Patient Education: The Creation of Patient Enablers • Heather Orsted
Three Tips for Creating Effective Enablers
by Sue Rosenthal
Red Auerbach of the Boston Celtics basketball team once said that a pass that looks spectacular but that isn’t caught by anyone is actually just a bad pass. That’s a good sentiment to remember when attempting to communicate. If your audience doesn’t “catch” the pass, meaning they don’t understand what you are trying to communicate, it’s just bad communication. Here are three tips that can help you to create “catchable passes.”
1. Consider your audience.
Here’s the first paragraph of the monofilament enabler written in two ways: one for an audience with a good grasp of English and with good clinical skills and one for a lay audience (patients and caregivers).
Clinical Audience
Managing foot ulcerations is a concern and often presents as a challenge for all involved. Patients who have a loss of protective of sensation (LOPS) from sensory neuropathy are at risk for developing foot ulcerations by repeated and/or sustained trauma to their feet. Ulcerations are the most common single precursor to amputation and have been identified as a component in 85 per cent of lower-extremity amputations (Pecoraro RE, et al. 1990). The lack of sensitivity in the feet results in an altered perception of pain, temperature and pressure (Mulder G. 2000). Foot ulceration is associated with a two- to 10.5-fold increase in the risk of lower extremity amputation (Mayfield J. 1998).
Lay Audience
Preventing sores on the foot should be a major goal of people with diabetes. Sometimes people who have diabetes do not feel pain or hot and cold sensations on their feet. This is called a loss of protective of sensation or “LOPS.” A loss of sensation can also be referred to as sensory neuropathy, and increases a persons’ risk for injury to their feet. If LOPS is found it is important to make sure feet have the proper attention and care.
As you can see from the two examples above, the language used in each is quite different. The amount and depth of the information varies as well, with a simpler approach used in the paragraph for the lay audience. In this case, only two points are made: that people with diabetes may not feel pain or temperature (a condition called LOPS), and that this may increase their risk for foot injury. In the clinician-focused paragraph, references to articles are used to provide verification of the statements and sources for further research, something that would not be useful for patients, who would not have access to the articles.
2. Use analogy to help explain concepts and assist retention.
This example comes from Christine Pearson who wrote the “How Wounds Heal” article in the previous issue of Wound Care Canada (Vol. 4, No. 1, 2006), who uses the analogy of a family moving into a neighbourhood as a way of explaining the differences between contamination, colonization, critical colonization and infection. Contamination and colonization are illustrated below.
- Neighborhood = the human skin and body
- Apartment = the wound
- Joe and other people = bacteria
Once upon a time in a lovely little town, Joe was wandering around a neighborhood looking for somewhere to live. He found a beautiful apartment and went in to have a look at it.
This is contamination: bacteria are on the surface of the wound not causing any harm. All wounds are contaminated.
Joe liked the apartment, so he decided to move in with his new bride. They bought dishes and furnishings, hung art on the walls, and made it their home. A short time later, Joe’s wife gave birth to quadruplets. The couple couldn’t manage all the babies on their own so their parents and in-laws moved in to help.
This is colonization: the bacteria have moved into the tissues and are multiplying but not causing any harm to the host. Some bacteria in the wound are essential for healing. All chronic wounds are colonized.
The story eventually continues with the behaviour of Joe and his family getting out of hand (moving through critical colonization and then to infection). The police (white blood cells) and, eventually, the army (systemic antibiotics) have to be called in.
3. Present information in more than one way.
Use visual cues to help your audience remember key concepts. Photos, drawings, charts and tables can provide readers with alternative ways to understand and remember the ideas you are trying to convey. In the monofilament enabler, the drawing of the foot, with the testing locations marked out by red dots, and the photograph of the bending monofilament clarify to the reader where and how the testing is to take place better than would be possible through words alone.
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