Patient Education PDF

10/8/24, 11:47 AM OneNote Patient Education Wednesday, September 04, 2024 6:15 PM [EXAM 1 includes information from Chapter 1-6 and the notes] CHAPTER 1: Patient compliance: the...

10/8/24, 11:47 AM OneNote Patient Education Wednesday, September 04, 2024 6:15 PM [EXAM 1 includes information from Chapter 1-6 and the notes] CHAPTER 1: Patient compliance: they degree to which a patient correctly follows their physician's medical advice. Other words ○ Comply, agree, follow through the treatment, concordance, alliance, adherence, or collaboration ○ The term compliance denotes a power differential between patient and health professionals. ○ Follow a treatment plan based on a collaborative effort between the patient and health professionals ○ TRUST-important for patient access healthcare ○ Patents are required to be fully informed about all aspects of their treatment. Patients are involved in their treatments. ○ Make expectations more realistic and patient became more honest and provide provider more information. APPROACHES Authoritarian approach ○ Idea of providers has attitude with patient. ○ The idea of " this is the best for you" -dictator ○ Illustrates arrogance and egoistical ○ Also place all responsibility on the physicians. Current approach Patient-centered approach ○ Focus approach on the focusing on the needs of patients rather than on the goals of the health professionals. ○ Increased patient satisfaction and better health outcomes ○ Pt are required to be fully informed about all aspect of their treatment and be more involved. ○ Patient treated as partners, fully informed about health-related matters, more involved in treatment planning and decision making and patient are encouraged to accept more responsibility for their health care. ▪ Use statements such as We will be working on.......... The WE --- very important. ▪ Compliance makes this work ▪ 50/50 with patient and physician for their outcome ○ Benefits ▪ Decrease in Liability issues ▪ Create trust and relationships ▪ Pt ask more questions about their treatments ▪ Pt become more honest and providers gain more information ▪ Expectation more realistic ○ Patient outcomes: ▪ "The results of patient care interventions, including measures of mental health, quality-of-life, satisfaction with care, and physical health measures. It also includes the impact of service and treatment use on patients and families" ▪ See pt initially –first assessment/ initial assessment -treatment Nonadherence (non-compliance) ○ Large number of instances, the cause of treatment failure is that patients simple do not adhere to health recommendations ▪ 1996: 58% of emergency room visits directly related to nonadherence. ▪ Widespread average of 25% across condition. ▪ Overuse and underuse of medication-most in emergency room ▪ Estimated that nonadherence patient that increase hospitalization/ additional visits cost around billions of dollars per year-economic burden. Consequences ○ Develop into chronic conditions ○ Unhealthy habits- ▪ predispose to various diseases ○ Individual consequences: ▪ increase risk of chronic diseases and recurrence ○ Societal Consequences: ▪ increase morbidity, mortality and disability, infection spread increase medical care. Difficulty in the extend of which treatment is effective. ▪ Economic consequences: ▪ financial costs be high-effects on quality and cost of care if preventive measures were taken. Estimated that nonadherence patient that increase hospitalization/ additional visits cost around billions of dollars per year-economic burden. https://cometmail-my.sharepoint.com/personal/axc210146_utdallas_edu/_layouts/15/Doc.aspx?sourcedoc={8fa6a194-a1f4-45d3-83b6-44def0bac988… 1/16 10/8/24, 11:47 AM OneNote Types of Nonadherence ○ Appointment keeping ▪ Patients can cancel their appointment. ▪ cause loss of income and would take another person’s possible treatment. ▪ "Lost of ratifications in these issues." ▪ Revenue in facility is based on the schedule. There is issue in the less than 24hr cancelation fee. How they able to collect if pt don't come back and anger pt. ▪ There is also Affect in delays of treatment ○ The 24hr cancelation fee does not work- can't be able to collect if pt don't come back ○ Medication (prescription) ▪ Issues: Pt is prescribed with medication. But they don’t take the incorrect ways and pt don’t tell the provider that they didn’t take correctly. They have three different prescriptions but only buy one without understanding that they must take all three to work. Antibiotic- they stop taking antibiotics after “feeling better” but can reoccur or less progress can happen for not taking the full two weeks. ▪ The percentage of people who do not pick up prescriptions is 60%. Which can cause physicians to prescribe more medications or increase dose. They provide their prescriptions to someone else ○ Dietary recommendation ▪ High patient noncompliance. ▪ It has become a touchy subject for patients. ▪ Don't consume the recommended diet provided ○ Lifestyle recommendations ▪ THE MOST difficult area to work with patient ▪ EX: smoking, alcohol, exercise, sleep schedule, ▪ Influences: stress management. Social factors. Geographic location. Drugs substance abuse. ○ Other aspect of treatment (home treatment) ▪ EX: Alternate hot and cold. PT and