Module 10 – Patient Education, Effective Communication, and Med Math Review

Objectives

By the end of this module you should be able to:
• Describe strategies for patient education
• Utilize strategies for how patients learn
• Evaluate elements of the nursing process that helps patients learn
• Create and environment conducive to patient education
• Identify methods of teaching across the life span
• Implement communication strategies across the life span
• Explain the SBAR method for effective interprofessional communication.

Patient Education and Communication

Patient education and communication are conducted collaboratively with the registered nurse and other health care professionals. People learn through a variety of approaches. People learn verbally, visually, by the written word, and by doing – for example, learning how to give an injection. In the clinical setting, the most used processes of learning are verbal and written. You can recognize that communication is a natural part of learning.
A practical nurse must know if the patient’s first language is the commonly spoken language. If the commonly spoken language is not the patient’s first language, then translation services must be used to communicate and teach the patient what they need to know. You must know if the patient can read and write or can see and hear adequately. There are many conditions and situations in which you will teach your patient. You will be administering medications and teaching them about the medication: what they are taking the medication for, what are common side effects, how to take the medication – with water, with food, without food — and other pertinent information about each medication. The complexity of what you teach your patient is determined by the patient’s readiness to learn. If the patient is acutely ill or in pain, or has a diminished level of consciousness, you will modify or delay teaching.
Please watch this short clip about teaching patients and preventing medication errors.
1. Several points must be considered when teaching your patient:
2. How will the patient and family best understand what is being taught?
3. What is your desired outcome of the teaching?
4. What method will you use? For example, will you use a pamphlet or an iPad or another method?
5. Tailor your teaching based on whether you are teaching a child or an adult.
6. Teaching materials should be written at the 5th grade reading level.
7. Routine nursing education does not require an order from a treating clinician and is often covered by institutional policy.
8. Provide an environment of privacy and confidentiality.
All patient teaching you will undertake is done so in collaboration with the registered nurse. Topics are focused on the patient’s need at the time. Does the patient need education about diabetes, heart disease, medications or many other topics, all based on why the patient was in your institution?

Elements of Professional Communication

The most common method of communicating with other medical professionals about patient care is in the medical record. Where electronic medical record or paper record is used, nurses must document critical and focused information readily available for access by other health care professionals.
Another form of communication you will implement is the nursing report or patient hand-off. This is completed between the nurse leaving shift and the nurse beginning shift who will provide care for your patients. It is usually a verbal accounting of the previous shift events of patient care.
Requirements of TJC (The Joint Commission) are intentionally flexible to allow hospitals to adopt techniques that best fit their organization’s culture and needs; however, TJC supports the use of the SBAR technique (Situation-Background-Assessment-Recommendation). SBAR is a mnemonic for a communication technique that encourages concise, consistent exchange of information (Runy, 2010).
Some organizations add an I and Q to the process for more complicated situations:
I: Introduction (individuals involved in the handoff identify themselves, their roles, and jobs)
S: Situation (complaint, diagnosis, treatment plan, and the patient’s wants and needs)
B: Background (vital signs, mental and code status, list of medications, and recent lab results)
A: Assessment (current caregiver’s assessment of the situation)
R: Recommendation (identify pending lab results and what needs to be done over the next few hours and other recommendations for care)
Q: Question and answer (an opportunity for questions and answers is built into the hand-off process)
Additionally, another research group modified the SBAR mnemonic to include airway, breathing, and circulation (i.e., ABC-SBAR) for use in hand-off of critical care patients (McCrory et al., 2012)
Other communication techniques include the Five-Ps and the I Pass the Baton technique (Runy, 2010)
The Five-Ps system involves:
Patient (name, identifiers, age, sex, location)
Plan (patient diagnosis, treatment plan, next steps)
Purpose (provide a rationale for the care plan)
Problems (explain what is different or unusual about this specific patient)
Precautions (explain what is expected to be different or unusual about the patient)
I PASS the BATON is a mnemonic utilized by the Safety Department of the United States Department of Defense and involves (Schub E., Balderrama D., 2018:
I: Introduction (individuals involved in handoff identify themselves, their roles, and jobs)
P: Patient (name, identifiers, age, sex, location)
A: Assessment (present chief complaint, vital signs, symptoms of diagnosis)
S: Situation (status and circumstances, including code status, level of consciousness, recent changes, and response to treatment
S: Safety Concerns (critical lab values and reports, socioeconomic factors, allergies and alerts [e.g., risk for falls])
(the)
B: Background (comorbidities, previous episodes, current medications, family history)
A: Actions (detail of actions taken)
T: Timing (level of urgency; priorities)
O: Ownership (identification of health care team and who is involved in patient and family responsibilities)
N: Next (anticipated action, contingency plans)
The following video, 18 minutes in length, covers the process of documentation. While the focus is Medical Assistants, the information is germane to your practical nursing responsibilities, and you should view this in terms of your scope of practice. Examples presented use paper documentation, but EMR has mechanisms for accomplishing what is documented on paper.
References:
McCrory, HAboumater, JW Custer (2012). ABC-SBAR training improves simulated critical patient hand-off by pediatric interns. Pediatric Emergency Care: June 2012 – Volume 28 – Issue 6 – p 538 – 543 doi: 10.1097/PEC.0B013e3182587f6e
Runy, L. A. (2010). Patient handoffs. Hospitals & Health Networks. Retrieved March 26, 2018, from http://216.92.22.76/discus/messages/21/Patient_Handoffs_-_2008_Article-2338.pdf (GI)
Schub E., Balderrama D. (2018). Nursing Report: Patient Hand-Off. CINALH Nursing Guide EBSCO Publishing. Ipswich, Massachusetts.

