Involving Family Members in Your Teaching
Since the advent of shorter hospital stays, patients are being discharged much sicker than may be ideal and in need of much more complex and technologically challenging care. They may or may not qualify for, or have coverage for, home health services. Family members and other caregivers may be expected to assume full and immediate responsibility for assisting patients with this care.
Daily procedures may need to be switched to a later time frame in order to accommodate family members and to facilitate their instruction in the care. One reason that home care nurses complain about poor teaching in the hospital is that daily procedures may be routinely done in the early morning and not during visiting hours or times when family members can be present. Consequently, patients are discharged with inadequate preparation.
To maximize patient/family/caregiver education and improve discharge planning, routines may need to be reconsidered. Options for ensuring family members/caregivers are present need to be explored. This includes having the caregiver come in early or delaying the procedure until the family member can be present. It also requires coordination of care with several parties including staff, the patient, and the family members.
If you are dispensing a new medication, instruct the patient in its name, action, dose, and any side effects or other implications. For instance, if your patient has just started taking an anticoagulant medication, instruct him in bleeding precautions and measures to reduce injuries. Discuss the reason for this medication such as a recent thrombosis or CVA, or as a prophylactic measure following joint replacement surgery.
If the patient needs assistance to get out of bed to go to the bathroom and back, instruct the caregiver in proper body mechanics and transfer techniques. Encourage the caregiver to participate in the lessons to learn how to safely manage the patient. Demonstrate the use of a gait belt or other measures to assist with safe ambulation. Correct any bad habits and work to instill confidence that they can do this in both the patient and his caregiver.
Encourage other staff to instruct the patients in their responsibilities for care as well. If the patient is going to need assistance with activities of daily living (ADLs) at home, have the family member present for meals, bathing, bed making, etc., to learn tips and tricks to help make their job easier once the patient is home.
You need to consider HIPAA and other privacy situations unique to your patient. However, similar to using every opportunity to include patient teaching in your care, whenever possible, you also need to take advantage of the fact that family members are present.