The nurses of The Family Learning Center (FLC) at The Children’s Hospital of Philadelphia (CHOP) deserve to be recognized for the exceptional patient-family education they provide. In a unique model designed to maximize learning and patient safety, these nurses assess learning needs and preferences. This unique combination of environment, content and style maximize learning. Follow-up with the family and their clinicians in the inpatient, outpatient and home care areas catches mistakes and misperceptions before they cause harm and ensures that families are able to safely care for their child. This individualized collaboration with and for learners enhances knowledge, care, safety and satisfaction.
Eating delicious food is one of life’s simple pleasures. Children with special feeding needs may be unable to have this pleasure, disappointing both parent and child. Parents of young children feel vulnerable when they do not experience the nurturing and fulfillment that comes from feeding and watching their child grow. When alternative feeding methods require surgery and a gastrostomy tube (g-tube) inserted through the abdomen and into the stomach, it can be distressing for the child and caregivers.
Healthcare providers see patients with g-tubes regularly and may lose sight of the impact such tubes have on a caregiver at home. One family that we cared for at The Children’s Hospital of Philadelphia had a child at home with a newly placed g-tube. When the tube came out at home, despite their preparation and teaching, they became frightened, forgot how to respond, and brought the child to the Emergency Department (ED). Another parent found she was so fearful about causing complications that she was unable to touch her child’s g-tube. These overwhelmed parents reminded us that g-tubes are not a normal part of parenting and that the tube can be intimidating at first. The Family Learning Center (FLC) nurses saw an opportunity to improve the way we care for and educate caregivers and staff about g-tubes.
The FLC is the core of patient-family education at CHOP. It provides an innovative environment where parents can learn to safely manage their child’s health care needs at home. Each class is private, tailored to an individual family’s needs, using the exact equipment they will have at home. The FLC is staffed by experienced nurses who are transformational leaders in patient-family education. When these nurses heard about the distressed parents, they immediately investigated. They listened intently to the parents’ stories and collaborated with physicians and nurses from Gastroenterology, Surgery, and the ED, as well as members of the Family Faculty, to fully evaluate how we prepare families to care for a child with a g-tube.
The FLC nurses wanted to ensure that every nurse appreciated how having a child with a g-tube affects caregivers and that nurses had the tools they needed to teach these families to be confident and safe at home. Studies have shown that 40-80% of medical information patients receive is forgotten immediately and half of the information retained is incorrect.* The FLC nurses improved the nursing class on g-tubes, incorporating the concept of Teach Back so that nurses could thoroughly assess the caregiver’s competency. Teach Back confirms the participant’s understanding, improves knowledge and assures self-management skills. This class consistently receives high ratings from the staff who attend.
With input from CHOP families caring for g-tubes, the FLC nurses rewrote the written materials on g-tube care and created a wallet card so that families could have readily available emergency care information. They critically reviewed the eight g-tube classes they teach to assure that they incorporated Plain Language and Teach Back. They collaborated with the Surgery Department to be certain that all parents of children receiving a g-tube are scheduled for a class in the FLC to maximize learning. Parents are encouraged to evaluate the class through a confidential survey. Parents responding are consistently positive and are grateful for the learning opportunity. FLC nurses contact the patient’s bedside nurse to support the transition of the parent’s knowledge from classroom to bedside and to answer any questions from the nurse or family.
This series of changes had a significant impact on the way we care for and educate caregivers and staff about g-tubes at CHOP, enhancing the patient-family experience.
*Health Literacy Universal Precautions Toolkit, AHRQ Publication # 10-0046-EF.
Through this unique program, the nurses in the Family Learning Center (FLC) enhance knowledge, care, safety and satisfaction for families and staff.
After revising the programs/resources for families and staff, the nurses developed a satisfaction survey for caregivers who attended classes in the FLC. 33 families responded; a 100% response rate. Survey questions included:
- Did your Nurse Educator explain things in a way you could understand?
- Were all of your questions answered?
- Do you feel more confident in caring for your child after your class?
- Were the written materials that you received helpful?
- Would you recommend The Family Learning Center to other families?
100% of the families replied “yes” to these questions. The personal comments illustrated that the nurses had achieved their goal of increasing knowledge and satisfaction:
- “I feel better and safer.”
- “I feel very confident about ensuring my son is successful with g-tube feeds.”
- “I liked the hands-on experience with the mannequin prior to having to perform the tasks on my toddler.”
The FLC nurses also wanted to ensure that the bedside nurses had the knowledge and skills needed to effectively teach families and support their transition to home. Twenty-two (22) nurses have attended the new class on g-tube care/education and have provided positive evaluations:
- Average Score for Content: 4.66/5.0
- Average Score for Teaching Strategy 4.48/5.0
The most consistent comment was that they appreciated practicing the Teach Back method to validate the competency of the caregivers.
To further ensure quality and safety with g-tube care/education, the FLC nurses called 50 bedside nurses after parents attended g-tube class. Twelve(12) percent of nurses had questions about teaching, which were clarified by the FLC team. Eighty-two (8) percent of parents had done a Teach-Back at the bedside and successfully demonstrated care.
Through innovation, collaboration and communication, the FLC nurses create the ideal patient experience.