Volume 27
Number 22
October 28, 2016
Hospital of the University of Pennsylvania
`` Photo: Patient Education specialist Maureen Bonnell (r) reviews a patient education pamphlet with Kate Elliott, of Silverstein 8.
Where’s the beef ? Wendy’s snappy catchphrase dates back more than 30 years but it still sticks with people. And it’s easy to see why. It’s simply written and to the point. This is how clinicians should approach patient education, said Carolyn Cutilli, PhD, RN, Patient Education specialist. “We want patient education to ‘stick’ with patients and families. Marketing concepts can help us influence our patient’s behavior to improve outcomes,” she said. Like a marketer, “we need to talk with patients to learn what will get their attention and motivate them to make changes.”
INSIDE A Special Remembrance..........3 5K Raises Nearly $35,000!........3 Getting Home, Safe and Sound.........................4 Readership Survey....................4 Teens Less Likely to Select Beverages with Warning Labels..........................4
For example, let’s say a patient is readmitted more than once for congestive heart failure due to increased salt intake. When the patient is asked to set a goal -- what she wants to do when she’s out of the hospital -- she states that she wants to get to her granddaughter’s wedding. “To do this she needs to keep healthy. Now you’ve got motivation.” “The information has to be meaningful for patients from the beginning,” agreed Maureen Bonnell, BSN, RN, Patient Education specialist. “If they don’t buy in, nothing will happen.”
Tackling a Sensitive Subject Nurses often use written education materials for patients, not only for in-hospital use but also for patients to refer to postdischarge. “It’s also a way to provide consistent and evidencebased information, no matter who is doing the educating,” Cutilli said. But how the material is presented is crucial to patient understanding. Bonnell recently worked with the nursing staff of HUP’s postpartum unit to develop a pamphlet on Neonatal Abstinence Syndrome (NAS), a group of problems that occur if a newborn is exposed to addictive opiate drugs while in the womb.
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Continued from page 1 “It’s very difficult to have this conversation with new moms,” she said. “The nurse has to explain that their babies are going through withdrawal symptoms and need to stay in the hospital for at least five days because the moms took an opiate such as Percocet.” In reviewing the draft of the brochure the staff put together, Bonnell kept several key points in mind. For example, did the information contain simple words or medical jargon? Was it “patient friendly,” with the right readability? Also, were patients involved in developing the pamphlet? “Patients have to be involved right from the start … especially if it’s an uncomfortable topic to discuss,” she said. Simplicity of message is key in all patient education material. “Clinicians know so much that we end up giving the patients too much information,” Cutilli said. “Evidence-based patient and family education guidelines stress that patient education should focus on core concepts.… A need to know, not nice to know. Give enough information to get patients to the next level of care.”
How You Say it Matters Effective verbal communication is as essential as the written component. “Clinicians often overestimate health literacy among patients,” Cutilli said. “They’re so steeped in the medical world that they may not even know they’re using medical lingo.” Indeed, studies show that up to 80% of the medical information patients hear from a clinician is quickly forgotten, and nearly half of the remembered information is incorrect. And simply asking “Do you have any questions?” or “Do you understand?” may not elicit truthful responses. This is where teach-back comes in, a method of confirming that a patient truly understands what is being explained and can “teach back” the information accurately. “It’s a whole different way of thinking,” Cutilli said. “You’re not just pushing education on patients.” Teach-back has three basic goals: making sure patients have the basic knowledge (ie, the patient knows he has to take a pill), the right attitude (he understands why), and the desired behavior (he knows he has to take with food). But teach-back is not a test of the patient’s knowledge, Cutilli stressed. Rather it is a test of how well clinicians explained the concept. “You have to ask in a way that patients don’t feel tested. Instead of just asking direct questions, say ‘I’ve given you a ton of information. You must have questions.… I would!’” Cutilli said. And go from there.
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Ensuring that patients understand is an ongoing effort. “Education and teach-back. You have to keep bringing them in,” Cutilli said. But it’s not a major conversation. “It could be as simple as when you’re doing something else in the room. Every moment with a patient can be a teaching moment.”
Health Literacy Across the Continuum Health literacy is a key consideration across the continuum of care and in all care settings. One example is the work of Patient Education specialist Andrea Blount, MPH, BSN, in the ambulatory patient population. She currently phones patients scheduled for a colonoscopy three days in advance of the procedure, in an effort to decrease the rate of cancellations and no-shows. Assessing health literacy is more challenging when it’s done over a phone – with no expressions to read or hand gestures – so her focus is on what she hears. “If the patient’s verbal cues are not engaging, I back up and ask ‘What is it you don’t understand?’” she said. “The assessment is woven throughout the entire conversation.” She never asks ‘Do you have any questions?’ Rather it’s ‘Tell me what questions I can answer,’ a more engaging, non-threatening approach. “I’m giving them permission to ask questions.” Frequently she asks to review the prep instruction sheet step by step as both she and the patient look at their respective copies. Then, she uses teach-back to make sure they understand. Cutilli encouraged staff to reach out to patient education specialists who are available to help develop evidence-based patient education, preferably at the start of the process. Go to http://uphsxnet.uphs.upenn.edu/hupnursing/patientfamilyed/ staffNew.html to contact a patient education specialist. And to learn more about health literacy and resources, go to http://bit.ly/2eYEV9g.