Med Math Review

Most medications in the clinical setting are unit dose, meaning there is little or no calculation required other than simple math; for instance, a dose comes individually packaged as 10 mg and you need to give 20 mg, so you know that you need two individual 10 mg packages to give 20 mg. Not all calculations are that straight forward. Therefore, some math is needed to give correct doses of medications to your patients. Calculation methods are the fraction method, ratio and proportional method, and the dimensional analysis method. You may use one of these methods, but for this lecture, the dimensional analysis method will be used for examples.
Dimensional Analysis Method
How many pounds (lb) are in 20 kilograms (kg) of a substance?
Need to know ahead of time: 1 kg = 2.2 lb.
The conversion factor is kg to lb (2.2lb/kg), so multiply 20 kg by the conversion factor, 20kg x 2.2lb/kg. Expressed in dimensional analysis:

Cancel out kg in numerator and denominator:

How about going the other way?
How many kg are in 315 lbs? So, the conversion factor flips to 1 kg/2.2lb.
315 lb X 1 kg/2.2 lb = 143.2 kg, so the equation looks like this:

A patient who weighs 220 lb is prescribed a dose of drug at 12.5 mg/kg body weight. The concentration of the drug solution on hand is 125 mg/mL (each mL has 125 mg of medication), and the patient wants to take the drug orally, by teaspoon. How many teaspoons of drug solution will the patient need to take per dose?
Use the following dimensional analysis steps for the conversions and accounting:

Step 1: 1 kg = 2.2 lb, so the weight conversion ratio is 1 kg/2.2 lb; the patient weighs 100 kg, so 220 lb × 1 kg/2.2 lb or

Step 2: The weight (amount) of drug needed based on body mass is 12.5 mg/kg × 100 kg = 1250 mg or

Step 3: 1 tsp = 5 mL, so the volumetric conversion ratio is 5 mL/tsp.
The concentration in teaspoons is now 125 mg/mL × 5 mL/tsp = 625 mg/tsp or

Step 4: The final dose in teaspoons is 1250 mg divided by 625 mg/tsp = 2 tsp, or

Steps 1 and 3 were conversions in which dimensional analysis was explicitly used.
Steps 2 and 4 were simple calculations but using dimensional analysis to solve for them allows for a higher degree of accountability and understanding of the units involved.
Practice Questions:
1. Convert 120 kg to lbs
2. Convert 220 lbs to kg
3. A patient weighs 220 lbs. They need a 25 mg/ kg of body weight of a medication. How much of the medication will they receive?
4. A medication you are going to give a patient comes as 5 mg/ 1 ml. The patient is to receive 5 mg of the medication per kg of body weight. The patient weighs 95 lbs. How much medication will you give?
5. A medication you are going to give comes as 10 mg/ 2 mL of liquid. The patient weighs 140 lbs and needs to receive 2.5 mg/ kg body weight. How much will you give?