Patient and Family Traumatic Brain Injury Education – An Effective Model
Kristine O’Malley - OTR/L, Suzanne Lawrence - PT, Ellen Sweet - PT, Cherlyn Dufresne - RN, CRRN,
Ashley Couture - MS, CCC/SLP, Owen Drudge - PhD, Roger Knakal - MD
Fletcher Allen Health Care – Inpatient Rehabilitation Center – Burlington, Vermont
Purpose
2) To understand the education process used by clinicians for
patient and family education.
Methods/Process
Results
8) Researched educational resources and developed a resource
table that corresponded to the items on the FEQ.
Conclusions
Post Implementation Staff Survey Results (N=33)
2005 pre
2007 post
18
16
3) To identify useful TBI educational resources.
Results
Scope of the Problem
3) Staff were satisfied with the FEQ, the new TBI education
process, the documentation, the clear delineation of their roles
and responsibilities, and the wide variety of TBI educational
materials.
14
12
10
8
6
4) The medical record audits results revealed clinician
compliance with 3 of the 4 new standards of care.
4
6) Developed and implemented the Family TBI Education
Questionnaire (FEQ) based on our experience with the FNQ
trial and feedback from patients, families, and clinicians.
7) Developed and implemented a multidisciplinary clinical process
flowchart for patient/family TBI education.
Staff's Satisfaction with New Patient/Family TBI Education Model
Post Implementation Survey (N=38)
Strongly
Agree
Uncertain
Somewhat
Agree
Somewhat
Disagree
Strongly
Agree
Strongly
Disagree
Somewhat
Agree
6
Next Steps
4
I am able to determine the patient/family TBI
learning needs:
Strongly
Agree
Uncertain
Somewhat
Agree
Somewhat
Disagree
Strongly
Agree
Strongly
Disagree
0
Strongly
Disagree
2
I was satisfied with the education
materials used for my TBI
education or my family member's
education: (N=11)
The survey response rate was 92% (11/12). Nearly all
families surveyed were satisfied with the education they
received. All 11 families completed the FEQ, however 4
did not recall completing it.
8
Uncertain
Strongly
Agree
Uncertain
Somewhat
Disagree
Somewhat
Agree
Strongly
Agree
I was satisfied with the Family TBI I was satisfied with the TBI
Education Questionnaire as a tool education I or my family member
to determine my learning needs:
received: (N=11)
(N=7)
Strongly
Disagree
Uncertain
Somewhat
Disagree
Somewhat
Agree
Strongly
Agree
Strongly
Disagree
Uncertain
Somewhat
Agree
Somewhat
Disagree
0
10
Somewhat
Agree
1
12
Somewhat
Disagree
2
Staff Responses
(Frequency Count)
3
I have adequate patient/family TBI educational
materials for teaching:
The survey response rate was 72% (33/46). Since
implementing the new TBI education model and standard of
care, staff have a better understanding of their roles and
responsibilities. They have a tool to assess learning needs,
adequate teaching materials, and a clear process.
1) Accumulate one year results of staff compliance through
medical record chart audits.
2) Survey 20 more patients/families about their satisfaction with
the TBI education and support they received during the
Inpatient Rehab admission.
3) Conduct a study on the psychometrics of the FEQ.
References
25
Staff Compliance with New Care Standard - Audit Results
20
Standard Not Met
Standard Met
14
15
1 Paterson
B, Kieloch B, Gmiterek J."'They never told us
anything': post-discharge instruction for families of persons with
brain injuries." Rehabilitation Nursing. 2001;26(2):48-53.
12
2
Serio CD, Kreutzer JS, Witol AD. Family Needs after traumatic
brain injury: a factor analytic study of the Family Needs
Questionnaire. Brain Injury. 1997;11(1):1-9.
10
Frequency Count
10
5
I am satisfied with the Fam ily TBI
Education Questionnaire as a tool to
determ ine the learning needs of the
fam ily:
Strongly
Agree
Somewhat
Agree
Uncertain
Somewhat
Disagree
Strongly
Disagree
Strongly
Agree
Uncertain
Somewhat
Agree
Somewhat
Disagree
Strongly
Disagree
Strongly
Agree
Uncertain
0
Somewhat
Agree
5) Discovered and trialed the “Family Needs Questionnaire”
(FNQ), a standardized tool used to identify educational and
support needs of families affected by TBI.2,3 During the FNQ
trial (N=5), patients and families expressed that the
questionnaire format was too long, too complex, and confusing.
