trying to understand the person’s emotions. Nonverbal expres- sions are important, such as a calming tone and relaxed body lan- guage. Healthcare professionals should avoid overreacting and remain rational. Using silence and giving time for decisions are also effective techniques. Boundaries must be respectfully set by providing clear and enforceable limits if behaviors are disruptive or belligerent, (Hallett & Dickens, 2017; McKnight, 2020). Case study: Mr. Frank Mr. Frank is a 74-year-old African American male who presents to the clinic three days after discharge from the hospital following an observational stay. He was brought into the hospital with dizziness and loss of consciousness and was newly diagnosed with type II diabetes. Mr. Frank now takes metformin and says he’s been taking “a water pill” for many years but doesn’t know what it is or why he takes it. He is a retired contractor, and states he has avoided “anyone related to hospitals” for most of his life. At dis- charge, he was given multiple patient education sheets, which he has brought in with him for his appointment. Upon review, the topics he was given include a full booklet (45 pages) on diabetes, a page about type I diabetes, one on type II diabetes, one on gestational diabetes, one on testing blood glucose, and one on taking insulin. ● What are considerations for developing rapport with Mr. Frank? Discussion: First impressions and building trust are important. This may be especially true with Mr. Frank, as it seems he may have some distrust of healthcare professionals. Acknowledgment and introductions should be done, including asking him how he would like to be addressed. Being aware of nonverbal behaviors during communication, using open-ended questions, and involv- ing Mr. Frank in the conversation are all needed. Demonstrate empathy during the discussion. ● What assessments should be done with Mr. Frank before providing education? What other information about him should be considered? Discussion : Mr. Frank should be assessed for his level of health literacy, as well as his learning style. He should be asked about his preferred language for learning. At this point, little is known about his personal and social background. Asking questions about his cultural beliefs will provide insight for individualizing teaching. Initial assessment shows Mr. Frank has low health literacy. He is primarily a visual learner and secondarily a tactile learner. He speaks and learns in English, although he was born and raised Conclusion There are many considerations when assessing patients prior to providing education, including determining health literacy, and learning styles. Teaching may be performed individually or in group settings. Teach-back is highly recommended as a strate- gy for effective patient education. Technology can be used with Resources AHRQ health literacy measurement tools: https://www.ahrq. gov/health-literacy/research/tools/index.html#short Barsch Learning Styles Inventory : https://www.honolulu.hawaii. edu/facdev/wp-content/uploads/2018/05/1-5_Barsh-Learning- Styles.pdf References • Agency for Healthcare Research and Quality (AHRQ). (2019). Health literacy measurement tools. https://www.ahrq.gov/health-literacy/research/tools/index.html#short • Agency for Healthcare Research and Quality (AHRQ). (2020a). Health literacy: Hidden barriers and practical strategies. https://www.ahrq.gov/health-literacy/improve/ precautions/1stedition/tool3.html • Agency for Healthcare Research and Quality (AHRQ). (2020b). Health literacy universal precautions toolkit (2nd ed.). https://www.ahrq.gov/health-literacy/improve/precautions/ toolkit.html • Agency for Healthcare Research and Quality (AHRQ). (2020c). The Patient Education Materials Assessment Tool (PEMAT) and user’s guide. https://www.ahrq.gov/health-literacy/ patient-education/pemat.html • Centers for Disease Control and Prevention (CDC). (2022a). Plain language materials & resources. https://www.cdc.gov/healthliteracy/developmaterials/plainlanguage.html
Self-Assessment Quiz Question #6 An important consideration for de-escalation is: a. Escalation is identified when violence occurs
b. De-escalation includes using restraints c. Earlier interventions are more effective d. Escalation occurs only in those with a history of violence
in Italy. Mr. Frank is a widower whose wife passed away last year from a heart attack. He states he is Catholic but hasn’t attended church for many months. Mr. Frank has a daughter who lives with her family in a different state. He plays golf weekly and considers his main support system to be his friends from his men’s club, whom he socializes with frequently at the golf course. Other than those friends at the golf course, he doesn’t like to go outside his house. He says he doesn’t really like technology but does have a cell phone that he uses for texting. ● What are possible strategies for effective teaching with Mr. Frank? What is the important information to cover with Mr. Frank? Discussion : Individual education with teach-back is one strategy to use with Mr. Frank. He could be asked if he would like one of his friends to participate, as a support for him. Visual aids are impor- tant to use with Mr. Frank because he is a visual learner. Written materials can also be used if they are concise, and the important points are emphasized. Demonstration and return demonstration can also assist, as they are both visual and tactile. Group educa- tion may not be effective with Mr. Frank, as he has verbalized dis- comfort in social situations outside of his norm. Use of technology is not appropriate for him. Mr. Frank should understand that he has type II diabetes and be given an overview of what that is. He needs to know about his metformin—that it is for diabetes, and when and how to take it. He needs to when and how to check his blood glucose. Mr. Frank should know what high and low blood glucose readings are, how to manage his glucose level, and when to see a provider. Healthy eating should also be discussed. Teach-back should in- clude return demonstration. Some examples of teach-back ques- tions are “What can you tell me about diabetes?” “How often will you check your blood sugar?” “Show me how you will check your blood sugar” and “Show me how you will take your metformin.” Another consideration is having Mr. Frank bring any medications, including over the counter, in for a brown bag review
some patient populations to enhance teaching. Language and culture must be considered as they related to knowledge and re- tention. Healthcare professionals should also know how to dees- calate behaviors as needed.
Kolb Learning Styles Inventory: https://aim.stanford.edu/wp- content/uploads/2013/05/Kolb-Learning-Style-Inventory.pdf National Library of Medicine health information in multiple languages: https://medlineplus.gov/languages/languages.html VARK Learning Styles Questionnaire: https://vark-learn.com/ wp-content/uploads/2014/08/The-VARK-Questionnaire.pdf • Centers for Disease Control and Prevention (CDC). (2022b). Visual communication resources. https://www.cdc.gov/healthliteracy/developmaterials/visual-communication.html • Hallett, N., & Dickens, G.L. (2017). De-escalation of aggressive behaviour in healthcare settings: Concept analysis. International Journal of Nursing Studies, 75 , 10-20. • Holt, C. (2022). Assessment of health literacy and preferred learning style of patients in a rural North Dakota primary care clinic (DNP disquisition). North Dakota State University. • Institute for Patient- and Family-Centered Care. (n.d.). Patient- and family-centered care. https://www.ipfcc.org/about/pfcc.html • Kato, I., & Siegmund, L. (2022). Empowering new ostomy patients through a novel inpatient group education class. Journal of Wound, Ostomy and Continence Nursing, 49 (4), 347-351. • Kuwabara, A., Su, S., & Krauss, J. (2020). Utilizing digital health technologies for patient education in lifestyle medicine. American Journal of Lifestyle Medicine , 14 (2), 137-142.
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