Hello all, I work at a children's medical. We are trying to develop an asthma boot camp in hopes of getting families actively engaged in the treatment and care of patients while in the hospital, in other words, patient/family "activation". The boot camp will be for families and patients. The asthma educator, nurses, respiratory therapists, case managers, and physicians will all have responsibilities in teaching families and patients as part of the boot camp. I pose these questions to anyone who would like to answer them, and I thank you in advance. 1. How do we assess family and patient prior asthma knowledge/skills? 2. How do we help families and patients recognize their knowledge/skill deficits? 3. How do we ensure they understand the knowledge/skills they are taught?
I love the concept of asthma "boot camp"!
Are you familiar with the Ask Me 3 concept ( http://www.npsf.org/page/askme3 )? It is designed to help patients/families have a better understanding of their health condition; however, a slightly modified approach can also help providers assess the patient's current knowledge. We encourage all patients to "Ask Me 3" questions:
1. What is my main problem?
2. What do I need to do?
3. Why is it important for me to do this?
That being said, you can use a similar approach to assess the patient/family understanding of asthma by asking things like, "With your asthma, what do you think is the main problem?", "What do you need to do to take care of yourself?", etc.
I would also suggest that everyone who will be part of the boot camp team receive formal training in using the Teach Back method. There is an art to effectively integrating Teach Back into patient education and it is highly effective when it comes to ensuring that the patient or family truly understands what is being taught.
One final thought - since you are developing what sounds like an "inpatient boot camp" - I would consider limiting the amount of material that is covered to 2-3 "must haves". As you know - these patients/families are often exhausted on admission and they generally have a pretty short hospital stay. We have opted to focus our inpatient asthma education on 2 things:
1) Proper inhaler technique, 2) How to use your Asthma Action Plan (which really also encompasses controller/relievers, symptoms, etc).
We don't spend a lot of time on "potential" asthma triggers but will definitely talk about avoidance measures for known triggers. It's not that triggers are not important to us by any means. We learned over time that when we were teaching inpatients about a long list of possible triggers, and talking about inflammation vs. bronchoconstriction, teaching proper inhaler technique, going over an asthma action plan, giving them ideas on how to reduce exposure to indoor/outdoor allergens or irritants, etc... they remembered virtually nothing at outpatient follow-up a week or 2 later. That's why we limit inpatient education to just a couple of super-important key messages.
Look forward to hearing from others and from you as you develop the boot camp!
Mike Shoemaker MBA, RRT-NPS, AE-C
Manager, Respiratory Care Services & Pulmonary Rehab/Diagnostics
Site Coordinator - Asthmania Academy (ASME Certified)
AnMed Health Women's and Children's Hospital
2000 E. Greenville Street
Anderson, SC 29621
Phone (864) 512-4833 or (864) 512-6626
Carolyn: great idea! In the past when we have done group in-patient asthma education we utilized pre and post-tests for assessing knowledge. If you go that route, I suggest limiting the questions to 3-4 at the most and make sure the literacy level is at a 3rd or 4th grade level (5th grade is the absolute highest you should go) and that you assure participants there is no pass/fail. Explain to them that the pre-test helps you know, as an instructor, what you need to focus on and the post-test lets you know how effective your teaching was. If more than one person is providing the education then make sure all teaching from the same script, so to speak. I agree with Mike to focus on just a few things because of what he explained. However, we did touch on triggers because our AAP is individualized to include the patient's known triggers. We, too, did not focus on potential triggers but those that have been identified as that patient's specific triggers. (It was rare that no triggers were identified. In that case we used URIs and smoke, especially tobacco smoke.)
We no longer use group in-patient education and do our education one-on-one at the bedside. Education is primarily provided by RTs although nurses and MDs / APRNs also provide education. We have developed a bedside education check-list (hard copy that is scanned into the EMR at discharge) so that all can see what education has been given and what is still needed. As Mike said, the length of stay is so short (about 1 day) that we have to limit what we focus on: what is asthma, asthma symptoms (the 3 S's: swelling, squeezing, and snot), meds used for control and symptoms (ICS and SABA), how delivered (especially correct spacer technique and that spacer deposits med into lungs more efficiently than no spacer), trigger control and/or avoidance, and and using the AAP (that is at the bedside) as our vehicle to explain daily meds, how to treat symptoms, and when to seek urgent / emergency care,
Hope this helps, too!
Ellen O'Kelley, PNP, AE-C, Division of Pediatric Allergy, Immunology, and Pulmonary Medicine, Vanderbilt University School of Medicine and Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, TN