This quality improvement project does not demonstrate
causality between the FEQ, patient/family and staff
satisfaction with the TBI education process. The FEQ was
not psychometrically tested before implementation.
14
4
Strongly
Disagree
4) Reviewed research literature and contacted model centers.
They were unable to identify a national standard for
patient/family TBI education.
Limitations
2007 post
16
5
Strongly
Disagree
3) Surveyed clinicians to identify key educational topics, current
practice and areas of needed improvement.
Strongly
Disagree
2005 pre
18
6
Somewhat
Disagree
2) Conducted baseline measurement of the patient/family
perception of their TBI education:
a) Informal interviews
b) Formal surveys of patients and their families
Somewhat
Disagree
7
Staff Responses
(Frequency Count)
1) Identified a clinical problem with TBI education for patients and
families.
5) There is opportunity for continued improvement in the area of
clinical documentation of patient/family education.
I clearly understand the process of
patient/family TBI education:
8
Methods/Process
An interdisciplinary team:
I am clear about my responsibilities for
patient/family TBI education:
Patient/Family Satisfaction with New TBI Education Model
Post Implementation Survey
Patient/Family Responses
(Frequency Count)
Our clinicians were concerned about the variation in
patient/family TBI education provided, materials and clinical
process used, and clinical documentation. These
inconsistencies resulted in less effective patient/family TBI
education and decreased satisfaction.
Satisfaction Survey Results
0
Uncertain
2
Research demonstrates that patients with Traumatic Brain
Injury (TBI) and their families frequently feel dissatisfied with
the education they receive during the rehabilitation process.1
There is a discrepancy between the education clinicians feel
they provide and the education and support that patients and
families feel they receive.
1) FNQ did not meet the needs of our patient/family population.
2) Patients/families were satisfied with the TBI education they
received after the new model was initiated.
20
9) Conducted post implementation surveys re: patient/family and
clinician satisfaction with TBI education, clinician knowledge of
roles/responsibilities, and compliance with the new standards.
Staff Responses
(Frequency Count)
1) To describe an effective tool that helps clinicians identify the
support and education needs of patients with Traumatic Brain
Injury (TBI) and their families.
I am s atisfied with the new education I am s atis fied with the TBI
process (documentation, resources, educational m aterials (TBI Manual,
ques tionnaire) for patients with TBI handouts , and educational s heets):
and their families :
The survey response rate was 70% (38/54). Ninety percent
of staff were satisfied with the FEQ as a tool to assess the
patient/family TBI educational needs, 82% were satisfied
with the new educational process, and 90% were satisfied
with teaching materials.
8
6
3 http://www.tbims.org/combi/fnq/index.html Last
4
accessed 1/15/08.
Tools available at FAHC website:
2
http://www.fahc.org/Rehab_Therapies/Evidence/TBI Education.html
0
Did patient’s
pt's family family
or support
Was
ompleted Adm FEQ
Was
FEQ reviewed
Did staff
paitent/family
Did
or
Wasccompleted
WasAdm
Admissions
FEQby Did
staffrecord
record
person
receive
FEQ
the 1st picked
up from family?
staff (signed,
dated, and
educationon
onthe
the Multisupport
person
receive
Admissions
FEQ (N=13) reviewed
by staff
education
week of admissions?
(N=15)
initials placed next to the
Disciplinary Pt/Family
FEQ the 1st week of
picked up from
(signed, dated,
Multidisciplinary
appropriate
topics inetc.)?
left hand Education
Flowsheet? (N=15)
admissions? (N=15)
family? (N=12)
(N=12)
Patient/Family Education
column)? (N=12)
Flowsheet? (N=15)
The multidisciplinary team demonstrated compliance with the
new care standard by consistently giving the FEQ to the
patient’s family, and by reviewing the completed
questionnaire. Twelve of the 13 families completed the FEQ.
•
•
•
•
Family TBI Education Questionnaire
Multidisciplinary Patient/Family TBI Education Process
Patient and Family TBI Education Resource List
TBI Manual – Online Format
Contact: [email protected]