Patient Coaching, Chapter 22

- tremors and paralysis - sensory limitations

. List two barriers to the psychomotor learning domain.

- return demonstration - experimental learning activities

. List two psychomotor teaching strategies.

- hygiene practices and recommended vaccines

. List two types of disease prevention coaching a medical assistant may provide.

- oral self-exams and foot

. List two types of health maintenance coaching a medical assistant may provide.

- applying suction to the skin, which can leave marks. Do not confuse these marks with signs of abuse.

. Many cultures have similar practices (cupping)

Coaching provides patients with:

- skill - knowledge - support and confidence

- blood transfusions, Dialysis patients, lack of safe water, poor sanitation etc.

. List three risk factors for hepatitis C.

- use nonverbal cues and gestures - face the person directly and make eye contact - have the patient repeat back important information

. List three strategies a medical assistant could use to adapt to the cognitive learning barriers.

- higher sensitivity for detecting CRC and advanced precancerous lesions than fecal immunochemical stool testing and a lower risk of adverse events.

. List two advantages of the cologuard stool DNA test over the guaiac fecal occult blood test.

- assigning work in group - music therapy or progressive relaxation technique to lower down learner anxiety

. List two affective teaching strategies

- do not have sexual intercourse for 48 hours prior, schedule the test about five days after menstrual period.

. A patient needs to have a Pap test. List common patient preparation instructions?

A. What questions should the medical assistant ask the patient? - do they have heart disease?, any history of cancer, do they have kidney disease?, do they have diabetes?, are they pregnant (female patients only) B. List common patient instructions. - check allergies, check if patient has kidney disease or is on dialysis, nothing by mouth (NPO) for 4-6 hours before test, address if medications need to be stopped.

. A patient needs to undergo a CT scan that requires contrast medium.

A. What questions should the medical assistant ask the patient? - are they wearing any jewelry or metal items?, do they have any piercings?, are they claustrophobic? B. List common patient instructions. - must remove all mental from patient including removable dental work, may require being NPO for 4-6 hours

. A patient needs to undergo a magnetic resonance imaging (MRI)

A. What questions should the medical assistant ask the patient? - do you use any type of perfume?, do you have any jewelry on your neck and chest?, have you breast biopsy screen before? B. List common patients instructions. - the patients will need to undress from the waist up. All jewelry from the neck area needs to be removed.

. A patient needs to undergo mammography.

- Has come to terms with the situation

. Acceptance

- the Americans with disability act requires effective communication with patients who have impairments. This may mean offering a qualified medical interpreter or other interpretation services free of charge. Large-print materials and written instructions are also required. Translated written materials are needed for non-English-speaking patients.

. Americans with disability act (communication barriers)

- anger can be directed at self or others.

. Anger

- attempts to bargain with the higher power the person believes in (I.e., God).

. Bargaining

- involves values, beliefs, emotions and feelings of learner that help him to receive, respond, valve.

. Briefly describe the affective domain of learning.

- the process of acquiring knowledge; these skills include reasoning, perception, intuition, recall or recognition of specific facts, procedural patterns, and concepts used in the development of intellectual abilities and skills.

. Briefly describe the cognitive domain of learning.

- involves acquiring gross and fine motor abilities and neuromuscular coordination to perform increasingly complex actions.

. Briefly describe the psychomotor domain of learning.

- belief of consequence (perceived severity), potential positive benefits of action (perceived benefits), perceived barriers to action, expose to factors that prompt.

. Briefly describe the three parts of the health benefit model.

- for healthcare agencies accepting federal funds, the civil rights act requires that all patients have equal access to service. People with vision, hearing, or speech impairments use different ways to communicate.

. Communication barrier (civil rights act)

- low-cost medications, food banks, transportation, medical supplies, assisted living, and so on.

. Community resources

- it is the set of behaviors, ideas, and customs shared by a specific group of people. It includes language, religious belief, geographic orgin, ethnicity, history, sexual orientation, and socioeconomic class.

. Culture diversity

- by listening to patients and by asking questions, the medical assistant can identify patients unique needs

. Define coaching a patient as it relates to adaptations (special needs) relevant to individual patient needs.

- low-cost medications, food banks, transportation, medical supplies, assisted living etc.

. Define coaching a patient as it relates to community resources.

- instruct patients on home care and follow-up as ordered by the provider.

. Define coaching a patient as it relates to compliance with a treatment plan.

- provide patients with information on preventing the disease or the spread of disease

. Define coaching a patient as it relates to disease prevention.

Provide information on routine screening and show patients how to do self-exams.

