Excellence in Patient Education: Evidence-Based Education that "Sticks" and Improves Patient Outcomes.

The patient education process has 4 equal components to be addressed by the nurse: assessment, planning, implement, and evaluation. Excellent patient education is an "art" and "science" using nuances and evidence-based strategies to effectively educate. The assessment and evaluation components often use nuanced approaches (motivational interviewing, teach back) to engage the patient/caregiver respectfully, whereas planning and implementation rely more on evidence-based strategies such as the Patient Education Assessment of Materials. Nurses should provide education that is simple, patient centered, and multimodal to meet the health literacy needs of patients/caregivers.

Health Literacy, Health Disparities, and Sources of Health Information in U.S. Older Adults.

BACKGROUND: Low health literacy in older adults has been associated with poor health outcomes (i.e., mortality, decreased physical and cognitive functioning, and less preventive care utilization). Many factors associated with low health literacy are also associated with health disparities. Interaction with healthcare providers and sources of health information are influenced by an individual's health literacy and can impact health outcomes. PURPOSE: This study examined the relationships between health literacy, sources of health information, and demographic/background characteristics in older adults (aged 65 years and older) related to health literacy and disparities. METHODS: This descriptive, correlational study is a secondary analysis of the 2003 National Assessment of Adult Literacy, a large-scale national assessment. RESULTS: Older adults with lower health literacy have less income and education, rate their health as poor or fair, have visual or auditory difficulties, need help filling out forms, reading newspaper, or writing notes, and use each source of health information less (print and nonprint). Many of these characteristics and skills are predictive of health literacy and associated with health disparities. CONCLUSION: The results expand our knowledge of characteristics associated with health literacy and sources of health information used by older adults. Interventions to improve health outcomes including health disparities can focus on recognizing and meeting the health literacy demands of older adults.

R.E.A.C.H. to Teach: Making Patient and Family Education "Stick".

Healthcare professionals teach patients and families about their health every day. Regulatory and accreditation organizations mandate patient and family education to promote better health outcomes. And recently, financial rewards for healthcare organizations are being tied to patient satisfaction (Hospital Consumer Assessment of Healthcare Providers and Systems-HCAHPS). A University of Pennsylvania Health System group of staff and patients, devoted to excellence in patient and family education, developed the graphic "R.E.A.C.H. to Teach." The purpose of the graphic is to make evidence-based practice (EBP) for patient and family education "stick" with staff. The group used concepts from the marketing book, Made to Stick, to demonstrate how to develop effective staff and patient and family education. Ideas (education) that survive ("stick") have the following attributes: simple, unexpected, concrete, credible, emotional, and narrative (story). This article demonstrates how to apply these principles and EBP to patient and family education.

The Mortality Review Committee: a novel and scalable approach to reducing inpatient mortality.

BACKGROUND: Despite the importance of reducing inpatient mortality, little has been reported about establishing a hospitalwide, systematic process to review and address inpatient deaths. In 2006 the University of Pennsylvania Health System's Mortality Review Committee was established and charged with reducing inpatient mortality as measured by the mortality index--observed/expected mortality. METHODS: Between 2006 and 2012, through interdisciplinary meetings and analysis of administrative data and chart reviews, the Mortality Review Committee identified a number of opportunities for improvement in the quality of patient care. Several programmatic interventions, such as those aimed at improving sepsis and delirium recognition and management, were initiated through the committee. RESULTS: During the committee's first six years of activity, the University HealthSystem Consortium (UHC) mortality index decreased from 1.08 to 0.53, with observed mortality decreasing from 2.45% to 1.62%. Interventions aimed at improving sepsis management implemented between 2007 and 2008 were associated with increases in severe sepsis survival from 40% to 56% and septic shock survival from 42% to 54%. The mortality index for sepsis decreased from 2.45 to 0.88. Efforts aimed at improving delirium management implemented between 2008 and 2009 were associated with an increase in the proportion of patients receiving a "timely" intervention from 18% to 57% and with a twofold increase in the percentage of patients discharged to home. DISCUSSION: The establishment of a mortality review committee was associated with a significant reduction in the mortality index. Keys to success include interdisciplinary membership, partnerships with local providers, and a multipronged approach to identifying important clinical opportunities and to implementing effective interventions.

