Patient Educators Research Articles

Stakeholder Perspectives on Changes in Hypertension Care Under the Patient-Centered Medical Home.

IntroductionHypertension is a major modifiable risk factor for cardiovascular and kidney disease, yet the proportion of adults whose hypertension is controlled is low. The patient-centered medical home (PCMH) is a model for care delivery that emphasizes patient-centered and team-based care and focuses on quality and safety. Our goal was to investigate changes in hypertension care under PCMH implementation in a large multipayer PCMH demonstration project that may have led to improvements in hypertension control.MethodsThe PCMH transformation initiative conducted 118 semistructured interviews at 17 primary care practices in southeastern Pennsylvania between January 2011 and January 2012. Clinicians (n = 47), medical assistants (n = 26), office administrators (n = 12), care managers (n = 11), front office staff (n = 7), patient educators (n = 4), nurses (n = 4), social workers (n = 4), and other administrators (n = 3) participated in interviews. Study personnel used thematic analysis to identify themes related to hypertension care.ResultsClinicians described difficulties in expanding services under PCMH to meet the needs of the growing number of patients with hypertension as well as how perceptions of hypertension control differed from actual performance. Staff and office administrators discussed achieving patient-centered hypertension care through patient education and self-management support with personalized care plans. They indicated that patient report cards were helpful tools. Participants across all groups discussed a team- and systems-based approach to hypertension care.ConclusionPractices undergoing PCMH transformation may consider stakeholder perspectives about patient-centered, team-based, and systems-based approaches as they work to optimize hypertension care.

Entering a new profession: Patient educator interns′ struggles for recognition

Objective: To ascertain patient educator interns' (PEIs) views on the internship experience and to explore how the transition to the workplace is experienced by new graduates from emergent professions. Methods: In this case study from Saudi Arabia, semi-structured interviews were conducted with 10 PEIs. Following a narrative type of analysis, case summaries were created, compared and interpreted. Results: Interns held preconceptions regarding the patient educator's role, and these preconceptions were frequently not mirrored by actual practice. The clash of preconceptions and actual experiences led participants to encounter shock. Conclusion: Transition shock for PEIs seemed to be exacerbated due to their position within a new profession. This study adds to a growing literature about the challenges experienced by workers in new and emerging healthcare roles.

The clinician's role as patient educator.

The clinician's role as patient educator.

Feasibility of Two Educational Methods for Teaching New Mothers: A Pilot Study.

BackgroundPrinted health educational materials are commonly issued to prepare patients for hospital discharge. Teaching methods that engage multiple senses have been shown to positively affect learning outcomes, suggesting that paper materials may not be the most effective approach when educating new mothers. In addition, many written patient educational materials do not meet national health literacy guidelines. Videos that stimulate visual and auditory senses provide an alternative, potentially more effective, strategy for delivering health information. The acceptability of these methods, as perceived by nurses executing patient education initiatives, is important for determining the most appropriate strategy.ObjectiveThe purpose of this study was to determine the feasibility of 2 educational methods for teaching new mothers how to care for themselves and their infants after hospital discharge. Feasibility was measured by adequate enrollment, acceptability of the intervention to patients and nurses, and initial efficacy.MethodsNew mothers (n=98) on a Mother-Baby Unit received health information focused on self-care and infant care delivered as either simple printed materials or YouTube videos on an iPad. Mothers completed a pretest, post-test, and an acceptability survey. Following completion of the initiative, nurses who participated in delivering the health education using one of these 2 methods were asked to complete a survey to determine their satisfaction with and confidence in using the materials.ResultsMothers, on average, were 26 years old; 72% had a high school education; and 41% were African American. The improvement in knowledge scores was significantly higher for the iPad group (8.6% vs 4.4%, P=.02) compared to the pamphlet group. Group (B=4.81, P=.36) and time (B=6.12, P<.001) significantly affected scores, while no significant interaction effect was observed (B=5.69, P=.09). There were no significant differences in responses between the groups (all P values >.05). The nurses had a mean age of 44.3 years (SD 13.9) and had, on average, 16.6 years of experience (SD 13.8). The nurses felt confident and satisfied administering both educational modalities.ConclusionsThe pamphlet and iPad were identified as feasible and acceptable modalities for educating new mothers about self-care and infant care, though the iPad was more effective in improving knowledge. Understanding the acceptability of different teaching methods to patient educators is important for successful delivery of informational materials at discharge.

