Discussion : It is important to clarify what Mrs. Jones means by “I can have surgery, chemotherapy, or radiation.” The way this is stated is open to interpretation. Does she mean she will have only one of these options, or does she understand that she can have multiple treatments? The statement about a medication she saw on television is also a teaching moment. Mrs. Jones needs to have information about the fact that providers will determine the appropriate medications for her, which will likely be IV che- motherapy. good strategy to check the effectiveness of teaching, and to focus on the information she needs to know for self-care. Including Miss Brown’s mother in teaching when she arrives will help enforce management at home. The use of technology can also enhance teaching with Miss Brown, such as providing trusted websites and videos. Although Miss Brown is considered a minor, she has the ability to learn and retain information. Patient teaching should be directed at her while including her mother as well. ● What important content should be covered with Miss Brown in the emergency department? Discussion : Miss Brown needs to know what is wrong and what she will need to do. This includes what her broken collarbone means, pain management, and immobilization of the arm. Miss Brown also requires information about follow-up with an ortho- pedic provider after discharge. She also has a possible concus- sion, so will need information on what to watch for and signs that she needs to return to the emergency department. Miss Brown’s mother should also be given this information, as she will be help- ing observe Miss Brown at home. Miss Brown will also be given a prescription for short-term use of acetaminophen and codeine for pain management of her fracture. Although Miss Brown may have a concussion, the provider has prescribed one pill of 325 mg acetaminophen with 15 mg codeine as needed every six hours for the next three days. She needs information about what the medication is, how to take it, and its benefits. Miss Brown’s mother arrives, and teaching includes both of them. Teach-back questions include “Please tell me how you will take care of your broken collarbone at home,” “What will you do if you start throwing up or get headaches when you get home?” and “How will you take your medicine when you get home?” Miss Brown replies, “I will make sure I keep my arm in this sling when I get home, and I won’t move it. I also need to see a special- ist soon.” She says, “If I start throwing up, I will come back to the emergency department. If I have a really bad headache, I will come back too.” Miss Brown also states, “I will take my pain pills only if I have really bad shoulder pain.” ● What teaching moments are there for Miss Brown? Discussion : The statement Miss Brown made about “a really bad headache” should be clarified. She needs to know that a head - ache is a warning sign, and her perception of “really bad” may be different from the physician’s meaning. Her medication should also be reviewed again, including how many pills she should take and how often she can take them. Again, her perception of “really bad” pain in her shoulder may be different from the physician’s perception of what “really bad” pain is. Waiting until the pain is severe can decrease the effectiveness of pain management. Another teaching moment is referring to Miss Brown’s statement about smoking marijuana. There is an opportunity to discuss how smoking—whether it is marijuana or tobacco—affects the lungs. The use of both marijuana and opioids may also cause symptoms that could be confused with concussion.
D uring teach-back, among other questions, Mrs. Jones is asked, “What does stage two breast cancer mean to you?” and “What treatment options do you have?”. She responds, “I know that my cancer level means I won’t die right away. I have a chance to get better.” She also says, “I can have surgery, chemotherapy, or ra- diation. I need more tests for my cancer first.” Mrs. Jones also says, “I saw a commercial for a chemotherapy drug that is a pill. I want that pill instead of an IV.” ● What teaching moments are there for Mrs. Jones? Case study: Miss Brown Miss Brown is in the emergency department following a motor vehicle crash as a passenger not using a seatbelt. She is 17 years old, Caucasian, and registered as Robert Brown. Her history shows she was assigned male at birth and wants to transition to female. There is a suspected concussion and a left fractured clavicle noted on x-ray. Family is not at the bedside. ● What are some strategies that will promote building rapport and successful communication? What are some initial considerations when going in to meet the patient? Discussion : It is important to ask the patient how they would like to be addressed. The emergency environment can be loud and busy at times, so any ability to decrease environmental stimula- tion should be done. A nonjudgmental demeanor with empathy can help create a good relationship. Respect can be shown with courtesy and responsiveness. Plain language and use of open- ended questions are essential, as is encouraging participation through dialogue and questions. Sitting at the level of the patient, showing active listening, and speaking clearly are all necessary. An accident can be traumatic for patients and ending up in the emergency department can add to the stress and anxiety. Ad- ditionally, pain and a potential concussion may have negative effects on patient learning. Health literacy, culture, and learning style should all be assessed. Developmental level and lack of sup- port systems present should also be explored. The patient states she identifies as female, and would like to be addressed as Miss Rachel Brown, with the pronouns of she/her/ hers. She says she is very active in the LGBTQ community, and her parents are supportive of her. She lives at home with both of her parents. Miss Brown says her mother was working and will be ar- riving at the emergency department soon. Miss Brown states she would like to include her mother in teaching when she arrives. She also says she has a boyfriend, who was driving when the accident occurred and who is being evaluated in the emergency depart- ment for a shoulder injury. Miss Brown has been healthy and does not take any medications. She says she doesn’t like medications, even the use of over-the- counter medicine. She does not smoke cigarettes but does smoke marijuana on a weekly basis. Miss Brown just graduated from high school a few weeks ago and celebrated her 17th birthday two months ago. Assessment shows that Miss Brown has a basic understanding of words related to health literacy, with a score of 16 on the Short Assessment of Health Literacy tool. Her learning style is visual. She is pleasant and appropriate in her communications. Miss Brown considers herself tech savvy and uses multiple apps on her phone. In addi- tion, she is active on many social media websites. ● What are some strategies that can be used to help educate Miss Brown and her family? Discussion : Individual education will work best for Miss Brown in the emergency department. Using visual aids and written informa- tion is important, as she is a visual learner. Teach-back will be a Case study: Mr. Lopez Mr. Lopez is a new patient admitted to a long-term care facil- ity from an acute inpatient stay for a fractured right hip follow- ing a fall at home. He is a Hispanic 82-year-old who has been diagnosed with early-stage dementia and hypertension, and he wears hearing aids. His medications include donepezil, metopro-
lol, lisinopril, oxycodone, and melatonin. He has started physical therapy with a walker. Mr. Lopez has a history of falling three times at home within the previous five months. He is widowed and had been living with his 50-year-old daughter and her husband prior to being admitted to the hospital. Mr. Lopez will not be returning
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Book Code: RPUS3024
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