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Making a Statement

Often when I am reading clinical records I see nurses offering information to patients in lieu of teaching them. I have read an account of a nurse teaching a patient that side effects of Coumadin could cause intracranial bleeding, stroke and death. She further taught the patient to call the MD should any of these side effects occur. I kid you not.

It is true that in the worst case scenario, Coumadin can cause really, really bad side effects including the Big Three (death, coma, convulsions). Similarly it is true that hypertension occurs more often in African Americans and that smoking can exacerbate COPD. I can only imagine a nurse telling a patient in their 80’s that it isn’t a good time to start smoking because they have COPD.

So, yesterday, I overheard an old colleague, Barbara Price counseling a nurse that while she offered a true and correct statement, no real teaching was performed. Statements are not teaching. Observations are not teaching. For the purpose of home health, let’s assume that teaching is the exchange of information that leads to changes in health related behavior.

Note that I used the word, ‘exchange’. Just like an engine needs fuel to run, our teaching machine (read brain) requires information on what to teach. That information comes from the patient by assessment which, by the way, is not mere interview. I cannot emphasize that enough. Teaching requires assessment of the patient and teaching according to their specific needs.

But it must also change behavior. Teaching a non-smoker to abstain from cigarettes does not meet that criterion. Teaching an African American patient that his race may have contributed to his high blood pressure may be true but is it useful? What’s a patient to do with that information? And emphasizing the Big Three as side effects from Coumadin might just induce non-compliance instead of reduce its risk.

Looking at the three examples used already, useful teaching would involve:

Assessment True and Correct Statement Useful teaching
Patient is on Coumadin for atrial fibrillation Patient has very small chance of serious side effects when medication is taken correctly Take medication at the same time each day. Teach how diet influences efficacy of Coumadin. Teach bleeding precautions.

Emphasize importance of regular lab if agency is not drawing PT/INRs.

Pt has been diagnosed with Bronchitis but does not smoke Cigarette smoke can worsen bronchitis. Teach patient to avoid cigarette smoke, including second hand smoke. Assist patient in posting ‘No Smoking’ signs in house to prevent visitors from smoking.
Patient is an 85 year old black male with hypertension Hypertension occurs more frequently in African Americans and the treatment is slightly different. Teach patient that although his race may have put him at higher risk for hypertension, the only way to treat to the disease regardless of race is to take medications, monitor salt and triglycerides, exercise, lose or maintain weight, etc. and then teach him how to do so!

As always, I am open to your suggestions on teaching. Please leave your comments below. Any new or creative or tried and true ideas or concepts are more than welcome. After all, if teaching was not a skill, we would likely have no home health industry.

3 Comments Post a comment
  1. Donna #

    So true – I also love when the nurse documents teaching to a patient with severe dementia who then ‘verbalizes understanding’….

    Always need to consider the abilities of your learner – and find another student if needed!

    August 18, 2010

    • Excellent point!!!! Do not teach the unteachable! Find another student if needed. I think we all ‘know’ that but if every nurse remembers just one thing from your statement – find another student – documentation will improve.

      August 19, 2010
  2. gail #

    Is “verbalized understanding” a catch-all statement everywhere? The patient can’t remember what they had for breakfast, but they “verbalized understanding” of some pretty detailed information. I will use “Making a Statement” to make a point with our nurses. Thanks for this.

    August 24, 2010

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