Benchmark: Research Critiques and PICOT Statement Final Draft                                                                   

OlabisiBabalola[MP1] 

Grand Canyon University: NRS-433V

08/27/2017
[MP2] 

HOW PATIENT EDUCATION AFFECTS PATIENT OUTCOME

The health care system enhances the patient’s quality of life through primary care, acute care, rehabilitation services and long term care. Education is a very important part of the healthcare system and nurses have an important role to play in patient education.How effective is the present patient education in acute care settings. The purpose of this paper is to revise the PICOT statement and the critique paper and to provide the evidence based change in nursing practice. The paper will also establish a relationship between the PICOT statement and the study problem.

PICOT Statement[MP3] 

 

            Problem[MP4] 

Patients still seem unaware of why they are in the hospital, unaware of their medication, and unaware of their disease process by discharge.

How can we[MP5]  ensure effective, measurable patient education of patients?The primary purpose of P[MP6] atient education is to create an understanding of health problems and healthcare requirements in the patient. By increasing knowledge of the health issues, the patient as well as their family or caretaker can improve their skills in assisting with treatment related tasks and foster the development of coping mechanisms. A random sample study of 372 patients by the Life Options Council shows higher levels of knowledge come tandem with better self-management and an overall improvement in well-being. Patients with a greater amount of knowledge of their healthcare situation show better outcomes because they are more likely to understand the importance of following treatment programs and can perform basic tasks on their own or with the help of family members. By educating the patient about their own heath care situation, one aims to make the patient part of the healthcare process and allow them to improve their own outcomes. By empowering the patient to take control of their own healthcare and have a behavior change by providing knowledge that enables them to make decisions themselves and have better health outcomes[MP7] .

Intervention

The study conducted in the article from Sara Paul, Hospital Discharge Education for Patients with Heart Failure, addresses the link between effective patient education and patient outcomes such as, improved quality of life, reduced hospital readmission and patient medication errors.(Paul,2008)[MP8] The intervention conducted in the article from the European Journal of Oncology Nursing is aimed at providing effective education on disease process, disease management, medication management and follow up visit by hospital discharge.(Reif, deVries, Petermann,Görres,2013)

Discerning the most effective course of education is often the greatest problem nurses face in patient education. Patients with low literacy, no at home help, or learning differences need different methods of education to be able to achieve the previously mentioned objectives.

Following up with patients at discharge is an vital step in ensuring that the education method used has been effective, such as asking  patients questions at discharge to determine if teaching throughout admission has been effective.

Outcome and Time

The outcome of this effort is providing effective patient education on disease process, disease management, medication management and follow up visits will decreases the incidences of hospital readmission, improve quality of life and prevent patient medication errors.Timing is also an important factor, it has been shown that patient education is most effective on  day  discharge.

PICOT Question: Howcan effective patient education decrease patient hospital readmission, increase quality of life and prevent patient medication errors.[MP9] 

 

Background of Study

Data suggests that in practice, discharge education is not emphasized as an essential component of optimal care in patients. A review of medical records in three large inner city hospitals reviewed the charts of 104 patients shows only 50%,48% and 9%  respectively were provided withdischarge instructions. (Paul,2008)

 

The method of study[MP10] 

Information for the research conducted was obtained througha previously researched study. The research was conducted ontheeffect of education on cancer related fatigue where patients were randomly selected for a 6 session education program. Data was collected and analyzed using the ANOVA.

Another material researched was a study bySara Paul, RN, MSN, FNP.  A total of 1623 hospitalizations for heart failure were reviewed; the mean frequencies of documentation of counseling about medications, weight, diet, exercise, and smoking cessation was obtained. (Paul,2008)

 

Conceptual / Theoretical Framework

“While the words are used interchangeably in the literature “Conceptual and theoretical frameworks are different terms.Conceptual framework is an analytical tool, used to make conceptual distinctions and organize ideas while a theoretical framework provides a broad explanation of relationships that exists between concepts. A theoretical framework is based on one theory. The concepts of the study relate back to the theory. Theoretical frameworks start out as a conceptual framework and with much research; develop into a research-based theoretical framework” (Tobiano et al [MP11] 2015).

The conceptual framework of this study is that patient education may not be effective given the reviewed charts that showed only 50% of patients  receive discharge instruction meaning the rest of the patients lack  knowledge of  disease process and  management and their medications or even know why they are in the hospital in the first place. According to national institute of health 50% of patients do not take medications as prescribed; the causes include lack of involvement in health decision making, complex medication regimen and lack of communication.

In this study and with much research we will understand why the current method of patient education is not working and then develop new conceptsand/or improve on the existing theory.

