Patient Education: You Can Do It!. Ginger Kanzer-Lewis

Maybe they will find themselves watching despite feeling bored. The TV is often on in waiting areas, so show something educational.

      I met a pharmacist once who works in a large hospital in Chicago and was a participant in my patient education workshop. He raised his hand at this point in the discussion and told me that he teaches people every day and was indeed the “discharge pharmacist.” When I asked for clarification, he explained that he had an office at the front door of the hospital and that every patient would stop at his office on the way out, where he would teach them about their medications. Picture this: the patient is on his way out, he has his coat on and his luggage in hand, and his wife is waiting outside with the car or a cab with the meter running. This is when he is taught about an important medication.

      I suggested that he get out of his office and go to the units to teach the patients while they would be interested in hearing from him. I also asked him how often he did medication reviews and updates for the staff members on the units who were administering medications. People do not do things outside of their comfort zone, and if the staff is unsure or uncertain about something, they certainly will not teach about that subject.

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      The Adult Learner

       Let’s discuss my favorite subject: adult education.

      Malcolm Knowles is considered the father of the adult education movement in the United States. He was an amazing man, and in his book The Adult Learner: A Neglected Species,⁵ he makes an incredible statement. He wrote, “We know more about how animals (especially rodents and pigeons) learn than how children learn: and we know more about how children learn than how adults learn.” He wrote this over 30 years ago, and we have learned a great deal during that period of time, but it remains amazing to me that we find educators everywhere who are still treating adult people as slightly moronic 6-year-olds.

      He said that the reason that adults have difficulty learning is that they are taught by people who are either experts in their subjects and don’t know how to teach or by teachers who were trained to teach children and not adults.

      Have you ever been a college student who was treated as if you were a child? Did you resent it? I will give you an example. I am a diploma graduate in nursing, so I had to go back to college and take the same courses that I took in nursing school. It had been decided that nurses who were educated off college campuses would not receive academic credit for those courses, so I was taking anatomy and physiology again, and I am skinning a cat 10 years after I skinned the first one. Now, we get to final examination time, and I am well prepared. I was sure that “the eye” would be on the final exam because the professor had spent six weeks on the eye and two weeks on the heart. I prepared well and if given a model of the eye, or a diagram, could accurately identify all of the components. Great. I need an A because I am a nurse and compulsive. The night of the exam arrives, and I open the exam, and it says, “draw and label a diagram of the eye.” I raise my hand and the professor comes over for my question. I stated my concern that I do not draw well, and if I draw an eye, he will not recognize the components and will deduct points. He said to just draw an eye. I told him that this was not an art class and if he gave me a diagram I would label it absolutely accurately. He said just draw it, and you will not lose points. I wrote on my paper, “I will not accept any deduction in points because of this poor art work. This is not an art class.” I had him sign it. I got an A on my eye.

      Think about what you ask patients to do, how you ask them to do it, and their treatment as adults.

      Andragogy means adult education, versus pedagogy, or the teaching of children. It stems from the Greek word aner, meaning man as distinguished from boy, and was originally used by the educators in Yugoslavia. It is rarely found in dictionaries, which drives many of my colleagues crazy when they try to validate adult education methodology.

      I started my first diabetes education program in 1972 when I was Director of Staff Development in a hospital in New Hampshire. The nursing staff came to me for help with inpatients who had been diagnosed with diabetes. We had few materials in those days to help us teach patients. There was a tear sheet on oral medications and a small booklet from Eli Lilly and Company about insulin. Patient education was a new idea in the Northeast, and pioneers like the Joslin Diabetes Center were doing groundbreaking work. If you were not in the “diabetes world,” you really did not know what was happening in other parts of the country, and many of us were operating in the dark.

      I started teaching patients with handmade materials, and it took me over a year to develop a manual to give to “diabetic patients.” Before you think I was an idiot, please remember that I was operating in the adult education world 10 years before I finally enrolled in Harvard for a master’s degree in Education. Dr. Knowles had not even written his book on adult education. I took my beautiful new manual to a newly diagnosed patient one day and told her to read the book and she would know everything about diabetes. No assessment, or even a conversation. I returned the next day and asked her what she had learned. She responded, in French, that she could not read or speak English. I had given her this beautiful book, and it was worth nothing. I had not taken the time to find out who this woman was and what she needed from me.

      Let’s think about the adult learner. Adults will learn what they want to learn, when they want to learn it, and your job is to facilitate that learning experience. We are talking about changing behaviors. Change is always frightening, and when you are talking about life and death issues, it can be so frightening that it is paralyzing.

      When dealing with adults, the terms relevant and validating are so important. The first rule of adult education is: Don’t teach junk! If I don’t need to know it and it will not impact my life, do not teach it to me. Adults do not have time in their lives and minds for unnecessary information. Your job is to find out what is relevant to each individual and give him or her that information.

      Consider adult education a partnership with another individual who is on an equal plane with you. He may have less, or more, education than you have, but he brings to the partnership life-long learning experience that may help or hinder the learning process. He may be an expert in another field and need more scientific data from you than most people require. Your assessment will help you determine his learning needs. I give my patients permission to disagree with me on the importance of certain actions that I expect from people with diabetes.

      Here is an example on the topic of exercise. I encourage every person to increase their physical activity level when diagnosed with diabetes, but I have to be realistic. Here is a person, perhaps 55 years of age, who has never done physical activity as an adult. It is unreasonable for me to expect her to join a gym and start being active just because I suggest it. I need to convince her of the need for more movement and help her find a reasonable activity. I hate to exercise, but I really love to dance. Does that make sense? I actually state that to my patients, and we talk about alternatives. Adults need to analyze information and synthesize it with their lifestyle.

      Several years ago, my husband Jack went to the doctor after being diagnosed with type 2 diabetes. My husband is an interesting man. He is the biggest pain in the neck I ever met but an amazing man. You need to know that we live on a boat in the Florida Keys, and we worked hard all our lives to be able to do this. Jack had emergency angioplasty, and I told him in the recovery room that he was fine and that I had called the boat dealer and ordered the boat we had been debating about when the doctor told me that he was going to be fine. After such a close call, I was not going to chance waiting any longer to buy the boat. Now, that boat means everything to Jack. Our doctor told him that he now had to lose 50 pounds and start exercising. Jack said “no.” The doctor repeated that it is essential that he lose 50 pounds and exercise. Jack asked the doctor, a great friend of ours who has kept us both alive longer than we ever expected, what part of the word “no” did he not understand. Then the doctor said, “You know, Jack, if you don’t take care of yourself, you’re going to drop dead, and I know three