working braces or gauze. Elevate their injury. Prescribed home treatments. ▪ It does not work well because the healthcare professionals do not train the patient correctly. ▪ Not doing it properly can cause the issues to worsen. ○ Preventive health practices ▪ EX: employee working there prevented measures when working. Do not bend over, but pt bend over. Interventions to increase adherence ○ Technological devices ○ Behavioral techniques ○ Patient contacting ○ Reminder postcards ○ Patient teaching as an intervention ▪ Health professionals in adherence: communication and explanation= important ○ PATIENT-CENTERED TEACHING=learning needs of the patient, best way to present information, also tailoring the teaching and recommendation to the patient's specific needs and circumstances at home. Misconception ○ -have serious illness/chronic issues-they will be more compliance. ▪ Big/small issues does not relate to compliance ○ -noncompliance occurs in certain healthcare settings/environment. ▪ It equal opportunity and happens everywhere ○ Certain type background/ patient cause them to be more non-compliance ▪ No variable that describes patient that would be non-compliance. ○ If we provide all and so much information and details , more they comply ▪ Not true, pt does not need all information only what is important to them more specifically If patient is given more referrals and forms ( ex: therapy, prescriptions, weekly visits) at same time, more likely not comply ○ Need to plan which is more priority ○ Issue now: many providers gave everything to patient. Dump information. Due to : it easy for providers Do not ask the pt " have you taken the prescription? [no yes or no question] https://cometmail-my.sharepoint.com/personal/axc210146_utdallas_edu/_layouts/15/Doc.aspx?sourcedoc={8fa6a194-a1f4-45d3-83b6-44def0bac988… 2/16 10/8/24, 11:47 AM OneNote ○ ISSUES: When providers not know if they actually taking it cause them to provide higher dose because they are not improving. ○ Ask more feedback question ▪ Ex: "Tell me how...." ○ Results in them giving information and providers can tell if they are taking it and follow the direction correctly WHAT Healthcare look for in providers Initiative (proactive) ○ Health professional school takes value in student 's initiative due to everything in healthcare is providers taking initiative for patients Leaderships=healthcare professionals ○ Everything that is transparent to patient we plan and initiate everything, not follow patient. In relationship of interventions ○ Technology doesn't replace providers rather help. ○ Providers need to still decide which is appropriate for patient. There is no step-step consistent rules ▪ APPROACH Provide detail description of how you would be working with the patient. ○ Understand that pt can't observe or understand fully on why you are doing what you are doing because the tools is in the brain ○ More organized approach: critical thinking Ask question on "how can I train the pt to be comply to the treatment, when providers not there. ○ Issue ○ Training pt is a process, not one time thing ○ Break information down in different appointment- 4 is perfect amount or less. Not too much appointment because payer source will not pay. APPROACH 1 ○ Cookie cutter approach ▪ Not good Payer sources/ bosses/ patients not like to see ▪ Idea of one size fits all treatment to all pt Can be seen in documentation, in where group of pt all has the same written documentation ▪ Perceive as lazy It makes it easy for the pt, and it ignores pt limitation, environment and capability ▪ Use scripted language ○ WHAT WE NEED TO PLACE ▪ We need to acknowledge patient limitation-document their limitation ▪ Use active listening See the Gesters and expression Face towards the patient Telephone-not active listening SCENARIOS FROM TEXTBOOK= [CHAPTER 2: TOWARD A MODEL OF PATIENT-CENTERED TEACHING] Providers providing information to patient ○ Patient is passive, don't understand, or is nonadherence due to professionals way of presenting information ○ Providers may document words such as "uncooperative" or "difficult" describing patients ▪ Payer sources does not like to see, show that provider does not have the skill ○ "considerate and respectful care outline in 1975 patient's bill of rights meant respecting patients' individuality and autonomy. ○ Health professionals build trust and rapport: effective patient teaching ○ Gather information and providing information= routine procedures, physical exams or time when patient pick up a prescription ○ Patient-centered teaching is not simply a matter of providing patients with information about particular condition, explaining risk and benefits, repeat directions or printed materials ▪ The process involve precise clinicals skills in terms of information gathering, individualization of information giving , and treatment planning. Scheduled intervention where a specific time is set aside for teaching Organized and structured sequence of events between patient and health professionals ▪ Information must be presented by it relevant and comprehensible. ▪ Must identify the information needs to know and what patient wants to know. ○ Identifying the need to know ▪ Physical, psychological, social, or cultural barrier-interfere patient's receptiveness and ability to learn ▪ Patient