A REMEMBRANCE When an employee dies – especially if it’s unexpected – coworkers experience a disenfranchised grief, said Denise Statham, administrative chaplain in Pastoral Care. “We’re not a family member or a close childhood friend but we grieve nonetheless,” she said. HUP’s annual Service of Remembrance provides a type of closure for employees who have lost coworkers over the course of the year, an opportunity to remember those who passed away, to share memories and honor life. “We spend 8, 10 or more hours together each day. It’s often more time here with your HUP family than your other family at home,” said Garry Scheib, CEO of the hospital, at this year’s service. “In gathering today, it’s an opportunity to remember those who we lost this past year and to be grateful for the positive impact they’ve had on our lives.” As part of the service, several coworkers paid tribute to their coworkers, as Rebecca Aker of PPMC Cardiac Care played a harp
softly in the background. A table held vases with a single rose, each representing the person who passed away, and a lit memorial candle. On the lectern stood a single candle “for all the times you were with patients who were dying, for tragedies that might have been happening in your own life … for the horrors in the news that we carry day to day,” Statham said. “This candle stands in remembrance for all of those who are now gone but not forgotten.” “We remember those who have left us with appreciation, admiration and great affection,” said Denise Moriarty, CHRO at the hospital. “When all is said and done, no matter how much you like your work, it’s really the people you meet and work with day in and day out that truly matter. “Colleagues hold a special place in our lives and leave a special impression in our hearts and minds.”
5K FOR THE IOA
Raises Nearly $35,000!
Last month, nearly 500 runners, walkers, and spectators turned up bright and early for the annual 5K for the IOA and Memory Walk. The 3.1-mile race took runners through Penn Park while others – including many four-legged friends -- enjoyed a one-mile walk through the University campus. Each year, the event brings together hundreds of people for one universal cause: to support Alzheimer’s and aging-related research at Penn’s Institute on Aging (IOA). “I think most of us in attendance have been touched through family members by neurodegenerative disease,” said PJ Brennan, MD, the Health System’s CMO and senior VP, at this year’s 5K. “It is exhilarating to get out and do something about it!” This year, the event raised nearly $35,000 for the cause and had one of its largest turnouts yet. “Your support will fund novel research at the IOA – work that would not otherwise be done except for your support,” said Brennan, who started the race in 2012. “I know our team of scientists and staff in the IOA are grateful to you.” So far, the 5K for the IOA has raised more than $170,000. To see more photos of the event, go to http://smu.gs/2eUTzOu.
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seats available are rated safe for babies five pounds and heavier. Kelly’s CAREs grant will pay for dozens of special, difficult-to-find car seats, rated safe for the smaller babies. The seats will be available for families who may not be able to afford them otherwise. “My passion is arming our mothers with everything they need to take their babies home,” Kelly said. “Transitional care is so important to the care we offer.”
Getting Home, Safe and Sound The day parents get to take their newborns home from HUP’s Intensive Care Nursery (ICN) is one they all wait for. Thanks to the work of Kerrie Kelly, MSN, RN, of ICN, and some help from a Penn Medicine CAREs grant, more parents will be able to do just that safely and securely.
Many parents with children in the ICN are so focused on their little one’s immediate needs, car seats still seem so far away. Then it can come up fast, and the parents may not realize that a standard car seat will not work. Now, however, due to the hard work of her Penn School of Nursing students, the ICN nursing and social work staff, Kelly and her team will have seats on hand to make sure all parents are equipped for the most important drive of their lives.
Kelly said that for some parents, the car ride home can be a serious obstacle. Many of the babies cared for in the ICN are born premature and can go home at just four pounds, but nearly all car
Penn Medicine Publications Readership Survey In an effort to ensure that our suite of internal publications is meeting the needs of our readers from across the health system, the Communications department invites you to share your feedback through a brief online survey. The results of this survey will help inform ongoing improvement efforts for our four main internal publications: System News as well as our three entity-based publications, HUPdate, What’s New and the Presby Bulletin. The survey is available at https://www.surveymonkey.com/RZ8SHTH.
Teens Less Likely to Select Sugary Beverages with Warning Labels Teens are more than 15 percent less likely to say they would purchase soft drinks and other sugary drinks that include health warning labels, according to a new study led by researchers at Penn’s Center for Health Incentives and Behavioral Economics. The study builds upon research published by the team earlier this year which showed that parents were less likely to select sugary beverages for their kids when labels warning about the dangers of added sugar were present. The new study is published in the American Journal of Preventive Medicine and has significant implications for policies being considered in several states and cities to require sugary drinks to display health warning labels. “The average teen in the United States consumes at least one sugar-sweetened beverage every day, which could account for more than twice the recommended daily serving of sugar,” said lead author Christina Roberto, PhD, an assistant professor of Medical Ethics & Health Policy. “The rate of sugar consumption in the U.S. is astounding and contributes significantly to obesity, type 2 diabetes, and other dangerous and costly health conditions.” The authors note that the warning labels also contributed to teenagers’ understanding of the potentially negative effects on health of regularly consuming sugary beverages; participants viewing the labels indicated they were more likely to understand that these drinks don’t contribute to a healthy lifestyle. Additionally, the majority of participants (62 percent) said they would support a warning label policy for sugary drinks. To read more about this study, go to http://www.uphs.upenn.edu/news/News_Releases/2016/09/ roberto/.
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