Patient education

from Wikipedia, the free encyclopedia

The term patient education (Latin: educare; raise, educate) is understood to mean diverse and targeted psychological and educational measures that are intended to support patients and their relatives in coping with illness. It makes an important contribution to achieving the general goals of care. This includes the strengthening of the individual self-care ability as well as the strengthening of competencies of the patients in order to enable them the best possible self-control and autonomy in everyday life. In addition, the state of health, the sense of coherence and adherence to the therapeutic measures should be strengthened. Patient education is recognized internationally as part of the concept of health promotion and is reimbursable in Germany as a delegable service on medical prescription by the health insurance companies .

History of patient education

The term “patient education” has been established in the USA since the 1930s (“nursing is teaching”). It is also now widely used as a term in Great Britain, Scandinavia and the Benelux countries. Compared to these countries, however, there is so far little evidence-based knowledge in Germany. The reasons for this are different lines of research and differently weighted focal points of the specialist disciplines and professions - for example, communicative barriers between the medical and nursing sectors. Different terms have been defined in literature, legislation and practice, which make a uniform definition of what constitutes patient education difficult. These include: "Care advice", "Patient and relatives training", "Instructions" and "Patient information".

Legal foundations of patient education in Germany

The legal basis relates to the following provisions of the Social Security Code:

§ 7a SGB XI - care advice

§ 17 paragraph 1a SGB XI - guidelines of the long-term care insurance funds

Section 37 SGB XI - care allowance for self-procured care assistants

§ 12 SGB IX - Measures to support the early identification of needs

§ 40 SGB XI - Aid supply

§ 81 SGB XI - procedural regulation

Sections 88 to 92 SGB X - social administration procedures

§ 94 Paragraph 1 Number 8 SGB XI - Personal data at the long-term care insurance funds

Section 46 (3) sentence 1 SGB XI - administrative costs of the long-term care insurance funds

Section 123 SGB XI - Advice for people in need of care and their relatives

Section 7b (1) and (2) SGB XI - advice vouchers

§ 7c SGB XI - care support points, authorization to issue ordinances

§ 8 SGB XI - Joint responsibility

The fifth book of the Social Security Code (SGB V) regulates the entitlement, scope and reimbursement of measures and material for patient education in the outpatient area

§ 33 SGB V - Ordinance on Aids

Section 37 SGB V - Entitlement to home nursing care

Section 132a SGB V - Remuneration for home nursing

process

Basics of advice

The basics of the consultation are based on the professional and personal competence of the nursing staff. The professional competence consists of establishing contact, the ability to cooperate and develop relationships, the application of knowledge, needs assessment, advice and supply planning. Personal competence relates to the ability to reflect, flexibility, conflict-solving, problem-solving, as well as observational and analytical skills of the individual nurse.

I) Requirements for advisory or advisory competence according to Koch-Straube:

  • dialogical communication
  • Respect for human dignity
  • Perception of the competence of those in need of care
  • Resource-oriented work
  • Respect for self-determination
  • Enable selection
  • Include environmental conditions and assume future prospects

II) Basic attitudes in counseling:

  • An open attitude based on the principles of reversibility (“treat others as you would like to be treated”) is important in counseling.
  • A respectful attitude, in respect and deference to the patient or family member.
  • The ability to tolerate, to take the other person as he is and also to respect it, is another point in the basic attitude.
  • The quality of being empathetic, to be able to empathize with another person, and to understand the understanding from which the other acts as he does.
  • Authenticity, which means that verbal and non-verbal communication are in congruence with each other. In this case, the action of the individual is not only determined by external influences, but also relates to the respective personal context.

Basics of communication

Communication is the main element in the interaction between two individuals. The communication researcher Paul Watzlawick clarifies this as follows: "You cannot not not communicate."

Whenever people come together, there is also some form of communication. However, not only the spoken word is meant, but also the appearance and behavior of a person, as well as what this unconsciously radiates.

The German Allenbach Institute found that around 80% of communication in Germany takes place on a non-verbal level. A distinction is made between verbal, non-verbal and paraverbal communication.

Verbal communication means only the spoken word and is used to convey content. It thus provides information on origin, education and the relationship between the sender and the recipient. If the sender expresses himself inadequately, this can influence the understanding and cooperation of the other; misunderstandings arise.

