Patient Education and Health Promotion

Effective health education is invaluable to the health care of society. Respiratory therapists (RTs) educate patients by providing information about disease processes, medications, and treatment procedures. They teach patients how to perform diagnostic tests like basic spirometry, and they educate patients about health promotion issues such as tobacco cessation. RTs educate patients in all age groups, including geriatric, adult, adolescent, and pediatric patients. In certain situations, RTs educate the parents or the spouse of the patient in the home-care setting. RTs are also frequently called on to provide educational programs to patients with asthma and cystic fibrosis.

For these reasons, this chapter reviews important issues related to patient education, disease management, and health promotion.

The top five causes of death in the United States are heart disease, cancer, cerebrovascular disease, chronic obstructive lung disease (i.e., bronchitis and emphysema), and accidents.¹ It is believed by most experts in health care that the majority of these illnesses are preventable. Public education about risk factors is the key to the prevention of these diseases and probably has the greatest potential for making an impact on health care in this country. Therefore, the emphasis in health care should be on health promotion and disease prevention. RTs will play a greater role in health promotion and prevention in the future.

Patient Education

If we think of patient care as customer service—which it indeed is—then we cannot ignore education as a crucial component of that service. Whether we buy a car or a television set, we expect the salesperson to educate us about the essential aspects of our purchase. We also expect this information to be provided in writing. Likewise, education is an essential component of patient care. For patients to assume or resume control of their health, they must be educated. Because they rely on the health care practitioner to provide this education, every respiratory care education program should include instruction regarding patient education.

Performance Objectives

Initially it is helpful for the RT to develop learning objectives that are appropriate for the specific patient education topic to be addressed. These learning objectives will help to clarify the teaching strategies that are needed for patient education sessions. Objectives should be stated in measurable terms so that the RT and the patient can recognize when the objective has been accomplished. Clear objectives describe what is to be accomplished and how evaluation will occur.

The format for writing an objective is as follows:

1. Begin with the phrase, “At the end of the lesson, the patient will … .”

2. Write the action verb (e.g., “list,” “describe,” “demonstrate”).

3. Write a condition, if needed (e.g., with or without the use of notes).

4. Write a standard, if needed (e.g., how fast, how accurate).

For example: At the end of the session, the patient will be given a metered-dose inhaler and spacer and be able to demonstrate the correct technique for using the metered-dose inhaler in 5 minutes or less.

Action verb: “demonstrate” (from the psychomotor domain; the relevant domains are discussed later in this chapter)

Condition: “given a metered-dose inhaler and spacer”

Standard: “in 5 minutes or less”

Learning Domains

Learning occurs in three domains: cognitive, psychomotor, and affective. Some learning sessions will involve only one domain, whereas others may involve all three. The cognitive domain is very important, because it will address the knowledge that a patient needs regarding his or her illness and how to manage it. The psychomotor domain addresses the skills that the patient will need to acquire to perform specific treatment modalities (e.g., the use of metered-dose inhalers). The affective domain involves teaching patients about the necessary attitudes and motivations for successfully living with their diseases.

Mini Clini

Developing Learning Objectives for the Use of an Albuterol Metered-Dose Inhaler

Problem

Your 31-year-old patient is newly diagnosed with asthma, and she is being discharged tomorrow. She requires instruction regarding how to properly use her albuterol metered-dose inhaler. Develop learning objectives for her, and address each learning domain.

Solution

Use a variety of learning objectives, including the following:

Cognitive domain: Describe the action of albuterol on the bronchial smooth muscle; recognize when it is necessary to seek medical attention.

Affective domain: Agree that it is important not to skip a dose; verbalize willingness to use the metered-dose inhaler; feel satisfaction by controlling the disease.

Psychomotor domain: Demonstrate the ability to assemble the metered-dose inhaler and spacer; inhale slowly and deeply with an inspiratory hold.

Cognitive Domain

The cognitive domain is probably the easiest to translate into learning objectives because it involves the facts and concepts that the RT wants the patient to know and apply by the end of the education session. Objectives for the cognitive domain might include the following:

1. List the indications for oxygen therapy.

2. Discuss the importance of using the prescribed liter flow.

3. Explain the relationship between oxygen and combustion.

Any factual information that you expect the patient to understand and apply falls under the cognitive domain. Action verbs for the cognitive domain are included in Table 49-1.²

TABLE 49-1

Verbs for the Cognitive Domain

Purpose	Example Verbs
1. Knowledge	Cite, define, read, identify, list, label, name, outline, recognize, select, state
2. Comprehension	Convert, describe, defend, explain, illustrate, interpret, give examples of, predict, paraphrase, summarize, translate
3. Application	Apply, compute, construct, demonstrate, change, calculate, use, estimate, modify, present, prepare, solve, proceed, relate, utilize
4. Analysis	Analyze, associate, compare, contrast, determine, diagram, differentiate, discriminate, distinguish, outline, illustrate, separate
5. Synthesis	Categorize, combine, compile, compose, create, design, develop, devise, integrate, modify, organize, plan, propose, rearrange, reorganize, revise, rewrite, translate, write
6. Evaluation	Appraise, assess, compare, conclude, contrast, critique, discriminate, make a decision, support, evaluate, judge, weigh

Modified from French D, Olrech N, Hale C, et al: Blended learning: an ongoing process for Internet integration, Victoria, Canada, 2003, Trafford Publishing.

