To make patient education programs prime, you must do the time
Preliminary research provides information that makes or breaks a program
The need for a patient education program usually has obvious indicators. For example, chart audits, readmission rates, and calls to the hospital’s information line point to the need for a program. The need is even more obvious if it isn’t met elsewhere in the community.
The question then becomes: Should you develop a program? Experts advise patient education managers to conduct preliminary research first. A literature search is a good beginning because it helps identify the current best practice, says Mary Szczepanik, BSN, program manager for cancer education, support, and outreach at Grant/Riverside Methodist Hospitals in Columbus, OH.
"A literature search is always a good procedure to make sure that what you are developing is consistent with or reflects what researchers have learned so you aren’t recommending something off-target or incorrect," agrees Barbara Hebert Snyder, MPH, CHES, president of Making Change, a health education consulting firm in Cleveland.
Your concept of what works may be out of date, and new methods or approaches to a problem may have been recently developed. A literature review will uncover the latest findings. It verifies the best approaches, explains Hebert Snyder. (For details on how to conduct a literature search, see article, p. 74.)
If there is a difference of opinion on the best course of action, looking at the available research is invaluable, says Nancy Goldstein, MPH, patient education program manager at Fairview-University Medical Center in Minneapolis. "We found a literature search to be particularly helpful as we went through the merger process. We established a number of population-based patient education groups. Looking at the literature helped guide many of our decisions regarding the direction we wanted to take," she explains.
Once articles are found about successful programs that fit your patient group and have been implemented at health care facilities similar to yours, call the author and get him or her to tell you why the program is working, suggests Szczepanik.
Before making that call, however, write a list of questions pertaining to internal and external obstacles that would make it difficult to put a similar program together. It might be lack of funding, physician resistance to others teaching their patients, or an administration that doesn’t see patient education as a priority.
Type the questions out, leaving space after each question to write down the author’s response. After you talk to one or two people, you will want to revise the questions, because issues will come up in conversation that you have not thought about, explains Szczepanik. "You want to change your template and improve it so when you call the next four people, you get that depth of information you are looking for in order to decide whether a program that you have been asked to create or want to create is even feasible," she says.
To track authors, she writes down the name of the institution where they work and calls the library to get a telephone number. Often, she is transferred several times when she calls before reaching the right person. When an e-mail address is included with the article, communication can begin right away. However, a telephone call also should be made after a list of questions is written. Questions might include:
• Why did you think you needed to do this program — what need were you trying to meet?
• What kind of support did you have?
• What budget did you have?
• If grant-funded, how do you fund the program now?
• How are you evaluating the program?
• What obstacles did you encounter, and how did you overcome them?
• How much does the program cost?
If all the pertinent facts cannot be gathered over the telephone, do a site visit, suggests Szczepanik.
In addition to talking to health care professionals about the successful components of their programs, it’s also an opportunity to discuss the instruments they used. For example, in the literature they may have discussed a survey or evaluation instrument they used or materials that enhanced the program. "Ask if you can review them to see if you can use them at your site and get permission to use the instruments," says Hebert Snyder.
While it is always a good idea to start with a literature search, there are many good programs that are never written up, says Louise Villejo, MPH, CHES, director of patient education at University of Texas MD Anderson Cancer Center in Houston.
A quick way to uncover good ideas is to post a message on an Internet listserv. "People throw questions out on the listserv and get good ideas. Either the people who have developed the programs respond, or you are referred to a person who has developed a model program or has done a good job in developing programs," says Villejo. (For information on a good patient education listserv, see editor’s note at the end of this article.)
Uncovering best practice
While "best practice" is a term used to define programs and interventions that have attained outstanding outcomes, there are not uniform standards for best practice. "It is really in the eye of the evaluator," says Patricia Mathews, RN, MHA, president of Mathews Associates, a patient education consulting firm in Chambersburg, PA.
There are, however, a few disease-specific national standards, says Hebert Snyder. For example, the Alexandria, VA-based American Diabetes Association has created national standards for diabetes education. "If the diabetes program you are developing was in line with the national standards, it would reflect best practice. In a lot of areas, it is not so nicely packaged, so you may have to check if there are clinical guidelines that have been developed by the national organization regarding the treatment area, especially if it includes the patient education component of treatment," she says.
In the absence of standards or guidelines from national organizations, look for health care institutions that have well-regarded patient education programs, suggests Hebert Snyder. For example, if developing a cancer program, look to some of the renowned cancer institutions for similar programs and see what elements they have that make them work well. The names of some of these institutions may surface during the literature search, or national organizations might be able to identify those with good programs.
When looking for best practices, Yvonne Brookes, RN, patient education liaison for Baptist Health Systems of South Florida in Miami, checks the Web sites of well-known health care institutions searching for programs that are similar to those she wants to create. "If I see they are doing a program I want to do, then I try to liaison with a person there to get details on what they have done and how they have done it," she says.
Look for best practices among programs that have been developed along health education theory and practice models. These programs usually are the ones found in the literature. The literature shows some of the best practices because the person who developed the program must show the methodology, the process, and the outcome, says Villejo. It’s then easy to see how the program fits your institution and how you can implement something like it.
"The program you develop from this point is going to be pertinent to your needs, so it will be best practice for you. Best practice is what has provided optimal results for your goals," says Villejo.
To determine which components of a program will work at your institution and which won’t, do a needs assessment, advises Villejo. Focus groups are a good way to reach both patients and staff, and they can be tailored to your budget and time frame.
Because Villejo currently is working on a hospital guide that will be left in each patient’s room, she doesn’t have a lot of time to devote to focus groups. Therefore, she developed a questionnaire and gathered a focus group made up of volunteer hosts and hostesses who go from room to room to help patients.
She selected this group because they were very easy to gather. Using the questionnaire, she was able to quickly find out what kind of information the patients were asking for.
She still plans to do individual interviews with about 30 patients using the questionnaire. Also, she will gather about 20 different disciplines to ask some of the same questions. "We will gather all the information and look at what we planed to put in the guide, and then see what we might add or take away," says Villejo.
It’s really important before completing the design of a program to do either a focus group or telephone interviews, agrees Szczepanik. Before creating patient education libraries on the nursing units, she held brainstorming sessions inviting all allied health professionals, from housekeepers to physicians.
"If you have a program you want to implement in different areas of the hospital, you can’t just decide in your office what the program will look like and plop it on each nursing unit. You have to get out there and beat the bushes and talk to people," says Szczepanik. (For tips on additional in-house and outside research that should take place before program design, see article, p. 76.)
[Editor’s note: PatedNet is an electronic mailing list available to patient education professionals. Subscrip tions are handled by the office of Patient Education, University of Utah Hospitals and Clinics. To subscribe, send your e-mail address to jackie.smith@hsc. utah.edu, or call (801) 581-4804. There is no charge for subscription to the list.]
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