Paraverbal communication includes choice of words, language, tone of voice, speed of speech, pitch, tone of voice, and the type of language one chooses. Examples of this are dialects or technical language. Paralinguistic forms of expression provide information on how to understand the spoken word. They vary depending on the goal of the communication exchange, the conversation partner or the situation.

Non-verbal communication stands for body language. This includes facial expressions and gestures as well as eye and body contact. It supports the language and is automatically interpreted by the other person. However, since the non-verbal form of communication is sometimes indistinct and, for example, individual from culture to culture, it can easily be misinterpreted, which in turn favors possible misunderstandings.

These three communication elements just mentioned need to be decrypted for the recipient of a message. If they match, this is called congruence, but if this is not the case, the message is therefore incongruent and what is said loses its authenticity.

The communication square

The communication square, or four-ears model , is a model that shows the different modes of action when a person expresses himself or receives an appeal for news. This model was developed by Friedemann Schulz von Thun and is probably his most widespread and best known to this day.

The communication square means that every person who communicates something always conveys a message to the interlocutor on four different levels, even if this happens without further intention.

The communication square is divided into the four levels, factual information (what I provide information about), self-disclosure (what I reveal about myself), relationship information (what I think of you), appeal (what I want to achieve with you). To illustrate this graphically, Schulz von Thun drew the four levels in a square. The utterances made by the sender come from the "four beaks" and these then hit the "four ears" of the recipient. Both parties have an influence on the quality of the resulting communication, since the goal is unambiguous conversation.

The four levels of the communication square: With self-disclosure, the sender also shows a piece of their own personality in the message sent. This includes feelings, values, needs and idiosyncrasies that may be brought to light without intent. Meanwhile, the recipient perceives the message with the “self-disclosure ear”, then the questions “what kind of person is this” and / or “what about him” can arise. In addition, this can be done both in the I-message, i.e. explicitly, and implicitly.

At the factual level, factual information is in the foreground, because this level is primarily about filtering out data, facts and / or factual content. In order for this to be carried out successfully, the criteria true / false, relevant / irrelevant and adequate / inadequate are required. The sender must express the message in an understandable way, since the recipient can react to the factual ear according to the three criteria.

On the relationship side, the sender shows, among other things, in the areas of facial expressions, gestures, tone of voice and wording, how he relates to the recipient. In addition, it is possible that these notes can also be conveyed implicitly or explicitly. As a result, the recipient can react with different perceptions on their own relationship ear (rejection, humiliation, respect, etc.).

Via the appeal level, the sender expresses wishes, instructions for action, appeals and / or advice, as he often wants to achieve something with this message. It is also possible to make an appeal indirectly or directly.

Theories of patient education

The Witten tools

The Witten tools are a communication approach that was developed at the University of Witten / Herdecke (Department of Nursing Science), among others, by Angelika Abt-Zegelin and Günter Bamberger. The Witten tools are a communication approach with a focus on family and patient education, the main task of which is the interactive work of nursing training and counseling. First of all, it was worked out which phenomena characterize the consultation and training. These are seeing, feeling, speaking and doing. In order to address these senses, so-called tools have been worked out with which one can conduct training or advice. You never have to use all tools at once. The Witten tools comprise ten elements (“tools”), five of which are directed towards the client and five towards the counselor. They aim at good conversations with patients, residents and relatives and particularly emphasize the “self-care” part of those working in the health care system and promote the team feeling. Not all tools have to be used all the time; The concept assumes that people have or are developing favorite tools and allow them to be authentically effective. There are courses and workshops in which this concept is practiced and presented. This concept was developed especially for caregivers, as they are often the first point of contact for health problems and concerns. In contrast to, for example, psychotherapeutic consultations, clients and caregivers do not make a fixed appointment. The consultations take place in a quiet environment with sufficient time. The communicative work therefore often takes place alongside the performance of other activities. There is often little time to respond to clients; so it is precisely this “casualness” that may be important to lower the inhibition threshold. The spectrum ranges from brief information to profound fears and worries. In order to meet this need for advice, the “counselor” must learn to “walk in the shoes of the other person”, as the need for advice increases. It seems important for caregivers to perceive themselves (in conversations) and to reflect on their own experiences. Therefore, the Witten tools include five aspects that are aimed at the consultant in terms of self-care.