current level of knowledge ▪ Patients' attitudes and beliefs about their condition and treatment ▪ Level of skills and physical ability to carry out the treatment plan ▪ Social factors ▪ Social support, the amount, they type of social support the patient has, how they function, supportive or harmful ▪ Patient's ethnic, cultural or religious values https://cometmail-my.sharepoint.com/personal/axc210146_utdallas_edu/_layouts/15/Doc.aspx?sourcedoc={8fa6a194-a1f4-45d3-83b6-44def0bac988… 3/16 10/8/24, 11:47 AM OneNote ▪ Identify potential barriers ▪ Assessing patient's strengths and limitations influences the health professionals' choice of words, dept of information, sequence according to patient's priorities and the type of teaching interventions ○ Effective patient-centered teaching encompasses a deliberate problem-solving approach ○ Gathering patient information ▪ Look at Everday interactions with patient ---need conscious effort to observe cues from patients EX: who brought the pt? Type of interaction they had?--- show their social support and family interactions Nonverbal cues: facial expressions, posture, or general body movements ○ Providers can ask questions such as you seem little restless. -statement opens the possibility of additional insight into patient's state of mind ○ Evaluating social support the pt has can be either negative or positive ▪ Sometimes the bigest determiner can be the people with titles sister, wife, father, mother ○ TOOL: active listening: ○ Providers see pt's Gesters, expressions, ect. Not just words ○ Look at the pt and face forward ○ Telephone-not active listening ○ Document every pt words ▪ Evaluated the information and then diagnosis ○ Patient pain assessment ▪ Pain is subjected to people Use pain scale (1-10) Documentation=payment (correlate) time space First appointment with new patient ○ Most office has an alert that states it is a new pt. ○ First appointment is important because it determines whether pt will continue to come ○ Must developed rapport(relationship) ▪ Built partnership ▪ Give extra effort ▪ Go up and respect the pt. Introduce: " Hello, my name is _____. We will be working together. ▪ Show that you care ▪ Can't do over phone ▪ Required by law, can’t do anything before first assessment ▪ ASK permission before examination ○ TOOL: skilled observation ○ Key opponent to diagnosis ○ It is self-directed for the providers ○ Open-ended questions- provide valuable information ▪ Great form of interaction: "Mrs. Ellis, I wanted to talk with you about your hypertension today and to answer any specific questions you may have about it. It would help me know something about the information you already have about your condition. Could you tell me a little bit about what you know about hbp and what it means to you?" This not only show their understand but wiliness to talk about it USA has high misdiagnosis Carry over affect Pt over pt over pt. Can cause providers with high stress and emotions The emotion and stress can "carry over " to pt and can affect them Will be evaluated over it. Developing a teaching plan ○ Incorporate patient goal with health professional goals ○ Little by little goals and progression ○ Nonjudgemental way Formulate a plan, the health professionals should ask: ○ What type of information, skills, and support does the patient need to effectively manage their condition? ○ What type of information does the patient want? ○ What issues are the most important to the patient? ○ What are patient's supports and strengths? ○ What factors could serve as potential barriers that would prohibit the patient from learning or following recommendation? ○ What potential alternatives may be appropriate? Organized patient teaching based on the preliminary assessment of patient's needs Assess pt every time—see any change, progress, new symptoms NEVER rush, assume and jump to conclusion Documentation of patient teaching https://cometmail-my.sharepoint.com/personal/axc210146_utdallas_edu/_layouts/15/Doc.aspx?sourcedoc={8fa6a194-a1f4-45d3-83b6-44def0bac988… 4/16 10/8/24, 11:47 AM OneNote ○ Prevent redundancy by communicating what has been taught and way of communicating what still needs to be taught, the patient's level of understanding and what needs to be reinforced Evaluation of patient teaching ○ Reaching the goals ○ The ultimate goal of patient teaching is to enable patients to carry out recommendations in their home environment when they are under direct supervision Evaluation of short-term goals ▪ Purpose of evaluation-identifying lack of knowledge or area of misunderstanding before long-term goals can be reached Evaluation of long-term goals ▪ Identify issues to provide additional help ▪ "Participating in this ___what do you want to do " The response is the long term goal Common phrase ○ Pt states “want to return to goal” ○ Break the long term goal into short term goals ▪ Long term goal into management goals ▪ 2-3 short term goals ▪ Goals must be Realistic (measurable) to that pt ▪Brief and specific ○ Process in treatment, move pt along in treatment ○ All doc has to reflect and connect ○ No progress-adjust short term goal ○ EX: ▪ pt will ambulate 50ft down hallway ▪ Ex: pt will remove contact lens every night ▪ EX: Pt will wear hand brace 6hr everyday and not while sleeping ▪ First address the severe situation first Such as drug addition Not give treatment plan to all pt ○ One time/ visit ○ Be in Or routine checkup ▪ Issues in treatment planning No reflection in patient's own word Not reviewed at certain time Not measurable ○ Can't see progress Not address initial assessment The steps to develop a treatment plan: 1. Initial assessment of the patient. 