Preventable mortality: does the perspective matter when determining preventability?

BACKGROUND: We report a novel approach to mortality review using a 360° survey and a multidisciplinary mortality committee (MMC) to optimize efforts to improve inpatient care. METHODS: In 2009, a 16-item, 360° compulsory quality improvement survey was implemented for mortality review. Descriptive statistics were performed to compare the responses by provider specialty, profession, and level of training using the Fisher exact and chi-square tests, as appropriate. We compared the agreement between the MMC review and provider-reported classification regarding the preventability of each death using the Cohen kappa coefficient. A qualitative review of 360° information was performed to identify the quality opportunities. RESULTS: Completed surveys (n = 3095) were submitted for 1683 patients. The possibility of a preventable death was suggested in the 360° survey for 42 patients (1.40%). We identified 502 patients (29.83%) with completed 360° surveys who underwent MMC review. The inter-rater reliability between the provider opinions regarding preventable death and the MMC review was poor (kappa = 0.10, P < 0.001). Of the 42 cases identified by the 360° survey as preventable deaths, 15 underwent MMC review; 3 were classified as preventable and 12 were deemed unavoidable. Qualitative analyses of the 12 discrepancies did reveal quality issues; however, they were not deemed responsible for the patients' death. CONCLUSIONS: The mortality survey yielded important information regarding inpatient deaths that historically was buried with the patient. Poor agreement between the 360° survey responses and an objective MMC review support the need to have a multipronged approach to evaluating inpatient mortality.

Case studies in geriatric health literacy.

The geriatric population has the highest rate of low health literacy when compared with other age groups. To maximize health outcomes with this group, healthcare providers have an obligation to recognize individuals with potential for low health literacy and educate these patients in a manner that ensures understanding. Research and clinical experience have demonstrated several interventions that are useful in providing effective health education including the use of the teach-back technique, multimedia material including visual aids, simple and clear language, support persons, and experiences. The cases presented in this article emphasize awareness of individuals at risk for low health literacy and interventions that are effective in helping patients understand how to care for themselves.

Seeking health information: what sources do your patients use?

Healthcare professionals believe that it is important for patients to be educated about health for optimal outcomes. For education to occur, healthcare professionals need to know where patients seek information. The concept of health information-seeking behavior (HISB) focuses on how patients obtain information (strategies/actions). Theories/ models are presented to describe how patients obtain information and what they do with information that is available. The most recent HISB research has examined the use of the Internet for health information. Although the Internet is utilized by many individuals, studies show that the most common and trusted source of information is healthcare professionals. Individuals use other sources of health information (e.g., TV, radio, newspaper, magazines, Internet, and family/friends/coworkers) to supplement information provided by healthcare professionals. When and how individuals use supplemental information varies and is associated with many factors such as race, education, income, health literacy, and health status. Utilizing health information also depends on an individual's health orientation. As nurses, we need to utilize knowledge about HISB to assist patients in obtaining health information to optimize health outcomes.

Ethical considerations in patient and family education: using the symphonological approach.

Most individuals view ethics in healthcare as reserved only for dramatic situations such as withdrawing life support. However, almost everyday, routine decisions in healthcare involve ethics. Providing patient education in an effective manner depends upon using an ethical approach. This article discusses various philosophical approaches to making ethical decisions in healthcare, specifically patient and family and education; however, the main purpose of the article is the application of the Symphonological approach utilizing case studies.

Understanding the health literacy of America: results of the National Assessment of Adult Literacy.

Health literacy refers to an individual's ability to understand healthcare information to make appropriate decisions. Healthcare professionals are obligated to make sure that patients understand information to maximize the benefits of healthcare. The National Assessment of Adult Literacy (NAAL) provides information on the literacy/health literacy levels of the U.S. adult population. The NAAL is the only large-scale survey of health literacy. The results of the NAAL provide information on literacy/health literacy and the relationship between background variables and literacy/health literacy. Multiple variables with potential for a relationship with literacy/health literacy were chosen for the NAAL including, but not limited to, education, language, race, gender, income, overall health, seeking health information, and health insurance.

