As a health manager you have been asked to design and develop a new model of patient education at the time of discharge with the aim of reducing the hospital readmission rate.
Contemporary issues on quality healthcareprovisionincrease the burden on health care providers to partner with patients. This partnership should help address “the greater health care responsibility placed on patients and their informal caregivers to manage the symptoms and disease process outside the hospital,” (Bahouth, Blum & Simones, 2013. Pg. 36). Successful patient education would improve the patient care quality and reduce health care costs. Therefore, when planning for the discharge of a patient, it would be appropriate for the healthcare provider to engage in patient education (Kirk, Dipchand, Rosenthal & Kirklin, 2014).
This paper aims at designing and developing a new model of HIV/AIDs patient education at the time of discharge in order to reduce the hospital readmission rate. To achieve this aim, the staff that should be involved in the new model are identified, the barriers that could hinder staff involvement are outlined and solutions to overcome these barriers explained, the planning processes that would be applied in this model are highlighted, the information types and sources that would be applied to this model are identified and finally an original diagram of the planning process for the new model is provided.
Kirk, Dipchand, Rosenthal & Kirklin (2014) explains that a transitional care, that is, post-discharge care, is based on four principles; medication reconciliation, patient-centred records, follow-up care and red flags that could trigger a more comprehensive intervention. It is essential to understand the above principles before designing or developing the patient education model.
Patient education towards reducing readmission rates involves a coordinated effort of those hospital staff who was involved in ensuring the patient care provision and enhancement during the treatment process when the patient was admittedto the hospital. The information passed during this education range from medical care advice, preventive information to reducing the risk of reinfection. Medical care education entails such pieces of advice as taking the medication exactly as directed by the doctor; reporting any side effects from the medication to the doctor; regular visits to the doctor; the patient informs all his or her health care providers about his or her HIV status; and communicating to the doctor before taking any vaccine.
Measures to help the patient prevent the spread of the disease, that could be informed to the patient at discharge would include: practicing safe sex, asking any sexual partner that the patient has to get tested for HIV, avoid sharing sharp objects, not to donate blood, plasma, semen or any other body part and consulting the doctor before getting pregnant for the female patients. Finally, the patient could also be educated on the ways to reduce the risk of HIV reinfection such as; taking care of his or her skin, avoiding electric razor for shaving, inquiring with the doctor before using cosmetics and avoiding contact with animals (www.mountnittany.org).
Different members of the hospital staff would be involved in the patient education model to ensure that it is effective in addressing the issue of reducing readmission rates from HIV/AIDs infected patients. These staffsinclude the medical staff, the nurses, pharmacist, nutritionist specialist, clinical social workers and counsellors,and the hospital administration.
These are the people who are directly involved in taking care of the patient and monitoring their recovery progress. Moreover, they do follow-upsto assess the patient’s progress further. Therefore, nurses have an important role to play in the patient education.
Patients taking the HIV drugs are often advised to ensure that they maintain a balanced meal dietso as to enhance their recovery and improvement processes. During patient education at discharge, information from the nutritionist would be valuable in advising the patient on how to eat healthy so as to maintain a healthy body when taking the prescribed drugs.
The hospital administration has the responsibility of setting the overall organizational strategic plan and objectives as well as providing and allocating financial and other resources to the current and potential projects to be undertaken within or without the health care facility premises. Formulating a HIV patient educational plan may require additional resources to be availed for the task, this would only be achieved through coordinating with the hospital administration personnel. Therefore, involving the hospital administration in the formulation of patient education plan at discharge would be beneficial as it would help ensure that the objectives and goals of the plan are set in accordance with the overall organizational objectives and also the availability of the necessary financial resources to carry out the planning process and for actual implementation of the plan. Thus, in this case, the hospital’s HIV department would be involved in conjunction with the overall administrative staff members.
