Cutting health costs in half for asthma patients, avoiding 80% of cases of diabetic coma and reducing mortality rates in patients with hypertension by 30% are only some of the results that can be obtained by educating patients about their therapy, an approach that has become more fundamental than ever before.
Why patients fail to adhere to treatment plans
Therapeutic education is based on an observation made by Jean Philippe Assal at the dawn of his medical career at the University Hospital of Geneva. Assal observed that many patients with chronic diseases were hospitalized due to poor adherence to prescribed therapy. He, thus, began to reflect upon solutions to this problem. His intuition made him one of the few researchers to ever delve into what happens after therapy is prescribed. From his studies and uncommon knowledge of what happens in psychology, he developed an entirely new discipline- therapeutic patient education.
Assal based his work on certain assumptions. The therapy of a chronic patient requires a series of behaviors that affect all aspects of a person’s life- from work to friends, free time and routine activities. A chronic patient suddenly finds him or herself living with an enormous amount of limitations and responsibilities. A disease such as diabetes, for example, necessitates many daily tasks such as measuring blood sugar levels and injections for the patient’s entire life. Acute diseases, despite the severity, instead, last for a definite period of time and the majority of acute patients are monitored in the hospital, where the patient has no other choice but to adhere to therapy.
A patient with an acute disease is a passive patient. Patients with chronic diseases live with the disease on a daily basis and the quality of their relationship with their physician is vital.
A chronic patient usually follows a well-defined psychological process, beginning with the negation of the disease and ultimately acceptance.
It’s a very long and complex journey that includes various courses and dead ends. Assal’s intuition was that a patient couldn’t possibly be left alone to face this path. If physicians do not accompany the patient throughout the process, they will never accept the disease and will end up making mistakes, even convincing themselves the drugs are ineffective and increasing or changing the doses when the therapy was correct, but lacked therapeutic patient education. When a patient arrives at this point, however, even the therapy becomes incorrect.
Seeing the patient’s point of view
We all know that the demographic picture of Italy is well-outlined and leaves little room for interpretation. The population of Italy is progressively aging, which is closely related to the phenomenon of comorbidity, all while the national healthcare system is facing an economic situation that does not consent an increase in the services offered, at least in the short/middle-term. According to the World Health Organization, the percentage of non-hospitalized chronic patients is equivalent to 80%, a high percentage that leads to a natural consequence- the need for quality and efficiency in healthcare. In this context, therapeutic patient education for healthcare professionals represents a concrete way to respond to the needs of chronic patients. For many years there has been the tendency to blame the patient, but a patient affected by a chronic disease must learn the skills and health behaviors needed to live, delaying complications related to the disease and allowing the patient to live as normal a daily life as possible.
This is how assistance began to be thought about in other terms, from the patient’s point of view. Health professionals must never forget that the patient is almost always in a state of relational asymmetry. A patient lacks the same knowledge and skills a professional has and more often than not feels subject only to the restrictions and responsibilities that inevitably influence his or her adherence to a treatment program.
Characteristics of therapeutic patient education
Before beginning any type of analysis, the following is an outline of the main features of therapeutic education:
- It is focused on the patient.
- It is offered by trained professionals.
- It is multidisciplinary.
- It must be structured. Organization is fundamental since it is a long-term operation.
- It is a continuous process.
- It is an intrinsic part of health assistance.
- It is a process of systematic learning.
- It includes an assessment.
The culture of therapeutic education
Thanks to Assal, therapeutic education is no longer a novelty, but a culture on the development of this method in the world of healthcare professionals is still necessary, even for patients. In other words, people need to understand that the use of an easily accessible language for the therapeutic education target population is both necessary and possible.
The process begins with a needs analysis, identifying content and objectives and then gradually tackling the educational methodology and other elements. Due attention, however, must be placed on the gradualness of the learning process. Patients and family members must not be overloaded with too much information and new habits to take on. To this regard, much work must still be done among doctors. Physicians must be able to adapt treatment plans to the specific needs of every individual patient.
How to prepare the patient
Therapeutic education is an integral part of the assumption of responsibility and healthcare treatment, and there are many different skills that the patient must be guided to learn. For this reason patients need to learn these skills gradually. These skills include:
- Learning to understand oneself.
- Self-monitoring capabilities.
- Self-care capabilities.
- Understanding the disease and how it is treated.
- Ability to adapt therapy to one’s own lifestyle.
In order to achieve this, the educational approach must be centered and modulated on the characteristics of each individual patient and must be systematic, or rather, it must be an education provided through the observance of logical-consequential phases that follow each other in an orderly manner.
The process begins with the collection of information about each individual patient and then the formulation of an educational diagnosis. Only at a later time is a plan prepared regarding the best methods, content and instruments to educate the patient. Finally, the services are provided.
At a certain point, an evaluation will be made on how the entire process is going and if the patient is learning without setbacks or if there is any risk of relapse. All this is evaluated paying particular attention to how the patient is dealing with treatment and whether or not the prescribed therapy is to his or her satisfaction.
In some cases, additional information is collected and the entire process is revised. Furthermore, in addition to the needs of the patient, even the needs of the caregiver are assessed.
In view of the importance of personalizing therapy, the preliminary phase includes negotiation, whereby the operator and the patient agree on what can be done and what the patient is willing to do. All this is completed bearing in mind the objectives of the entire process:
- Improving the patient’s quality of life.
- Increasing control of clinical conditions.
- Improving adherence to therapy.
- Improving the quality of services offered.
- Optimizing care management times.
- Promoting the more rational use of services.
- Reducing the consumption of drugs and related costs.
- Enhancing the role of the patient.
- Reducing the number of hospitalizations.
- Optimizing care management times.
The role of the nurse in therapeutic education
As mentioned, therapeutic education is a multi-disciplinary process that involves the entire clinical team in order to guarantee total assistance that not only improves the effectiveness of the services offered, but also patient satisfaction.
Nurses play a significant role in this process, which is not only functional, but also ethical. Furthermore, healthcare professionals that carry out this role are in contact with the patient the most in the daily management of the patient’s health problems. The majority of these are nurses, who work alongside other figures who are just as involved. All the same, the importance of educational planning must not be forgotten, planning that includes the collaboration of different professional figures all involved in the same process.
Nurses are responsible for supervising the clinical condition of the patient and making sure it does not worsen, monitoring the patient to spare him or her as much pain as possible and mediating states of anxiety related to patients not being able to control the situation. After assessing a patient’s level of health literacy, the cognitive and social capacity a patient has to obtain, understand and process health information that is useful to maintaining and promoting one’s own state of health, the nurse and the rest of the team define the priorities and key skills that the patient must learn to master. Finally, the educator must accept that the patient will not reach all skills at the same time, but must deem each patient as potentially capable of reaching them.
Don’t inform, educate
Therapeutic patient education touches upon the different phases of the helping relationship, from information through the use of communication and a specific methodology to the ability to dynamically cope with the difficulties that the disease brings with it. The objective is to identify an incentive to keep improving despite stressful situations that works in agreement with growth objectives, all while performing a control and prevention function to reduce the negative impact of events.
Contrary to just simply and passively providing information, therapeutic education places interaction with the learner at the center of attention. It is a complex practice that, after diagnosis, provides for the definition of learning objectives and the application of the most appropriate educational methods regarding the content to propose. The educational process ends with an evaluation, finally describing what the patient has learned and his or her ability to manage the treatment of the disease and prevent as well as recognize eventual complications.
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