2. Additional pt information (important information to know about pt, but not included in the initial assessment) a. Work/occupation i. Travel, schedule b. Skills/abilities of pts i. Vocab ii. Compliance –wanting to get better All information helps with etiology (root cause of the illness/ issues) c. This helps in how to structure the treatment 3. Develop specific treatment steps a. Describe the dx(diagnosis) to pt. b. Setting treatment goals with pt i. Convey payer sources that pt and provider work together c. Need to document the pt word such as “my goal is to walk my dog at the end of treatment” d. Good because providers can use it as source of motivation to pt. 4. Evaluate pt outcomes 5. Adjust treatment as needed based upon treatment. 6. Must contain goal and timeline: based on data and treatment take this long to this direction 7. Monitoring the course of the treatment and how they are responding to the treatment. https://cometmail-my.sharepoint.com/personal/axc210146_utdallas_edu/_layouts/15/Doc.aspx?sourcedoc={8fa6a194-a1f4-45d3-83b6-44def0bac988… 5/16 10/8/24, 11:47 AM OneNote ISSUE: Not correct treatment planning Nationally-62% Schools don’t teach about treatment planning Incorrect treatment planning cause payment issues and other issues. Common issues ○ Treatment planning did not reflect the patient’s own word ○ Treatment planning was not reviewed at certain time. ○ Is not measurable ▪ no way to see if pt is doing progress ○ The treatment plan did not address any of the patients from the initially assessment. -bad SCENARIOS FROM TEXTBOOK= (9/12/2024) [CHAPTER 3: ENHANCING PATIENT MOTIVATION: INCREASING ADHERENCE] Motivation is important= providers responsibility The "unmotivated" comment can be ○ A patient who is unaware of how information/ recommendations contribute to their health status ○ A patient whose goals do not match those of the health professionals ○ Patient who may not attribute the same positive meaning to end result as does the health professional Intrinsic factors in motivation ○ (definition- doing of an activity for its inherent satisfaction rather than for some separable consequence. Moved to act for challenge rather than because of external products, pressures, or rewards) ○ Physical or psychological factors ○ Psychological factors-pt may be more receptive to hearing information or following recommendations will help them reach a desired goal. ▪ Ex: wanting to go to upcoming daughter's wedding ○ Can also cause negative affects –no benefits or anxiety-lack of confidence-no following treatment plan. Extrinsic factors ○ Impact a patient's motivation to learn or to follow recommendation are related to relationships or factors outside of the individual and within their environment. ○ Relate to the degree of social encouragement or reinforcement from family or friends or to external rewards individual receive for reaching their goal. ▪ EX: Son encourage dad to go to physical therapy ○ Negative factors: sense of dependency or inadequacy that hinders his or her ability or willingness to follow treatment recommendation ▪ More example Work condition Pain Family influence (live with specifically) Economic factors Environment Motivation to gain information ○ Seek or gain new information stems from recognition of the need to know. Goals as motivators ○ Motivation to avail themselves to patient teaching and to follow health recommendations, are related to their goals. Motivation to learn ○ Levels of physical and psychological comfort Fear as a motivator ○ Studies indicate that fear does little to non-motivation for pt. ○ Helping pt recognize fear and anxiety-conductive to a discussion of fears, lower anxiety and enhancing pt motivation to receive information and learning Motivation to follow recommendations ○ Help them identify strategies/ interventions that will help them achieve their optimal health outcomes, based on pt goals and circumstances ○ Depends on ▪ Their perception of the cost versus benefit of following recommendations ▪ The degree of social support they receive ▪ Any environment factors that serve as support/barriers to their ability to adhere Enhancing pt motivation to change ○ Behavior is important Stages of change ○ Precontemplation ▪ No understanding nature of issues ○ Contemplation https://cometmail-my.sharepoint.com/personal/axc210146_utdallas_edu/_layouts/15/Doc.aspx?sourcedoc={8fa6a194-a1f4-45d3-83b6-44def0bac988… 6/16 10/8/24, 11:47 AM OneNote ▪ Recognize there is an issue ○ Preparation ▪ Plans to change ○ Action ▪ Active steps to implement the plan ○ Maintenance ▪ Staying ○ Relapse Self-efficacy ○ High-interest and task to do ○ Low-challenges beyond their capabilities ○ Helping---social influence, sees examples, mastery of skill coping styles and responses SCENORIES FROM lecture = Healthcare providers do not explain why something must be done adequately. ○ Ex: OT makes the pt do the pedal cycle things and they are doing it without