It is astounding to me how little diet education we as nurses provide to our patients across healthcare. Nearly each and every disease process has a nutritional component that depending on if adhered to properly or even partly can greatly affect the outcome for our patients. Implementation and compliance to many prescribed diets in relation to their disease decreases hospitalizations, increases life expectancy and sometimes even reverses the very diagnosis the diet is prescribed for. But how can a patient stick to a nutritional plan if they have not been educated on it effectively or if at all?
The greatest issue I found as a certified nurse nutritionist is that patients who had documented education and verbally stated that they were educated numerous times on their diseases such as CHF, COPD, and Diabetes to name a few, lacked understanding of the education provided. One of the first things we learn about patient education in nursing school is not only to provide teaching based on how your patients best learn, but to also assess the patient’s level of understanding. Otherwise, how do we know they have learned?
So what is the barrier to progress here and why aren’t we teaching enough and if we are why so often is it not effective? The main reason I am quite sure without having any need to research this is time. Time is our number one issue in almost every aspect of nursing, and that is something I do not see changing for the foreseeable future. Proper education takes time and this is the number one thing that we lack in the nursing profession. Who the heck has the time?
So how can we simplify nutrition education for our patients in the little time that we do have while also teaching it effectively?
Before reviewing all different diets and foods to eat, avoid etc. First, assess the basics… Can your patient read a food label? This is the number one issue I have found while going into patients homes and providing nutrition education and assessment. Needless to say, I was shocked. These patients had been instructed for years on their dietary needs by multiple professionals and they did not know how to read or understand a food label. How can they do anything without learning this basic first step? They were either never instructed or instructed poorly without demonstrating what they learned. Teach-back is so important. I sometimes find that being in this profession we often assume people know things that seem fairly simple and obvious to us. That isn’t always the case so it is best to never assume.
SAVE SOME TIME AND SOME BREATH
All too often we start talking or providing handouts etc. and we don’t even know what the patient already knows. We are not the diagnosing clinician so these patients have been hopefully instructed on at least something dietary along the way. Also, they could have had a family member with the same disease or they may have obtained information on the subject from a number of different sources. Ask them what they know and have them teach it to you. See if what they know is accurate and then you can move on to instruct on only the knowledge that they lack. Time saver!
Before you assume your patient is just non-compliant and give up, which is a situation we occasionally find ourselves in, assess if it’s true non-compliance that is the issue or is it not really a choice at all? It is of vital importance to assess your patient’s living and socioeconomic status in regards to dietary education. If your patient is not the one in their home that does the food shopping then your teaching may need to include the shopper. You also have to consider financially your patient may not be able to adhere to a diet very easily. Modify your teaching to fit the client’s lifestyle.
SMALL GOALS AND POSITIVE REINFORCEMENT
The saying Rome wasn’t built in a day applies to many things and you can apply it very often in patient education. In fact, if you don’t have this thought process you will become frustrated very easily. People are resistant to change, that’s a fact. It’s difficult for anyone to break habits or rituals that they have had for years. Sometimes a patient will never change their lifestyle or choices and that is their right. Other times, although rarely, you will take a patient from A to Z and they will completely embrace and comply with the needed changes. Often it is somewhere in-between. I have found that if you set small goals with the patient that are more realistic and obtainable you will have much more success. When the small goal is achieved you as a nurse feel like you have done your job and the patient feels good that they are making progress. I once could only get a CHF patient to give up ramen noodles and buy only low sodium deli meat. That was it. But these two things were staples in her diet for years. This was a big deal to her and it was a success for me. Yes, she was still eating other foods with too much sodium and would never elevate her lower extremities or weigh herself but none the less it was a huge accomplishment and I was sure to let her know it.
Do you teach diet to your patients as often as you should or could?