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Patient Education

Patient Education in Interdisciplinary Health Care Settings
(High School, College)

Doctor's and PatientApplicable to Courses: cross-training, people skills, communication. HOSA high school students, college students

Description of Students' Roles and Problem Situation: Students will assume roles of various health care professionals and educators to problem solve patient education issues. Problem: provider is cross-trained in phlebotomy and EKG, with an x-ray background and is confronted by a patient with concerns over her training.

Educational Goals: The student will:

  • introduce and understand cross-training in health care
  • assess problem, brainstorm

Submitting Teacher: Amy B. Orders, NC State University, Raleigh, NC, amy_orders@mindspring.com


MEET THE PROBLEM DOCUMENT

INTERDEPARTMENTAL MEMORANDUM

TO: All clinic staff
FROM: Amy Orders, BS, RT(R)
DATE: July 18, 1999
RE: Multidisciplinary Workers and Patient Education

June Harris, an employee within our clinic, approached me with a scenario that I feel is worth examining for current and future employees in our facility. As you may know, June is a member of our multidisciplinary team that has received training in phlebotomy, EEG and office procedures. She performs these duties in addition to her primary focus of radiography in which she received her degree.

Recently, June had an interesting situation arise with a patient. The patient questioned June’s abilities and expertise as a phlebotomist since her nametag denoted her as a radiographer. The patient became speculative and leery of the employee, prompting a barrage of questions. The employee answered the questions adequately and in a friendly manner and the office visit proceeded amicably.

I am assembling a team of health care professionals from our facility, including a nurse, a patient care advocate, a legal staff representative, an instructor, a physician and an allied health student to examine our responsibilities and roles as patient educators in a multidisciplinary staffing environment. My hope is that the team can develop some level of understanding of situations of this nature and determine various appropriate approaches.

The team will meet July 29, 1999 at 8:00am. I would like for the team to present its recommendations and opinions at this meeting. Please devote 20% of your work time to this issue, both for meeting preparation and to review various solutions that may be immediately implemented in our clinic.


CURRICULUM ALIGNMENT

OBJECTIVES

Major Area
  1. Radiography students will learn positioning skills and radiographic procedures.
  2. Radiography students will learn fundamental physics principles, including exposure, processing, protection and quality assurance.
  3. Radiography students will learn basic anatomy and physiology and radiobiology.
Interdisciplinary Area Objectives
  1. Students will learnappropriate and professional levels of communication skills (Public Relations Curriculum for UNC system).
  2. Students will learn to function as aninterdisciplinary team member in a health care setting. (Allied Health ProgramCurriculums for UNC system).
  3. Students will learn introductory researchmethodologies and techniques (English/Language Arts Curriculum).
STUDENT CHARACTERISTICS
  1. Students are dedicated to their profession and healthcare.
  2. Students are committed to learning new skills that make them more marketable.
  3. Students have a strong desire to function independently.
  4. Students desire to stay abreast of changes and new trends in healthcare, including multi-disciplinary positions in facilities.
  5. Students want opportunities to relate knowledge to hands-on application in clinical settings.

SAMPLE KNOW AND NEED TO KNOW BOARDS

Know

  1. Meeting is July 29th
  2. 20% of time allowed to prepare information
  3. Meeting will include: nurse, physician, legal representative, patient advocate, instructor
  4. Students receive education on "team work, team players"
  5. Radiography students have training options outside their scope of practice
  6. Reason behind the meeting is to discuss patient education in multidisciplinary, multi-skilled staffing environments
  7. June Harris performs radiography, phlebotomy, EEG and office duties
  8. Patient concern of staff training in phlebotomy when nametag denotes radiographer
  9. Patient speculative and leery of employee and asked questions
  10. Meeting members should prepare solutions for immediate implementation and for the meeting

Need to Know

  1. Marketability opportunities for new students; jobs available.
  2. Monetary budget for meeting, implementation of solutions and staff training if needed
  3. Participation (or desire to) of other allied health professionals in problem solving process
  4. Interdisciplinary education methods and topics on communication and patient education responsibilities
  5. Multi-modality preparation, including radiography, EEG, phlebotomy
  6. Certifications, licenses, registrations of health care professionals
  7. Legal implications: patient concerns, providers expertise and training, medical ethics and confidentiality.
  8. Responsibilities of providers, educators and patients to stay abreast of changes and concerns in health care
  9. Level of education, expertise, autonomy employee functions with in workplace

SAMPLE PROBLEM STATEMENT

How can we as allied health professionals and educators prepare recommendations for educating students and staff who are cross training or already cross-trained to function in and handle a variety of patient education situations in the workplace, in such a way that:

  • it meets the July 29th deadline
  • it does not exceed 20% of the team’s work load and time commitments
  • educates students and staff on how to address and work through situations like this
  • the public is aware of changes in healthcare, including multi-disciplinary teams and cross-trained students and staff

PROBLEM MAP

Problem Map


RESOURCE LIST

Cervero, R. (1992). "Professional practice, learning and continuing education: An integrated perspective." International Journal of Lifelong Education, 11(2), 91-101.

