Effective teaching for the elderly: back to basics

Scoping review of the preferences of older adults for patient education materials

OBJECTIVE

To provide an overview of studies that describe the preferred mode and format of delivery of patient education materials to older adults.

METHODS

A scoping review was used to identify relevant literature published between January 2010 and June 2021, with specific attention given to studies conducted in high income countries with similar health systems.

RESULTS

A total of 3245 titles were identified, and 20 met the inclusion criteria and were included in this scoping review. Older adults preferred written information that could be accessed via health professionals or downloaded online. Other key features were identified including logical layout, signposted information, larger text size, labelled visual aids, and use of images appropriate and relevant to the target group were preferred. Audio visual resources were also considered valuable when well designed. Formats for patient education such as apps, group classes and online courses were less popular with older adults.

CONCLUSIONS

Patient education materials for older adults should be carefully designed, with attention to layout and content. Older adults indicated a preference for hard copy handouts or in a format that can be downloaded.

PRACTICE IMPLICATIONS

Regular engagement with older consumers about their preferences is important as technology for delivery of patient education materials evolve. Key features for specific attention during the design process include a logical layout (tested with consumers), signposted information, text size, labelled visual aids and appropriate images. The perspectives of other key groups of older adults such as those from minority populations or other disadvantaged groups are largely unexplored.

Education and skills training for care partners of hospitalised older adults: A scoping review

Background

The care partners of hospitalised older adults often feel dissatisfied with the education and skills training provided to them, resulting in unpreparedness and poor health outcomes.

Objective

This review aimed to characterise and identify gaps in the education and skills training used with the care partners of older adults in the hospital.

Methods

We conducted a scoping review on the education and skills training practices used with the care partners of hospitalised older adults in the USA via sources identified in the PubMed, PsychINFO and CINAHL databases.

Results

Twelve studies were included in this review. Results illustrate that nurses utilise multiple modes of delivery and frequently provide education and skills training tailored to the needs of care partners at the latter end of hospital care. The provision of education and skills training varies greatly, however, including who provides education, in what way information is conveyed, and how care partner outcomes are measured.

Conclusion

This is the first scoping review to describe and synthesise the education and skills training practices used with care partners of hospitalised older adults. Findings highlight the need for education and skills training to be interprofessional, tailored to individual care partners' needs and begin at, or even before, the hospital admission of older adult patients.

A quasi-experimental evaluation of advance care planning improves consistency between elderly individuals and their surrogates regarding end-of-life care preferences: Development and application of a decision aid with cartoon pictures

OBJECTIVE

This study sought to develop a decision aid with cartoon pictures and evaluate its effectiveness in increasing consistency between elderly individuals and their surrogates regarding end-of-life care.

METHODS

A pre-post quasi-experimental design was adopted using the Life Support Preferences Questionnaire. The intervention had two components: (1) increasing participants' knowledge of medical treatments related to end-of-life care, and (2) sharing their end-of-life wishes. The experimental group received an intervention, whereas the control group received usual care.

RESULTS

A total of 110 participants in 55 pairs of elderly individuals with average aged 86.4 and their surrogates (27 in the experimental group, 28 in the control group) were recruited from a veterans hospital in northern Taiwan. Nearly 90 % of elderly individuals were male. The multiple linear regression showed that the inconsistent gap between elderly individuals and their surrogates in the experimental group decreased 12 points than the control group after controlling the covariances (B = -12.116, p = 0.032).

CONCLUSION

The intervention improved the consistency between elderly individuals and their surrogates regarding end-of-life care.

PRACTICE IMPLICATIONS

A decision aid with cartoon pictures may support the discussion of end-of-life care in older Asian populations.

How are health literacy principles incorporated into breast cancer chemotherapy education? A review of the literature

BACKGROUND

Chemotherapy is commonly used in combination with other treatments for breast cancer. However, low adherence to chemotherapy is a growing concern, particularly among breast cancer patients. Side effects such as nausea and vomiting, fatigue, and arthralgia can contribute to reduced adherence. Other factors such as provider communication and limited insurance coverage can affect adherence. Studies have shown that as much as 28% of patients with breast cancer did not continue with their prescribed dose of chemotherapy. Research suggests that chemotherapy education materials can be critical to addressing problems with non-adherence, and may include written materials, verbal instruction, and multimedia programs. Despite this wide variety, the effectiveness and benefit of chemotherapy education hinges on the patients' health literacy. Breast cancer patients with low health literacy may be unclear about chemotherapy or face difficulty adhering to treatment if they do not understand the information provided to them. Thus, this scoping review summarizes the existing research on how health literacy principles are incorporated into breast cancer chemotherapy education materials.