 

RESULT OF STUDY

Thearticle pertaining tocancer related fatigues by the European Journal of Oncology Nursing, shows that the patients that receives the 6 sessions of education show a significant differences in outcome as shown below

(F = 76.510, p < 0.001, η² = 0.248). Secondary outcomes also showed significant improvements in all measures, including quality of life (F = 29.607, p < 0.001, η² = 0.113), general self-efficacy (F = 27.680, p < 0.001, η² = 0.107), exercise self-efficacy (F = 49.230, p < 0.001, η² = 0.175), physical activity (F = 8.036, p < 0.001, η² = 0.033), anxiety (F = 33.194, p < 0.001, η² = 0.125), depression (F = 24.604, p < 0.001, η² = 0.096), and fatigue knowledge (F = 55.157, p < 0.001, η² = 0.192).(Reif, deVries, Petermann,Görres,2013)

The Results of the study on the effect of education on heart failure patients whose charts were reviewed after discharge are as follows. A total of 1623 hospitalizations for heart failure were reviewed; the mean frequencies of documentation of counseling about medications, weight, diet, exercise, and smoking cessation were as follows: Medications: 97% (range, 95%-98%) Weight: 6% (range, 3%-12%)Diet: 70% (range, 58%-94%) Exercise: 61% (range, 26%-81%) Smoking cessation: 14% (range, 0%-33%) The variability of counseling between hospitals was high, and documentation may not reflect what was actually practiced.12 The documentation may or may not have reflected the extent of the counseling. How the information was conveyed and the depth of the patient understands of the information(Paul,2008)

 

Ethical consideration

     Although health education and decision-making can occur without the nurse, the nurse’s role as teacher and facilitator of learning is vital to enhancing patients’ otherwise limited health literacy and providing encouragement, support, and direction in any needed decision-making. Effective patient education can reduce complications of illness and further incidence of disease, promote adherence to treatment plans and continuity of care, and encourage patients to be independently and actively involved in their care and daily well-being. Thus, the nurse is morally responsible for effective communicating health information to the patient. In order to do so, the nurse must evaluate and be accountable and responsive to factors affecting the patient’s ability and readiness to learn. A patient’s health literacy is one of the major factors contributing to his or her ability to learn and is defined as “the degree to which individuals have the capacity to obtain, process and understand basic health information and services need to make appropriate health decisions.” Often, patient-professional communication is stunted when the patient and involved family do not understand the information being presented. This must be attended to as poor health literacy is a stronger indicator of a patient’s health than other socioeconomic factors. Furthermore, the nurse must consider how the patient’s situation, state of mind, cultural and socioeconomic background, and, where family and friends are involved, relationship dynamics might affect how information is received. The nurse must also effective balance honest a practical disclosure of health information with hope that is the possibility of future good. Through such considerations, the nurse must strive to maintain patients’ dignity in sensitive in respectful communication.

Data source was from six peer reviewed quantitative and qualitative research articles, from the article I was able to review study findings and implication for nursing practice, the present state of patient education and how effective it is. Articles reviewed protected human participants; reviews were done legally and duly cited.

Patient’s privacy was protected as researchers did not disclose ant personal information. There were no ethical considerations[MP12]  in both of these studies

 

PROPOSED EVIDENCE BASED PRACTICE CHANGE[MP13] 

The p[MP14] roblem in this study is the inadequacy of patient education. This problem is related to the PICOT question. From the PICOT question the purpose is to establish a link between inadequate patient education and frequent readmission rate, poor quality of life and patient medication errors. The PICOT question wants to find solution to the problem.The fact that the research article showed that only 50% of patients received education at discharge and the other study in the research article on cancer related fatigues showed a significant change in quality of life, no hospital readmission reported, and activity level increased. Therefore, the PICOT question, the article and the nursing practice problem are related. (Paul,2008)

This study proposed that 100% of patient should receive education before discharge especially in a medical/surgical units where hospital readmission rates are high.

 

CONCLUSION[MP15] 

       Wagner chronic care model suggests the following interventions for chronic care disease management: Self-management education, tools for behavior modification and clinical information. The results from several studies concluded that the use of educational assumptions from social learning theory waskey for the results of the teaching. These assumptions were consonance, relevance, individualization, facilitation, feedback and rewards, findings and Interpretation of Finding/ Implication. (Tobias et al, 2015).  In addition, self-management education is also important; the goal is to improve both subjective and objective management of disease. Patient education alone is not recommended by most guidelines, the recommendation is for self-management education with disease management. Self-management teaches problem solving skills in addition to offering information about the disease.

 

 

 

 

 

 

 

 

 

 

                                                              REFERENCE[MP16] 

Paul, S. (2008). Hospital discharge education for patients with heart failure: what really works and what is the evidence?. Critical Care Nurse, 28(2), 66-82.

Reif, K., de Vries, U., Petermann, F., &Görres, S. (2013). A patient education program is effective in reducing cancer-related fatigue: A multi-centrerandomised two-group waiting-list controlled intervention trial. European Journal Of Oncology Nursing, 17204-213. doi:10.1016/j.ejon.2012.07.002

Tobiano, G., Marshall, A., Bucknall, T., &Chaboyer, W. (2015). Patient participation in nursing care on medical wards: An integrative review. International Journal Of Nursing Studies, 52(6), 1107-1120. doi:10.1016/j.ijnurstu.2015.02.010

 

 

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