"Executive Leadership and Management Consulting Group," http://www.competere.com/

Felch, William Campbell. (1996). The secret(s) of good patient care: thoughts on medicine in the 21st century. Westport, CN: Praeger.

Gelmon, Sherrill. (1997). "Accreditation, core curriculum and allied health education: barriers and opportunities." Journal of Allied Health, 119-125.

"Human Anatomy Online," http://www.innerbody.com/htm/body.html

Makely, Sherry. (1998). Multi-skilled health care workers : issues and approaches to cross-training ; how to combine skills, design training programs, utilize staff, overcome obstacles, and make multiskilling work for you. Bloomington, ID: Pine Ridge Publications.

Nurse patient interaction [videorecording]. (1990). (Available from Concept Media, Inc., PO Box 19542, Irvine, CA 92623-9542)

Rosenberg, Steven. (1989). The changing rural health care delivery system: development of alternative models. Kansas City, Mo.: National Rural Health Association.

Sullivan, Toni. (1998). Collaboration: a health care imperative. New York: McGraw-Hill, Health Professions Division.

"Virtual Health Care Teams," http://www.vhct.org/index.shtml


DESCRIPTION OF CAPSTONE PERFORMANCE

Based on the meet the problem document, students are to perform impromptu skits of the meeting scheduled for July 29th. The skits will be based on the following information:

  1. Each group will perform a skit. Groups may not exceed six members, since there are six individuals being asked to participate in the meeting.
  2. The skit is to depict the meeting activities and discussions. It should cover the information presented in the meet the problem document, research opportunities, opinions of the participants based on prior knowledge and expertise and possible solutions to the situation.
  3. Students will have thirty minutes to prepare. Materials are available in the classroom for reference as well as the Internet connection in the back of the room.
  4. Skits should last 10-15 minutes.

The intent of this exercise is to address the topic of patient education in this scenario in an adequate fashion for the materials and timetable provided. Students should propose various solutions to the problem and provide support for those options. Other intents of the exercise are to teach students to prepare for a variety of presentation situations, team approaches to work, effective communication skills and time management.

The audience for the presentations will include classmates and other faculty or staff members from the disciplines involved in the scenario. The invitation is open to all allied health faculty and staff, but all radiography instructors will be in attendance.

During each presentation, the audience members will critique the presenting group based on ability to address the topic, to offer solutions, communication skills, team effort and meeting time constraints stipulated (10-15 minute limit). Audience members are to record scores on the capstone assessment instrument.

After all skits are complete, students and audience members will discuss the proposed solutions. Each student and additional audience members will be asked to reiterate the solutions discussed in the skits (these will be recorded in space provided on the rubrics). A list of all possible solutions will be developed and posted for further discussion in upcoming class meetings.


ASSESSMENT INSTRUMENT FOR CAPSTONE PERFORMANCE

Content Organization

  1. Problem is clearly stated and explained
  2. Solutions are proposed and explained 20 pts______
  3. Problem is vaguely stated, but solutions are still proposed and explained 15 pts______
  4. Problem is not stated and solution quality is low 12 pts______

Team Work

  1. Each member actively participates in the skit
  2. Each member contributes valuable information or support 15 pts______
  3. Members participate moderately and offer semi-relevant information 12 pts______
  4. Members participate slightly and offer little information 10 pts______

Communication Skills

  1. Team members speak clearly
  2. Members maintain good eye contact with others during skit 20 pts______
  3. Team members mumble slightly, decreased eye contact 16 pts______
  4. Team members mumble and focus on script too much 13 pts______

Presentation Performance

  1. Group used creativity in presentation
  2. The appropriate meeting members were portrayed 10 pts______
  3. Group shows attempts to be creative and plays parts well 8 pts______
  4. Group shows little creativity and redefines characters in meeting for skit 6 pts______

ALTERNATIVE SOLUTIONS

Possible Solutions to Problem

  1. Worker is able to address situation appropriately and allay the concerns and fears of the patient.

PROS

  1. Worker is able to communicate effectively with patients.
  2. Worker allays fears, promoting more personal relationship with patient.
  3. Worker performs task correctly and painlessly, building trust with patient.
  4. Worker is able to multitask, i.e. communicate, perform tasks with an amicable ending.

