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Chuck: Hello and welcome to the Patient Educators Update, where we talk about patient
educators and patient education topics in the clinical environment. My name is Chuck
Jones, I'm with Synergy Broadcast and I'm joined today by our guest, Fran London. Hi,
Fran. Fran: Hi, Chuck.
Chuck: Fran is a Patient Education Specialist, I should say, at Phoenix Children's Hospital
in Phoenix, Arizona. She is also a published author, most recently she has published the
book "No Time To Teach", which is a great book for patient educators, and in 2010, it
was voted the the Most Outstanding Book, or Book of the Year Award by the American Journal
of Nursing. Is that correct? Fran: Correct.
Chuck: Cool. It's a great book. I read it myself. I keep it with me since we deal
in the patient education space, and it's been real valuable for me. Well, Fran, our topic
today is going to be about something called the teachable moment. I'm sure this is a topic
that's near and dear and to your heart.
I will tell you from personal experience that with both my wife and mother, and kids in
the hospitals, that patient education begins at discharge. Correct?
Fran: That is erroneous. Chuck: Oh, okay. So when should it begin?
Fran: It should always happen with every conversation. It may not always be teaching,
some of it may be assessment. But, patient education should always be on your mind.
Chuck: Okay. That makes a lot of sense and I think is germane to our topic today,
which is, teachable moments. Can you kind of describe for us what a teachable moment
is? Fran: Yes. First, let me preface it with
a little bit of theory, which is really relevant. Adult learning theory talks about how adults
learn differently from children, and the key with adults is they already know stuff, and
they function and they get along just fine.
So, in order to really get them interested in learning, you have to get them at a time
when they have a problem that they need solving and that's what motivates them. So, that ties
right into teachable moments, because basically a moment is a good teachable moment when a
learner wants to learn something, when they perceive a problem and they need an answer.
Chuck: Okay. I suspect that we will see how that evolves as we go through the conversation.
Fran: Yeah. Chuck: The first thought that comes to
mind is, does the patient raise their hand when they have a teachable moment? Or how
will the nurse educator know that there's one right there?
Fran: It can be subtle, or it could be a straight out question. They probably don't
raise their hands much, but they do ask questions. Sometimes the questions are direct medical
questions, like "Will the scar go away?" or something specific. Sometimes they're more
concerns or issues. They're vague and they're subtle. The key,
really, is to pay attention and listen and try to identify what the underlying question
is whenever there's a conversation going on with the patient.
Chuck: Okay. So, perhaps it might be if they become extra talkative, rather than when
asked "How are you doing?" they say "fine" and don't talk any more. But if they say "Well,
I've had this problem here or this problem there", that's probably a clue?
Fran: Exactly, exactly. They key is to listen to what they're saying and try to figure
out what's behind it. They may actually complain about their daughter isn't calling them as
much as they would like. Then you have to explore maybe there's not enough social support
at home for follow-up home care after discharge.
So, it's really listening, and trying to find the underlying issue. Then, once you find
what the concern is that's a teachable moment because they're open to listening to the answer.
So, teaching is a lot more efficient and effective when you've got a learner who's involved and
ready. Chuck: Yeah. Much like breakfast conversations
while you're reading the paper or whatever, and the wife asks you a question and you go,
"Mm-hmm." That's not a teachable moment. Well, it would be if she would reach out and slap
me. But I know what you're talking... If someone's distracted or not paying attention, it's going
to make it a little bit more difficult. Fran: Yeah.
Chuck: Well, okay. So, that helps us recognize the teachable moment. Once you recognize it,
what should the nurse educator do? How do you capitalize on the teachable moment?
Fran: Don't let it go. Chuck: Okay.
Fran: Acknowledge it. Don't let it go. Explore [inaudible 00:05:29] a little bit
more behind it, and then find out exactly what you need to provide to answer the question.
So, if the question is about, "How long will it take me to recover, and when can I go back
to work?" then if you don't know the answer right away, research the answer and let the
patient know that you will find out what the answer is.
Chuck: Okay. Fran: Come back with the answer.
Chuck: Okay. What about when you're, maybe bringing in some medication or doing something,
is that a good time to explain things to the patient?
Fran: Sometimes teachable moments happen when you don't have the time to teach.