. Define coaching a patient as it relates to health maintenance.

- they identify patients financial, cultural, physical, and emotional barriers. They work closely with the healthcare team and the patients to ensure barriers are eliminated and patients get timely care.

. Define patient navigator

- refuses to accept the fact (I.e., diagnosis or prognosis)

. Denial

- people feel sadness, fear, and uncertainty.

. Depression

- teaching someone and encouraging them to be knowledgeable

. Describe coaching in your own words.

- involves knowledge, comprehension and critical thinking if particular topic

. List two barriers to the cognitive learning domain

- emotional barriers, social barriers and cultural barriers

. List two barriers to the cognitive learning domain.

A. Physical abuse: giving too little or too much medications, bleeding , and sudden changes in the person's personality or behavior B. Emotional abuse: not communicating, withdrawn, agitated, and symptoms that mimic dementia C. Neglect: lack of proper living conditions, and failing to treat health problems.

. Describe common signs of elder abuse and neglect for each of the following categories.

- series of actions to take if you are coughing or sneezing.

. Describe cough etiquette.

- face the person when speaking - limit extra noises in the environment - if an interpreter is present, look at the patient, not the Internet - keep your hands away from your face when talking. - say the person's name before you begin a conversation

. Describe five strategies to use when communicating with patient who have impaired hearing.

- there is need to say about the compliance of medications and the benefits of the medication course completeness to the patient or any other people.

. Describe how grieving may impact a patient's compliance with a treatment plan.

- to facilitate the appropriate and efficient delivery of health care services both within and across systems.

. Describe the goals of care coordination in the ambulatory care setting?

The help patients navigate through the system. Ex:- insurance policy information, medical bills, physician/provide orders, and so on.

. Describe the role of the medical assistant as a patient navigator?

- encourage the patient to use his or her own magnification aids - face the patient directly. Make eye contact. Use a normal tone of voice - gestures and other nonverbal cues are not as helpful with visual impairments - ask the patient how he or she prefers the information. Provide the patient with large-print directions - consider the impact of color contrast and glare on the materials used.

. Describe three strategies to use when communicating with patients who have impaired vision.

- use body language, use an interpreter, use written materials

. Describe three strategies to use when communicating with patients who have languages barriers.

-social and recreation services - financial support - Communications resources - Behavioral resources - Multi-service agencies - counselors - books - doctors - internet - parents and family

. Describe types of community resources

- instruct patients prior to diagnostic tests. This can include special preparation (eg:- fasting and bowel cleansing preparations).

. Diagnostic tests

- provide patients with information on preventing the disease or the spread of disease. Medical Assistants can provide information on hygiene practices, recommended vaccines, and nicotine cessation. (eg:- STD, Flu, diabetes)

. Disease prevention

Includes lab information system, affiliated hospital system, insurer web sites, electronic health record (EHR), patient portal etc.

. For care coordination/patient navigation, with what areas could the medical assistant assist the patient?

- the first part of this model deals with a person's perception of his or her chance of developing a disease. - . The second part of this model deals with a person's perception of the severity of the disease. A person's perception is influenced by the following: - personal factors (eg;- age, gender, race, employment) - social factors (eg;- peers, personality, family) - perceived threats of the disease - cues to action (eg:- mass media campaigns, social media, advice from family, friends, and healthcare providers, and professionals) - the third part of the model focuses on whether the person will take preventive action.

. Health belief model

- provide patients with information on routine screenings and show patients how to do self-exams (eg:- food, breast, and oral self-exams)

. Health maintenance

- tobacco make contains more than 7000 chemicals, of which 250 are harmful and at 69 can cause cancer. One in five deaths is related to smoking. Secondhand smoke causes lung cancer, strokes, low-birth-weight babies, and heart disease.

. Health risks associated with cigarettes, smokeless tobacco, and E-cigarettes

- it can help patients understand information from the visit.

. How can coaching help increase a patient's compliance or adhere ce to the treatment plan?

- commit to health coaching, build the health coaching model, recruit, train and mentor the coaches, start coaching and track progress.

. How should a medical assistant start the coaching process?

- obesity, depression, brain trauma, pregnancy complications and chronic pain.

. Intimate partner violence includes what behaviors?

- use adaptive equipment, such as a magnifying glass and magnifier

. List a strategy a medial assistant could use to adapt to the psychomotor learning barriers.

- MA can inculcate motivation in learners by positively reinforcing them.

. List a strategy a medical assistant could use to adapt to the affective learning barriers.