CONS

  1. Worker did not incorporate other team members in the situation.
  2. Worker may be distracted with the onslaught of questions from the patient.
  3. Worker may not have the authority to answer all questions (medical ethics).
  4. Worker may not have been as time efficient with patient due to multitude of questions.
  5. Worker involves other health care team members in handling the situation with the patient.

PROS

  1. Worker is able to function as a team player.
  2. Worker completes task with help of other team members.
  3. Other health care team members can provide communication assistance.
  4. Other health care team members can perform the task if necessary.

CONS

  1. Involving others in this situation may incite doubt in the patient about the worker.
  2. Involving others in this situation may cause delays in the patient's medical visit.
  3. Involving others may cause overall delays in other duties (other patients do not receive their care as promptly)
  4. Involving others may incite hard feelings for added work.

CONSEQUENCES

For #1
  1. Showing confidence and ability to perform a task will give the patient a sense of confidence (if not gratitude) in the worker.
  2. If the worker attempts to answer all questions from the patient, even those that might be out of the worker's scope of practice, the issue of professional boundaries and ethics might have to be addressed
For #2
  1. Handling a situation efficiently and effectively may show other team members certain skills the worker has and may be able to use in various situations.
  2. Inability to handle certain situations that necessity the help of other workers may cause animosity within the team because of lack of time to complete individual tasks.

My preferable solution to the situation is to handle the situation independently of other team members. When working with patients, the worker should have an appropriate level of communication skills that allows he/she to convey their skills and confidence to the patient. When patients ask questions, the worker should be candid and attempt to allay the fears of the patient. Workers who have to relay heavily on their coworkers to handle situations might cause unnecessary animosity within the unit. So, I would promote independence unless the situation is outside the worker's scope of practice or ability.


DEBRIEFING SESSION DESCRIPTION

After the impromptu skits are completed, the class will review the scenario and all possible solutions presented. Students will state the solutions that were presented in each skit while the instructor records the statements on a black board or poster board. Space will be provided on the Capstone Rubric for students to record the solutions presented in the skits. If any solutions are not stated, the instructor will offer coaching questions to elicit the desired responses from the students.

Once all possible solutions are announced and recorded, the students will rank the solutions from highest to lowest in terms of importance and viability. The statements will be numbered on the left side of the board./p>

The next step is to determine the best possible solution for the situation. Students will be limited to selecting one solution and will be asked to discuss their decision and the reasoning for selecting it. Then, with coaching questions and statements from the instructor, students will examine other solutions and alternatives to their best possible solution selection. All discussions will occur as a class.

After examining all solutions, their rankings and the class' selection of a solution, the instructor will coach the class through questions and statements to ensure all topics and areas of concern have been addressed in the discussion and activities. If other information is uncovered, it will be addressed and analyzed. Once the information is discussed, changes may be made to the solution list prepared earlier in the session.


COACHING QUESTIONS

Meeting the Problem

  1. What information do you have to begin with in this patient education situation? (C)
  2. What resources or insights into clinic staffing and staff education would be helpful to prepare with? (M)
  3. What is the best approach to addressing this worker's dilemma immediately and long-term? (EC)

Know/Need to Know Board

  1. What is the first step in preparing for the upcoming staff meeting? (C)
  2. What are the strategies for addressing patient education issues based on the information presented on these two boards? (M)
  3. How can you verify the staffing and education information presented on these two boards? (EC)

Writing Problem Statements

  1. What information about this patient education dilemma do you have from the problem statement? (C)
  2. How do you apply the information from the problem statement to determine the best way to train the public on changes in health care (multi-disciplinary teams)? (M)
  3. What constraints might inhibit reaching the four solutions depicted in the statement, including the deadline, time budget, educate the staff on communication skills and educate the public on new trends in health care? (EC)

Information Gathering and Sharing

  1. What is most important to students and professionals in multi-disciplinary environments in this scenario, i.e. the goals? (C)
  2. Have you considered interviewing the former student for more information? (M)
  3. From what you have, what medical or staffing information do you want more on? (EC)

Generating Possible Solutions

  1. Is patient education a viable solution, based on the amount of time that they interact with health care providers? (C)
  2. What 'holes' exist in this possible solution presented? (M)
  3. What scenarios would offer in the meeting for patient and staff interactions and what you implement as an immediate remedy? Why?(EC)
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