Diabetes foot complication: assessing primary and secondary outcomes of multidisciplinary team versus standard care (a systematic review)

About 15 % of all diabetes patients experience foot complication at some stage in their life. The goal of this review is to systematically assess on effectiveness of multidisciplinary teamwork compared to the standard care in risk reduction of diabetes-related foot complications with a primary and secondary outcome. Literatures of only English language were analyzed under strict inclusion criteria from electronic databases search. Result from overall pooled estimate up to 0.65 % reduction, with 95 % CI (p < 0. 005) in foot ulceration and amputation using a multidisciplinary team care as a tool compared to the standard care in primary outcome. Evidence also supports program benefits in overall cost (0.6 % reduction, p < 0.005), rate of hospitalization (80 % dropped, p < 0.003), and patient quality of life as secondary outcomes. Study’s characteristic differed substantially in term of health care setting, nature of interventions, and outcomes measured reported. Evidently, multidisciplinary team efforts from specialists in diabetes, vascular and infectious disease, along with podiatry expertise and patient educators result in a significant reduction in diabetes-related foot complications compared to the standard care.

A Model of Clinical Reasoning: What Students Learn From Patient Educators

Abstract Date Presented 4/17/2015 This study examines how a lab experience with patient educators (PEs) affected reasoning 1 yr later during students’ Level II fieldwork. Results suggest that students have increased self-awareness, confidence, and empathy, which contributes to advance reasoning. A model of clinical reasoning is presented.

Common concepts in separate domains? Family physicians' ways of understanding teaching patients and trainees, a qualitative study.

BackgroundMedical education is increasingly expanding into new community teaching settings and the need for clinical teachers is rising. Many physicians taking on this new role are already skilled patient educators. The purpose of this research was to explore how family physicians conceptualize teaching patients compared to the teaching of trainees. Our aim was to understand if there is any common ground between these two roles in order to support faculty development based on already existing skills.MethodsSemi-structured interviews with twenty-five family physician preceptors were conducted in Vancouver, Canada and thematically analyzed.ResultsWe identified four key areas of overlap between the two fields (being learner-centered; supporting the acquisition, application and integration of knowledge; role modeling and self-disclosure; and facilitating autonomy) and three areas of divergence (aim of teaching and setting the learning objectives; establishing rapport; and providing feedback).ConclusionsFinding common ground between these two teaching roles would support knowledge translation and inquiry between the domains of teaching patients and trainees. It would furthermore open up new avenues for improving training and practice for clinical teachers by better linking faculty development and continuing medical education (CME).

Practical guidance on the recognition of uncontrolled asthma and its management.

To highlight the significance of asthma in primary care and offer a practitioner-friendly interpretation of the asthma guidelines for the busy provider, while introducing new treatment options currently in clinical trials, such as the once-daily long-acting anticholinergic bronchodilator tiotropium Respimat. Articles with relevant adult data published between 2004 and 2015 were identified via PubMed. Additional references were obtained by reviewing bibliographies from selected articles. In the United States, uncontrolled or symptomatic asthma is common, with rates of 46%-78% in primary care. Uncontrolled asthma has a substantial impact on patients' quality of life and represents a significant healthcare burden. Nurse practitioners can improve patients' asthma control through education, monitoring, assessment, and treatment. Although asthma management guidelines are readily available, the authors recognize that nurse practitioners see patients with multiple comorbidities, all of which have treatment guidelines of their own. Nurse practitioners have a compelling opportunity as frontline caregivers and patient educators to recognize and assess uncontrolled asthma, along with determining the steps necessary to help patients gain and maintain symptom control.

Association of Standardized Patient Educators

Association of Standardized Patient Educators

How to become an expert educator: a qualitative study on the view of health professionals with experience in patient education.

BackgroundHealth professionals with the level of competency necessary to provide high-quality patient education are central to meeting patients’ needs. However, research on how competencies in patient education should be developed and health professionals trained in them, is lacking. The aim of this study was to investigate the characteristics of an expert educator according to health professionals experienced in patient education for patients with coronary heart disease, and their views on how to become an expert educator.MethodsThis descriptive qualitative study was conducted through individual interviews with health professionals experienced in patient education in cardiac care. Participants were recruited from cardiac care units and by using a snowball sampling technique. The interviews were audiotaped and transcribed verbatim. The data were analyzed with thematic approaches, using systematic text condensation.ResultsNineteen Icelandic and Norwegian registered nurses, physiotherapists, and cardiologists, who had worked in cardiac care for 12 years on average, participated in the study. Being sensitive to the patient’s interests and learning needs, and possessing the ability to tailor the education to each patient’s needs and context of the situation was described as the hallmarks of an expert educator. To become an expert educator, motivation and active participation of the novice educator and a supportive learning environment were considered prerequisites. Supportive educational resources, observation and experiential training, and guidance from experienced educators were given as examples of resources that enhance competence development. Experienced educators expressed the need for peer support, inter-professional cooperation, and mentoring to further develop their competency.ConclusionsExpert patient educators were described as those demonstrating sensitivity toward the patient’s learning needs and an ability to individualize the patient’s education. A supportive learning environment, inner motivation, and an awareness of the value of patient education were considered the main factors required to become an expert educator. The experienced educators expressed a need for continuing education and peer support.

