Nurse as a patient-nurse educator

Imliyangla Imsong
MSc (Clinical Nurse), CIHSR, Chümoukedima

Anyone who has been to a hospital for any treatment can surely relate to the anxiety of the unknown; whether the doctor will be able to diagnose the sickness, whether it is a life-threatening sickness, whether they will be able to afford treatment or whether they will be cared for properly are a few questions that run in the mind of any patient. 

Many times, a lot of patients walk out of a healthcare center without full clarity regarding what they are supposed to do even after consulting with the healthcare team. Patients often hesitate to ask questions and clarify with the healthcare team. To make matters worse, healthcare professionals tend to use complex medical jargon/terms and overload the already anxious patients with information. As a result, patients end up misinterpreting or struggling to follow healthcare instructions as intended by the healthcare team.

The roller coaster of questions continues when one gets admitted. What tests will be done on me and for what purpose? How long will I be admitted? What is the sickness that I have or why do I have this sickness? Will I completely recover? Will these medicines have any adverse side effects? Will these medicines and treatments work on me? In addition to these, the patient may have further confusion and worries about the kind of comprehensive diet to follow, caregiver support, financial implications of the treatment, and at times, grapple with deeply personal or culturally sensitive subjects, which may be considered taboo or difficult to address openly.

These concerns may further complicate when managing a chronic illness that requires timely and continual follow-ups and admissions. Therefore, a support system that addresses, guides, and caters to this area of need has become very vital. This is where the pivotal role of a nurse as a patient educator becomes very vital for a patient in terms of support and guidance throughout the patient’s medical journey.

As nurses, health education is covered as an important part of the Nursing curriculum. In fact, lesson plans for health education are even designed as part of the curriculum. However patient care activities become paramount as part of a nurse’s job and often patient health education takes a back seat. Many assume that nurses, as part of their job, explain what the patient needs to know. But this rarely happens. I recall a fellow nurse once saying that if given the choice to prioritize administering medication, tending to wounds, and patient education, educating the patient often loses out due to “sheer lack of time”. While it is very true that a nurse’s job is very demanding and can also be very overwhelming at times, we cannot afford to relinquish our responsibility for patient education as it is simply not a luxury that we can afford to miss. Patient education can be as simple as integrating patient education into our everyday conversations when administering medication, wound care, checking for vitals, or simply put “routine nursing care”.

Nurses assuming the dedicated role of a patient educator can have a great impact on the care that is provided to patients and can harmonize the various care activities. This activity is often overlooked and many fail to see the importance of this. But when the patients and the families are made aware of what and why of their care activities, they participate in the care more meaningfully and make more informed decisions in the care provided rather than only consenting without complete clarity. This not only helps patients follow their treatment better but also leads to improved health because it makes patients and healthcare providers work together better.

Nurses must take up the role of patient educators in various health sectors and in turn, motivate patients to take an active part in their treatment because delivering what we believe is the best care for the patient. Nursing care of a patient is only half the job done without their engagement. As the saying goes, “It takes two to tango”, when patients comprehend the entire care process, they become proactive participants in their own care. One significant way of involving them is byeducating and discussing the care plan together. This ensures that the ‘what’ and ‘why’ behind the care are clear and also ensures that uncertainties arising from misinformation are reduced. It is crucial to note that a lot of patients are quite well informed about their conditions and often conduct their own research and come for validation as well. Engaging them in their care plan encourages active involvement and initiatives in their own care. This active participation fosters a partnership, shifting the dynamic from a healthcare team dictating the course of action to collaborating with patients and their families. This results in practical plans that are achievable and contextually relevant.

Nurses are taking up various roles even outside the health industry. However, this critical area of patient education and counseling is an unexplored area, especially in Nagaland. The journey with the patient starts when the nurse-patient educator meets them. They make the best efforts to try and understand the person in the patient beyond their illness; by understanding their illness perception, their worldview, illness behaviour including their sick role and dynamics within the family, All these have a great impact on the way they respond to the illness and continuing care post-discharge as well. They then discuss and explore the illness together by enquiring what they already know about their illness, how they have been managing the illness, their concerns, and their expectations. Throughout the patient education, allthe treatment plans and the rationale behind every testneed to be explained patiently so that they know what the test is about and why they have toundergo the myriad of tests or the need for surgery, care before and after surgery, instruction about medicines, signs of common side effects, treatment and warning signs to watch out for. In some cases, some diagnoses may not be conclusive and may take time requiring furtherinvestigationuntil a conclusive diagnosis is achieved. During such periods, some medications may be prescribed. In such cases,where patients have to wait for further diagnosis, they may get anxious, and frustrated, and go for a second opinion and then a thirdand so on, something generally referred to as “doctor shopping”. This results insignificant health expenditure. Due to workload, doctors often have limited time-sometimes not spending more than 10 minutes for a patient as theyneed to cater to the needs of the patients both in the OPD as well as in the IP wards. Patientsdiagnosed with chronic illnesses such as diabetes require lifelong management,and even those with acute illnesses need time to grasp their diagnosis, get clarifications, and come to a practical plan forthe management of their health. This is where the patient-nurse educatorsteps in and plays a very crucial role. However patient educators do not work in silos and all activities must have a co-ordinated team approach. The patienteducators need to work hand in hand with the treatment consultants, therapists, and other clinicalnurses and staff in order to connect the dots and streamline the treatment process. And at the core is the patient acting as the central link connecting all the dots in this holistic approach.One may sometimeswonder, “If the treatment is effective then why the need for an extra role?”. However, we must understand that this approach aims to empower the patient and their families. And empowerment is achieved when all stakeholders engage inall the treatment processes meaningfully. This will result in quality care and enhanced patientsatisfaction. In certain common chronic conditions like diabetes and stroke, the patients and family needto be trained for certain care needs such as insulin administration or tube feeding at home. Many of us are aware of the impact these illnesseshave on not just the individual with the illness but the family as an entirety. It requires a whole lifestyle change for the family and requires proper planning and assessment from the healthcare team. As a healthcare worker listening to the consultant declaring carefully worded sentences e.g.,‘you have a stroke and the recovery will take time unless, of course, it is critical’. We should think about how they are going to manage at home. Who is going to take up the role of the caregiver? Who is going to manage the finances or what are the role changes the family will have to embrace, who currently makes the decisions in the family? where will the patient be taken care of (for those who are not from around the local hospital) and many more that need to be understood and taken into consideration if we are to come up with a doable plan tailor-made for the family. It is a lot more thantaking these medicines twice a day and coming back after two weeks. We need to understand who is buying the medicine for the patient and who brings them to the hospital and many more similar questions. For some, it may be, ‘who is giving the medicine? Are they competent? Do they need to be trained?’. The care prescribed will be tailored to the patient’s need after understanding all these areas that make the person of a patient. When the patient and family are made aware of the treatment plan, after considering all these factors, they are more cooperative and well-disposed because they trust the team that is contributing to their recovery. Once the patient and family are equipped well, complications can be kept at bay. These will prevent re-admission and further it not only helps the patients but also the hospitals because re-admission increases the cost and burdens the healthcare system reducing capacity.

Thus, nurses taking up these roles as patient educators can contribute a lot to the orchestration of the care which will improve the quality of care and improve patient satisfaction.