Design of Individualized Home Care Programs

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Design of Individualized Home Care Programs

• Module 10

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HEPPurpose

• Provide concrete instructions on how to carry out
  an exercise or treatment at home

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Development of HEP

• Content?
• Process
• Who will develop?
• What methods to use?
• Will pt/family have input?
• When to issue?

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Instructional Design

• Needs Assessment
• Goal Statement (Purpose)
• Key Concepts (Content Outline)
• Objectives
• Planning evaluation for objectives
• Designing teaching strategies
• Implementation of Design
• Evaluation
• Modify Instruction

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Types of Communication Skills Used in
Patient Education

• Expressive skills
• Giving verbal information to others regarding
  their behaviors
• Articulating own beliefs and feelings
• Emotional skills
• Taking responsibility
• Making difficult decisions when transmitting a
  message

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Listening Skills Used in Patient Education

• Listening with undivided attention
• Using verbal/nonverbal expressions during
  listening
• Acknowledging patients message
• Checking with the patient for correct
  understanding/meaning of message
• Asking questions for clarification

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Body Language Patterns During Patient
Education

• Positive pattern Non defensive behavior
  expressing trust, openness, sincerity,
  responsiveness, understanding
• Negative patterns
• Aggressive expressing hostile and antagonistic
  behavior
• Appeasing expressing shy and nervous behavior

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Addressing Patients Priorities Using Modified
FIDO

• Feelings of the patient toward outcome
• Information given by the patient that is
  specific, accurate and relevant to the outcomes
• Decisions expressed by the patient
• Outcomes expressed by the patient - are to be
  accomplished

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Communication Skills Promoting Therapeutic
Relationships

• Asking the patient nonjudgmental questions
• Supporting patients perspective
• Listening to the patients replies to pick up
  clues about understanding of information
• Involving the patient in active problem solving
• Working with the patient and family members to
  set realistic goals for behavior change

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Health Communication in Patient/Health Education

• Health communication - strategies to inform and
  influence patients and their decisions to enhance
  their health
• Importance
• Adds to patients knowledge about health issues
• Decreases patients health risks
• Increases patients adherence to patient/health
  education
• Enhances the relationship between patient and
  therapist

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Characteristics of Effective Health
Communication

• Accurate and understandable - language/format
  appropriate for the patient
• Easily available
• Consistent
• Balanced including risks/benefits of potential
  actions
• Culturally competent
• Evidence-based
• Applied in a timely basis
• Targeting a large number of people

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HEPIndividual Considerations

• Can patient read?
• Can patient follow directions?
• Does patient understand English?
• What is their cognitive level?
• Is patient educable?
• Is someone available to help patient?

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Illiteracy

• "A normal blood sugar is a range between 60 and
  140. Today yours is 150. Is your blood sugar
  normal?"
• How many of your patients would be able to
  accurately respond to this question from the Test
  of Functional Health Literacy in Adults (TOFHLA)?
  In one survey of 3,200 elderly patients, 68
  could not answer that question correctly.

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HEPKey Factors to Remember

• Avoid medical jargon
• Health care providers tend to
• give too much information
• Give information at too high a level
• When instructing, focus on three main ideas

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HEPKey Factors to Remember

• Attentiveness to communication principles
• Be an active listener
• Reflect back to them what is being said
• Reinforce (repeating is ok)
• Make eye contact (if culturally appropriate)
• Be aware of your body language

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HEPKey Factors to Remember

• Remember adherence factors
• Establish Trust
• Address main areas
• Knowledge
• Motivation
• Resources
• Help them overcome barriers

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Addressing Main Conditions

• Knowledge
• Condition itself
• How/when to do treatment program
• When to expect results
• Possible side effects
• Results of non-adherence
• Appropriate psychomotor skills

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Addressing Main Conditions

• Motivation
• Therapeutic relationship
• Discuss incentives/advantages to making
  behavioral change
• Ask questions that encourage patient to recognize
  positive or negative consequences to behavior
• May take a while to convince them
• Is it worth it?

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Addressing Main Conditions

• Resources
• Time
• Money
• Space
• Equipment

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HEPRationale for Patient to do HEP

• Patient MUST understand why the HEP is necessary
  or else they will not do it

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HEPKeep it Simple

• Limit to 3 exercises
• Can add on extra exercises as patient progresses
• Always put it in writing to help patient remember
  
• (7th-8th grade level, but 5th grade level for
  someone with low health literacy)
• Use large, easy to read type
• Use simple pictures or diagrams

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HEPSpecifications to Include

• Frequency number of times per day
• E.g. once a day or twice a day
• Repetitions number of exercises trials to do
  each time they exercise
• E.g. 2 sets of 10
• Duration number of days of performance
• E.g. daily for one week

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HEPContraindications / Precautions

• Provide specific and clear contraindications
• E.g. DONT CONTINUE to exercise if leg becomes
  red, swollen or painful
• Provide specific and clear precautions
• E.g. do not raise your heart rate above 120 beats
  per minute
• E.g. hold on to a table for stability when
  balancing on one foot

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HEPBe Available to Answer Questions

• Provide patient with
• Work phone number
• Work fax number
• Work E-mail address
• Liability issue you must respond to patients
  questions
• Avoid giving out home phone number, etc.

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HEPDocumentation

• Record exercises included in HEP in your daily
  note
• On HEP handout, include
• Patient name
• Identifying information from facility
• PT name
• Exercises with specifications
• Contraindications and precautions

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HEPFollow-Up Visit

• Have patient demonstrate exercises in HEP
• If performed correctly okay
• If performed incorrectly -- modify

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Assess your HEP

• Suitable?
• Feasible?
• Acceptable?

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Assess your HEP

• Suitability
• Does it meet goals/objectives/purpose?
• Is it relevant to patient?
• Need both

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Assess your HEP

• Feasibility
• Can they read it? (illiteracy vs poor vision)
• Size of print
• White space
• Cost
• Achievable?

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Assess your HEP

• Feasibility
• Readability formulas Flesh Reading Ease test,
  Gunning Fog index, SMOG
• 12 to 14 point font sizes
• Black letters on white background
• Bullets, headings, subheadings
• Plenty of white space
• Alignment on left side of page
• Interactive elements involving patient
• Short sentences, active voice

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Assess your HEP

• Acceptability
• Amount of time?
• Willing to perform?

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Sources for patient education

• Government documents
• Professional health organizations
• Commercial sources
• Human resources
• Web pages
• Video/DVD