Patient binders: Creating a tool that helps patients and nurses

Patient binders: Creating a tool that helps patients and nurses
Patient binders: Creating a tool that helps patients and nurses

Good communication and effective teaching are needed to provide comprehensive chemotherapy patient education. Poor communication can have a negative effect on patient care.1 Patient education needs to address a wide variety of topics from diagnosis and treatment to genetics and advance care planning. Patients', as well as their families', concerns should be addressed. Patients and families/caregivers want as much information as they can get about the diagnosis and treatments.2 Hundreds of Web sites offer easily accessed information about cancer, an important task for oncology nurses is to make sure the information patients receive is up-to-date and reliable.

Franciscan St. Elizabeth Health has a 20-bed medical oncology unit that provides care to both inpatients and outpatients undergoing chemotherapy. Patient volume on the outpatient service varies month to month from two patients to more than 30. In the past, new patients were given a folder with teaching booklets on chemotherapy, dietary hints, drug information, and a few extra items related to the patient's specific cancer. Each patient was offered an opportunity to watch a chemotherapy-teaching video. The nurses provided patient education on the main side effects of each drug and instructed patients on when to call the office. All the nurses taught the common topics, such as nausea, vomiting, fatigue, and hair loss. If a more experienced nurse provided the patient education, the discussion might cover more topics. In general, the nurses covered the topics they were most comfortable discussing.

A recent change in charting procedures, however, has affected how nurses conduct patient education discussions. In the paper world, a double-sided sheet was used to chart the topics that were discussed that day. Each nurse looked up what was taught at a prior visit and taught a different topic at the current visit. But the form could not be integrated into a new, paperless charting system. The unit nurses were no longer sure which patient education topics were covered or what else needed to be discussed. At follow-up visits, the nurse practitioner (NP) noted that often many topics were not discussed.

IDENTIFYING EDUCATION NEEDS

An important part of developing a tool that would be well-received by the staff was to gain a better understanding of what the nurses were comfortable teaching. At the time the patient journey binder program was in development, the medical oncology unit had 22 chemotherapy-certified nurses, and their experience ranged from 15 years to less than 1 year. We utilized the yearly needs assessment to assess staff comfort level with providing the complete chemotherapy patient education program. Eighteen of the 22 chemotherapy-certified nurses on the unit returned their surveys; 12 of them (66%) reported being uncomfortable with providing the complete chemotherapy patient education program. The other six nurses reported being comfortable with providing the complete program; however, none of these nurses rated their comfort level as high.

The nurses Our survey asked the nurses to list the topics they were not comfortable discussing. The topics were clinical trials, genetic testing, sexuality concerns, and advance care planning. The survey respondents felt that discussions on clinical trial participation should not be part of the nurses' role; it was viewed by many as the oncologist's responsibility. Genetics was described as confusing, and nurses did not want to give the wrong information and cause unneeded stress. Sexuality discussions were viewed as taboo. None of the survey respondents were comfortable bringing up this subject with a patient. In addition, many viewed sexuality as the least of the patient's concerns at that time. Nurse respondents felt that discussing advance directives during initial chemotherapy patient education would scare the patient or cause undue stress. Respondents admitted this would likely only be discussed as the disease progressed or would be addressed at another visit.

Through the survey and follow-up discussions, the nurses reported not having enough time to complete patient education. They reported that their patient load (three to four inpatients plus a chemotherapy patient) made providing complete patient education challenging. The nurses first had to gather the patient information materials, then due to time constraints were only able to cover a minimum of the material. Nurses also feared overloading patients with too much information. A new-patient chemotherapy patient education session could take 1 to 2 hours. Nurses were giving patients multiple handouts without having the time to read what the handouts covered.

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