understanding why they are doing it—make them unmotivated. ○ adequately grasp and understand why they are using the pedal cycle helps the hip Motivation –unmotivating is noncompliance ○ —due to not understanding its importance and more specially in terms of their improving their issues. And treatment ○ Many pt have many components so sometimes they don’t understand the connection too. Things that impact motivation ○ Just because they didn’t ask questions doesn't mean pt knows everything. ○ Scare tactics ▪ If you don’t do this more issues will happen ▪ It doesn’t work ○ Have to acknowledge that pt has anxiety (hospital or any healthcare environment is scary) ▪ “don’t jump in, talk to them and explain what you are going to do to them” Motivation factors ○ Costs vs benefits ▪ Costs-personal sacrifice, time, stress, effort, adjustments-(such as walker), financial ▪ Most are mentally weighing costs and benefits ○ Patient’s perception of achieving desired outcomes ○ Degree of social support ▪ Family, friends, co-workers-----big influence on pt (around most of the time) ▪ Degree, different people have different amount of influence and how they do it ○ Environmental factors ▪ Transportation Document all information of the motivation factors and concerns the patient have with and during patient ▪ Predetermined Health status is destined Higher power determines my health Nothing is really going to change Its attitude shows such as “does not matter, not going to change”" what if we just try this and see the outcome” ○ Give something simple for pt so they can see a positive change so they can trust more Document with pt own word Hidden agenda: pt claim same issue, but you checked and there is issue. They ask paper since they didn't go to work for awhile ○ Enjoys the help ○ Pt manipulate the providers Work with chronic pt – must train the pt to adjust to limit ability ○ Adapt to this activity in different manner or style ○ If you said no can’t do that anymore ▪ Demotivate Them ▪ Mental health—decrease ○ Want pt to move around cause- lack cause more problems ○ Cognitive reasons-want pt to do what they want ○ “how to do what they like to do Illness=> unpredictablity Models Stages of Change Model https://cometmail-my.sharepoint.com/personal/axc210146_utdallas_edu/_layouts/15/Doc.aspx?sourcedoc={8fa6a194-a1f4-45d3-83b6-44def0bac988… 7/16 10/8/24, 11:47 AM OneNote Developed by researcher- help to explain to students. ○ First time you see the pt, all pt is not the same, ○ Illustrate on why pt came to see you and why they did not immediately see you ▪ First stage of model: First time pt Precontemplation: general, vague ○ Providers have a hard time formulating the issues. Because there is nothing concrete ▪ Second stage Contemplation ○ Specific and know they have issues ▪ Third stage Preparation ○ Know that they must do everything, but not fully ready to take ALL the actions ▪ Fourth stage Action ○ The best kind of pt. Want and take action to be better. ○ Sometimes the first time the pt would be like the action pt, because psychologically they are not ready CHAPTER 4: INDIVIDUAL FACTORS IN PATIENT TEACHING AND PATIENT ADHERENCE Psychosocial issues in patient teaching ○ Past experience, gender, age, culture, support system, financial and physical environment Patient as an individual ○ Different levels of knowledge and skills and different beliefs about their illness ○ Own person: experiences, coping mechanism, lifestyle Social influences ○ Patient's system of social support, attitude and beliefs, culture and religious influences Environmental factors ○ Geographics location, living arrangement, financial status, daily schedule or type of employment The nature of treatment recommendations ○ More frequent visits, medication –more noncompliance because it can get cumbersome Influence of different personality styles ○ Interaction with others, emotional states, reaction, stress, traits all important Pt self-view ○ Self-identity ○ Self-esteem ○ Self-efficacy ○ Self-concept Pt adjustment to illness ○ Understand illness can cause a change of how they view themselves ▪ Sick role in characteristics: Individual are not viewed as being in power to overcome being sick by themselves, some therapeutic process is necessary for pt to recover While pt are ill, they are not-expected to function in their normal role or to perform their regular obligations Pt are expected to want to get well Pt are expected to seek help for their illness and to cooperate with provider in attempt to get well ▪ Illness may be used for coping with personal problems Teaching pt how to cope with illness ○ Strategies and methods of adaption ▪ Denial What type of information may be most useful for pt and the timing ▪ Compensatory strategies ▪ Benign forgetfulness ▪ Avoidance ▪ Role modeling ▪ Regression ▪ Blaming others ▪ Self-blame ▪ Rationalization ▪ Hiding feelings ▪ Redirecting emotions ▪ Excess activity ▪ Diverting feelings ○ Must help pt cope https://cometmail-my.sharepoint.com/personal/axc210146_utdallas_edu/_layouts/15/Doc.aspx?sourcedoc={8fa6a194-a1f4-45d3-83b6-44def0bac988… 8/16 10/8/24, 11:47 AM OneNote Provider's behavior can cause non complaince ○ More prescription at same time, no likely not pick them out (low). ▪ They don’t understand what they medication is for and when to take it and