Familial GI Cancers Unit

Patient Teaching

Teaching patients and families about Inflammatory Bowel Disease and living with this devastating illness is a crucial aspect of providing care. In the hospital in particular, health professionals need to provide endless information about medications, procedures, tests, treatments and special instructions.

The reality is, we also need to go beyond the hospital stay and prepare patients and families as best as possible to cope with the changes and challenges they may face in day to day living once they go home. While community resources are available, it is very important to be effective teachers and help facilitate learning before discharge.

In order to be effective teachers and ensure learning is occurring, it is important to have some knowledge about adult learning and consider adult learning principles in your approach to caring for these individuals. The following is an outline of the principles of adult learning and strategies that will help you in the teaching process.

Adult Learning Principles

Learning is:

a process
an integral part of living
a consequence of living
initiated by the learner
restructuring of previous knowledge
co-operative and collaborative

Learning is best:

when it occurs in the whole person:
- cognitive
- affective
- psychomotor
when it is relevant to the situation
when it focuses on tasks or problems

Other considerations to keep in mind:

people bring a lifetime of experience
developmental stages influence adult learning
people learn in a variety of ways
teacher and learners share responsibility for learning

Strategies for Teaching

It is important that our patients have respect for us as health care providers and that we have respect for our patients. We must be positive, have an empathetic concern for the individuality of the learner.
We need to empower our patients. Empowering our patients will allow them to recognize and develop their own abilities in order that they can meet their own needs, solve their own problems and mobilize their own resources to feel in control of their own lives.
We need to create an environment that is conducive to learning. Ensure that your patient is free from pain and nausea, is rested and alert. Learning can be emotionally exhausting.
Establish privacy, limit noise and disruption and most importantly give yourself the time to teach.
Avoid prolonged teaching situations. Introduce the information slowly, allow accomplishment and reinforce all teaching steps.
Set mutual goals. Both you and your patient need to agree on the learning goals.
Draw on your patient’s past experiences. Ask how your patient best learns. Is it through verbal repetition, or does he respond best to written material or picture format? Make use of all forms of teaching material and methods.

Involve family members or friends for support. They can be instrumental in encouraging and helping to reinforce learning material.
Allow your patient to make mistakes. Learning takes time. Humans do not readily gain comfort or confidence with new material.
Encourage and praise your patient with accomplishments whether it be learning a new task or acquiring a new skill.
Take into consideration your patient’s developmental and emotional stage, their physical limitations, culture and family dynamics. That entails truly knowing your patient which can only come with continuity of care and caregiver.
Evaluate your teaching. Ask the questions and be aware of your patient’s verbal and nonverbal responses.

Patient Engagement

Whether you are a social worker or a health care professional working with patients, the process of engagement is an essential part of connecting with people in a meaningful, therapeutic way.

Engaging with your patient allows you to understand their personal stories and struggles, and to develop a common definition of their situation and problem. Developing a common definition of the patient's problem during the engagement phase can facilitate movement toward mutual problem resolution.

While the process of engagement is ongoing, the importance of developing a therapeutic connection is most significant in the first meeting. It is during the initial connection that the basis for your ongoing work together occurs. Although the development of a strong engagement and therapeutic alliance is important for work with all patients, when working with the chronically ill, the relationship built at the beginning will set the stage for possible long-term work together during the progression of different phases of illness.

During the engagement phase, a patient will be assessing whether you are someone that they can feel safe and comfortable with to share their very personal stories and struggles, and whether they can see themselves developing a therapeutic alliance with you for ongoing work. Engagement is a multi-faceted skill involving many layers of practice. Developing successful engagement with patients is key to our success as health care professionals. The "Engagement Experiential Module" written by University of Toronto, Faculty of Social Work outlines helpful strategies to facilitate engagement.

Before meeting with a new patient, we as professionals can bring personal qualities or "attributes" to the relationship with a prospective patient which will set the stage for the engagement process. The "Engagement Experiential Module" outlines these as follows:

Attributes

respectful attitude toward patient and family genuine/authentic presentation of self acceptance/non-blaming/non-judgmental approach/attitude self-awareness, especially about own emotions/discomfort and how these may impact patient engagement work together. trustworthiness (displays willingness to help) controlled emotional involvement: aware of own emotional reactions, so it does not impede the work together positive attitude warmth interest awareness of cultural/diversity issues and address them when required

The above-mentioned personal qualities or "attributes" form the foundation on which health care professionals can build engagement skills and behaviors during all phases of the therapeutic relationship with the patient

How do we engage a patient?

Clarify your role and purpose of your visit. Introduce yourself with warmth and friendliness. Present yourself in a professional manner without using technical jargon or knowledge that is difficult to understand. Obtain verbal consent from the patient to proceed with visit. Create a safe, private environment for the meeting (if possible). Start where the patient is by inquiring about the problem in a respectful manner. Maintain eye contact when talking with the patient. Employ good listening skills. Use active listening, body language which reflects openness, and calming facial expressions. Pay attention to your voice - modulate tone, rate of speech, volume. Develop a mutual understanding of the problem or issues affecting the patient by encouraging feedback.

Moving forward in the engagement process

Provide support to "help the patient verbally tell their story". Encourage the patient to “tell their story”. This involves a complex combination of skills. Use open-ended questions to engage the patient in discussing their “story”. Pay attention to verbal and non-verbal cues during communication. Support the patient in expressing his or her feelings, and validate his or her feelings and concerns by providing realistic reassurance and hope. Respect the patient’s boundaries and do not push them into disclosure. Create an environment and opportunity for patients to discuss sensitive issues. Address and be attentive to issues of culture/diversity where necessary.

Although these strategies are from engagement literature in the field of social work practice, these skills can be adapted to the practices of most health care professionals. The engagement process is the fundamental foundation on which to build a therapeutic relationship with patients and their families.

Reference:

Power, R. "The Engagement Experiential Module", University of Toronto, Faculty of Social Work, 3-7, October, 2004. The material for the "Engagement Experiential Module" was a summary of a literature analysis, some of the key references for it follow:

Coady, N. (2002). The helping relationship. In F. Turner (Ed.), Social work practice: A Canadian perspective (pp. 116-130). Toronto: Prentice Hall

Marziali, E. (1988) The first session: An interpersonal encounter. Social Casework (1), 23-27.

Murphy, B. and Dillon, C. (2003) Interviewing in action: Relationship, process and change. Pacific Grove, California, Brooks/Cole ch. 10 The Clinical relationship: Issues and dynamics, p 221-246

Marziali, E. & Alexander, L. (1991) The power of the therapeutic relationship. American journal of orthopsychiatry. 61 (3), 283-391

Shulman, L. (1999) The skills of helping individuals, families, groups, and communities. Illinois: Peacock Pub Inc

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