Teaching the geriatric patient. Making the most of "cognitive resources" and "gains".

Educating the older adult about healthcare information can be a challenge because of the cognitive decline that accompanies the aging process. This article focuses on the cognitive "resources" that have been linked to declines in cognition: sensory input, processing speed, working memory, and inhibition. Although much attention is focused on the cognitive losses that occur with aging, there are also "gains" such as wisdom that assist the older adult in learning healthcare information. The nurse's understanding of "resources" and "gains" will assist her in choosing effective teaching strategies to use with older individuals.

Health literacy in geriatric patients: An integrative review of the literature.

The concept of health literacy is a recent addition to healthcare literature, appearing in the early to mid 1990s. Health literacy refers to individuals' ability to understand their healthcare issues and effectively care for themselves in the healthcare system. Individuals' health literacy abilities vary greatly and can be viewed on a continuum ranging from adequate to marginal to inadequate. Repeated research has demonstrated that older individuals, the geriatric patient population, are at risk of inadequate or marginal health literacy. This risk impacts health outcomes and cost for caring for the older people in our society who are the consumers of a large quantity of healthcare services. The demographic data from the research show that multiple factors influence an individual's health literacy. Besides age, individuals with less education, lower income, "blue collar" jobs, and poor health status (mental and physical) can be at risk of marginal or inadequate health literacy. Providing care to low health literacy patients is complicated by commercially prepared healthcare materials and presentations that are often written well above the average national literacy level. Studies in this review examine various approaches to healthcare education and provide viable options for educating those with low health literacy. This review stresses the importance of healthcare professionals identifying older individuals with marginal or inadequate health literacy and being able to provide education in an effective manner to this segment of the population.

Patient Education Corner. Accessing and evaluating the Internet for patient and family education.

In the last decade, the Internet has become a vast resource for healthcare information. Multiple Web sites, produced by the federal government, healthcare institutions, and individual healthcare providers, give Americans a wealth of useful information sources. Nurses recognize that more Americans than ever before are using the Internet and that nurses are in an excellent position to help patients learn how to search for healthcare topics and evaluate the information found. This article will focus on seeking information, judging the quality of the information, and listing specific Web sites.

Do your patients understand? Providing culturally congruent patient education.

Providing culturally congruent patient and family education is crucial for the current U.S. society. The advances in medicine and changes in the U.S. healthcare system require that patients take a more active role in their healthcare. To assist patients in assuming this role, nurses must be prepared to teach all members of the multicultural U.S. society. This article will provide information on transcultural nursing models, approaches to assessing a patient's culture, and strategies for working in cross-cultural situations.

Do your patients understand? Determining your patients' health literacy skills.

Despite teaching endeavors, nurses are constantly faced with patients who do not understand how to manage their healthcare. This problem has come to the forefront of healthcare issues. As a society, there is concern that despite medical advances, progress with healthcare may be in jeopardy because the skills needed by patients to manage their care are insufficient. This issue is affected by many factors. One of the most prominent factors is the lack of patient health literacy skill assessment. One of the first and most basic parts of the nursing process is to assess the patient. To teach patients, we must identify their learning needs, but the assessment cannot stop there. Nurses need to know patients' health literacy skills so that they can teach them in the best manner possible. This article provides specific information on health literacy assessment tools and the skills needed by nurses to use these tools. Each nurse must decide what tools will work for his or her patients, so that in the end, each patient will understand how to manage his or her healthcare.

Developing continuing education for contact hour approval through NAON.

Developing quality continuing nursing education for contact-hour approval requires a basic understanding of the continuing nursing education (CNE) system and the application process through the National Association of Orthopaedic Nurses (NAON). The Approver Unit of NAON helps CNE providers (i.e., members, chapters, and corporate members) develop education activities and obtain contact hour approval. This article contains the latest information on CNE terminology and the application process for contact hour approval through NAON.