forget everything you have done—no pt education ▪ Must explain the prescription – and like must take these two together. ▪ When you see them again- ask how you are taking the medication. ○ Number of treatments ▪ Divide the treatments to most important to the least important ○ Length of time ▪ The longer a pt is required to participate in treatment, higher pt non compliance. ▪ Environment can make pt uncomfortable ▪ Elevated of anxiety ○ coping mechanisms ▪ People learn as they grow up, they turn into something to feel better when facing anxiety. Pt can place this coping mechanism to the providers ▪ Negative coping mechanism can cause barriers during treatment Providers should identify them and report in documentation Developed during the childhood, react and see reaction Through Reinforcement COPING MECHINISM: Denial- ▪ Give diagnosis and pt does not accept ▪ Can response to I did you what you told me—lying Compensatory strategy ▪ Positive ▪ I understand, and helping others or finding alternative ways to be involve in their hobbies or things ▪ Ex: dancer can’t dance anymore, but support others and train others in dance Benign forgetfulness ▪ “I forgot, I will do it later” ▪ Forget everything you asked Avoidance ▪ Anything you asked them to do, they avoided (not go near that place) Role modeling ▪ Can be +/- ▪ Negative form- pt in group environment, you cause others to anxiety. I am going to sue, here is my attorney ▪ Positive form- group environment, see other people and see that they are participant, and talk to them for reassurance Regression ▪ "Could you....." ▪ Regress to juvenilize behavior/ childlike behavior –sick Blaming others ▪ Pt/OT hear it a lot ▪ Injury blame others for it Self-blame ▪ If I wasn’t so stupid, forgetfulness ▪ Everything is blaming themselves, they are Detroiter Rationalization https://cometmail-my.sharepoint.com/personal/axc210146_utdallas_edu/_layouts/15/Doc.aspx?sourcedoc={8fa6a194-a1f4-45d3-83b6-44def0bac988… 9/16 10/8/24, 11:47 AM OneNote ▪ I couldn’t do that because ▪ Finding reasons for why they don’t do things Excess activity ▪ Overly engaged to many activities to take their mind off ▪ Common for people with eating disorder—excessive physical activity Document the coping mechanisms in why they don’t comply with it. Can't make more appointments for people that has not engages in their own treatment SCENORIES FROM TEXTBOOK= CHAPTER 5: Patient teaching through the lifespan Lifespan development Knowledge of lifespan development is fundamental for patient teaching to be effective. Behavioral changes (lifespan development enables health professionals to use strategies appropriate to the individual- ○ Ill-additional stress-varies in how they deal with it varies during different stage of life ▪ Language ability ○ Specific patient populations ▪ Neonatal Two pt, mother and developing child OBGYN, family medicine Status of mother and developing child Many pt do not appear to Lots of pt education Need to ask who is the responsible adult that will drive you to facility. ---can't assume—must document Include in postpartum depression Can't assume they everhn Finacial housing ---changes in different questions OBGYN-work with the mother and baby in stomach after deliver- baby not pt ▪ Prenatal Infants Continue pt education for people that is involved with the pt(baby) Many adults Lots of questions on diets (parents) ○ –formula ○ - stages of food ○ Effects of certain foods—must explain ○ Many nutrients questions- must answer those questions 9/24/2024 ▪ Infancy 1 Day old –12 months old Family medicine or pediatric Parents –rely on them but they are not your patient Rapport with parents Rely on them totally on information, consent, trust and rapport Parents don’t trust you they won’t bring the kid Parents are assessing you as you are assessing the kid Parents are very particular With your assessment- you ask the parents Do document of who the responsible adults Document who is giving the information Level of maturity of parents-----how are they responding to the assessment How to delivery of information Broad range of maturity-parents are different ages Parent anxiety--- first child to multiple child Might ask lots of questions Standard appointments to check growth and development Lots of pt education Trying to answer all questions so the parents don’t call all the time Use the word “normal” alot Range of perceive of what is serious Parents are rushing the ER all the time ○ Adress of everything—provider Lots of safety issues ○ Infant will eat everything and are fragile Diet https://cometmail-my.sharepoint.com/personal/axc210146_utdallas_edu/_layouts/15/Doc.aspx?sourcedoc={8fa6a194-a1f4-45d3-83b6-44def0bac98… 10/16 10/8/24, 11:47 AM OneNote ○ Formula to baby food ○ When to eat different form of food ○ Or alternative formula---cause it can be expensive Lots of medication is liquid form ○ Can be a big area ○ IMMUNIZATION Determine the schedule of immunization Many kickback from parents Providers have developed form ○ If rejected, they have to fill up the form ▪ For liability ○ Some providers will reject pt if not have immunization ▪ “they don’t want to deal with any potential liability issues” ○ Sibling rivalry Many siblings might not be excited about the infant Many parents are not aware Results to bad behavior of the