Sunder & Segmüller

The German health and nursing scientists Sunder and Segmüller describe three forms of individual intervention in the context of patient education.

information

Described as a communicative intervention with an orienting character to generate a targeted expansion of knowledge, it is appropriate in cases of personal or situational excessive demands on the part of the patient. Language barriers and / or the inability of the person receiving the information to independently assess what they have heard or to deal with it can also make the educational measure necessary.

The objective here is primarily the selective reduction of information or knowledge deficits, but also the correction of already existing incorrect knowledge bases (e.g. caused by outdated and dubious medical sources).

The overriding aim is to stimulate cognitive learning processes as well as the associated improvement of the personal prerequisites for action in the co-determination of one's own therapy.

The challenge for the educators is to adapt the information to be conveyed to the level of education of the information recipient in the above intervention, since they are usually not familiar with the context of the information conveyed.

Furthermore, the educator should be sure that the knowledge he is imparting is technically correct and well-founded.

Direct addressing and the provision of information materials (e.g. brochures, information films and media) are suitable as a communication level.

enlightenment

Described as a communicative intervention with an orienting character to remedy health-specific knowledge and behavioral deficits, the aim of the education is to achieve a general understanding of the problem of the conveyed facts and a change of the enlightened to the conveyed content. Clearly defined goals and usable and understandable specialist knowledge are prerequisites for a successful intervention.

Here, too, the educators have to adapt the information to be conveyed to the individual, in the case of a broad-based awareness campaign, take into account the diversity of the possible target groups and reflect their real possibilities for change. If you ignore these points, the person receiving the information will not be able to adapt to the information (for example, an actually enlightened patient with high blood pressure continues the original lifestyle, as the severity of the secondary diseases was not understood by the educator due to technical language).

Both direct language and communication via visual and auditory media are possible as a communication level - just like with targeted information. However, it is important to have a didactic connection between the selective interventions, since otherwise the situation to be clarified can only be understood with difficulty in its entirety. The content and written adaptation of a collection of information to different audiences can help to understand the latter.

consultation

Described as a communicative intervention with a situationally supportive character to remove problem pressure and limited decision-making ability, the counseling aims at individually adapted problem-solving strategies of the individual or several people. If the individual has problems coping with health deficits and unmanageable problem situations, his ability to reflect on his or her health self-determination can be severely restricted. Here, according to Sunder and Segmüller, the educator can show the counselor his or her ability to achieve health autonomy through his professional advice by means of orienting and enlightening knowledge and other discussion tactics. The educator should always strive for a neutral and independent relationship with an appropriate closeness-distance ratio and individual case reference in order to provide the counselors with a neutral overview of their situation and possible therapy options by means of empowerment concepts and a change of perspective. The form of imparting decision-making knowledge is adapted to the individuality of the person being advised in order to promote his competence development and not to generate language / knowledge barriers due to foreign knowledge. Since counseling takes place on a voluntary basis, the educators recommend a non-directive, client-centered and low-threshold attitude. The practical implementation is described as open-ended in order not to put any additional pressure on those to be advised; this is characterized by problem-solving communication.

As a communication medium in practice, the linguistic level is recommended for individuals or groups in order to enable a planned and structured interaction process with the aim of preparing individual, needs-based problem solutions and accompanying their practical implementation. The development of problem-solving-relevant competencies within the above process is described as definitely desirable and eligible for funding.

Consulting processes according to Sue Culley

The nursing scientist Sue Culley dealt with the questions of how good advice can be achieved, what methods and strategies there are, what kind of interpersonal factors must be given and what skills the consultant should bring with him in order to be able to provide a good advice process. Here, Culley's counseling process is related to the caregiver-patient relationship. In the following, those of Culley are listed as necessary personal characteristics of the caregiver for good advice.

Active listening:

This includes listening attentively, summarizing key messages in your own words in order to verify what has been understood, and trying to express the patient's feelings that are difficult to express in words.

Reflective Skills:

This includes repeating, paraphrasing and summarizing. According to Culley, this has an impulse-giving effect and encourages the patient to carry out what has been said more precisely. Paraphrasing aims at summarizing central statements in your own words. It creates a feeling of sympathy and understanding in the patient. This in turn strengthens the relationship of trust between the nurse and the patient, which forms the foundation of the counseling process. Paraphrasing is also used to collect information and to look back on the joint work. Summing up the entire conversation gives both parties a structured overview at the end.

