Planning

The planning stage is critical for successful patient education. The health care professional and patient partner to develop an education plan. The choice of evidence-based strategies depends on many factors, most important being the patient’s unique learning needs identified in the assessment, followed by availability of resources.

It is critical that the health care professional possess knowledge and skill for implementing patient education strategies. Ultimately, patient education should be a conversation where the patient’s current knowledge and goals/priorities, as well as health information needs, are incorporated. 

Planning Steps

1. Use all aspects of patient assessment information to guide plan development and determine mutual educational goals.
2. Develop teaching plan utilizing evidence-based teaching strategies (e.g., easy to understand language and multi-modal approach) with a focus on patient’s needs, priorities and behaviors.
3. Identify educational resources to achieve identified learning goals.


Planning Steps Explanations/Examples/Scripts Ref List
1. Mutual Goal Setting Strategies    

Partner with patient to devise mutually agreed upon learning goals.

Goals should focus on patient behaviors and be clearly stated, action-oriented, measurable and achievable by the patient.

Patient and health care provider develop diabetic diet. The patient chooses the type of carbohydrate to eat based on their preferences and what makes them feel less sluggish.

The patient will learn the skills needed to demonstrate the following behaviors:

  • Check blood pressure every day when you wake up.
  • Take your blood pressure medicine every day.
List 6

Individualize/tailor education

  • Education meets patient’s individual health literacy needs such as patient with disability who needs recorded instructions.
  • Education is approached in culturally sensitive manner. For example, patients are given diabetes diet information based on the foods they normally eat.
List 7
Consider preferred language
  • Offer education tailored to preferred oral and written language.
  • Provide interpreter/translator as needed.
List 8
Include family, caregiver or significant other Identify support individuals and include in education whenever possible. List 9

Build on current knowledge

"Based on what you told me, you know the basics; the next step will be to learn how this will affect your day to day life."
List 10
Use Motivational Interviewing  (MI) (Appendix 4)

Motivational interviewing (MI) techniques include:

  • Open-ended questions
  • Affirmations (positive feedback)
  • Reflection (mirror patient’s statements)
  • Summary (summarize what the patient has said)
List 11

Consider the educational setting
A. Primary/Outpatient Care   

Primary care settings: education focuses on goal setting to optimize behavior change and safely transition patient from hospital to home.

  • HbA1c at 6.0; able to count carbohydrates

Outpatient setting: add delivery of education through the internet, phone, and/or groups, based on patient and caregiver preferences and skills.

  • Follow-up phone calls and text messages to remind patients to weigh themselves and take medication.
List 12
B. Pre-operative

Education should be given pre-operatively to improve knowledge and reduce anxiety.

  • Pre-operative class
List 13
C. Acute Care

In hospital settings, patient education should be started on admission and taught over time, allowing patients time to demonstrate comprehension.

  • Session 1: Teach signs of infection
  • Session 2: Dressing change
  • Session 3: Follow-up care
List 14
D. Discharge/last session

E. Education in all settings


Include opportunities for structured education, including teach back and content reinforcement to achieve optimal outcomes.

  • “What would you do if you gained more than 4 lbs in 24 hours?”
List 15
Back to Guidelines Homepage  
2. Develop the Education Plan    

Teach all patients in a manner they can understand

  • Use simple, direct messaging
  • Avoid medical jargon
  • Use common everyday language
  • For a patient who has diabetes and eats rice with every meal, use plain language/clear communication such as, “You may eat a half-cup of rice 2 times a day for your carbohydrate servings.”
List 16
Identify content/key message to support learning objectives

Objective: Daily Dressing Change

  • Content to include:
    • Hand hygiene
    • Preparing dressing change area
    • Old dressing removal/disposal
    • Apply new dressing
List 17

Keep the message focused

  • Limit education to several key points
  • Place most important information first
  • Educate in small segments, “chunk and check”
  • Stepwise instructions
List 18

Identify patient behaviors to demonstrate knowledge

Build education to teach desired patient behaviors (teach to goal).

  • Patient demonstrates toe-touch weight bearing
  • Implement behavioral contract
List 19

Employ effective communication strategies

Consider need for staff training in effective communication strategies (e.g. active listening, build rapport) and content. List 20
Promote self-efficacy, skill mastery

Maximize self-efficacy/ build confidence through 

  • Use of short term achievable goals
  • Knowledge acquisition (classes, one on one sessions, practice hands on skills/problem solving) 
  • Modeling of behavior; self monitoring
  • Positive reinforcement/ persuasion 
List 21

Use team-based approach

Team members (nurse, primary care provider, pharmacist) work with patient to achieve objectives.