METHODS

Using a combination of keywords (e.g. chemotherapy, education) and Medical subject headings (MeSH) terms (e.g., drug therapy, antineoplastic agents), we searched five databases (1977-2017): CINAHL, PubMed, PsycINFO, Cochrane Library, and Web of Science.

RESULTS

Eight of 4,624 articles met the inclusion criteria. Five articles incorporated health literacy principles (e.g., plain language, maintaining an active voice, using white space) into the development of written materials. Few articles used a theoretical framework to guide education material development (n = 3). Of the three articles that described pilot-testing of educational materials, two used post-tests only and one used a pre/post-test design.

CONCLUSIONS

Findings indicated that limited research exists regarding the use of health literacy principles in chemotherapy education materials. Much of the development of chemotherapy education is not grounded in theory and the application of health literacy principles is limited. Implementing health literacy principles may improve overall comprehension of education thereby increasing adherence.

Increasing risk awareness and facilitating safe sexual activity among older adults in senior housing

The prevalence of HIV in older adults is rising. This increase can be attributed to inconsistent condom use, low perceived disease susceptibility, and a sexual health knowledge gap found in older adults. Yet, little to no health promotion for older adults focuses on sex education. This study sought to determine the feasibility of a group-based educational program in senior housing settings and consider the utility of a self-efficacy based group education program on knowledge of disease risk and preventive techniques among older adults living in senior housing.

Assessing Patients' Disaster Preparedness in Home-Based Primary Care

Background: Chronic conditions paired with normal aging put home-bound individuals at risk of harm during a disaster. Because of their high rate of comorbidities, veterans receiving care from the Veterans Health Administration (VHA)'s home-based primary care (HBPC) program are especially vulnerable, which may prevent them from being prepared for disaster. With intimate knowledge of their patients' home environments, medical needs, resources, and limitations, HBPC practitioners are uniquely positioned to assess and improve disaster preparedness of patients. Objective: This study explored issues regarding disaster preparedness for HBPC patients, including ways in which policy and procedures support routine assessment of disaster preparedness for patients as well as patient education activities. Methods: This project involved 32 semi-structured interviews with practitioners and leadership at 5 VHA HBPC programs - 3 urban and 2 rural. Transcripts of the interviews were analyzed using content analysis techniques. Results: Three themes emerged regarding the assessment of a patient's disaster preparedness: (1) assessment tools are rudimentary and, in some cases, individually developed by practitioners; (2) comprehension of criteria for assigning risk categories varies among practitioners, and (3) patients' cognitive impairment, limited resources, and out-of-date or inaccessible materials are the primary challenges to their preparedness. A fourth additional theme emerged as well: (4) the interdisciplinary nature of the HBPC team allows for unique innovative practices, such as a central focus on caregiver support and personal safety, as it relates to assessment and preparedness of the patient. Conclusion: Health and functional limitations may prevent home-bound patients from being adequately prepared for disasters. Standardized strategies and tools concerning disaster preparedness assessment for HBPC patients, which allow flexibility in consideration of factors such as local hazards, could assist in creating more comprehensive planning approaches and, in turn, more prepared persons. This is a work of the US Government and is not subject to copyright protection in the USA. Foreign copyrights may apply. Published by S. Karger AG, Basel

Effectiveness of home monitoring according to the Model of Living in hip replacement surgery patients

AIMS AND OBJECTIVES

To evaluate the effectiveness of home monitoring according to the Model of Living in hip replacement surgery patients.

BACKGROUND

Hip replacement surgery is important for increasing the quality of life of patients. After these operations, patients may encounter many problems having an impact on their activities of daily living.

DESIGN

Quasi-experimental.