Psychomotor Domain

Repetition and active involvement are important when teaching a psychomotor skill. RTs who teach new skills to patients need to provide plenty of opportunity for the patient to practice the activity. Simple demonstration of the skill to the patient is not enough. To confirm performance in the psychomotor domain, have your patients provide a return demonstration. Be sure to provide help and encouragement as needed. Be patient; not everyone develops skills at the same rate.

Examples of action verbs for the psychomotor domain are included in Table 49-2.²

TABLE 49-2

Verbs for the Psychomotor Domain

Purpose	Example Verbs
1. Perception: prepares and recognizes sensory cues to want to respond	Detect, distinguish, differentiate, identify, isolate, relate, recognize, observe, perceive, see, watch
2. Ready to act and respond	Begin, explain, move, react, show, state, establish a body position, place, posture, assume a stance, sit, stand, position
3. Guided response: imitate and practice; rough sequencing of events	Copy, duplicate, imitate, manipulate, operate, try, practice, dismantle
4. Efficiency: smooth sequencing of events	Assemble, calibrate, construct, display, fasten, fix, grind, manipulate, measure, mix, sketch, demonstrate, execute, increase speed, improve, make, show dexterity, pace, produce
5. Perform alone: modifies, responds as needed	Act habitually, advance confidently, control, excel, guide, manage, master, organize, perform quickly and more accurately
6. Creates a new or original model	Adapt, alter, rearrange, reorganize, revise

Modified from French D, Olrech N, Hale C, et al: Blended learning: an ongoing process for Internet integration, Victoria, Canada, 2003, Trafford Publishing.

Rule of Thumb

People learn by doing. Get the learner involved.

Affective Domain

The patient’s attitudes and motivations influence his or her ability to learn. It is important to remember that, with patient education, timing is everything. Patients who have recently been given a poor prognosis or who are in pain are not in an optimal position to learn. Maslow suggested a hierarchy of needs, and he identified physiologic needs as the most basic of human needs, followed by safety, love, esteem, and self-actualization.³ Lower-level needs must first be satisfied before moving on to higher-level needs. For example, if a patient is dyspneic or in pain, he or she will probably not be receptive to learning the steps that are involved in cleaning a small-volume nebulizer. It is important for RTs to assess a patient’s readiness to learn by talking with the patient and his or her family and by listening to the patient’s concerns. It is important to develop a relationship of trust and to be empathetic with the patient.

The RT should begin with easy-to-master facts and skills. After the patient conquers these, motivation should increase, and the patient will have a feeling of accomplishment. Motivation is also enhanced by presenting material clearly with the use of a variety of teaching methods and by relating the facts and skills to practical applications. Getting patients to see how these skills will benefit them is the key to motivation. Communicating to the patient that there is something that he or she can do to maintain or improve his or her health and sense of well-being is important.

Objectives in the affective domain—using the oxygen therapy example mentioned earlier—might include the following:

1. Demonstrate genuine concern for yourself by using your oxygen therapy correctly.

2. Demonstrate a willingness to learn by being an active participant in the program.

Affective domain action verbs are included in Table 49-3.²

TABLE 49-3

Verbs for the Affective Domain

Purpose	Example Verbs
1. Receive: becoming aware of	Accept, acknowledge, alert, choose, give, attend, notice, perceive, tolerate, select
2. Respond: interested in or doing something about something	Agree, assist with, aid, answer, assist, comply, conform, communicate, consent, label, obey, cooperate, follow, read, report, visit, volunteer, study
3. Value: concerned about, developing an attitude	Adopt, assume, behave, choose, demonstrate, commit, desire, initiate, join, exhibit, express, prefer, seek, share
4. Organize: arranging systematically, confirming	Adapt, adjust, arrange, classify, conceptualize, group, rank, validate, verify, strengthen, substantiate, corroborate, confirm
5. Characterize: internalizing a set of values, championing	Demonstrate a change in lifestyle, discriminate, defend, influence, invite, listen, preach, qualify, question, serve, act upon, advocate, devote, expose, justify, support

Modified from French D, Olrech N, Hale C, et al: Blended learning: an ongoing process for Internet integration, Victoria, Canada, 2003, Trafford Publishing.