sibling---may harm the kid Must educate the parents about it Pets--- infant can be harmed from them Normal changes ○ Toddler ▪ 1-3 years ▪ Parent/parents ▪ Safety issue is greater Due to movement of kid (more mobile) And curiosity ▪ Continue diet More questions more solids ▪ How mobile they should be Ask and assess the attempts to walk, stand or any mobile stuff ○ If they don’t something is going on cognitively or neurologically Immunization continues Around age 2: language development =comprehend 400 words ○ If not talk, issues over the esophagus, sounds Girls are early than usual ○ "NO"-terrible twos ○ Can start talk directly to pt ▪ Greeting ▪ Engagement ○ Not really understand the words fully-no reason behind the words Be aware of behavior ○ They have cognitive awareness We are going to be working on Parental complement Different administrate style Toilet training ○ Many questions related to it ○ Preschool ▪ 3-5years of age ▪ Parent/parents ▪ Contact with doctor spreads (some may bring, some don’t) ▪ Starts of patient non compliance ▪ Start with information Many things going on ▪ More alert More reaction ▪ Vocabulary by 5: understanding 2,500 words Normal development 9/26/2024 Preschool ○ Towards the end (around 5) ○ Mirror what you are doing ○ Talk to the patient and participant more ○ Pt has comprehending ability of fear ▪ “Hospital is a place of pain” ○ Around age 5, very fearful https://cometmail-my.sharepoint.com/personal/axc210146_utdallas_edu/_layouts/15/Doc.aspx?sourcedoc={8fa6a194-a1f4-45d3-83b6-44def0bac98… 11/16 10/8/24, 11:47 AM OneNote Later childhood ○ (6-12 years) ○ Developed more independent ○ Greater amount of vocabulary ○ Parents are there. ○ They take more cues from adults ○ Everything we do with the pat in like handle the pt, ask is more positive reinforcement ▪ Can you _____ (more directional) ▪ We are going to do blood, it not going to hurt----negative ▪ Behavioral disorders ---emerge Mostly teachers notice this ▪ Age where autism spectrum disorder emerge They have list of referral with mental health physician ▪ Able to report to you. Directly ask the pt the assessment question ▪ Unfortunately, substance abuse is detected Booming in age of 6-8 6-9 substance abuse programs Mixing rx—kids mixing up prescription drugs Report to parents, or informing ▪ Diet Many processes junk food Take to school for lunch ▪ Sports physicals Many different forms school give out Document if there is something they can’t play a sport and must ○ Adolescents ▪ (13-18year) ▪ Directly talk to pt ▪ All assessment questions can be answered ▪ Pt can be by themselves or parent ▪ Have to report the finding to the parents cause they are minors ▪ Kid is under parent’s insurance ▪ Standard range of substance abuse ▪ Start ask you questions Never ask about themselves “I have a friend...” Even when asking referral stuff-parents still have to be involved Smoking ○ Must discusses about Alcohol abuse Diet questions Older part – weight loss Process food Sports Physicals First pt population- sports injuries First time for rehabs They have more control over compliance and non-compliance ○ More noncompliance to happen They don’t really think about their own conquences of their own behavior First time to encounter risk-taking behaviors ○ Motocycle riding, rock climbing ○ No equipment ○ “Let them parcipant in “ ○ Division of parents and teh oinfagion Young adults 19-30 You don;t see them frequenty Not really have a chart Beginment ing of future desemi Midd ouy drpvisliu rwithout first encoursytrddl ○ Long term dociios,. ○ Stress ▪ Academic ▪ Financial ▪ Career ▪ Social https://cometmail-my.sharepoint.com/personal/axc210146_utdallas_edu/_layouts/15/Doc.aspx?sourcedoc={8fa6a194-a1f4-45d3-83b6-44def0bac98… 12/16 10/8/24, 11:47 AM OneNote ▪ Death ▪ Kids ▪ Marriage ▪ Home Not living w/ parents ▪ Car ▪ Crime ▪ Relocation Young adult Changes-transitions Making appointments and going is not their properity Prevention –first to start talking about it ○ Specifically tailored to that patient ○ Tell you ways to prevent, ○ Adress the issue and what is contributed to those issues They read generic information from nonhealth people such as magazines Most information, they get from online Once you see them deliver the prevention measures cause who knows when they will come Stress management ○ Manage your own stress before it becomes overwhelming and takes over ○ It is an issue Diet ○ Issues ○ Fiest to talk to the pt directly about it ○ First separation from parents begins ○ Have control of their own consumption ○ Lots of weight gain ○ More physical activity Sedentary lifestyles ○ Going through the same pattern, but gain more weight ○ Can't really study and be physically at the same time ○ Not really being active ○ First population to go through this issues ○ This goes into issues of ▪ Joint issues ▪ Cardiovascular ▪ Hypertension ▪ Cholesterol ▪ Obesity ○ These issues are preventable ○ Must address this issues ○ Can't really take about exercise cause it doesn’t go anywhere most of the time ○ Instead use movement not exercise ○ Asking about their day routine to place more movement in their schedules ○ Putting movement throughout the day ○ Excise : usually think going to gym or sports ○ More curiosity questions over prevention ▪ Especially diets ▪ What is apporient for