  • Use physicians, pharmacist or other health experts to teach health information
List 22
Use multi-modal approach

For each learner use more than one teaching strategy at a time. For example, when teaching verbally provide a simple written handout. Additional examples of strategies that incorporate multi-modal approaches or can be combined with other strategies: 

  • Shared Decision Making (Appendix 8)
  • Teaching verbally with written handout then follow-up with phone call.
  • Education program with immediate feedback
  • Addressing knowledge, emotional and behavioral changes
  • Social support (parents, peers, school, healthcare team)
  • Self-regulatory learning (self-testing, monitoring) (Appendix 9)
  • Positive Affect and self-affirmation (Appendix 10)
List 23
Use multi-sensory approach

Education should engage as many senses as possible (e.g., auditory, visual, tactile, smell).

  • Combination of verbal and written health education
  • Video with auditory and visual content
  • Edutainment
  • Pictures, illustrations, 3D models, images etc.
  • Hands-on skill sessions
  • Interactive games
List 24

Use multi-prong approach 

Offering the same education in various formats to meet the learning preferences of patients. Patients can select method to learn health information. 

  • In-person class, webinar, videos, 1 on 1 session, written materials
List 25
Have repeated contact with patient to reinforce teaching  Examples: Follow-up phone calls, counseling or coaching sessions, group classes over a designated time period, pharmacy visits, unlimited access to skill learning on the web, start education early List 26
Use problem-centered learning - patient knowledge is gained through solving real world problems
  • Patient can demonstrate what to do when blood sugar is too high or too low.
  • Patient given physiological feedback with goal to improve health measure (i.e, HbA1C, blood pressure, cholesterol level).
List 27
Use experiential learning
  • Learn through “doing” and reflecting on learning.
    • Patient with diabetes plans, shops for and prepares meal.
  • Role Modeling: Provide role models for patients to learn from.
  • Performance: Give patient an opportunity to perform health behaviors.
  • Use analogies during education:
“Your knee joint is like a door hinge. A door hinge can become hard to move and squeaky over time.  That is what can happen with your knee when you start to have arthritis.”
List 28

Use personalized action plans 

Develop an action plan with the patient that is individualized and meaningful to them.

  • When blood sugar is low, patient will eat quick acting sugar product they prefer (favorite candy or juice)
List 29

Back to Guidelines Homepage

 
3. Select Educational Resources    

Consider available resources that support educational content

  • Written materials: use easy to understand language; available in languages other than English.
  • Videos: available in languages other than English.
  • Technology: promote ease of access to health information and interactive format (app, smart phones, tablets, kiosks, video games, eBooks, automated phone disease management, computer assisted video instruction).
    • Blood pressure kiosks at mall or a phone “app” for tracking carbohydrate intake & blood sugars.
  • Interactive games or activities: use to reinforce teaching message and skills.
  • Decision aids used in shared decision making (Appendix 11)
  • Pictures, illustrations, 3D models, images pictograms
List 30

 Back to Guidelines Homepage

 

Education Concepts/Models

The following educational concepts/models provide unique approaches that may be helpful to educators when planning and providing patient education.

Education Concepts/Models    

EDUCATE model for verbal patient education

(Appendix 12)

E = Enhance comprehension and retention
D = Deliver patient-centered education
U = Understand the patient
C = Communicated clearly and effectively
A = Address health literacy and cultural competence
TE = Teaching and educational goal

List 31

EMMA Dialogue Tools
(Empower, Motivation, Adherence)

  • Reflection tools: dialogue on the challenges experienced by patients related to their disease and its treatment.
  • Goal-setting tools: help patients in planning and adhering to goals for change.
  • Knowledge and learning tools: individualize knowledge and learning for patient.
List 32

NEED

(Appendix 13)

Dialogue tools stimulate patients to express themselves and foster participant involvement.

  • Picture cards, quotations, and ‘gamification.’  Each tool has step-by-step instructions and promotes flexibility and individual variation.
List 33

Stanford Chronic Disease Self-management Model

(Appendix 14)

Interactive classes with peers providing education and training. Focus on problem solving abilities through discussion. List 34

Social learning and self-management theories

Social learning states that new behaviors can be learned by watching and imitating others. Self-management is geared toward patient managing own health concern through knowledge and skills. List 35

Health Coaching techniques with behavior and social support 

  • Identify what is most important to patient.
  • Guide self-discovery of ambivalence to making behavior change.
  • Assist to set realistic goals and develop action plans; identify support systems.
  • Explore/minimize obstacles to progress.
  • Hold patient accountable for the change.
List 36

 

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