Module 10

HEPPurpose

Provide concrete instructions on how to carry out an exercise or treatment at home

Development of HEPContent?Process:

Who will develop?What methods to use?Will pt/family have input?When to issue?

Instructional DesignNeeds AssessmentGoal Statement (Purpose)Key Concepts (Content Outline)ObjectivesPlanning evaluation for objectivesDesigning teaching strategiesImplementation of DesignEvaluationModify Instruction

Types of Communication Skills Used in Patient Education

Expressive skills:• Giving verbal information to others

regarding their behaviors• Articulating own beliefs and feelings

Emotional skills:• Taking responsibility

• Making difficult decisions when transmitting a message

Listening Skills Used in Patient Education

Listening with undivided attentionUsing verbal/nonverbal expressions

during listeningAcknowledging patient’s message

Checking with the patient for correct understanding/meaning of messageAsking questions for clarification

Body Language Patterns During Patient Education Positive pattern: Non defensive behavior

expressing trust, openness, sincerity, responsiveness, understanding

Negative patterns:• Aggressive expressing hostile and

antagonistic behavior • Appeasing expressing shy and nervous

behavior

Addressing Patient’s Priorities Using Modified FIDOFeelings of the patient toward outcomeInformation given by the patient that is

specific, accurate and relevant to the outcomes

Decisions expressed by the patientOutcomes expressed by the patient - are

to be accomplished

Communication Skills Promoting Therapeutic Relationships• Asking the patient nonjudgmental questions

• Supporting patient’s perspective• Listening to the patient’s replies to pick up

clues about understanding of information• Involving the patient in active problem solving• Working with the patient and family members

to set realistic goals for behavior change

Health Communication in Patient/Health EducationHealth communication - strategies to inform and

influence patients and their decisions to enhance their health

Importance:• Adds to patient’s knowledge about health issues• Decreases patient’s health risks• Increases patient’s adherence to patient/health

education• Enhances the relationship between patient and

therapist

Characteristics of Effective Health Communication• Accurate and understandable - language/format

appropriate for the patient• Easily available • Consistent • Balanced including risks/benefits of potential

actions• Culturally competent • Evidence-based • Applied in a timely basis• Targeting a large number of people

HEPIndividual Considerations

Can patient read?Can patient follow directions?Does patient understand English?What is their cognitive level?Is patient educable?Is someone available to help patient?

Illiteracy"A normal blood sugar is a range between 60

and 140. Today yours is 150. Is your blood sugar normal?"

How many of your patients would be able to accurately respond to this question from the Test of Functional Health Literacy in Adults (TOFHLA)? In one survey of 3,200 elderly patients, 68% could not answer that question correctly.

HEPKey Factors to RememberAvoid medical jargonHealth care providers tend to:

give too much informationGive information at too high a level

When instructing, focus on three main ideas

HEPKey Factors to RememberAttentiveness to communication

principlesBe an active listenerReflect back to them what is being saidReinforce (repeating is ok)Make eye contact (if culturally appropriate)Be aware of your body language

HEPKey Factors to RememberRemember adherence factors

Establish TrustAddress main areas

Knowledge Motivation Resources

Help them overcome barriers

Addressing Main Conditions:Knowledge

Condition itselfHow/when to do treatment programWhen to expect resultsPossible side effectsResults of non-adherenceAppropriate psychomotor skills

Addressing Main Conditions:Motivation

Therapeutic relationshipDiscuss incentives/advantages to making

behavioral changeAsk questions that encourage patient to

recognize positive or negative consequences to behavior

May take a while to convince themIs it worth it?

Addressing Main Conditions:Resources

TimeMoneySpaceEquipment

HEPRationale for Patient to do HEP

Patient MUST understand why the HEP is necessary or else they will not do it

HEPKeep it Simple

Limit to 3 exercisesCan add on extra exercises as patient

progressesAlways put it in writing to help patient

remember (7th-8th grade level, but 5th grade level for

someone with low health literacy)Use large, easy to read typeUse simple pictures or diagrams

HEPSpecifications to Include

Frequency = number of times per dayE.g. once a day or twice a day

Repetitions = number of exercises trials to do each time they exerciseE.g. 2 sets of 10

Duration = number of days of performanceE.g. daily for one week

HEPContraindications / Precautions

Provide specific and clear contraindicationsE.g. DON’T CONTINUE to exercise if leg

becomes red, swollen or painfulProvide specific and clear precautions

E.g. do not raise your heart rate above 120 beats per minute

E.g. hold on to a table for stability when balancing on one foot

HEPBe Available to Answer Questions

Provide patient with:Work phone numberWork fax numberWork E-mail address

Liability issue – you must respond to patient’s questions

Avoid giving out home phone number, etc.

HEPDocumentation

Record exercises included in HEP in your daily note

On HEP handout, include:Patient nameIdentifying information from facilityPT nameExercises with specificationsContraindications and precautions

HEPFollow-Up Visit

Have patient demonstrate exercises in HEP If performed correctly – okayIf performed incorrectly -- modify

Assess your HEPSuitable?Feasible?Acceptable?

Assess your HEPSuitability

Does it meet goals/objectives/purpose?Is it relevant to patient?

Need both

Assess your HEPFeasibility

Can they read it? (illiteracy vs poor vision)Size of printWhite spaceCostAchievable?

Assess your HEPFeasibility

Readability formulas – Flesh Reading Ease test, Gunning Fog index, SMOG

12 to 14 point font sizesBlack letters on white backgroundBullets, headings, subheadingsPlenty of white spaceAlignment on left side of pageInteractive elements involving patient Short sentences, active voice

Assess your HEPAcceptability

Amount of time?Willing to perform?

Sources for patient educationGovernment documentsProfessional health organizationsCommercial sourcesHuman resourcesWeb pagesVideo/DVD