METHODS

Sixty patients were included in the study: 30 in the experimental group and 30 in the control group. Patients in the control group received the existing care provided in the hospital. In addition to existing care, patients in the experimental group received training and counselling according to the Model of Living from the time of admission to the clinic. After discharge, home monitoring was performed in the 1st and 6th weeks for control group patients and in the 1st, 3rd and 6th weeks for experimental group patients. Statistical analysis was carried out using percentage calculations, mean, median, chi-square test, Fisher's exact test, likelihood ratio test, Mann-Whitney U-test, Kruskal-Wallis test, anova for repeated measures, independent-sample t-test, Friedman test, McNemar test and McNemar-Bowker tests.

RESULTS

It was found that the experimental group patients' knowledge scores increased, they were more independent in performing activities of daily living, and they encountered less problems in the 1st and 6th week after discharge.

CONCLUSION

As a result, it can be claimed that by means of providing training, counselling and home monitoring hip replacement surgery patients according to the Model of Living, the level of knowledge of patients on activities of daily living increased, they were more independent in daily living activities, and they experienced less problems.

RELEVANCE TO CLINICAL PRACTICE

The use of the Model of Living in the home monitoring of patients who have undergone hip replacement surgery could assist in focusing on the problems most frequently experienced by patients in postoperative care and achieving effective solutions.

Counselling for patients and family members: a follow-up study in the emergency department

Although the research indicates that patients and family members are not fully satisfied with the counselling they receive, little is known about the quality of counselling in more detail. The purpose of the study was to describe patients' and their family members' experiences about counselling in emergency department, and follow how these experiences possibly change after the educational intervention for the whole nursing staff of the ED ward. The pre-test-post-test follow-up design was implemented including online continuing education for ED staff. The data were collected via questionnaires from patients and their family members in two phases and analyzed statistically. After online education of staff, experiences of patients and family members concerning counselling were better than before the education. Especially, family members' satisfaction had increased. However, our results also indicated that patients and family members desire more information for example, regarding medications. Care practices had developed towards family-centeredness, which patients and family members appreciate. Online education proved also in some degree its usefulness in educating ED staff, by offering the same education to a staff which works in shifts. Furthermore, family presence and participation practices should be developed by offering possibilities for families to stay with each other on ED ward.

Total joint arthroplasty patients' perception of received knowledge of care

BACKGROUND

The education of orthopaedic patients is an essential component of nursing, because it has been shown to have a positive impact on outcomes of care and treatment.

PURPOSE

To describe total joint arthroplasty patients' perceptions of received knowledge on discharge.

DESIGN/METHOD

Patients (n = 123, mean age 68 years) undergoing total hip or knee arthroplasty self-administered a structured instrument, including 6 different dimensions of knowledge.

RESULTS

Patients perceived that they received most knowledge on the biophysiological dimension and least on the financial dimension. Patients' discharge destination and positive evaluation of hospitalization were related to their perceptions of the knowledge received.

DISCUSSION

Individually tailored education is needed to meet patients' educational needs. Nurses are responsible for ensuring that patients have enough knowledge even if they do not ask for this knowledge.

Hemodialysis arteriovenous fistula self-cannulation: moving theory to practice in developing patient-teaching resources

PURPOSE/OBJECTIVES

This article discusses how Orem's theory was applied to the revision of supporting documents in the patient-teaching process and subsequently the nurse's role in the patient's learning experience.

BACKGROUND/RATIONALE

Teaching based on didactic, provider-focused objectives is ineffective in meeting patient's learning needs. There is a lack of conclusive research on the development of appropriate patient-teaching endeavors for the acquisition of knowledge and skills related to the performance of hemodialysis arteriovenous fistula self-cannulation.

DESCRIPTION OF THE PROJECT/INNOVATION

To prepare patients for home hemodialysis, Orem's self-care-deficit nursing theory was used to guide the revisions of a patient assessment and learning documentation template, the development of a self-cannulation teaching resource and to foster a renewed sense of the nurse's role in the teaching process.