- denial: The primary response characterized by shock and disbelief. - anger: expression of anger as if why just this happened to me only? - bargaining: attempts to strike a bargain, typically with God in exchange for prolong life. - depression: feeling of loss, grief and intense sadness - acceptance: a quiet stage characterized by a gradual and peaceful withdrawal from life.

. List adaptive interactions used for each stage of grief and dying.

- Poor hygiene, loss of increase in favorite things, very energetic, talking fast, very sociable, tried etc.

. List five common signs of drug abuse.

- a lip or mouth sore that doesn't heal, mouth pain, loose teeth, a growth or lump inside your mouth.

. List four symptoms of oral cancer

- lack of motivation in learner - unrealistic and inappropriate expectations - anxiety or panic disorders in learner

. List three barriers to the affective learning domain.

Hand washing, cough etiquette, vaccines

. List three common disease prevention coaching topics a medical assistant may provide.

- may place a lot of value in family and spiritual belief s - state of health occurs la when living in total harmony with nature. Illness is the imbalance between the person and nature. - may use a traditional tribal medicine person - often avoid direct eye contact out of respect and concern for the loss of one's soul.

. Native Americans (cultural differences)

- praising the already known information - interacting with them to know their queries and answering them.

. Related to the affective domain, list two ways a medical assistant can help patients remember critical information.

- rehearsal, elaboration, imagery, mnemonics

. Related to the cognitive domain, list four ways a medical assistant can help patients remember critical information.

- discussion, written information, online videos, and computer instructions

. Related to the psychomotor domain, list four ways a medical assistant can help patients remember critical information.

- a lighter natural skin color, blue or green eyes, a personal history of skin cancer.

. Risk factors for skin cancer.

- skin that is lighter than normal skin color. - family or personal history of skin cancer - history of sunburns - green or blue eyes - red or blond hair

. Risk factors for skin cancers

- may view healthcare with the same mistrust, based on experience. - may not be used to asking questions and participating in a discussion with a provider. - some practice home remedies and bonki. Bonki is practiced by pressing glass cups against the person's shoulders to ease the symptoms. Bruising can occur.

. Russian (cultural differences)

- believe that individuals do not prevent illness, which is only done through prayer and living a life according to their religion. - use traditional spiritual healers. - may not take medication if they feel healthy. - healthcare decisions are made by the family, and the father gives consent for the procedures. - male and female circumcisions are performed l; being uncircumcised means the person is unclean.

. Somali (cultural differences)

- patients have unique concerns. These can include personal, family, social, financial l, and culture-related issues.

. Specific needs

- these are written protocols that authorize designated members of the health care team. (e.g., nurses or medical assistants) to complete certain tasks without having to first obtain a physician order.

. Standing orders

- present the information at an appropriate level for the patient. - build on the patient's prior knowledge about the topic - present information in small chunks, in a clear well-organized manner. - provide the information in two different ways (eg:- verbally discuss it and provide a written handout) - tell the patient "this is important to remember" and repeat important information several times during the session. - have the patient teach back the information you provided

. The following tips can be used to help patients remember critical information (cognitive domain):

- personal factors (eg;- age, gender, race, employment) - social factors (eg;- peers, personality, family) - perceived threats of the disease - cues to action (eg:- mass media campaigns, social media, advice from family, friends, and healthcare providers, and professionals)

. The second part of this model deals with a person's perception of the severity of the disease. A person's perception is influenced by the following:

- MA should consider the learning needs of patient, environment in which learning has to occur.

. Things a medical assistant should consider when adapting coaching to a patient.

- sensory stage: or a memory to be created, we must pick up something from our senses (eg:- touch, hearing, sight). - short-term memory: this is our temporary working memory. If nothing is done with the memory, it will fade within 30 seconds. - long-term memory: the more use short-term memories, the quicker they enter our long-term memory. We can add endless memories to our long-term memory, but without use (recall), those memories can fade.

. Three ways to store memories (cognitive domain)

- instruct patients on home care and follow-up as ordered by the provider. Research has shown that coaching can help patients understand information from the visit.

. Treatment plans

- The health belief model takes into consideration and individuals attitude towards a threat by a health condition.

. What does the health belief model help to explain?

- breast awareness helps you understand the normal look and feel of your breasts.

. What is the purpose of self-exams?

- rubbing a silver coin or spoon vigorously on the skin. These practices leave red marks on the skin. Do not confuse the marks with signs of abuse.

. many cultures have similar practices (coining and spooning)

- work at the top of their credentials - improve utilization management - engage patients in their own care - enter into value-based contracts with greater confidence

. name four advantages of care coordination?

