Tips for Educating Patients in the Age of Biologics

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Patient education has always been at the core of the nursing profession. Nurses pride themselves on being great teachers and patient advocates. When self-injectable biologics were first introduced to the market, one of the main goals was to make patients independent and put them in the driver’s seat of their own care. Yet without a proper teaching session, many patients would return with bruises or wasted medications. Nurses took on the job, and teaching patients about self-injection became a priority.

Currently, physicians’ offices and hospitals offer teaching sessions on self-injectable biologics. Recently, some pharmaceutical companies have started a visiting nurse/home care program for patients who are started on biologics.

Patient education is a process in which the patient comes to comprehend their physical condition and self-care needs by the use of various mediums and experience. The goal is that the patient will understand their current health status and be able to make appropriate healthcare decisions and make changes necessary to reach optimum health.¹

So how does that translate to our modern patients? The old, unidirectional style of teaching no longer works. The authoritarian/hierarchical style does not encourage patient participation. The 21st century patient is a savvy consumer and researcher, and nurses and other healthcare providers need to be ready at all times to answer questions, concerns and odd inquiries that may rise from too much research on Dr. Google. It’s always important to know where your patient is getting their information.

The best approach is the coaching method, used now in many settings. In this approach, the nurse is a partner and not a teacher. In this model, teaching has to be custom fit, driven by the patient’s agenda to enhance their quality of life and health. That means you need to know your patient in order to know how they learn, what they want to learn and what their barriers are. The patient is viewed as resourceful, unique and whole, and not a chronic illness to be managed. On the other side, the coach/nurse facilitates, motivates, provides feedback and helps retain commitment. The teaching session becomes a sharing event.²

Here are a few practical steps that will guarantee a successful teaching session:

1. Make sure the proper device was ordered. If possible, let the patients see both syringe and device and choose what best fits their lifestyle prior to ordering. It’s very important to assess for any dexterity problems and/or hand deformities that may reduce the patient’s ability to self-inject.
2. Prior to the session, call your patient, and make sure that the medication will be available at the time of the meeting. Avoid sessions where the medication is not available. That is not really the best approach because they may have issues with the device at the time of the injection, and there will be no immediate help available. If you have a chance, you can ask the patient to watch the instructional video on the pharmaceutical website prior to the session—that way the patient will be slightly more familiar with the task ahead.
3. The first part of the session is focusing on the partner/patient. Make sure your patient is comfortable with the new medication, ask if they have read or researched anything and if they have any questions, and make sure to ask about their fears, which are usually your biggest barrier. Patients that overcome their fears have less anxiety, better outcomes and better adherence to the plan of care. Allow enough time for any questions the patient may have. Be aware that sometimes patients will bring a family member or friend to the meeting. They may be intimidated by the thought of injecting themselves and have asked somebody else to do it for them. This could be the case for children and adolescents. In this particular case, make sure to listen to both parties and answer all questions and concerns.
4. The second part is teaching about the device and the correct injection procedure. Currently, most patients opt for the pen-like devices, where no needle is visible. During this time, you should allow the patient or the family member to handle and manipulate the training device; this will help them to overcome preconceptions and fears of self-injecting. For children, particularly girls, you can ask them to bring a doll—that way they can train/play with the doll first prior to injecting. This may ease some of their fears as well. You can also play with the fake skin kits. Use the training device to do the procedure as many times as the patient desires, and wait until they are ready. Rushing will only cause problems in the future, when the patient either forgets or doesn’t complete the procedure correctly.
5. The third part is the injection part itself. Allow for breathing room. There is always a little tension in the air as the patient gets near the finish line. Be sure to coach the patient at all times without being overbearing. Make sure the patient knows all the steps, from gathering the materials, to hand washing and preparing the area, and, if needed, reinforce as many times as necessary. Sometimes during the injection itself, I gently place my hand over the patient’s; this not only gives them some comfort, but also prevents them from pulling the device from the skin too soon and wasting the medication. Sometimes it is necessary to offer follow-up visits with return demonstration until the patient is proficient in the procedure.
6. Ask the patient to stay for another 20 minutes, and monitor them for any side effects.
7. Provide the patient with all of the support materials and helpline phone numbers. Most pharmaceutical companies now provide 24-hour hotline support that is staffed by registered nurses.
8. Another important issue is traveling with biologics. Most start-up kits contain information on proper documentation and how to properly store and travel with their medication.
9. Be aware that some patients will never be independent, either due to severe hand deformities and/or fear of self-injecting. At each visit, make sure to re-instruct the patient on the procedure and encourage them to do part of the procedure themselves (e.g., choose the site, and prep the materials and the area to be injected). Use every opportunity to make the patient independent.
10. A follow-up phone call the day after the teaching session and again after the second injection will guarantee smooth sailing and decrease possible complications. It also solidifies the relationship between patient and nurse and creates a safety net for the patient and their family.

References

1. Syx RL. The practice of patient education: The theoretical perspective. Orthop Nurs. 2008 Jan–Feb;27(1):50–54.
2. Hayes E, McCahon C, Panahi MR, et al. Alliance not compliance: Coaching strategies to improve type 2 diabetes outcomes. J Am Acad Nurse Pract. 2008 Mar;20(3):155–162.