Dos and Don'ts of Patient Education
By Jean McCaslin, RN CNE IgCN - April 21, 2023

One of the most anxiety-producing aspects of life is "fear of the unknown." This is particularly true in healthcare. From relatively benign medical conditions to devastatingly critical or life-threatening illnesses, the statement "knowledge is power" should not be underestimated when developing patient treatment plans; it can be a powerful tool in establishing the levelheadedness needed for a patient to manage their illness. Patient education is often as simple as explaining a laboratory test or a minor dietary change. As nurses, we may impart knowledge in a casual or off-the-cuff manner when discussing medical issues that have become routine for us, yet not for the patient. Patient education processes are oftentimes not formalized, particularly in some private physician offices. When programs do exist, time constraints in an office setting can make it almost impossible to share crucial information from their educational programs with each and every patient.

As nurses, we can be instrumental in filling the patient educational voids created by many scenarios. We can adhere to certain guidelines of good practice (the dos) and avoid the pitfalls of ineffective (don'ts) patient teaching.

This blog will address the dos and don'ts of creating and executing patient teaching plans; whether formal or informal. When your institution has a formalized patient education program in place, it is helpful, yet there are many variables that can impact the effectiveness of such plans. It requires each of us to understand how to best assess individual needs, create a patient-specific plan, implement it in a meaningful way, and evaluate based on patient-specific metrics.

The Dos:

1. Have a plan. Some organizations have formal patient education programs in place, others do not. In either case, each nurse should know basic information about the patient, disease process, testing, treatments, or infusion prior to speaking with or treating the patient. If personally charged with creating an education plan, it should be written, and accessible to all. It should include a needs assessment, implementation timeline, and metrics, as well as an evaluation process.
2. Respect patient privacy. Ask the patient who specifically may know details about their diagnosis as well as the proposed treatment and educational aspects.
3. Know your topic. Accept assignments based on your experience, so you become the subject matter expert to the patient. Request specialized training as needed before engaging the patient.
4. Consult experts when needed. When you are asked to opine on topics (like unexpected questions from a patient) that make you uncomfortable (due to lack of personal expertise), ask a supervisor or mentor.
5. Stay current and relevant. In medicine, change is inevitable. As new testing and treatment options are developed and package inserts and brands change, so must the education specific to them. Patients must be offered materials relevant to their specific condition as well as their treatment modalities. Individual education should be streamlined to be relevant to their needs. Have your agency request Nufactor CE Programs at no cost to you.
6. Provide various educational mediums and language options. Technology has created endless options for the dissemination of patient educational materials. Communication to and from patients can be accomplished electronically and instantaneously.
1. For tech-savvy consumers, pamphlets left in physician offices are less desirable than e-correspondence. When possible, virtual MD visits and virtual patient teaching is preferred.
2. For some, written or printed materials are preferred as they are not tech savvy; many do not own or have access to a computer or tablet. Some prefer large print due to a lack of visual acuity or audible versions for blindness.
3. Adaptations must also be made to learning materials to address language versions as well. When printed materials are limited due to unavailability, a translation service should be used.
7. Share successes, and be a mentor. Nurses should be engaged in educating each other. This is true whether on an education committee or through reporting their own success with a specific patient or an innovative teaching method. Nurse mentorship is an invaluable tool in teaching future teachers.
8. Conduct a thoughtful patient teaching assessment. This should include the patient-preferred timing of education, patient verbalized goals, language preference, preferred medium, patient prioritization of learning goals when appropriate, how they identify (pronouns or cultural), and identification of barriers to learning when present.
9. Elicit ongoing patient engagement. Set expectations with the patient that the learning process is ongoing; support and education will continue and evolve as needed/requested. Inquire about additional questions or concerns that might be addressed by education.
10. Report changes in medical condition(s). When an unknown medical condition has been identified as a barrier to learning or is life-threatening, the information should be communicated to the prescribing physician and other involved healthcare professionals when appropriate and agreed upon by the patient.
11. Prepare and adapt to barriers to learning. Once a learning barrier has been identified, the patient education plan must be adapted to accommodate it. This could include aspects previously discussed, such as language, learning, visual, dexterity, age-related, or psychological challenges.
12. Report to other patient education practitioners. For continuity of care, nurses should provide progress toward goals to others involved in the education process. This will minimize redundancy and allow a sharper approach toward goals not yet met.
13. Ask for help. After initiating and providing patient education to a specific patient, sometimes a roadblock is observed. Eliciting assistance from another RN to perhaps re-evaluate can be instrumental; having another set of eyes can potentially uncover and overcome a specific stall in the learning process.
14. Utilize available patient support systems. Having a family member or friend engaged in the learning process can be helpful. They can be instrumental in diminishing anxiety or perhaps be trained to assist with the self-administration of certain medications; for example, subcutaneous immune globulin (SCIG).
15. Utilize Nufactor patient education resources. Review patient education materials included in the patient's first Nufactor shipment. These items include:
1. New Patient Packet (IG Side Effect Management card, Infliximab Side Effect Management card, My Anaphylaxis Plan, and therapy-specific tips).
2. Encourage the patient to subscribe to IG Living Magazine if the patient is receiving immune globulin therapy.
16. Implement patient teaching in digestible sessions. Many disease processes affect concentration and stamina. Several education sessions may be needed to achieve all educational goals.
17. Be patient. Expect some patient teaching visits to be prolonged due to unexpected factors. Domestic situations and age or disease-related delays could precipitate interruptions in patient teaching visits. Be patient. When this threatens the timeliness of other patient visits, it may be necessary to reschedule the visit or inquire if the subsequent patient(s) is(are) amenable to having their visit(s) pushed back when feasible.
18. Use plain language explanations. Many patients do not respond to overly medical language. When possible, explain in ordinary language. This in no way denotes a lack of patient intellect, yet makes the learning process more easily understood.
19. Evaluate effectiveness. Understanding educational success is critical. Body language, patient engagement, feedback, actions, and behaviors are all indicators of successful or ineffective attainment of teaching goals.
20. Make goals measurable when possible. Having a patient teaching/training checklist is a good method for measuring goal achievement. This helps to make additional measured gains of those goals not yet met by focusing one's efforts.
21. Become an expert in your field. Join field-related societies that will help enrich your knowledge and will help you become a better educator. Organizations such as IgNS provide field nurses with many free educational sessions and are even known to provide scholarships for first-time conference attendees to become experts in the Ig community.