Several factors could hinder staff involvement in the designing and develop a patient education model intended to reduce the rate of readmission for HIV/AIDs patients. These range from workplace environment to personal factors that could hinder effective patient education. They may include:
Incivility barrier
Patient education requires the nursing staff to commit their attention towards the needs of the patients. Incivility affects the nurse’s judgments. The clinical decisions made by nurses are affected by incivility within the healthcare facility in different ways. First, incivility in the workplace affects the emotional state of the nurse through making him, or her feel ashamed or disrespected. People base their judgments, in most cases, on their emotional feelings. Therefore, rudeness or lack of respect may lead to disagreement between the nurse and the disrespectful party or colleague. Workplace conflicts or disagreements will more often than not distract the nurse’s focus on the patient’s needs, and instead draw the greater attention from the nurse to his or her emotions or the existing conflict. The distracting effect of conflicts will in turn influence the nurse’s clinical decisions or judgments.
Furthermore, incivility causes stress to the nurse, more so when it is originating from the supervisor. This is because the nurse gets a feeling of being disliked when his or her supervisor shows rudeness towards him or her. This feeling of not being liked may, in turn, affect the clinical judgments made by the nurse through causing uncertainty and self-doubt when making judgments, or fear for the supervisor’s reactions will regard to the decisions that the nurse has made. Additionally, this also affects the ability of the nurse to carter for patient’s needs effectively. The nurse may also lose interest in the profession, therefore feeling the need to quit the job. This lack of interest in the profession will further negatively influence the nurse’s clinical decisions since the nurse tend to put more of his or her focus on the resignation process, rather than attending to the needs of the patient (Yoder-Wise, 2014).
Incivility barrier could be solved through the application of the American Nurses Association (ANA) Act. ANA is one of the various Acts that address the workplace incivility problem. This Act stipulates for obligatory treatment of colleagues, superiors, and students in a given manner by every nurse. The Act further requires all nurses to possess character traits of kindness, dignity, and respect. Violence and bullying in the workplace are also condemned under this act.
Every person involved in patient education should be able to understand the learning needs of the patient. This is because patient education relies on the patient’s learning needs. Failure to understand these needs would hinder delivery of effectiveeducation. Providing all the necessary information about the patient and his or her condition, coupled with staff training would help solve this barrier.
Demanding schedules and responsibilities of the nursing staff makes it difficult for the nurses to find time to allocate to teaching patients. It requires the nurses to adopt an abbreviated, efficient and expeditious approach to patient education. Moreover, this barrier can be solved through discharge planning that helps ensure continuity of care across different settings (Bastable, 2003).
Many healthcare staff personnel lack clear principles of teaching. They do not feel confident or competent enough to provide patient education. This is due to lack of adequate information on becoming an educator during the nursing or medical education process (Bastable, 2003). This barrier could be prevented through strengthening the roles of the healthcare staff as patient educators, through training and seminar programs.
Some nurses and physicians are not sure of the effectiveness of patient education in improving health outcomes. Bastable, 2003, explains that some professionals may continue to feel excluded from the responsibility to provide patient education unless they all believe it can lead to significant behavioural changes and increased compliance to treatment regimens, even out of the hospital. Providing more information on the importance of patient education may help solve this barrier.
Many healthcare providers cover much of the same content. This is due to inadequate coordination and delegation of responsibilities to ensure timely, smooth and thorough progress of patient education (Rankin & Stallings, 2004). It would be appropriate to standardize contents, make clear teaching responsibilities and strengthen the lines of communication among the healthcare
Type of documentation system used by the healthcare facility also affects the quality and quantity of patient teaching recorded (Rankin & Stallings, 2004). Lack of time and attention to documentation or inadequate forms on which to record teaching activities explains the reason behind many formal and informal patient educations being done but not written down. Lack of these records impedes communication among health care providers regarding what has been taught and decreases the attention paid to patient education.
Planning processes refer to the step-by-step activities that could be undertaken to ensure smooth flow and coordination of the different efforts applied to achieve a successful patient education. These processes are:
This entails considering the specific needs, values, abilities, knowledge and learning styles of the patient. Beginning the learning process involves patient empowerment; providing the patient with choices whenever possible; making the patients an integral part of the education model development and process, and collaborating with the patients.