The Voices of Breastfeeding Resource Nurses

To describe and evaluate the Breastfeeding Resource Nurse (BRN) role and program at The Children's Hospital of Philadelphia (CHOP). The primary study was a multimethod study including a survey and key informant interviews to meet the study's objectives: to describe how the BRN implements his or her role at the unit level throughout the hospital, to describe the successes and challenges of the BRN role, to provide data on how BRNs may be better supported in their roles, and provide data for the translation of the BRN program to other institutions. We present the qualitative descriptive component from the primary study. The Children's Hospital of Philadelphia enterprise. Eighteen BRNs within the CHOP enterprise. Semistructured interviews were conducted with the BRN participants. The data were analyzed with conventional content analysis. Four major themes emerged from the BRN interview data: Empowering through evidence, Advocacy, Going the extra mile, and Personal connections to breastfeeding. Compelling stories illustrated the role of the BRN as patient advocate and educator for staff and families. Knowing the evidence about lactation and breastfeeding empowered the BRN to be successful in his or her role. The BRNs derived great personal and professional satisfaction from their roles. The BRN program can be easily adapted to other pediatric care centers and will enable improved breastfeeding outcomes at the point of care.

I Can’t Read That! Improving Perioperative Literacy for Ambulatory Surgical Patients

Low literacy and low health literacy are surprisingly rampant problems facing health care providers. Patient educators in all settings should consider the need for improved patient education materials that are easy to read and understand for the majority of patients. In the ambulatory surgery setting, patients often have time to prepare for scheduled outpatient surgery, yet education is provided primarily in the postoperative period. This article highlights the need for incorporating education into all phases of the perioperative process, beginning in the preoperative period. Perioperative educators should address all learning styles that provide education in a simple and cost-effective way to appeal to all patients and help to reduce postoperative complications and increase patient satisfaction in the ambulatory surgery setting.

Learning about a patient-empowering discourse: Testing the use of a computer simulation with nursing students

The development of patient education towards greater patient empowerment requires more competent patient educators. Therefore, there is a need to design novel methods for nursing students to learn about patient education. One such method is the use of computer simulation, which has shown encouraging learning outcomes regarding other nursing interventions. This study was undertaken to evaluate nursing students’ knowledge structures of an empowering discourse, and the change in these structures after using a computer simulation program. Furthermore, the aim of the study was to compare these possible changes with the students’ background factors. A pretest-posttest design, without a control group, was used. The data were collected from graduating nursing students (n = 43) in six Finnish polytechnics using concept maps pre- and post-test in connection to using a computer simulation program. The students’ knowledge structures were quite fragmented concerning an empowering discourse both pre- and post-test. About one fifth of the students had an improved knowledge structure post-test. The changes in the students’ knowledge structures did not associate with the students’ study orientations or with the students’ socio-demographic factors. This study provided new insight into students using computer simulation when learning about supporting patient empowerment and recommends further testing of learning methods that facilitate the development of patient educators.

The Online Presence of Physical Consumer Health Information Collections in Multisite Toronto Hospitals

This study investigates the online presence of physical (on-site) consumer health information collections (CHICs) on the public Web sites of three multisite hospitals in the City of Toronto. All three are affiliated with the University of Toronto, Faculty of Medicine. They are located in downtown Toronto, north Toronto, and northwest Toronto, respectively. The Web pages of multisite hospital-based CHICs contain basic information about hours of operation, phone number, e-mail address, and location. Most provide information about collections (print and digital), lending policies, and information services. Although staffing is mentioned in the context of profession, as librarians, patient educators, or volunteers, staff names and qualifications are not mentioned. The CHIC Web pages of two of three multisite hospitals have online public access catalogs (OPACs) to search their collections. As well, both provide multilingual information resources to better serve the linguistic diversity of Toronto residents. Unique features include access to consumer health and medical online databases through the Web page for its consumer health information collections at one multisite hospital, Humber River Hospital, and information about health-related mobile apps, access to e-books, and customized newsletters in PDF file format for individual consumer health information collections at another multisite hospital, University Health Network.

