Purpose: The purpose of this article was to describe a collaborative clinical nurse specialist (CNS) project to enhance the patient education provided by registered nurses across 7 medical nursing units in an acute care hospital.

Background: Electronic data reviews assisted the medical CNSs with identifying a deficit in using appropriate education plans and documentation of patient education.

Description of the Project: The interventions implemented included the creation of new patient education brochures, updating the electronic system to enhance nurses' ability to provide patient education materials and to simplify documentation, creating a video-on-demand education channel, and ensuring that patient education materials were easily accessible.

Outcome: Postassessment results showed that nurses' reported use of disease-specific education plan increased 33%. The staff's perception of the importance of documenting patient education provided also increased 9%.

Conclusion: This project demonstrates CNSs' ability to design, develop, and implement a systematic and structured process to promote a consistent way for medical nurses to utilize the best disease-specific patient education resources.

Implications: With hospital stays being shorter and patients more acutely ill, partnering with the patients in learning how to manage their care as they transition from the hospital to home is key to help prevent hospital readmissions.

A number of core CNS competencies specify the role of the CNS in patient education. These include the following:

* facilitates the provision of clinically competent care by staff/team through education, role modeling, team building, and quality monitoring;

* determines nursing practice and system interventions that will promote patient, family, and community safety;

* establishes collaborative relationships within and across departments that promote patient safety, culturally competent care, and clinical excellence; and

The purpose of this article was to describe a collaborative CNS project to enhance the patient education provided by nurses across 7 general medical nursing units in a large acute care hospital.

PROBLEM

Quarterly electronic quality monitoring of nurses ordering disease-specific patient education plans and chart reviews assisted the medical CNSs with identifying a deficit in using disease-specific education plans and documentation of patient education. This institution utilizes electronic plans for ordering and documenting education. Each specific disease has its own education plan. In addition, there is a generic education plan that nurses can utilize when disease-specific education plans are unavailable or by the nurses' choice. The goal is to use disease-specific education plans as they help ensure that patients receive the appropriate education.

To determine what was causing this lack of using disease-specific education plans and documentation, an anonymous, electronic knowledge assessment of the nursing staff was administered. Key questions nurses were asked included the following:

(1) How often do you use disease-specific patient education plans?

(2) What barriers are there to using disease-specific patient education plans?

(3) How important is it to you to document the patient/family education you have provided?

The nurses needed an easy way to electronically order the appropriate education and then to document against the order. With the previous system, nurses were presented with multiple choices for education, and it was difficult for them to pick the ones that would be best for their patients. In order to facilitate the most appropriate care by the nurses, the CNSs developed and revised electronic education plans to improve this process. The Patient Education Center reviews all patient education materials every 2 to 5 years. Clinical experts, as well as patient education specialists, ensure that the materials are current, appropriate for patients, and evidence based. Thus, the CNSs were assured that the most current materials were available within the facility. The materials were then reviewed so that the pamphlets and videos that were consistent with the specialty's current practice and appropriate for hospitalized patients who need "survival skills" can be chosen. The items the CNS group felt would benefit most of the patients were preselected in the electronic education plan. Nurses could also select any of the other education resources, if needed, based on the patient's learning needs, abilities, and readiness to learn.

The institution has VOD programming for patients. The list of programs that are available is extensive; including 119 videos. This means that at times choosing the appropriate video was confusing and cumbersome for patients and the nursing staff. The nursing staff reported a lack of knowledge regarding the various programs available and requested making the channel easier to navigate. The CNSs collaborated with a patient education specialist from the Patient Education Center to explore opportunities to revise the VOD channel. The content of each of the videos was reviewed for relevance and congruity with the educational plans being developed. A separate channel was proposed that would be clearly labeled for inpatient medical patients. In addition, the videos were categorized into groups that corresponded with the categories of the educational plans, such as cardiovascular and gastrointestinal. The goal is that if a nurse implements a specific educational plan for a patient, then the appropriate video will be easily identified and available for the patient.

It is also very important for the education to be readily available to the bedside nurse. Each unit restructured its patient education setup to fit its needs. One unit organized the individual pamphlets by body system. Others organized the pamphlets alphabetically. Another unit created packets of education materials for each disease process that coincided with the prechecked education items from the education plans. Units clearly labeled the education pamphlets and set up a system for timely reordering. One unit placed a list of the available education plans next to the computer work stations so the nurses could readily view what was available. The units worked to make education more readily available to patients and nursing staff by placing most commonly used pamphlets on racks in the hallways for patients and nurses to access.

To facilitate implementation of these changes, the medical CNSs provided education to the nurses at Professional Development Days about how to use the new system. One-on-one education was also provided to some of the nursing staff.

OUTCOMES

To determine the successful implementation of project initiatives, multiple evaluation methods were used including a preimplementation and postimplementation knowledge assessment of nursing staff, electronic tracking for ordering disease-specific education plans, and electronic chart reviews to determine documentation rates.

In the postimplementation assessment, nurses were asked which interventions were the most important to them. They reported reorganization of patient education material drawers/cupboards, updating the electronic patient education plans, creation of new brochures, and Professional Development Day presentations to be the 4 most useful interventions.

The final outcome measured was the documentation rates for learning needs assessment, disease process education, and medication education. Documentation rates increased by 5%, 15%, and 12%, respectively, and have held stable at this increase for 9 months. There continues to be a need for further improvement in documentation.

DISCUSSION

Because hospital stays are becoming shorter, and patients are frequently acutely ill with complex medical needs, it is a challenge for nurses to do quality patient education. An organized education process can help guide the nurse to provide the patient with the survival skills needed for success at home. To maintain this type of patient education process, there are ongoing CNS activities that include evaluating current and newly developed patient education resources, updating existing educational plans, and developing new educational plans as needed. This review is essential so the nurse can be confident that he/she is discussing the most current information with patients regarding their medical conditions.

Ongoing quality improvement audits are being completed to assess how often the specific disease education plans are being documented. This information is being shared with the nursing staff. This follow-up is very important so the CNS can mentor the registered nurse in the importance of patient education and that disease-specific education can potentially improve patient outcomes.

CONCLUSION

Disease-specific patient education plans enhance the ability of the nurse to partner with the patients/caregivers, to use appropriate educational materials, and to assist the patients in managing their care when they leave the hospital. This project demonstrates CNSs' ability to design, develop, and implement a systematic and structured process to promote a consistent way for medical nurses to utilize the best disease-specific patient education resources.

References