them Middle adulthood ○ (31-65yrs) ○ Not transition ○ But all issues and stuff as young adult is the same ○ May have kids, and deal with them ○ Have caregiving responsibilities ○ Big issue is CAREER ○ Experience advancement for career ▪ May lead to greater stress issues ○ Make more money but greater stress ○ More focus on going to healthcare providers- realize more importance of them ○ Issues over ▪ Career----big connection or reason of why ▪ Diets ▪ Stress ▪ Sedentary https://cometmail-my.sharepoint.com/personal/axc210146_utdallas_edu/_layouts/15/Doc.aspx?sourcedoc={8fa6a194-a1f4-45d3-83b6-44def0bac98… 13/16 10/8/24, 11:47 AM OneNote ▪ Exercise ○ See them alot ○ The past health issues might have been more issues ▪ Lots of diabetes ▪ Multiple issues ▪ Started at 31 ○ More complex patient to work with ○ Work on multiple things ○ Make more referrals for ○ Greater interest in prevention –from getting worse ○ Work with adults ▪ Considered working on Saturdays Big demands Late adulthood ○ Above 65+ ○ Same issues as middle adulthood ○ Now more people working at that age ○ Many healthcare professionals work ○ Ask same questions as middle age adulthood ○ Do not based on age ○ They have a caregiver ▪ Paid-- family member or adults hire ○ You as healthcare professionals make decisions to determine if they should go to the appointment ○ National problems for this positions ○ High turnover ▪ Many have different caregivers ▪ May not want them inside because of HIPAA ▪ Not pt decisions, it healthcare decisions ○ Most don’t allow caregivers to come over ○ May have issues of stealing prescription ○ Look out for when managing the patient ○ Greater of them to live alone ▪ Can't assume family being supported ○ Greatest issues---no is no ○ Disease oriented approaches ▪ Shouldn't have this approach ▪ Most healthcare refers on the diagnosis of the pt than the pt ▪ Not want to label ▪ Should not focus on what they cannot do ▪ Focus on strengths of the patients and build on it ▪ Providers can create the noncompliance ▪ Most interest in prevention CHAPTER 6: The family, patient –centered teaching and patient Adherence ○ Have to engage with family ▪ Thye can be challenging ▪ Have lots of influence over patients ▪ Understand what is serious and what is not serious ▪ Negative influences Diets-following changes Different prescriptions Diagnostic tests ▪ May seems to comply but family can influence that ○ 10/3/2024 ▪ Working with family members Family members has large amount of influence Positive influence ▪ Make changes as a family ▪ Family members try to support what you are trying to do ▪ You may enlist family member to assist you. ▪ Some health care fields this is standardize ▪ Ex: PT, OT, and rehab centers They schedule a training session with family to help them, such as vehicle—how to safely transfer the patient. https://cometmail-my.sharepoint.com/personal/axc210146_utdallas_edu/_layouts/15/Doc.aspx?sourcedoc={8fa6a194-a1f4-45d3-83b6-44def0bac98… 14/16 10/8/24, 11:47 AM OneNote ▪ Other setting, we all have the opportunity to enlist them to train family to support the patient ▪ The addressing has many steps ▪ Pick the consist family member-involved one ▪ Don't forget to ask first with pt thou ▪ In the training you are going to demonstrate ▪ Safety area-bathing—must pick a person You document that “you enlisted the pt’s husband, bob smith, I have demonstrate.........” Long-term illness ▪ It can impact everyone in that family ▪ Impact by ▪ Responsibilities ▪ Attention ▪ Financial –biggest one ▪ Stressful ▪ Restrictions, can’t work ▪ (This may cause family to take their anger to you) ▪ They might not be our pt, but have to manage them cause they can be impactful and vocal ▪ Close the door if that were the case ▪ “ I am seeing this person..... I can’t change, if there is arictule, i advice to seek concil” ▪ Remember that they are not another healthcare ▪ Use normal terminology not medical terminology ▪ Skill: check for understanding ▪ “Do you have questions. Okay show me.......” ▪ Shows that you are confident to trust them and catch their mistake ▪ Give small amount of information, stop ask if they understand, and check for understanding, than continue with information (repeat) ▪ Don't want to dump the information cause non compliance ▪ Gives confidence that the patient will transpair on the things they need to do ▪ They need to understand it not a whole treatment plan but rather a to help them ▪ Make sure the family don’t need to do everything for the patient--- preventing them to exercise their things ▪ Not want to add another limitation that was not in there before ▪ Next step: ▪ When they come back to ask questions ▪ Report but they might misinterpret stuff ▪ Get information that is correct-more information such as environment---information that pt has not given ▪ Conveying realistic expectations about the patient ▪ 0-18 year old –this happen alot ▪ If family always wants to come---know that they don’t have to come. You are the healthcare provider https://cometmail-my.sharepoint.com/personal/axc210146_utdallas_edu/_layouts/15/Doc.aspx?sourcedoc={8fa6a194-a1f4-45d3-83b6-44def0bac98… 15/16 10/8/24, 11:47 AM OneNote https://cometmail-my.sharepoint.com/personal/axc210146_utdallas_edu/_layouts/15/Doc.aspx?sourcedoc={8fa6a194-a1f4-45d3-83b6-44def0bac98… 16/16