Patient Education: The Nurse as Source of Actionable Information

Matthew Humphrey Loxton

Disclosures

Topics in Advanced Practice Nursing eJournal. 2003;3(2) 

In This Article

Introduction

A patient typically leaves the hospital or clinic with a patient education package that has been vetted by department heads, checked and sanitized by the legal department, trimmed and restricted by finance, and augmented by sponsors. The patient has perhaps also spoken to physicians, radiologists, nurses, and administrative staff. Much of the information given to the patient is intended to educate the patient in self-care following the period of dependence upon hospital staff. How does this information help the patient at home when there is no medical staff on hand? Does it tell the patient how to remove the dressing, what to clean the wound with, or what to do if the drainage tubes seem to be clogged? There are questions the patient will simply not think to ask while still at the hospital.

If all patients were physicians or nurses who belonged to the medical community and all ascribed to common conventions and practices, there would be no difference essentially as to who was on which side of the stethoscope; the patient could reasonably be expected to understand exactly what was going on, and why. Each issue the nurse highlighted would fit neatly into demarcated categories and every significance placed on them would be understood and accepted by the patient. After returning home, there would be nothing that was unfamiliar to them about what to do and when to do it.

However, in reality, patients are bricklayers, plumbers, bankers, welders, accountants, teachers, lawyers, and philosophers. They cannot be expected to understand what it is you are doing or saying in the same way as your fellow physicians and nurses are likely to. These real-life patients may demarcate issues and assign significance differently from how the medical professionals do. The resonance will have been lost, and the information will stand alone without the rich context of mutuality that was shared in the previous scenario.

Just as facts are "theory-laden," so also information does not "speak for itself," it is interpreted and acted on through the spectacles and gloves of our beliefs and view of the world. The nurse needs to impinge on patients' world views, conveying the information to them by resignifying and demarcating it in such a way as to make it actionable by the patient.

As an example, one patient had the experience of being given practical instruction that included taking her physically through many sequences and procedures that would prove to be important to her. Her nurses didn't just tell her how to change a dressing or clean the surgical wound, they showed her, and critiqued her techniques. It was not just this practical, actionable knowledge that was imparted, but also the knowledge of where more knowledge resided. The nurse as an information-source stands out.

As it happened, the patient's nurse was changed and the new nurse did not become familiar with the patient's history and could not answer questions about what to do next when a particular test was returned negative. The flow of information had changed and the patient's experience was altered entirely.

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