How Patient Educators Teach Students: “Giving a Face to a Story”

Patient Educators are persons with specific pathologies that have participated in an education program in which they learn how to instruct students on physical examinations. The aim of this study was to explore the impact of graduate student experiences with Patient Educators during coursework on occupational therapy clinical internships. A phenomenological design was used to explore the lived experiences of students through a qualitative interview. As participants described their experiences with the Patient Educators, three primary themes emerged: (a) self-awareness, (b) confidence, and (c) empathy. The quotes from the transcriptions were organized into four sequential plot categories: (a) Before the Interaction, (b) During the Interaction, (c) Immediate Change, and (d) Impact on Clinical Internship. The results reveal a narrative of the learning process experienced by students from before the Patient Educators lab through clinical internships. These results suggest that incorporating Patient Educators in the classroom could be a critical component in preparing students for clinical internship and future clinical practice.

Factors Influencing Practice of Patient Education among Nurses at the University College Hospital, Ibadan

Patient education is the process of influencing patient behaviour and producing the changes in knowledge, attitudes and skills necessary to maintain or improve health. Health education may be general preventive, health promotion or diseases specific education. With an education system in place, patients will be satisfied with care, patients will be healthier, and will seek medical services less frequently. There is little or no documentation on the practice of patient education at the University College Hospital, Ibadan. The aim of this descriptive study was to explore factors influencing the practice of patient education among nurses at the University College Hospital, Ibadan. Stratified and simple random sampling techniques were used in selecting 200 nurses at the University College Hospital Ibadan. A self-designed questionnaire was used to collect data. Statistical package for social sciences version 15 (SPSS 15) was used in analysing data. The study revealed that the knowledge and practice of patient education among the nurses in University College Hospital was high and the knowledge was found to be significantly associated with its practice (X2 = 7.89, p = 0.017). The working experience of nurses does not determine whether they practice patient education or not. Almost all the respondents (70% - 90%) in this study affirmed that the nurses’ experiences, cultural barriers, work place culture, lack of time, heavy workload, insufficient staffing, and the complexity of patients’ condition were important factors that influenced the practice of patient education. In conclusion, nurses at the University College Hospital have good knowledge and positive attitude towards patient education but could not practice effectively. A more critical approach in addressing heavy workload, insufficient staffing, among others is needed to improve patient education. Further studies should be carried out on developing nurses’ roles as patient educators.

Intentions of College Students to Serve as Informal Caregivers for Their Older Relatives: Theory of Planned Behavior Approach

As the older adult population increases, the healthcare system is experiencing a shortage of professional health care providers and caregivers. Consequently, the role of family to serve as caregivers will expand to care for older relatives at home. Thus, a larger proportion of adult children will become caregivers, including young adults enrolled as college students. Therefore, a need exists to examine the intentions, attitudes, and subjective norms of typical college students to assume the role of informal caregivers. The present study is based on the theoretical framework of the Theory of Planned Behavior (TPB). The TPB assumes attitudes, subjective norms, and perceived control influence intentions which provide the best predictors of actual behavior. The cross-sectional study included an attitude scale, additional scales based on TPB, and a demographic profile. Data were collected from 750 currently enrolled university students then analyzed for descriptive statistics, Pearson correlation, and hierarchal multiple regression statistics. The students' quality of experiences and interaction with older relatives correlated significantly with intentions, subjective norms, and perceived behavioral control to serve as informal caregivers. Our study shows that, in the present context, TPB offers a viable explanation of students' intentions to serve as informal caregivers. Implications of the study suggest health care providers, geriatricians, health educators, and patient educators should become involved in the education and strategy development necessary to assist this young group of informal caregivers.

Association of Standardized Patient Educators

Association of Standardized Patient Educators

Pharmacists as vaccination providers: Friend or foe?