Probing skills:

Culley's exploratory skills are based on skills that give direction to the counseling session. This includes: "Asking questions and making statements". Asking questions has a significantly more influence on the conversation than stating. However, this is more important for information gathering. Ultimately, both skills would aim to get the patient into fluent narration and accurate description.

Concretizing skills:

These help to recognize generalized, vaguely expressed statements of the patients and to address them. The aim is to present things as concretely as possible. Because this is, among other things, the basis for an expanded self-image and for new impulses for action.

The phases of the consultation process

For good advice, the counselor requires some communication skills ( openness , respect , tolerance , empathy , authenticity). This can lead to a good dialogue and successful advice.

  1. In the initial discussion, the ideas and expectations of the patient and the nursing staff are set up and the topic and goal are determined. The framework conditions are also determined. In addition, the patients consider which role the nurse will assume in the course of the consultation.
  2. In the orientation phase, counselors and patients have to adjust to each other. The counselor is responsible for creating a fertile atmosphere. The patient should define his topic and formulate a realistic goal of the consultation.
  3. In the clarification phase, the patient can express the problem freely in order to name and work out the problem situation as specifically as possible. The nurse takes on the passive listener role. If the patient is overwhelmed, the nurse can reflect the feelings or express his own feelings empathetically and thus focus, paraphrase or structure specific W-questions on the problem and thus provide support.
  4. This is followed by the phase of developing possible solutions. On the one hand, various proposed solutions are named and collected by the patient. Finally, the nurse can support the process by showing further hypotheses and ideas that have not yet been taken into account (expert advice).
  5. Finally, the consultation ends with the final phase. There the carer reflects the proposed solutions again. Then the patient has to find a solution that seems appropriate to the respective problem (advantages and disadvantages can be weighed up). In the end, the solution should be specified and the procedure for solving the problem should be clear. Otherwise, new consultation appointments must be discussed with the nurse.

Formats of patient education and family education

The training and micro-training courses are about imparting planned knowledge and / or skills to the patient (for example, how to perform a subcutaneous injection or about fall prevention . There are also complex programs in which detailed training courses are offered for several days (for example, instruction daily life with diabetes . in addition, there are structured instructions). this important in individual training information is given so that care can be carried out independently. it is important that the Executive adapt their language to Anzu Executive and Advisory opposite, so that they understand everything There are also information options in the form of information sheets or brochures. Patients or their relatives can turn to counseling centers on topics where patients need specific support. If a family member would like to learn how to care in order to be able to care at home, they can m to attend nursing courses. These are financed by the care insurance funds (§ 45 SGB XI), there are some successful projects in Germany at patient information centers (PIZ).

A new approach in Germany is the family moderation project. The approach is systemic, as the counseling includes the whole family system. Family moderation occurs when a family member is forced to take care of someone in need of care in the family. Special nurses are trained with the tools of the trade in order to conduct appropriate family discussions. They also find out where families can get targeted care support and can refer families there. This field is still very young, which is why it is only offered in a few places.

Abt-Zegelin's theory

Patient education is used by nursing scientist Angelika Abt-Zegelin as an umbrella term for four main strategies in nursing; these are information, advice, guidance and moderation.

For a successful patient information, knowledge should be made available directly in the form of information material for the patient. The consultation is an interplay of information and training that describes the imparting of skills that together promote an open-ended and dialogical process, at the end of which there is the preparation of a needs-based problem solution. The counselor helps the client to deal with problems in a tailored way. The instruction takes place as a goal-oriented, didactic process with bundling and securing of results. The moderation includes a group discussion, for example with family members, for information and conflict resolution in the event of relatives in need of care. This takes place either at the beginning of the care situation, upon discharge from the hospital or later if the care situation develops more difficultly. Patients can only actively participate in the treatment and therapy of their disease if they are adequately informed, advised and trained. Affected people want to be more active and make informed decisions. Through patient education, the self-care ability and the competence of the patients are promoted in order to enable them to make a contribution to the restoration of their quality of life. The cost bearers are also interested in increasing the patient's personal responsibility in order to shorten the hospital stay, reduce visits to the doctor and outpatient services and thereby save costs.

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