Health Education Plan
Health Education Plan for Mrs. Gamble, an Atrial Fibrillation Patient
Introduction
Adherence to prescribed medication and in the right dosage is crucial to positive health outcomes — it can save emergency hospitalizations and also disease complications. However, recent research revealed that over 60% patients do not understand their prescribed medication regimen properly and hence, become non-compliant (Conway & Freedman, 2017). According to this research, the health care sector can save about $100-$300 billion in healthcare costs resulting from such medication non-compliance by patients. Perhaps, the only way to save these costs is through proper patient education, so that patients do not self-medicate or do not remain less informed about their medicines and doses. Unless they adhere to their prescribed treatment plan, recovery is difficult and further disease costs and complexities are inevitable. Nurses and healthcare professionals have the responsibility to educate patients about their disease, medicines, treatment program, self-management techniques, etc. (Bergh, et. al., 2015). The case of Mrs. Gamble is one such scenario where the patient is under-informed about her condition and takes medicines in wrong dosage. In her condition, this might turn fatal. Therefore, it has been assessed that she needs an appropriate health education plan to manage her health better.
This document is a health education plan customized for Mrs. Gamble to help her be more aware of her disease and its proper management. It is not only intended to serve as a sample for Mrs. Gamble’s atrial fibrillation management, but also inspire other clinicians to incorporate health education plans into their patient-care routine, which they usually neglect doing (Paterick, et. al., 2017).
Mrs. Gamble: Case Brief
According to the case study, Mrs. Gamble is a 78 year old widow, who was started on Warfarin therapy (Coumadin tablets) about three months ago, after she was found to be suffering from atrial fibrillation (AF). Atrial fibrillation is a condition where the heart beats irregularly, increasing chances of blood clots and stroke (Government of Western Australia, n. d.). Her international normalized ratio or INR is tracked on a weekly basis. The INR is a standard method for assessing the risk of bleeding and blood clotting time (Shikdar & Bhattacharya, 2018). When a patient is on Coumadin, as is the case with Mrs. Gamble, the normal therapeutic INR range is between 2.0 and 3.0 (Cunha, 2018). INR levels below 2 suggest susceptibility to easy blood coagulation and that above 3 suggest excessive bleeding tendencies in the patient.
Mrs. Gamble had a recent pneumonia attack and was admitted to the hospital for treatment. There, her INR was found below 2.0, at 1.5. This indicated a propensity towards blood clotting and consequent stroke. Naturally, the clinicians doubted her medication adherence and upon testing, she was found to be knowledge deficient about her condition and treatment plan. Her knowledge deficit areas were:
- She was unaware why she was still on Warfarin therapy.
- She could not differentiate between the various bottles of Warfarin having different dosages of Coumadin.
- She did not know how Warfarin worked and how it helped her condition.
- She did not know why Warfarin intake interfered with the consumption of some of her favorite foods like the broccoli and green leafy salads.
Her knowledge deficit is a result of clear ignorance and negligence — ignorance on her part and negligence on the part of her doctors. Mrs. Gamble chose to live in the retirement village, far away from her son. She even ignored her son’s suggestion to stay in a nursing home. Therefore, no one could guide her through any of her treatments. She seemed comfortable in her way of living alone, the hospital/doctor visits alone and taking medications alone. She thought she managed it well by maintaining a written log of her medicine intake. However, the nurse found her incapable of selecting the right Warfarin dosages at the hospital. The doctors she visited or those who prescribed Warfarin therapy to her did not explain her the benefits and risks associated with it. Appropriate medical knowledge from her doctors/nurses would have helped her manage her condition better, instead of leading her to blindly comply to the treatment plan.
Goals of the Health Education Plan
The fundamental goals of any patient’s health education plan are delivering disease-specific information and teaching self-management techniques (Lippincott Solutions, 2017). However, as Hess (2009) rightly observed, a successful plan should also be customized and have S-M-A-R-T (specific, measurable, achievable, realistic and time-bound) objectives. According to Bloom’s taxonomy, learning happens across three domains — cognitive, affective and psychomotor (Bloom, 1956). Cognitive learning is intellectual, affective is value-oriented and psychomotor is motor-skill oriented (Krau, 2011). The Bloom’s taxonomy also described six levels of learning as: Remembering, Understanding, Applying, Analyzing, Evaluating and Creating (Szabo, 2000). Keeping these in mind, the goals of Mrs. Gamble’s health education plan are to include content and activities that span across the six levels of learning and have SMART parameters for assessment.
Educational Materials for Mrs. Gamble
There are many materials available on AF and on Warfarin therapy. But, for the purposes of educating Mrs. Gamble, the following two resources are chosen:
- Fiumara, K. & Goldhaber, S. Z. (2009)
- Hull, Garcia & Vazquez (2018)
Fiumara & Goldhaber’s (2009) patient education on Warfarin/Coumadin is a very easy-to-read and easy-to-comprehend document for any ordinary patient who wants to gather some basic information about the medication, its side effects, mechanism of action, etc. The content is spread under distinct, clear headings, making it easy for a 78 year old like Mrs. Gamble to scan through it and spot the required information quickly. Another reason why this can be a good reference for Mrs. Gamble is because it is brief, concise and not heavy with medical jargons. The coloured image of the Coumadin tablets, as compared with generic Warfarin pills, serves as a handy visual for Mrs. Gamble to check anytime she needs it. She can even have it printed and pasted in her notebook for quick reference. As Conway & Freedman (2017) had said, repetition of important information is always crucial for learning.
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