Bill 41, an act to extend the role of pharmacists in Quebec, was passed by the National Assembly on December 8, 2011.1 Implementation was slated to begin in September of this year but has been delayed. Once the bill is enacted, pharmacists will be allowed to renew and adjust prescriptions, prescribe and substitute medications under certain conditions and order laboratory analyses for monitoring purposes.1 Unfortunately, the injection of vaccines has been limited to educational demonstrations only.1 This is a far cry from the United States, where by 2009, all 50 states had granted pharmacists the right to vaccinate.2 This is also a step behind Alberta, British Columbia, Manitoba, Ontario, New Brunswick and Nova Scotia, which have all rolled out pharmacist-administered vaccination schemes.3 Although regulations vary by state or province, at bare minimum, community pharmacists in these jurisdictions are allowed to provide the influenza vaccine to adults. With extended opening hours and drop-in services with short wait-times, pharmacists are in an excellent position to increase accessibility.4 The evidence clearly illustrates that states that first allowed pharmacists to immunize have significantly better flu shot coverage.5,6 Pharmacists are also effective patient educators; several studies have indicated that pharmacists’ recommendations can lead to better vaccination outcomes, even compared with traditional care.7-9 Moreover, pharmacists’ impact on vaccination rates is especially important in rural and medically underserved areas, which are often disproportionately affected by vaccine-preventable diseases.5,10,11 Despite the evidence, Bill 41 intentionally omitted this service. The Federation des medecins omnipracticiens du Quebec (FMOQ) commented: On the issue of vaccination, complications after injection are still possible and it is essential to properly assess the patient, conduct clinical monitoring after vaccination and to provide emergency treatment, if necessary. Only doctors and nurses have the training and skills to take such actions.12 This statement ignores the fact that pharmacists are only allowed to vaccinate after having received appropriate training. In Canada, certification is typically achieved by completion of either the Canadian Council on Continuing Education in Pharmacy’s (CCCEP) accreditation or another course approved by the provincial pharmacy organization.13-16 Furthermore, all pharmacists wishing to vaccinate are required to provide proof of current CPR and first aid certification.13-16 Additional safety measures include the requirement to recertify every few years, the need to submit an annual declaration of competency, or both.13,15-17 These precautions, if followed closely, can lead to the successful use of pharmacists as regular immunizers; a pharmacy chain in the United States reported no serious injection site or allergic reactions following almost 20,000 injections.18 In addition to safety, several other concerns have been raised. Fragmentation of care is one of the main reasons why doctors are hesitant to refer their patients to a pharmacist.19 This issue will be difficult to reconcile until patient information is available on electronic health records.20 For the time being, patients receive paper immunization records for their vaccination booklet and some public health data are collected. For example, in British Columbia, pharmacists keep records in their electronic database, and for some immunizations, like influenza, they report aggregate injection data to local health authorities. Additionally, pharmacists must report adverse events following immunization.21 Another issue commonly cited by the medical community is the risk that pharmacists will be motivated by economic interests if they sell and administer vaccines. However, pharmacists who choose to vaccinate do so out of an interest in public health and not because it represents a fiscal opportunity; in contrast, remuneration is often considered to be inadequate and a barrier to providing vaccines.22 Demands for pharmacists to vaccinate are coming from pharmacists and their clients. A 2010 survey by the Institut national de sante publique du Quebec (INSPQ) found that nearly half of pharmacists would be interested in vaccine injection.23 Similarly, when Ipsos Reid conducted a poll to determine Canadian perspectives on expanding pharmacy services, individuals from Quebec were most likely to support having “trained pharmacists administer doctor-prescribed vaccines.”24 With influenza coverage in the province being the lowest in Canada in 2011, it appears that patients in Quebec have good reason to want their pharmacists to vaccinate.13 Although the concerns that physicians raise may be well intended, there is an undeniable “territory” struggle. As Diane Lamarre, head of the Ordre des pharmaciens du Quebec (OPQ), remarked, vaccinations were left out of Bill 41 negotiations because of their potential to cause friction between health professional groups. However, given that these groups are dedicated to improving the health of individuals, they must learn to check their vested interests at the door. ■

Design of Interactive Cancer Education Technology for Latina Farmworkers.

Latinas in the United States experience higher levels of cervical cancer (CC) incidence and mortality rates than the general population, and many lack access to healthcare or face communication, literacy, and knowledge barriers preventing proper CC screening. Interactive technological interventions, like embodied conversational agents (ECA)/virtual agents, are currently used in other populations, settings, and for other health topics, however, no known initiative has used culturally- and literacy-appropriate technological interventions to deliver Spanish-language CC education. This study aims to create a culturally tailored Spanish-language Virtual Patient Educator (VPE) application to augment a patient navigator (PN) intervention for increasing CC screening rates among Hispanic women in a rural agricultural community. The VPE is a computer character that can simulate face-to-face conversation with an actual person and will embody the characteristics of a PN. Through iterative interviews with the target population, key cultural design factors were identified to inform the design and implementation of a prototype VPE. This paper discusses design and usability issues associated with development of the VPE for low-literacy users in addition to a framework methodology for development of similar tools and a cultural matrix of design factors. A VPE might help close the knowledge gap between Hispanic women and the general population regarding cervical cancer screening. Incorporation of culturally tailored features in technology aids in increasing overall understanding and trust of health information presented. An iterative approach that engages the patient population in design of technology is important to identify population-specific patient preferences.