#PTonICE Daily Show – Wednesday, November 15th, 2023 – Patient education: finish the drill

In today’s episode of the PT on ICE Daily Show, Modern Management of the Older Adult lead faculty Julie Brauer as she discusses that the problem with patient education lies in the tendency of healthcare professionals to overwhelm patients with excessive recommendations, mistakenly believing that this approach is effective. They often act like a “fire hose,” bombarding patients with information without considering whether it is truly understood or has a positive impact. This ineffective method of simply talking at patients, providing detailed explanations, or presenting long to-do lists is often learned from clinical instructors and perpetuated without recognizing its limitations. To enhance patient education, healthcare professionals should adopt a three-step framework. This framework involves “show and tell” by combining education with action and intervention, clarifying and recapitulating information to ensure comprehension, and following up and following through with patients to establish mutual accountability. By implementing this framework, healthcare professionals can avoid overwhelming patients and ensure the effectiveness of their education.

Take a listen to learn how to better serve this population of patients & athletes.

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Welcome to the Geri on Ice segment of the PT on Ice Daily Show. My name is Julie Brauer. I am a member of the older adult division. Excited to be here with you all on Wednesday where we jam on all things older adults. Excited to be talking to you all this morning about patient education. Our topic specifically is patient education finish the drill. All right, so what we are going to talk about this morning is the problem with what many clinicians perceive to be effective patient education. And then I’m going to unpack a three-step framework that you all can use to level up your patient education interventions. And I’m going to then share a few really detailed examples of how you can implement this going forward using clinical scenarios that many of you all experience pretty frequently. The goal here is that we just walk into the rest of our week doing 1% better, okay?

All right, so what is the problem with patient education? The standard. Too often, we act like a fire hose. We flood our patients with too many recommendations, and we think that it’s effective patient education. Team, we cannot fool ourselves. that simply talking at our patients, right? So explaining the very detailed pathophysiology of their condition or explaining their fall risk profile after running your outcome measures or giving them a 10 item to-do list of safety and lifestyle recommendations that they have never heard before and assume that we are making a positive impact. Many times I think this comes from the fact that we didn’t really learn in school how to be effective at communicating to our patients and providing education. And then we just kind of followed what our CIs did, right? I am so guilty of this. I remember as a new grad going into a patient and you’re so excited because you want to tell them everything in your brain that you know, you want to share your knowledge. And I remember I would just fire hose, fire hose for 10 to 15 minutes and I would walk out of that room and be like, man, I crushed it with Dolores. Like she just learned so much. I just did an awesome job. And then I would sit down and write literally a paragraph of all the things that I educated my patient on. And for some reason, because I wrote an entire paragraph of my educational interventions, that must make it good, right? Like I perceived that I did this awesome thing. So I think that’s a scenario that we find a lot. The other scenario, which I’ve also been here, and many of you have probably been here too, is that you constantly have this productivity being shoved down your throat, or you are just so freaking burnout and so exhausted, you look at your clock and you’re like, I gotta get this last patient in. I gotta get this last patient in. I’m exhausted. I don’t have a ton of time. I don’t know if I’m going to get a second set of hands to get them up to do any exercise interventions. So what am I going to do? I’m going to go into this room and I’m going to sit there and I’m going to educate. I don’t even know if I can stand up to do it. So I’m going to just stay in my chair, educate and type as I’m there. I know a lot of us had been there, right? I know a lot of us have been there, but are we really helping our patient? Do we really think that just by sitting there and telling them a bunch of stuff, it’s going to cause any positive impact? We have to really start to dig in there. So I want to offer you all a solution. I’m going to explain this three-step framework. So what does finish the drill mean? It means one, we’re going to show and tell, Two, we are going to clarify and recap. And then three, we are going to follow up and follow through. So let me unpack each of those.