The Dont's:

1. Violate HIPAA. Get clear consent from the patient before engaging family members or friends in the patient education process.
2. Make assumptions. Socioeconomic, domestic, and limitation of formal education can create stereotypes about intellect or ability to achieve superior patient teaching goals; this is incorrect and discriminatory. Avoid making any predeterminations based on any biases, including physical attributes such as age or disease-related appearance.
3. Be unprepared. Bring all appropriate patient teaching materials to your visit. When available and requested, have digital copies of all materials available as well.
4. Be rigid. Patients are often limited to certain times of day to learn effectively. Their medications, lack of sleep, or disease processes dictate their schedule. Other necessary medical treatment or physician visits can potentially cause cancellations of patient education appointments.
5. Be a "talking" head. The repetition of the same or similar education materials can cause learning fatigue. It can cause a perceived attitude by the patient that they are being rushed. Never speak over the patient, instead take frequent breaks when speaking to see if the patient understands the materials before moving on to the next topic.
6. Ignore body language. Pay attention to facial expressions and body movements. A blank stare could denote confusion or boredom. Glossy eyes could denote sleepiness or sadness. Fidgeting could mean many things, including the need for a bio-break or the desire to ask a question. It likely would benefit the patient to take a break and inquire how they are doing.
7. Be an island. Actively collaborate with others as needed for the best outcomes and continuity of care.
8. End the process after 1 session. Follow-up is an essential element of patient education. The learning process is ongoing, not one-and-done. Some RNs may conduct a brief patient education session for a relatively simple topic, but then other assigned personnel should conduct a follow-up assessment to ensure the patient has not thought of other questions or concerns after the first RN has left. This follow-up call could be accomplished by a Client Service Specialist. Another RN patient education session, either in-person or by phone, may be needed.
9. Fail to reassess or try something new. When all traditionally available patient teaching modalities fail, it is important to understand why and adapt your process; perhaps engaging other available staff, including managers.

It Takes a Village:

Thoughtful and effective patient education is everyone's job. We engage other healthcare professionals often daily to achieve our joint goals. Patient education is especially a joint venture as it is a work in progress; it never stops. It requires a meaningful conversation to answer ongoing patient questions, concerns, and evolving medical needs. Patient loved ones are also part of the education process; they might need to learn or are often engaged in aspects of the teaching process. Oftentimes physicians begin the learning continuum; it is our responsibility to keep them informed of our educational challenges and recruit their assistance when obstacles are met. We are all blessed to be trusted, integral members of the patient education village.