- write down all medicines you take including over-the-counter drugs and dietary supplements. The list should include the name of each medicine, amount you take, and times you take it. If it's a prescription, also note the doctor who prescribed it and reason it was prescribed.

. what type of information do patients need to know when taking medications at home?

The inability to feel or experience pleasure during a pleasurable activity

Anhedonia

Bring to an end

Cessation

The act of following through on a request or demand patient compliance sounds negative

Compliance

- do not have sexual intercourse for 48 hours prior - Schedule the test about five days after the menstrual period - do not use tampons, birth control foams, jellies, cream, etc.

• A patient needs to have a Pap test. List common patient preparation instructions.

- first part deals with a person's perception of his or her chance of developing a disease - second part deals with a person's perception of the severity of the disease - third part focuses on whether the person will take preventive issues

• Health Belief Model

- Abdominal Aortic Aneurysm . Males between 65-75 who have smoked at one time in their lives - human immunodeficiency virus (HIV) screen (blood test) . People 15-65 years: at least once in their lifetime . All pregnant women . People with high risk should be tested annually - Hepatitis C . A person with risk factors should be tested ( history of a blood transfusion or organ transplant)

• One-Time Screenings

- all patients have the right to information before they agree to receive care - conduct adequate patient education and follow-up - document each patient education intervention completely and accurately - meet needs of all patients without evidence of prejudice

• Legal and ethical issues

A Colorectal cancer screening test requires no patient preparation and consists of a computer analysis that checks the stool for cancer and precancerous cells

• MD-sDNA

- work at the top of their credentials - improve utilization management - engage patients in their own care - enter into value-based contracts with greater confidence

• Name four advantages of care coordination?

A person who identifies patients' barriers works closely with the healthcare team and patients and guides the patients through the healthcare system.

patient navigator

The act of sticking to something

adherence

- disease prevention - health maintenance - diagnostic tests - treatment plans - specific needs - Community resources

• Coaching

Also called a patient advocate. They identify patients' financial, cultural, physical, and emotional barriers. Then, they work closely with the healthcare team and the patients to ensure barriers are eliminated and patients get timely care.

• Define patient navigator.

-social and recreation services - Financial support - Communication resources - behavioral resources - Multi-service agencies - Counselors - books - doctors - Internet, - parents and family

• Describe types of community resources

- cognitive domain • mental processes of recall, application, and evaluation - psychomotor domain • "Doing" domain - affective domain • "Feeling" domain

• Domains of learning

- blood pressure (age 18-39: every 3-5 years, age 40 +: every year) - bone density (age 65+: females: every 2 years) - cholesterol ( age 18: every 5 years) - colorectal cancer screening - dental exam ( every 6 months ) - dilated eye exam (age 60+: every 2 years) - lung cancer screening ( age 55-80) - mammograms (age 45-54: every year, age 55 or older: every 2 years) - Pap test (females are: 21-29: every 3 years) - prostate cancer (males age 50) - type 2 Diabetes Mellitus (every 3 years, fasting blood sugar)

• Regular screenings

- Denial and isolation - anger - bargaining - depression - Acceptance

• Stages of grief

- a patient navigator is a person who helps patients and families with insurance problems, explains treatment and care, communicates with the healthcare team, assist caregivers, and manages medical paperwork - medical assistants are cross-trained in administrative and clinical skills, so they are in a unique position to serve as patient navigators in an ambulatory care settings

• The medical assistant as a patient navigator

- write down all medicines you take, including over-the-counter drugs and dietary supplemental. - The list should include the name of each medication, the amount you take, and the time you take it. - if it's a prescription, also note the doctor who prescribes it and the reasons it was prescribed

• What type of information do patients need to know when taking medications at home?

- alcohol misuses screening - nicotine or tobacco screening - drug abuse screening (poor hygiene, changes in eating and sleeping patterns) - intimate partner violence screening - elderly safety screening: physical abuse, sexual abuse, emotional abuse, neglect, financial abuse, abandonment) - functional status screening - depression screening - peripheral neuropathy screening

• additional screening

- provides personalized patient- and family-centered care in a team-based environment - advantages: . greater efficiency with providing patient care . reduced cost . greater patient care . individualized person guidance and services . encourages patients to focus on goals and self-management . reduces hospital emergency department visits and readmissions . Ensure a person's needs and preferences for healthcare services are met

• care coordination

- provide necessary information for diagnostic and laboratory tests ordered for patients - some tests require fasting: others do not - provide answers to the following: . What is the test? . Where does the patient need to go for the test? . When is the test scheduled? . Does the test require fasting? If so, how long? If no food or beverages, does that include water? . Should patients continue or stop taking their medications?

