagnosis, the treatments available, and the expected outcomes.

choices

This information is necessary so that informed ? by clients relative to their respective diagnoses can be made in concert with advice offered by health professionals.

natural

Ethical principles of human rights are rooted in ? laws, which, in the absence of any other guidelines, are binding on human society.

natural

Inherent in these ? laws are, for example:
• principles of respect for others
• truth telling
• honesty
• respect for life

Ethics

? refers to the guiding principles of behavior

Ethical

? refers to norms or standards of behavior

Moral

? refers to an internal value system (the moral fabric of one's being)

morality

this value system, defined as ? is expressed externally through ethical behavior.

Ethical principles

? deal with intangible moral values, so they are not enforceable by law, nor are these principles laws in and of themselves.

Legal rights and duties

? refer to rules governing behavior or conduct that are enforceable under threat of punishment or penalty, such as a fine, imprisonment, or both.

ethics/law

The intricate relationship between ? and the ? explains why ethics can be found within the language of the legal system.

nurses

In keeping with this practice, ? may cite professional commitment or moral obligation to justify the education of clients as one dimension of their role.

Autonomy

The first of these principles, ? is derived from the Greek words auto (self) and nomos (law) and refers to the right of self-determination (Tong, 2007).

Autonomy

Laws have been enacted to protect the patient's right to make choices independently such as informed consent.

Veracity

It is also called truth telling and closely linked to informed decision making and informed consent.

Tuma (veracity)

This ruling provided a basis in law for patient education or instruction regarding invasive medical procedures. Nurses are often confronted with issues of truth telling, as was exemplified in the ? case (Rankin & Stallings, 1990).

In the interest of full disclosure of information, the nurse (Tuma) had advised a cancer patient of alternative treatments without consultation with the client's physician. Tuma was sued by the physician for interfering with the medical regimen that he had prescribed for care of this particular patient.
Although Tuma was eventually exonerated from professional misconduct charges, the case emphasized a significant point of law to be found in the New York State Nurse Practice Act (1972), which states, "A nursing regimen shall be consistent with and shall not vary from any existing medical regimen."
In some instances, this creates a double bind for the nurse. Creighton (1986) emphatically explained that failure or omission to properly instruct the patient relative to invasive procedures is tantamount to battery (intentional and harmful contact with another person).

TUMA CASE SUMMARY

New York State Nurse Practice Act (1972)

"A nursing regimen shall be consistent with and shall not vary from any existing medical regimen."

Creighton

? (1986) emphatically explained that failure or omission to properly instruct the patient relative to invasive procedures is tantamount to battery (intentional and harmful contact with another person).

Confidentiality

Refers to personal information that is entrusted and protected as privileged information via a social contract, healthcare standard or code, or legal covenant.

Confidentiality

Such information may not be disclosed by healthcare providers when acquired in a professional capacity from a patient without consent of that patient.

anonymous

Information is ? for example, when researchers are unable to link any subject's identity in their records

confidential

Information is ? when identifying materials appear on subjects' records, but can only be accessed by the researchers (Tong, 2007).