This is the first planning process. It entails developing a statement containing information about the overall direction and purpose of the program (Bensley & Brookins-Fisher, 2013). This process affects resources allocation to the program through determining a well fit of the educational program mission statement into the overall organizational mission. Therefore, planning process should cover sourcing for ways to properly develop the mission statement.
Through needs assessment, the program designer obtains information relevant to determining the relevant materials that would be used in providing the patient education and focus on the program (Watson, 2011). Needs assessment also entails considering the different types of resources needed to undertake the educational program; physical, financial and personnel resources. Assessing patient needs is key to ensuring that the educational program is efficiently designed to address the patient needs and address the importance of taking good care of the patient health to avoid hospital readmission.
Setting goals and standards is another important planning process. Goals are important guidance for establishing objectives and ensuring the continuation of the planning activities. Standards, on the other hand, determine the successfulness of the program (Bensley & Brookins-Fisher, 2013). Through the goals and standards, the manager gets to plan on the ways to effectively gear the company resources towards attaining the desired outcomes.
Objectives address the change expectation of the target patients. Patient education planning involves different objectives types including administrative, behavioural, environmental, learning, impact, outcome objectives (Watson, 2011). This process should ensure that the aims of the program are realistic and attainable within the specified time frame. This is through proper use of resources and involvement or all relevnt personnel towards the success of the program.
These are the methods of teaching and activities designed to help in achieving the objectives and ultimate goals of the educational program. These strategies include health communication, education, and behaviour change and follow up. Appropriate teaching materials and information are provided, ways to achieve the objectives determines and implementation of the designed program is done.
This is the method of determining whether the goals, standards, and objectives of the educational program have been met or not. Evaluation is done at the end of the educational program, and the results obtained used to make changes where necessary to realize more positive outcomes (Watson, 2011). Continuous evaluation is necessary to ensure continuous improvement of the educational program depending on the changes in patient needs and the organizational structure.
Different types of information are used when designing and developing an HIV/AIDs patient education model to help reduce hospital readmission rates. These may include; medical history information, patient care information, information on preventive measures, dietary information, information on infection risks and information on proper care for HIV/AIDs infected persons.
Medical history information helps in determining the number of times that the patient has been admittedto the hospital and the different nature of complications that led to the number of admissions. These can be obtained from the hospital’s data systems and the nursing records. Moreover, direct communication with the doctors involved in handling HIV related cases would also provide the necessary information on the medical history of HIV patients (Mishra, n.d.).
Information on HIV preventive measures is also crucial in HIV patient education. This will provide the basic outline for the person assigned to take care of the patient at home after admission to ensure that he or she stays safe from being infected. Or the patient himself or herself get HIV reinfection in cases where the caregiver is HIV positive (In Volberding, 2008). Such information is available on secondary information sources such as world health reports on HIV studies, CDC records; community-based health care centers and online sources of HIV information.
Patient care information with regards to the required equipment and materials for handling HIV patients are also necessary when developing an education plan. The nurses themselves can provide this education appropriately, or the HIV department records on usable could also be used as a source of this information type.
Another important information type would be on the diets and nutrition requirements of the patient. This helps elaborate the food kinds and amounts to be taken by the patient depending on the viral load in the patient’s body, along with other patient requirements such as medication. Such information is obtained from the hospital nutrition specialist and online dietary information.
Moreover, information on risk factors and other health complications associated with the patient’s condition is also important when developing HIV patient education program. Risk factors contribute towards enhancing HIV health complications, which would, in turn, lead to hospitalization. Therefore, it is important to educate the patients and their caregivers, on admission, about those factors that could further pose health risks to the patient and how to avoid or manage these factors. The health care facility’s HIV department should clearly explain these risk factors and the ways to handle them. In addition, much risk factors information is also available through online websites and articles (Biggs, n.d).