INTERPRETATION/CONCLUSION

The application of self-care-deficit nursing theory to the update and development of patient-teaching documentation and resources for self-cannulation provides the nurse with a theoretical approach to assess, plan, evaluate, and document teaching from a patient-focused perspective. Theory in practice provides a means to support and highlight the role of nurses in the patient-learning process. The utilization of practical activities to introduce theory into teaching provides a means to structure care processes and to enhance nurse's adoption of theory in practice.

IMPLICATIONS

Orem's theory provides a relevant, useful framework to guide nurses in teaching patients self-care. Research on the exploration of nurse's attitudes related to the benefit of adopting theory when teaching patients to perform hemodialysis self-care is needed.

Role model clinical instructor as perceived by Jordanian nursing students

Nursing is considered to be an applied science. Thus clinical teaching is central to nurse education, where the learning situation often cannot be repeated. The aim of this work was to identify motivating behaviours of role model clinical instructors that enhance student learning, as perceived by Jordanian senior nursing students. Critical incident technique was utilised and analysis of the incidents through Cormack’s technique was applied. A total of 156 student nurses participated in this study and 210 critical incidents related to behaviours of role model clinical instructors were obtained. A total of 10 categories that reflected the behaviours of role model clinical instructors were created. The overall findings indicated that the behaviours of role model clinical instructors identified by Jordanian nursing students as enhancing their learning in the clinical setting were mainly those already identified in the literature as good teaching in nursing practice.

Storytelling as an educational strategy for older adults with chronic illness

As the population of older adults with chronic illness continues to increase, it is imperative to implement patient education strategies that are designed to elicit information and help health practitioners understand the world of the older adult. This article describes how storytelling, grounded in the basic principles of gerogogy, serves as an effective teaching and learning patient education strategy for older adults with--or without--chronic disease.

Osteoporosis Preventive Behavior in Thai Older Adults: Feasibility and Acceptability

The authors used a one-group pre-test-post-test design to examine the feasibility and acceptability of an osteoporosis prevention program and the effects of the program on knowledge, health beliefs, self-efficacy; and osteoporosis preventive behaviors in older adults. Participants included 48 older adults who attended a health center in Thailand. Results revealed that the program was feasible and acceptable. A significant improvement in osteoporosis knowledge, health beliefs, self-efficacy, and osteoporosis preventive behaviors occurred. Findings suggest that the program helps older adults incorporate new knowledge and skills into their daily lives and helps them maintain bone health.

Revision total hip and total knee arthroplasty

For thousands of patients with advanced degenerative joint disease, total joint arthroplasty provides improved function, decreased pain, and the opportunity to resume a more active lifestyle (Drake, Ace, & Maale, 2002). Although hip and knee replacements are both successful interventions for degenerative joint conditions, complications may arise that require revision of the original surgery. In 1999, approximately 25,000 revisions of knee replacements (ICD Code 81.22) and 30,000 revisions of hip replacements (ICD Code 81.53) were performed in the United States (American Academy of Orthopaedic Surgeons [AAOS], 2002). Approximately 10,000 revision total hip arthroplasty procedures were performed on Medicare patients in 2000. The total cost of revision surgery, including the 10,000 total knee revision procedures performed on this same patient population during that year, exceeds USD 3 billion (Bourne, Maloney, & Wright, 2004). Descriptions of the risk factors and indications for revision total hip and total knee arthroplasty are included in this article. Nursing interventions and patient education specific to these patient populations are outlined, and a discussion of complications following revision total joint arthroplasty is included.

The Advanced Practice Nurse in Gastroenterology Serving as Patient Educator

The role of the advanced practice nurse is evolving in the specialty of gastroenterology, requiring flexibility and an openness to change on the part of the practitioner. The gastroenterology advanced practice nurse performs history and physical assessments, orders diagnostic studies, determines medical and nursing diagnoses, prescribes and evaluates pharmacologic and other therapeutic regimens, manages followup care, and evaluates patient outcomes. The advance practice nurse also provides patient, family, and group education and screening programs. Collaboration with other healthcare professionals; serving as a mentor and as a consultant; participating in continuing education, research and quality management; and providing professional leadership underscore the professional aspects of advance practice nurse activities. The focus of this article is the educational role of the advanced practice nurse. The body of knowledge applicable to the educational role is discussed, in addition to contributory professional activities.