Stroke Education in the

Acute Care Setting

Presented By:Dana M. Smith, MS, MCHES, CCE

Patient Education SpecialistUAMS Medical Center

ObjectivesBy the end of this presentation, participants will be able

to:  Verbalize what health literacy is and it’s importance to

stroke education.

Verbalize the importance of stroke education to stroke survivors and their caregivers in the acute care setting.

 Verbalize the key steps to providing effective stroke education.

Use the teach back method as an evaluation tool for stroke education.

What is Literacy?

Using printed and written

informationto function in society, achieve one’s goals, and develop one’s knowledge and potential.

- Kirsch et al, 1993

What is Health Literacy?

“The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.”

- Ratzan and Parker, 2000 / Healthy People 2010

Expanding the Definition

A patient's ability to obtain, understand and act on health information.

A provider’s capacity to communicate clearly, educate about health and empower their patients.

What is it Like?

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Health Literacy Impacts

AccessSafetyQuality

Outcomes

Only 12% are Proficient

Health Literacy results from the National Assessment of Adult Literacy, US Dept of Education, 2003

Why Are Patients at Risk?

Reliance on the written word for patient instruction is increasing.

Increasingly complex healthcare system▪ More medications▪ More tests and procedures▪ Growing self-care requirements▪ Esoteric language

Who is Most at Risk?

ElderlyEthnic and racial

minoritiesLimited

education immigrants

Low socioeconomic status

People with chronic disease

Red Flags

Making excusesPerceived resistanceHas no questionsFrequently missed appointments, tests

Non-adherent with meds or treatment

So What Can We Do?

Why is Stroke Education Important?

Helps patient and caregivers understand why quick access to care is important after stroke symptoms.

Identifies ways that the patient can reduce the risk of having another stroke.

Provides caregivers needed information on how to care for a stroke survivor.

Increases patient compliance and decreases re-admission rates.

After TIA –

Within 2 days after a TIA, 5 percent of people will have a stroke. Within 3 months after a TIA, 10 to 15 percent of people will have a stroke. -National Stroke Association, 2012

The Problem

Life Altering Event

Short Admissions

Large Amounts of Information +Limited Staff Time

Four Steps to Effective Teaching

Assess patient for educational readiness

Plan what you will teach

Implement teaching

Evaluate teaching

Assessment Who should education be targeted toward?

Are the learners emotionally ready?

Are there literacy issues?

What might be some potential barriers?

What are the learners preferred learning styles?

Are the learners motivated?

Planning for EducationWhat does the patient NEED to know?

“Get with the Guidelines - Stroke”:

1. Activation of emergency medical system2. Need for follow-up after discharge3. Medications prescribed at discharge4. Risk factors for stroke5. Warning signs for stroke

And What Else Would Be NICE to Know?

Emotions after stroke Avoiding complications: falls, UTI,

aspiration pn, etc. Managing ADLs Help for the caregiver Understanding deficits: memory,

communication, motor skills, etc. Rehab Where to get further information –

support groups, websites, organizations

Education is Best Using a Multi-Disciplinary Approach

Physicians Nurses Patient Educators Case Coordination Speech Therapy Occupational

Therapy Physical Therapy And many others

Planning for Education

What Resources are Available? Videos Materials/Handouts Other

Regarding Materials Are handouts written in plain or common

language? Are materials written at a 6-8th grade level? Are materials free of medical jargon?

Health Literacy Checklist for Stroke Materials

Font should be at least 12 point

Use ample ‘white space’

Use 1.5 or double spaces between sentences and more space between bullets.

Organize information with the 3-5 most important “need to know” points.

Give the most important information first and last to enhance memory.

Use a conversational writing style and active voice.

Implement Teaching Use plain language and avoid acronyms.

Get the learner actively involved.

Don’t make assumptions.

Use a variety of teaching strategies, if able.

Ask questions during teaching to make sure the patient is understanding.

Always give written information as a back up to all teaching.

Evaluate Learning

“The greatest impediment to communication is the illusion that it’s actually happening.”

-George Bernard Shaw

Evaluate Learning Research shows that patients remember and

understand less than half of what clinicians explain to them. Ley, Communicating with patients: improving communication satisfaction, and compliance 1988

Rost, Predictors of recall of medication regimens and recommendationsfor lifestyle change in elderly patients 1987.

Use the Teach Back Method – aka: “Show Me” or “Closing the Loop”

Is a way to confirm that you have explained to the patient what they need to know in a manner that the patient understands.

What Teach Back Is…● Asking patients to repeat in

their own words what they need to know or do, in a non-shaming way.

● NOT a test of the patient, but of how well you explained a concept.

● A chance to check for understanding and, if necessary, re-teach the information.

Teach Back is Supported by Research

● “Asking that patients recall and restate what they have been told” is one of 11 top patient safety practices based on the strength of scientific evidence.”AHRQ, 2001 Report, Making Health Care Safer

● “Physicians’ application of interactive communication to assess recall or comprehension was associated with better glycemic control for diabetic patients.”Schillinger, Arch Intern Med/Vol 163, Jan 13, 2003, “Closing the Loop”

Stroke Education TB Questions

●“I want to be sure I explained everything clearly. Can you please explain it back to me so I can be sure I did?”

●“What will you tell your husband about the changes the doctor made to your medicines today?”

●“Can you tell me some things you might do to reduce your risk of having a stroke?”

●“Can you tell me what you would do if you started to feel some of the symptoms of a stroke when you were at home?”

On Going Education On-Going Education after Discharge:

Newsletters Follow up phone calls Stroke support groups Listservs Social Media Video-conferences, etc.

Education centered on staying healthy, reducing risks, adjusting to life after stroke,etc.

UAMS Stroke Support Group

3rd Thursday of Each Month11 a.m. – Noon

UAMS Family Home 4300 W. Markham

Little Rock, Arkansas 72205

To Register: 501-686-7791

Resources American Stroke Association

▪ Stroke Connection Magazine▪ Stroke Handouts

www.strokeassociation.org

American Heart Association▪ Get With the Guidelineswww.heart.org

National Stroke Associationwww.stroke.org

National Institutes of Healthwww.stroke.nih.gov