Patient Educational Strategies NC Razali Mahdi Nurse Clinician, Infectious Diseases/HIV Care Communicable Disease Centre (CDC) Tan Tock Seng Hospital
1. Identify the patient 2. Assess Readiness Contents 3. Assess Background Knowledge, Belief System & Motivation 4. Education Plan 5. Assessment & Evaluation 6. Follow Up Care
Before Patient education? Achieve dual Communication System Gain Understanding Committed Adherence Molassiotis A, et al. Int J Nurs Pract. 2007;13:370 376
Why is patient education important? Chronic disease approach (Patients living longer) To Increase patient participation in treatment
Identifying the patient Identify reasons for referral Newly diagnosed HIV Old cases No show / Default cases Problems with managing illness
Identifying the patient What is the CD4 levels? Current CD4 Level? Previous CD4 readings? Upward Vs Downward Trend? Management of patient with Low CD4 levels Risks for Opportunistic Infections Any prophylactic medications?
Identifying the patient Is ARV on board? Yes No, Why? - Not Ready to take - Financial problem - Refused to take - Wants to try other methods of treatment
Identifying the patient Are there any family members who are aware of patient s diagnosis? Yes Can involve family in the care / session No, Why? - Ashamed (Stigma, Discrimination) - Not understanding - Thrown out - Prefer to keep confidential
Assess Readiness Is patient ready for education session? Yes No, Why?
Possible reasons Assess Readiness Have not come to terms with diagnosis Denial Shock Feels ashamed Family members around Frustrated at diagnosis Feels helpless
Possible reasons Assess Readiness Having Suicidal thoughts Others (Non-communicative, Psychotic, Coma) Overwhelming information
Assess Background Knowledge Assess awareness and knowledge of condition Aware what is HIV? Disease progression and routes of transmissions CD4 count Importance of ARV Identify need for ARV and need for adherence
Assess Background Knowledge Check what have been informed by the physician Have the Dr told you of your diagnosis? Can you let me know what you understand from his explanation? Do you want to share your concerns and fears if any?
Assess Belief System Understand patient s belief system on What illness meant to them What they think of ARVs? Do they belief treatment works? Wants to try other methods first? Molassiotis A, et al. Int J Nurs Pract. 2007;13:370 376
Assess Motivation Assess motivation and willingness to start /Continue with treatment Vs
Patient Education Plan Gather what patient have informed you during the assessment phase and work the objectives together with patient (ONLY with Patient Consent)
Patient Education Plan What should be included in the Plan? What is HIV? How HIV is transmitted How HIV is NOT transmitted Progression of HIV Interpretation of lab results (E.g CD4, VL) Treatment information - Indications for treatment, goals of treatment - General information regarding the benefits of treatment
Patient Education Plan Goal Of HAART treatment
Patient Education Plan What should be included in the Plan? Treatment Information - General information regarding potential side effects of treatment - Access to medication Treatment options Prevention for positives Support services and support groups available to the patient
Patient Education Plan
Patient Education Plan Who should provide patient education? Doctors, Nurses, Medical Social Workers, Pharmacist Can be done collaboratively, multidiscipline approach However, information must be consistent - Sharing of information across - Latest treatment guide, ARV information & resources
Patient Education Plan How should patient education be conducted? Optimum 15-20 mins Ideally, sessions should spread out; - Peer Support Session - Drug Adherence Program - Dietary Recommendations (Dieticians) - Clinic Consult - Specific Nurse Clinician Consult
Patient Education Plan How should patient education be conducted? Objectives of session, should be specific to needs Given opportunity to learn as much as they like Retain information necessary to keep them safe & healthy Do not need to have high level of information
Patient Education Plan How should patient education be conducted? Some would like to know more information - helps them in making decision in their treatment Some only want to know the basics - Worried will be overwhelmed/confused with information Some Wants to be told what to do - Prefers to leave to healthcare
Assess Understanding Evaluation and assess need for further sessions Re-check goals / objectives of session Ensure patient receives information and perceives correctly
Check understanding Assess Understanding Is there anything else that you want to ask? Do you want to share with me what we have discussed just now? What do you know about the purpose of ARV? Why do you think it is important to keep on taking ARV? Can you list me the type of food that you should avoid?
Summarizing Round up session by summarizing main points, We have covered about routes of HIV transmissions mainly We know that ARV helps in.. It is important that ARV is taken consistently and. If any side effects appear, please seek..
Follow-Up Care Identify patient who needs follow up session - Some might need to go slow - Some need time to build rapport Arrange another date to review
Conclusion Every patient is unique and requires education package tailored to their needs Education session is a constant process and it takes time Patient might not register anything you said BUT, It is good enough if one day somehow the patient remembered what you said and decided to act on it to change their life That is then why you are here for
Thank you
References & Resources 1. AIDS.org http://www.aids.org/ Online home of AIDS Treatment News. 2. AIDS InfoNet http://www.aidsinfonet.org/ Comprehensive collection of fact sheets on clinical topics, available in English and Spanish, in printfriendly and downloadable formats. Regularly updated. 3. AIDSmeds http://aidsmeds.com Information regarding HIV-related medications for patients, including drug interactions calculator. 4. AIDS Project Los Angeles http://www.apla.org/ Fact sheets, newsletters, and program information. Some information in Spanish. 5. The Body http://thebody.com Major HIV information resource geared toward patients and the community 6. Project Inform http://projectinform.org Comprehensive information and advocacy information geared toward individuals infected and affected by HIV. 7. San Francisco AIDS Foundationhttp://www.sfaf.org/ AIDS 101, BETA treatment newsletter, and prevention and program information. Some information in Spanish. 8. Test Positive Aware Network (TPAN) http://www.tpan.com/index.shtml Chicago-based community organization with newsletter, drug guide, and service information. 9. VA National HIV/AIDS Program http://www.hiv.va.gov/ Comprehensive information portal for patients and providers 10. http://www.aidsetc.org/ 11. http://www.cdc.gov/hiv/default.htm