• coaching on diagnostic tests

- By group: — school-age children (handwashing and cough etiquette) - Teens and adults (STI's, cigarettes, tobacco, smoking, drug) - all ages groups (vaccines; immunization schedules, influenza yearly, tetanus every 10 years, shingrix two doses for adults age 50 or older, pneumococcal age 65 and older)

• coaching on disease prevention

- based on the patient's answer to screening questions, a medical assistant may need to provide coaching on specific topics - medical assistant completes some screenings but also educates on-at-home self-exams - the provider establishes standing orders for specific education to be given based on the patient's history or age. - MA may need to provide coaching on specific topics per the provider's standing orders.

• coaching on health maintenance and wellness

- medical assistants review treatment plans with patients • taking medications • caring for casts and splints • applying hot or cold therapy • using assistive devices

• coaching on treatment plans

Language barriers are barriers to learning

• cognitive domain

The imaging procedure uses X-rays to create pictures of cross-sections of the patient's body

• computed tomography scan

- role of family and community - religion - views on health, wellness, death, and dying - views on complementary therapies - views on gender roles and relationships - beliefs related to food, diet, illness, and health - beliefs regarding sexuality, fertility, and childbirth

• cultural diversity

A patient is experiencing sadness and uncertainty when grieving

• depression

- to facilitate the appropriate and efficient delivery of health care services both within and across systems

• describe the goals of care coordination in the ambulatory care setting?

- they help patients navigate through the system

• describe the role of the medical assistant as a patient navigator.

Providing patients with information on hygiene practices, recommended vaccines, and nicotine cessation

• disease prevention

- it includes lab information systems, an affiliated hospital system, insurer websites, electronic health records (EHR), patient portal, etc.

• for care coordination/Bashan navigation, with what areas could the medical assistant assist the patient?

Providing patients with information on routine screenings and showing patients how to do self-exams

• health maintenance

According to Erikson's theory, an adolescent is in the stage:

• identity versus role confusion

The diagnostic test provides an x-ray picture of the breasts and is used to find tumors

• mammography

- patent education materials can be: . On paper . Apps . YouTube links . Other websites and videos - use the only provider-approved sites

• patient coaching

- care coordination helps provide patiens with individual assistance - patients who feel well cared for (and who feel comfortable talking with the healthcare team) stay with their provider - care coordination will increase in popularity over the coming years

• patient-centered care

- face person when speaking - determine if a person has a better hearing in one ear over the other; position yourself accordingly - if the patient has hearing aid, encourage patient to use it - say person's name before beginning conversation - keep hands away from your face when talking - limit extra noises in the environment

• patients with impaired hearing

- alert patient that you are in the room and identify yourself - patient is unable to pick up your body language; use clear, concise language and a normal tone of voice - provide all written material in a large font or print size - consider the impact of color contrast and glare on materials - make eye contact

• patients with impaired vision

- address the patient by his or her last name - be respectful and courteous - use simple phrases - use an interpreter; focus on patient - use translated materials - pictures and models can be helpful during a coaching session

• patients with language barriers

- breast self-exam (affect both females and males, 1 in eight women will have invasive breast cancer, ACS recommend a monthly breast self-exam) • yearly mammograms start between 40-50 - testicular self-exam (50% of those diagnosed are between 20-34 years of age, it is estimated that 1 in 263 males will get testicular cancer) . Also part of the routine physical exam - skin self-exam . ABCDE (asymmetry, border, color, diameter, and evolving) rule, basal cell, and squamous cell carcinoma are curable. Melanoma is more dangerous and can cause death) - oral cancer self-exam (check every 6 months, most cancers occur after age 40, causes: tobacco, drinking alcohol, etc.) . Also done routinely by a dentist

• self-exams: identify changes in one's body.

- assessing the learning needs: it is important to identify the patient's learning goals or the main reason for learning the content. - determining teaching priorities: it is important to prioritize what the patient needs to learn first. - planning the teaching process: when planning, determine what teaching aids and strategies will be used. - implementing the teaching process: it is important to start with the basics and build from there. - evaluating the patient's learning: after teaching important points, have the patient summarize what needs stated. - documenting the teaching-learning process: it is important to document the content taught to the patient, how the patient responded, evidence that the patient learned the content, handouts given, and any plans for follow-up.

• teaching-learning process

The diagnostic test uses high-frequency sound waves to create an image of the organs

• ultrasound