The Effective Tactic: For me, using a fluid sodium simulation to teach patients about daily limitations on sodium and fluids is the most successful approach. Many patients do not understand the abstract concept of 2 grams of sodium or 2 liters of fluid, so I often have them fill up 2-liter bottles with water as a way to see what they can actually consume each day. The visual effect that this has is much more powerful than providing them with printed education materials. The Practical Example: I had an older gentleman who was thinking about eating a can of high-sodium soup during the holiday weekend. However, when he remembered the demonstration we had done together, he realized that one meal of soup contained most of his daily sodium intake. Because of that, he made an alternate choice of a low-sodium soup, avoiding any rapid fluid shift that typically results in "flash" pulmonary edema and requires readmission during holiday weekends. He later stated that the visualization of 1 teaspoon of salt—which represents about 2,300mg of sodium—helped him continue to eat low sodium to stay compliant. The Outcome: Patients can grasp the complex nature of nutrition science through these visualization methods. By providing patients with a simplistic approach to understanding the rules of the road regarding heart failure, nurses empower patients to safely shop for groceries and make better food choices when preparing meals at home. Most heart failure readmissions occur after the patient is discharged from the hospital due to complications related to non-compliance with the safe and appropriate consumption of sodium and fluids, so these visual tools are essential for long-term health.
The Effective Tactic: My first step is to use the "Teach-Back Confirmation" technique when educating patients about heart failure medications, with a focus on the difference between "maintenance" and "rescue" medications. With this nurse-led protocol, patients are asked to explain back to the nurse the function of each medication and the signs or symptoms they would expect to observe if there was a need for an adjustment to their current treatment plan. This process verifies that the patient not only understands but also is able to internalize the rationale behind their complicated and somewhat confusing medications. The Practical Example: One example from my own practice reinforces this effectiveness. A patient during a "Teach-Back" session realized that he had confused his daily beta-blocker with his diuretic, taking the wrong medication combination to treat a heart failure fluid overload, for which the nurse was able to clarify prior to discharge from the hospital. If he had left the hospital with this misunderstanding, he would have increased his chances for the development of a potentially harmful condition like syncope, thus increasing his chances for emergency readmission. The Outcome: The Teach-Back technique identifies patient knowledge gaps prior to placing patients at risk of an adverse clinical event, and therefore can serve as a quality assurance tool for effective discharge patient education. In an extensive healthcare organization, the Teach-Back is a valuable nursing intervention to maximize the possibility that patients will comply with their discharge plan, leading to safer patient behavior within their home environment.