Show and tell. Are we pairing our education with action on our part, an intervention, a demonstration? Are we facilitating action on our patient’s part? Show and tell. Next, clarify and recap. Are we ensuring that the education that we are giving, the literal words, the process, the steps that are coming out of our mouths is actually being understood? Are we ensuring that the message we are sending is being received in the way that we intend? Are we asking the patient to recap what they heard? Are we asking questions to clarify misunderstandings or gaps in knowledge transfer? And then lastly, follow up and follow through. Are we following up with the patient after we make those recommendations? Are we following through with a caregiver or the next provider? Are we holding ourselves accountable and the patient accountable? That is what it means to finish the drill. Show and tell, clarify and recap, follow up and follow through. Okay, let’s go through a few scenarios to give you guys a very detailed, clear example of how you can implement. I have a massive list of these, but I’m just gonna give you three here this morning, okay? All right, for you acute care clinicians, You have Dolores on your caseload. She has just had a lumbar fusion surgery, and you go in to evaluate her. Instead of just telling her, Dolores, you have movement restrictions. No bending, lifting, or twisting, right? We all know the BLT restrictions. What we know is that restrictions can cause a lot of fear. A lot of patients never discharge them and they walk around like they’re in straitjackets for a really long time. So instead of just telling Dolores what she can’t do, let’s show and tell. Let’s show Dolores how to hip hinge safely. and distinguish that from actually bending and flexing at the spine. So how do we do that? If many of all have been following ice for a long time, you know this awesome hack. You can take the toiletry bucket that is in Doris’s room. You can go take some towels, roll them up, soak them in water and put them in the toiletry bucket. You can put that toiletry bucket on an elevated surface like the bed or the chair, and you can show Dolores how to safely hinge. Let’s clarify and recap. Let’s ask Dolores, hey, Dolores, do you have any questions about moving your back safely and rebuilding its strength? Let’s have Dolores recap the points of performance of that hinge motion and demonstrate it for us. Lastly, let’s follow up and let’s follow through. If you are lucky enough in acute care to see your patient twice, let’s say it’s the very next day, or maybe it’s later in the day, on the same day, you can ask, Dolores to set the environment up. Show me how to pick this up. We are checking for Dolores’s ability to have those points of performance and be able to form that hinge movement. Let’s follow through, which is very hard to do as an acute care clinician because many times you have no communication with the next provider. You don’t ever get to see Dolores again. How can we do it to the best of our ability? We can follow through by talking to Dolores, maybe putting it on her phone or on a piece of paper. I need you to show this to your outpatient PT. And what does it say? Can you please teach me how to deadlift? Right? We are planting a seed, passing the baton, trying to make sure she stays in that fitness forward lane because we don’t want her back on our caseload. Maybe we even take it a step further and we actually recommend to Dolores a specific fitness forward PT in the outpatient setting who we are going to want Dolores to go to. Finish the drill. Okay. Let’s talk about a home health example here. So let’s say you have Dolores in home health. We know that her visual acuity is impaired, right? Maybe you have done an acuity test. You know that her prescription on her glasses are really outdated. Let’s not just tell Dolores about the importance of vision, helping her balance to prevent a fall. Let’s not just tell her to make that eye appointment with her doctor and then walk out the door and hope that she does it. Let’s show her how to send a message via MyChart. Guys, systems are starting to charge patients for MyChart messages. Let’s start to show them how to send appropriate messages via MyChart, right? Let’s make this actionable. What if we call the doctor, put them on speakerphone with Doris, guide Doris how to schedule her own appointment to increase her self-efficacy? Let’s clarify with Dolores by asking, are there any barriers that you can perceive getting to this eye appointment? Let’s follow through by contacting a caregiver to schedule with them. Hey, this appointment, Dolores has a eye appointment this day, this time. Are you going to be able to take her? Let’s make sure it’s on both of your all’s calendars, right? Or maybe we plan ahead with a service like Go Go Grandparent so that we know that the transportation piece that was a barrier is now something that is facilitated and that we have taken care of that. Okay. Lastly, let’s talk about an outpatient example. All right. You’re working with Dolores, an outpatient. She lives with her partner at home. She’s got some balance issues. She has had a fall. So you are treating her. Let’s not just tell Dolores to take up her rugs and put nightlights around her house. How often do we give that cookie cutter recommendation of let’s remove all your rugs, right? Instead, How about this? How about we make this actionable and we get Dolores or Dolores’ partner or a caregiver to get a video walkthrough of the pathway from Dolores’ from the edge of her bed into the hallway, into the bathroom, into the living room, out her front door, whatever her normal pathway is for the day. What if we get a video so that we can actually see what her home environment looks like? And then we can say, okay, Dolores, that rug, that one, the one with the tassels that you know she’s probably gonna trip over or she has tripped over. Can we get rid of that rug, Dolores? Why don’t we clarify by asking, Dolores, are you willing to get rid of that rug? She may, older adults, we know this guys, right? It’s really hard to tell them to get rid of rugs. They may be really resistant to that. So Dolores, are you willing to get rid of that one rug? Because you have gone through and you’ve triaged out of all of the rugs, that’s the one that’s gonna cause us the most problem. What if we ask Dolores, what are your feelings surrounding getting rid of your rubs? And you dig a little deeper there. Let’s follow through with talking about how we’re going to actually get this done. Because maybe Dolores may not have the capability to get down on the ground and remove her rubs. So what if our follow through is calling nephew Johnny to ask him, Hey, will you, within this week, come over to Dolores’s home and help her take up her rubs? Right? What if, We don’t just tell Dolores to have those lights throughout the home. Now that we have the video, we say, Dolores, the lights would be most helpful if you put them here, here and there. Here is the Amazon link of some cheap but effective ones to buy. Let’s put it in your cart right now. That is how we follow up and follow through and make this actionable, right? Then we can say, Dolores, here’s your follow-up. Bring in a video in the next week and show me what your pathways look like now. So you are able to see that we have followed through with this recommendation. The nightlights are where they’re supposed to be and the rugs are taken out. Guys, this is what it means to finish the drill with our educational interventions. Show and tell, clarify and recap, follow up and follow through. I would love to hear you all take this framework into the rest of the week. And while you’re with your patients and you’re starting to just fire hose and spew out those recommendations, I would love for you to pause take the pause and really think how you’re going to finish the Drew. How are you going to show and tell, clarify and recap, follow up and follow through? All right, team, that’s all I got for you today. Lastly, let’s talk to you all about our courses that are coming up. We have some sold out courses, which is wild to have at the end of the year. November, we have a sold out course in Illinois. In December, we are sold out or we’re very near sold out in Portland, Maine. And then we have another chance for you all to catch us on the road in Asheville, North Carolina. In January 1st of the year, we are going to have both of our online courses, our Level 1 and Level 2, formerly known as Central Foundations and Advanced Concepts, that are going to be starting up on January 10th and 11th. You know where all that info lives, ptinex.com, mmoa.online. Hit us up if you have any questions. Go out there and start to make those educational interventions. Just 1% better team. All right, y’all.

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