Chuck: Yeah. Fran: Which is I think what you're talking
about, and those can be awkward but they're certainly handle-able. The most important
thing is take advantage of the teachable moment, because if you lose it, they're going to lose
interest and you just missed an opportunity to really effectively teach.
Chuck: Okay. Fran: So if you don't have time to respond
right then, if they ask a complicated question then it's the kind of situation where you
might need to sit down and have a chat about and you can't, then acknowledge it. Try to
clarify the question a little bit more and think about what resources you have readily
available, whether it's a handout on that topic or a video on that topic.
Plug them into that right away, and say, "Okay, I don't have time to address this right now,
but here's an introduction to the topic." So we get it started, take advantage of that
teachable moment, and get them at least continuing on the growth in that area so that you can
come back when you do have time. Chuck: Yeah. That's incredibly good advice.
As someone who's involved in the video-on-demand business - a self-serving plug here - it's
a great opportunity to use a video-on-demand system, because you've got literally hundreds
of hours of content available that could help address a situation. Then come back and specifically
address that, because the video is not the teacher, the nurse is. The video is going
to provide the information. So that would be a good opportunity to use that.
Fran: That's the key to video-on-demand, so that when you need it, you can demand the
exact video that you need. Chuck: Yeah, absolutely. Well, let me ask
you, since we've talked about how to recognize them and how to use them, should you try and
teach if the patient is not very receptive? They're just kind of blocking you in every
way, what should you do? Fran: Ah, okay. There are a couple of keys.
Some is if the patient is not capable. If they're drugged and sleeping, then don't bother.
But if they're not interested, there could be lots of reasons for them not to be interested.
It's good to listen when you do have a conversation to find out what's going on. One other thing
you can do, since you don't really want to keep all the teaching until the time of discharge,
is to try to create a teachable moment.
The way you do that is to create a need. Everyone has concerns and worries and things that they're
thinking about. So if you could find out what the patient is really worried about, it may
not be what you think they should be worried about. But it may be very important to them.
So find out what concerns them that could be an in for where you start teaching.
So, if they're concerns are that they have to give themselves shots when they get home,
you talk about, "Well, what is concerning about the shot-giving?"
Chuck: Yeah, okay. All right, well I guess if we think about everything that you've provided
information-wise today, the things that we can take away are that patient education doesn't
start with discharge. It starts really at admission, and then every opportunity that
you're with the patient. It's important for the nurse educator to be
alert to those teachable moments where the patient, or perhaps even the family care giver
- we didn't talk about them - perhaps they're either asking questions or giving information
or some kind of a verbal or even physical feedback that gives you a clue that they might
be interested in some different information or some additional information.
Or for you just to question them more to get to the bottom of what perhaps may be on
their mind. Then, when you're in the process of doing things like procedures or whatever,
you want to explain what they're doing and give them an opportunity to ask questions
to make sure that they're comfortable. Then if you find that they're not in a
position where they're interested but you can't teach at the moment, provide some tools
in order to give them some basic information until you can get back to address that specific
situation. Is that about the gist of what we were talking about?
Fran: That was a great summary. I don't think you left anything out.
Chuck: Well, I'm trying to pay attention. Okay. Well, that's all the time we have for
today and this episode. I think your feedback was great, and I hope our listeners can take
some good, solid tips away from you on that. I want to remind people where they can find
you, so why don't you tell everybody where they can find you online?
Fran: Well, I've got a website, a blog at www.notimetoteach.com, same as my book
title, and then my Twitter, @NoTimeToTeach. Chuck: Okay. I want to point out that your
book is available in both paperback and e-book form, wherever books are sold. Your publisher,
Pritchett & Hull, and that's p-h.com, has a sizable discount for organizations that
want to order bulk quantities. So, if a hospital wants to implement these
incredibly practical tips that you have to take advantage of patient education, they
can make a deal directly with the publisher and we'd encourage them to do that.
Fran: Thank you. Chuck: I would like to also let everybody
know that the Patient Educators Update is brought to you by Synergy Broadcast Systems
and our video-on-demand patient education system we call MMDS, or the Medical Media
Delivery System. It's a video-on-demand system that allows you to take advantage of delivering
patient education video to your patients when they are ready, willing, and able to learn. So, Fran, thank you very much for your feedback
this week, and I look forward to our next visit.
Fran: Thanks, Chuck. Chuck: Okay, bye-bye.
Fran: Bye.