By Nancy J. Brent, MS, RN, JD
One of your obligations with any patient with whom you work is to help the patient be as independent as possible when it comes to healthcare. Whether the issue is proper self-medication, following a required diet, or sticking to mandated exercises self-care is the ultimate goal.
Successful self-care not only improves the patient’s health and life in general, it can also result in a reduction of readmissions or visits to the emergency room, according to a study funded by the Agency for Healthcare Research and Quality.
Self-care has been defined as personal and medical care done by the patient in collaboration with and after instruction by a healthcare professional. Nurses have been collaborating with patients and their families for years in teaching patients about self-care, whether at home, in an assisted living environment or as an important aspect of discharge planning.
However, the patient’s self-care involves more than just following the instructions given by you. It also involves self-management, meaning the patient is involved in his or her own self-care through monitoring symptoms, making decisions and evaluating the impact of those decisions. Self-management is a process where the patient utilizes cognitive decision-making in response to symptoms. Self-management is a process whereby the patient begins as a novice and hopefully reaches the expert phase of that process.
There is a wealth of information on how best to teach patients to reach the goal of self-care. Much of this information focuses on identified problems and relies on basic principles of risk management during the teaching process in order to avoid any potential for liability. Here are some of the issues identified:
1. Assess the patient’s needs.
2. Ask the patient how he learns — reading information, demonstration, pictures or videos — and then incorporate them into the process.
3. Evaluate the health literacy of the patient. Only 12% of adults in the U.S. have “proficient” health literacy, meaning they can understand and use health information effectively. Millions of individuals in the U.S. don’t understand the necessary information healthcare providers give them concerning their health and self-care. Tactics to avoid problems with health literacy issues include speaking slowly; repeating key points; and avoiding medical jargon.
4. Assess such personal characteristics as the patient’s motivation to learn, self-perception, attitude toward learning and motivation to adhere to the self-care teaching plan.
5. Develop a teaching plan based on the patient’s needs and the nursing process.
6. Select the right time to do the teaching — uninterrupted periods of time, when patient is receptive, when patient or family asks a particular question about the patient’s care.
7. Use teach-back to evaluate the patient’s understanding by using strategies such as asking the patient to tell you in his own words how he will take his medication or asking the patient to perform a demonstration of a taught procedure.
8. Provide take-home forms that include information, instructions, checklists, and drawings for the procedures the self-care the patient is to follow.
9. Provide contact information for the patient to use if he/she needs further clarification, more instruction or support.
10. Be certain to timely, carefully and fully document any patient teaching done, including forms used, assessment of the patient’s teach-back and the patient’s assessed willingness to carry out his self-care responsibilities.
Potential liability for you is possible if a patient is injured or dies and alleges you were negligent in teaching him/her all that was necessary to prevent an unreasonable and foreseeable risk of harm to that patient. Allegations could include negligent assessment, your omission of necessary information, teaching in a manner that was not comprehended by the patient or family, failing to assess the learning obtained by the patient after being instructed in self-care, not providing follow-up information (e.g., when to make an appointment for lab tests, where to call for additional instructions) and not being available when additional help is sought.
Following these, and other, steps based on avoiding risk when helping a patient achieve self-care can result in a win-win situation for both you and the patient.
Nancy J. Brent, MS, RN, JD, is Nurse.com’s legal information columnist and an attorney in private practice. This article is for educational purposes only and is not to be taken as specific legal or other advice.
• FierceHealthcare Custom Publishing (nd). Reducing Hospital Readmissions with Enhanced Patient Education. Sponsored by Krames Patient Education, 2.
• Mosby’s Medical Dictionary (2009). “Self-care”. 8th Edition. Philadelphia: Elsevier Publishing.
• Lorraine Evangelista and Mary Ann Shinnick (2008), “What Do We Know About Adherence And Self-Care”, 23 (3) Journal of Cardiovascular Nursing, 251.
• Jennifer Ward (2013), “A Guide To Patient Teaching And Education In Nursing”, Nursetogether, 1. Available at http://www.nursetogether.com/patient-education-in-nursing. Accessed 2/16/15.
• Nursing Service Organization (2012). Risk Advisor for Nurses: Improving Health Literacy Improves Patient Outcomes. NSO Risk Advisor, 1.