Transcript Stroke Education in the Acute Care Setting

Presented By:
Dana M. Smith, MS, MCHES, CCE
Patient Education Specialist
UAMS Medical Center
By the end of this presentation, participants will be able
to:

Verbalize what health literacy is and it’s importance to
stroke education.

Verbalize the importance of stroke education to
stroke survivors and their caregivers in the acute care
setting.

Verbalize the key steps to providing effective stroke
education.

Use the teach back method as an evaluation tool for
stroke education.
Using printed and
written information
to function in
society, achieve
one’s goals, and
develop one’s
knowledge and
potential.
- Kirsch et al, 1993
“The degree to which individuals have
the capacity to obtain, process, and
understand basic health information
and services needed to make
appropriate health decisions.”
- Ratzan and Parker, 2000 / Healthy People 2010

A patient's ability to obtain, understand
and act on health information.

A provider’s capacity to communicate
clearly, educate about health and
empower their patients.
GNINAELC – Ot erussa hgih ecnamrofrep,
yllacidoirep naelc eht epat sdaeh dna natspac
revenehw uoy eciton na noitalumucca fo tsud
dna nworb-der edixo selcitrap. Esu a nottoc
baws denetsiom htiw lyporposi lohocla. Eb
erus on lohocla sehcuot eht rebbur strap, sa ti
sdnet ot yrd dna yllautneve kcarc eht rebbur.
Esu a pmad tholc ro egnops ot naelc eht
tenibac. A dlim paos, ekil gnihsawhsid
tnegreted, lliw pleh evomer esaerg
ro lio.
Access
Safety
Quality
Outcomes
Health Literacy results from the National Assessment of Adult Literacy, US Dept
of Education, 2003

Reliance on the written word for patient
instruction is increasing.

Increasingly complex healthcare system
▪ More medications
▪ More tests and procedures
▪ Growing self-care requirements
▪ Esoteric language
Elderly
Ethnic and racial
minorities
 Limited education
immigrants
 Low socioeconomic
status
 People with chronic
disease


 Making excuses
 Perceived resistance
 Has no questions
 Frequently missed appointments,
tests
 Non-adherent with meds or
treatment

Helps patient and caregivers understand why quick access to
care is important after stroke symptoms.

Identifies ways that the patient can reduce the risk of having
another stroke.

Provides caregivers needed information on how to care for a
stroke survivor.

Increases patient compliance and decreases re-admission
rates.

After TIA –
Within 2 days after a TIA, 5 percent of people will have a stroke.
Within 3 months after a TIA, 10 to 15 percent of people will have a
stroke. -National Stroke Association, 2012
Life Altering Event
Short Admissions
Large Amounts of Information +
Limited Staff Time

Assess patient for
educational
readiness

Plan what you will
teach

Implement teaching

Evaluate teaching

Who should education be targeted toward?

Are the learners emotionally ready?

Are there literacy issues?

What might be some potential barriers?

What are the learners preferred learning styles?

Are the learners motivated?
What does the patient NEED to know?
“Get with the Guidelines - Stroke”:
1. Activation of emergency medical system
2. Need for follow-up after discharge
3. Medications prescribed at discharge
4. Risk factors for stroke
5. Warning signs for stroke







Emotions after stroke
Avoiding complications: falls, UTI, aspiration
pn, etc.
Managing ADLs
Help for the caregiver
Understanding deficits: memory,
communication, motor skills, etc.
Rehab
Where to get further information – support
groups, websites, organizations








Physicians
Nurses
Patient Educators
Case
Coordination
Speech Therapy
Occupational
Therapy
Physical Therapy
And many others

What Resources are Available?
 Videos
 Materials/Handouts
 Other

Regarding Materials
 Are handouts written in plain or common language?
 Are materials written at a 6-8th grade level?
 Are materials free of medical jargon?

Font should be at least 12 point

Use ample ‘white space’

Use 1.5 or double spaces between sentences and more space
between bullets.

Organize information with the 3-5 most important “need to know”
points.

Give the most important information first and last to enhance
memory.

Use a conversational writing style and active voice.

Use plain language and avoid
acronyms.

Get the learner actively
involved.

Don’t make assumptions.

Use a variety of teaching strategies, if able.

Ask questions during teaching to make sure the
patient is understanding.

Always give written information as a back up to all
teaching.
“The greatest
impediment to
communication is
the illusion that it’s
actually
happening.”
-George Bernard Shaw

Research shows that patients remember and
understand less than half of what clinicians
explain to them. Ley, Communicating with patients: improving
communication satisfaction, and compliance 1988
Rost, Predictors of recall of medication regimens and recommendations
for lifestyle change in elderly patients 1987.

Use the Teach Back Method – aka: “Show Me” or
“Closing the Loop”

Is a way to confirm that you have explained to the
patient what they need to know in a manner that the
patient understands.
●
Asking patients to repeat
in their own words what
they need to know or do,
in a non-shaming way.
●
NOT a test of the patient,
but of how well you
explained a concept.
●
A chance to check for
understanding and, if
necessary, re-teach the
information.
●
“Asking that patients recall and restate what
they have been told” is one of 11 top patient
safety practices based on the strength of
scientific evidence.”
AHRQ, 2001 Report, Making Health Care Safer
●
“Physicians’ application of interactive
communication to assess recall or
comprehension was associated with better
glycemic control for diabetic patients.”
Schillinger, Arch Intern Med/Vol 163, Jan 13, 2003, “Closing the Loop”
● “I want to be sure I explained everything clearly. Can you
please explain it back to me so I can be sure I did?”
● “What will you tell your husband about the changes the
doctor made to your medicines today?”
● “Can you tell me some things you might do to reduce
your risk of having a stroke?”
● “Can you tell me what you would do if you started to feel
some of the symptoms of a stroke when you were at
home?”

On-Going Education after Discharge:
 Newsletters
 Follow up phone calls
 Stroke support groups
 Listservs
 Social Media
 Video-conferences, etc.

Education centered on staying healthy, reducing
risks, adjusting to life after stroke,etc.
3rd Thursday of Each Month
11 a.m. – Noon
UAMS Family Home
4300 W. Markham
Little Rock, Arkansas 72205
To Register: 501-686-7791

American Stroke Association
▪ Stroke Connection Magazine
▪ Stroke Handouts
www.strokeassociation.org

American Heart Association
▪ Get With the Guidelines
www.heart.org

National Stroke Association
www.stroke.org

National Institutes of Health
www.stroke.nih.gov