Miami Dade College Ethical and Legal Aspect of Nursing Practice Discussion

Have you empowered a patient to believe they could make needed lifestyle modifications irrespective of the barriers that exist in their environment? Please provide examples. If so, you were engaged in health promotion activities as part of your nursing role.

Were there any strategies used in this simulation exercise that you use to improve patient health literacy? Are there any that you use that were not mentioned here? In your experience, how effective are these strategies?

What are some of the biggest challenges you encounter when trying to improve health literacy? What solutions can you offer to manage these challenges?

Read below:

Safe opioid use and the prevention of adverse drug events (ADEs) are critical tasks for health care providers.

Chronic pain is reported by over 100 million Americans annually1, with pain affecting more Americans than diabetes, heart disease, and cancer combined. There is a general consensus from experts that the under treatment of pain is a major problem.

Yet, growth in the amount of pain medication dispensed in our society is correlated with increases in prescription misuse and abuse. Opioid overdose deaths have recently surpassed motor vehicle deaths, making it the single most common cause of accidental death.

Health care providers don’t have to choose between successfully treating pain and stopping ADEs. With education and training, health care providers can reduce opioid-related ADEs.

This program provides basic guidance on pain management and the prevention of ADEs for nursing professionals.

The nurse’s role in pain management is critical. You have a unique responsibility within the team to:

• Counsel and listen to patients;
• Assist in the coordination of care;
• Monitor the proper use of medications;

In addition, no one has access to the information that you do. No one can observe a patient’s situation quite like you do.

The Prescription Drug Monitoring Program (PDMP)1 provides a record of Schedule II through IV controlled substance prescription and dispensation information. The PDMP attempts to reduce non-medical abuse, diversion, and duplication of prescriptions while preserving the professional practice of health care providers and legitimate patient access to optimal pharmaceutical-assisted care.

Health care providers are given electronic access to PDMP data in real-time, at the point-of-care to improve their ability to screen for substance use disorders, reduce pharmaceutical drug diversion, and assist legitimate medical practice and patient care.

Almost every state in the country has a PDMP, though programs differ greatly from state to state and sharing of information among states is not always optimal.

HEALTH LITERACY STRATEGIES

Warm greeting: Greet patients with a smile and a welcoming attitude.

Eye contact: Make appropriate eye contact throughout the interaction.

Plain, non-medical language: Use common words when speaking to patients. Take note of what words they use to describe their illness and use them in your conversation.

Slow down: Speak clearly and at a moderate pace.

Limit content: Prioritize what needs to be discussed and limit information to 3-5 key points.

HEALTH LITERACY STRATEGIES (Continued)

Repeat key points: Be specific and concrete in your conversation and repeat key points.

Graphics: Draw pictures, use illustrations, or demonstrate with 3-D models.

Patient participation: Encourage patients to ask questions and be involved in the conversation during visits and to be proactive in their health care.

Teach back: Confirm patients understand what they need to know and do by asking them to teach back directions.

BENEFITS OF TEACH BACK

Use teach back, especially when the situation is complicated. Confirm patients understand by asking them to explain your instructions using their words in the context of their life.

Studies have shown that from 40 to 80% of medical information patients receive is forgotten immediately and nearly 50% of the information retained is incorrect1. Only 12% of patients are proficient in understanding health information1.

BENEFITS OF TEACH BACK (continued)

One of the easiest ways to increase your counseling effectiveness is to employ the teach back method with everyone, even when you think the person may understand. Remember: This is not a test of the patient’s knowledge or intelligence, this is a test of how well you explained things.

Teach back also allows the patient to practice problem solving in a supported situation, it can be more than an assessment. Ideally, it’s a coaching session in decision-making skills. For conditions like chronic pain, self-care skills are the key to successful management.

Nurses may be called upon to work on follow-up activities with pain management patients. Follow up can be as simple as a phone call to check on their progress, see if they’re taking their medication correctly, and find out if they have any new questions that didn’t occur to them during their visit.

Contact with patients between office visits can enhance patients’ sense of being cared for by your practice. Studies show that patients appreciate and respond well to follow-up contact.

After teach back, it’s helpful to provide a hand out that summarizes instructions for the patient.

Just as important as effective communication with the patient is communication with the rest of the heath care team. Having an observation, getting an insight, or picking up new information from a patient does no one any good if it’s not properly communicated in a timely fashion.

The PDMP can provide critical information for the prevention of adverse drug events and to protect the integrity of medical care.

Always check the PDMP as a key step to monitor patient compliance with opioid agreements and protecting patient safety.

If you’re a nurse, you know that time management plays a major role in today’s health care.

Patients dealing with pain may need extra time, coordination, and care than others. Making the effort to have productive conversations with these patients to fully explain complex medication regimens and explore decision making and treatment alternatives is critical for preventing ADEs and providing the best care. Also attempt to involve other members of the health care team – patient care, like patient safety, is not the sole responsibility of one caregiver.

Going the extra mile to link patients with pain to non-medical support can make a key difference in patient outcomes. Health care may be only part of the solution. Proactively encourage solutions by providing contact information or initiating contact on the patient’s behalf. A simple action such as writing down the phone number of a local yoga studio on a sticky note for a patient can make a real difference. The essential process:

• Assess the problem – Listen for the non-medical challenges the patient may have.
• Involve current support systems – See if you can encourage use of a patient’s existing resources.
• Develop a community resources list – Ask agencies to send pamphlets and know a contact person for each.
• Support and coordinate if necessary – Consider assigning a staff person to specifically take on this role, developing a simple referral form for community resources, and developing referral relationships.
• Locate a social worker or community health worker – Some assistance provided by these individuals may be reimbursable through some insurance plans.
• Sometimes financial pressures can create disincentives for the extra patient care and coordination that patients with pain may need. Everyone, including yourself, can be an advocate for change.
• Substance use disorder screening is often overlooked.It may also be worthwhile to screen this patient for depression. Comorbidity is common in patients with chronic pain. Patient Health Questionnaire (PHQ-9) is the most common screening tool to identify depression1.
• Protecting the patient, and your practice, from misuse of opioid and other medications is challenging. You don’t want to be suspicious or accusatory to the people you’re trying to help. Still, adverse drug events are unacceptable and patients must be held accountable for any potential misuse.Making an informed judgment of potential patient misuse starts with taking the time to screen for risk and engaging in productive conversations with the patient.