They had me at patient-centered, patient engagement, and choice. Then came patient involvement, shared decision making, and self-management. It sounded lot like adult education within healthcare, and I was immediately curious, as I have spent almost 40 years in adult education and just became registered nurse (RN). I had been aware of adult education in healthcare in several forms: degree and certificate programs aimed at preparing better academic and clinical educators and community education programs aimed at wellness, rehabilitation, or learning to live with chronic diseases. But, this patient-centered discussion in healthcare was part of something new: coordinated and transitional care, initiatives considered essential to healthcare reform. I chose to focus on patient transitions and the education that lies at the heart of its success. Transitional Care Transitional is needed to facilitate the moves patients make among healthcare providers and settings as their conditions and needs change, particularly during chronic or terminal illnesses. It is not new concept, but in the context of healthcare reform, it has finally gained traction. An example is the transition from hospital to home, or from hospital to skilled nursing/rehabilitation facility and then home. Patients are most vulnerable at these transitional times and in need of coordinated and empowering support. Transitional care, funded through the Affordable Care Act, plays role in reducing healthcare cost (Brock & Boutwell, 2012). Cutting costs and improving quality, particularly in Medicare, are goals of healthcare reform, and transitional is considered key because it reduces avoidable and costly hospital readmissions (Center on Budget and Policy Priorities, 2013; Lavizzo-Mourey, 2013). Readmissions often result from a fragmented system of that too often leaves discharged patients to their own devices, unable to follow instructions they didn't understand, and not taking medications or getting the necessary follow-up care (Lavizzo-Mourey, 2013, p. 3). The goals of transitional are to ensure patients are not left to their own devices, do understand and are able to follow instructions, do understand how to take their medications properly, and do receive follow-up care. The hope is patients become active participants in their own care. Coordinators, navigators, transitional nurses, and coaches can now be found in hospitals, primary physician offices (seeking to become medical homes), and other healthcare settings, all to assist with providing comprehensive, coordinated within their communities. Challenges exist, however. A 2011 national survey noted clinicians are lacking in their sharing of information and creating opportunities for decision making with their patients (Fowler, Gerstein, & Barry, 2013). Healthcare providers tend to focus on the transfer of knowledge, while patients tend to be engaged in seeking information (Knox, 2013). It may be that healthcare providers and educators are not focused on the scale of personal change they are asking of patients. They are asking patients to learn how to see themselves and live their lives differently, not just correctly take their medications. Without understanding the transformative learning process, how can any of the patient education efforts of transitional care, or any care, be effective? Healthcare needs adult educators' understanding of learning and change. Adult educators understand the enormous complexity of transformational learning and the changes in perspective that can occur during health transitions. These changes do not solely occur as result of bedside teaching, classes, or follow-up telephone calls. They take time and support, and the journey is different for each patient. Recommendations for Adult Learning and Patient Education There are three discussions I would like to engage in with healthcare providers interested in patient-centered education, patient engagement, and patient empowerment. …
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Jan 1, 2016
Hélène Kergoat + 1
Open Access