The patient needs information is also important in designing an HIV patient education model at discharge in order to reduce readmission rate. Since quality health care should be patient-centered, information on how to make the patient the center of care provision would be appropriate (In Modschiedler, In Bennet & American Library Association., 2014). This is possible through patient needs assessment. Such information can be obtained through a survey on patient records, asking the physicians involved with the patient, talking to the nurse who was in charge of caring for the patient in the hospital and through the patient, interviews too; get their views of their needs.
Finally, proper patient care at home is necessary to reduce the rate of patient hospitalization. This can only be doneby providing all the necessary information with regards to subject matter. Therefore, both primary and secondary information sources are importantin giving information on how to care for the patient after discharge and to report any health complications immediately to the doctor.
Explanation of the diagram
The manager first identifies the target population, which in this case are the patients admitted with complications resulting from HIV infection. The planning process then proceeds to the development of the mission statement that specifies the reason for the patient education. Afterward, planning for patient needs assessment is then done. From the needs assessment plan, the required staff involvement is determined, and through the hospital administration, the relevant staff is availed to support through the planning process. Goals and standards for the education program are then set that provides the guidelines for objectives development. The objectives will, in turn, lead to planning for the intervention; behavioural change and teaching strategies that would help carry out the main activity of patient education. The final planning process would be an evaluation to ensure that the educational strategies meet the set objectives and the overall company aim, which is to reduce readmission rate for HIV/AIDs infected patients.
Conclusion
Patient education at discharge greatly contributes towards quality healthcare provision both in and out of the hospital. This, in turn, leads to a reduction in readmission rates for the patients involved. Developing an effective educational program for HIV patients not only entails the efforts of the health care facility nurses who are directly involved in taking care of the patients in the hospital wards, but it also requires getting a coordinated effort of all other relevant staff that would help towards planning and execution of the patient education, not necessarily involved in the direct care or treatment of the patients. An effective patient education plan should be formed in line with the organizational goals, thus requiring coordination with the HIV department staff as well as the overall hospital administration staff members. Moreover, appropriate information sources should be identified and availed to ensure that such processes as patient needs assessment and goals formulation are done in line with the target population requirements.
References
Bahouth, M.N., Blum, K. & Simones, S. (2013). Transitioning into hospital-based practice: A guide for nurse practitioners and administrators. New York, NY: Springer Pub. Co.
Bastable, S.B. (2003). Nurse as educator: Principles of teaching and learning for nursing practice. Boston: Jones and Nartlett.
Bensley, R.J., & Brookins- Fisher, J. (2013). Community health education methods: A practical guide. Sudbury, Mass: Jones and Bartlett Publishers.
BIGGS, (n.d). Education and HIV/AID. A&C Black.
Daaleman, T.P. & Helton, M.R. (2018). Chronic illness care: Principles and practice. Routledge Pub.
Dzieglewski, S.F. (2013). The changing face of healthcare social work: Opportunities and challenges for professional practice. New York: Springer.
Gingerich, B.S., & Ondeck, D.A. (2007). Discharge planning for home health care: A multidisciplinary approach. Gaithersburg, Md: Aspen Publishers.
In Modschiedler, C., In Bennet, D.B., & American Library Association. (2014). Guide to reference in medicine and health. American Library Association.
In Volberding, P.A. (2008). Global HIV/AIDS. Philadelphia, PA: Saunders Elsevier.
Kirk, R.I., Dipchand, A., Rosenthal, D. & Kirklin J. (2014). ISHLT Guidelines for the Management of Pediatric Heart Failure. Cork: BookBaby.
Lees, L. (2011). Timely Discharge from Hospital. M & K Update Ltd.
Mishra, R.C. (n.d.). HIV/Aids education. S.I.: Aph Publishing Corporation.
Rankin, S.H., & Stallings, K.D. (2004). Patient education in health illness. US: Lippincott Williams & Wilkins.
Watson, M.E. (2011). Systems Approach Workbook for Health Education & Program Planning. Jones and Bartlett Publishers.
Yoder-Wise, P. S. (2014). Leading and managing in nursing.St. Louis, Mo: Elsevier Mosb
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