Computer Assisted Instruction for Patient Education

Communication is essential for the effective delivery of health care.

Unfortunately, there is often a mismatch between a clinician's level
of communication and a patient's level of comprehension. Evidence
shows that patients often misinterpret or do not understand much of
the information given to them by clinicians (Baker, Gazmararian,
Sudano, & Patterson, 2000).

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There are many reasons why patients do not understand what

clinicians tell them, but key among them is inadequate health
literacy. (Nielsen-Bohlman, Panzer, Hamlin, & Kindig, 2004).

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Limited or low health literacy diminishes a person's capacity to

engage in fruitful interactions with care providers (Baker et al.,
2000).

Many are embarrassed to let the health care team know of their
inability to read or understand instructions, which often leads to
poor health outcomes, less knowledge of disease management,
frequent return visits to the health care provider, and additional out-
of-pocket expenses (Gazmararian, Williams, Peel, & Baker, 2003;
Howard, Gazmararian, & Paker, 2005; Sudore et al., 2006).

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This limited literacy can also lead to medication errors, missed

appointments, adverse medical outcomes, and even malpractice
lawsuits” (Weiss, 2003, p. 4).
Traditional patient education relies heavily on written material about
disease prevention and management. Unfortunately, most patient
education materials are written at too high a grade level for low-
literate patients to comprehend essential points (Gazmararian et al.,
2003; Nutbeam, 2000; Wolf et al., 2004).

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Novel methods of patient education are needed to overcome health

literacy barriers. One promising method is computer-assisted
instruction (CAI), the use of computer programs to deliver an
educational message.

Computer-assisted instruction

- Offers the potential to overcome literacy barriers by combining

graphics, video clips, and audio segments to minimize reliance on the
written word.

- Standardizes the material being presented and allows patients to

proceed at their own pace.

- It also can incorporate interactivity to engage the user and target

the content delivered.

3 Factors that Contributed to the Delivery of Patient Education

1. Expectation of accreditation organization like the Joint

Commission on Accreditation of Health Care Organization
(JCAHAO) that patient education will be systematic and
documented.
2. Increase in lawsuits against heath care facilities and provider
due to the result of having not enough patient
education.(Gabello 1997)
3. Fostering a deliberate patient education is the rise in
consumerism in our society.(Bell, 1986)

Interactive CAI software is also available for patient education

such as the ff.
- Pre and post - operative teaching
- Asthmatic Education
- Cardiac Education
- Smoking Cessation
- Health Risk Appraisal
- Communicable Diseases
(Huss et al., 1992)
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Computer Assisted Instruction for Nursing Students and

Nursing Staff

A.) Application of CAI to basic nursing education is

extensive. Programs are available that teach the ff.
 Psychomotor skills
 Dosage computation
 Care planning
 Problem solving
 Critical thinking
 Content on many medical conditions.
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B.) Nursing staff can also benefit from this technology.
Staff development education has developed computer
labs where staff views software applicable for them, such
as;
  Mandatory in service topics
 Advanced skills
 Critical thinking
 Leadership and Management

Research on Effectiveness of Computer Assisted Instruction

 Huss and co-authors (1992)

- Researched the effectiveness of Interactive CAI as a method
for asthma patient education compared to conventional
teaching.

 Software is available that tailors health instructions to

individual patients. (Skinner et al.,1993)
- This type of program requires the patient to first answer the
demographic and background information about health
beliefs and behaviour’s.
- An individualize prevention plan or care plan can be
generated.
(Skinner et al.,1993)
Research on tailored instructions related to cancer
prevention and diet change has found the information to be
better remembered and more thoroughly read than ordinary
printed instructions ( Skinner et al., 1993)
 Computerized patient education may take place in a
professional office, a clinic, a hospital or even at a patient’s
room.
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Computer Managed Instruction

 Teacher’s can use computers to :
 Manage
 Prepare
 Organize
 Evaluate Educational Experiences

Computer Managed Instruction also includes any system of record

keeping such as :

 Recording Grades
 Keeping attendance Records
 Recording Student Profiles
 Records of Student Performance

Nursing Faculty may use computers to :

 To schedule clinical agencies and assignments
 Assign Rotations
Authoring System – are pre developed software packages
that guide the educator through the process of development
of CAI

Using the Computer as a Tool

 People who have computer knowledge at all usually know

how to use a word processing program.
Computer as a tool
 Help us write more efficiently
 Serves as a search tool for students
 Nurses uses it as a tool for patient care management
 Used as part of the Hospital Information System
The best way to prepare nursing students and newly
licensed orientees to use the computer in a health care
 Facility is to enable them to use the computer in many
different ways during their education and then to give them
specific training on practice programs during their
orientation work.

The Internet
The Internet
-is a mammoth complex of computer connections across
continents, connecting many millions of computers.
- With an Internet node, or a modem, potentially anyone
can connect to the Internet.
- The primary use of Internet in nursing are email, new
groups, and access to the WWW.

Email
Email( electronic mail)

- Can be used to provide greater collaboration between

teachers and students and between students and teachers.
- Many faculty members have attested to the fact that e-mail
has enriched the learning interactions between them and
their students (Brown 2000)
- Students report email as a source of peer support, especially
when they have less face to face contact than in traditional
classrooms.
- It can be used between patients, physicians and nurses, used
as a means for patients to seek referrals, for consultation,
and for post discharge follow up.
Listservs
 Mailing or Subscription list
 Is a group of people who have similar interests and want to
share information and experiences regarding those interests
in a type of discussion group.
 There are listservs for nurse educators, for nursing students,
and for many nursing practice speacialties.
 To subscribe to a listservs, send an email message to the
listserv address, which you can usually find on the Internet
via search engine. ( Bliss & DeYoung,2002)

New Groups
- are similar to listservs in that they are discussion groups of
people with similar interests.
 In New groups, messages appear in a general mailbox that
everyone views, compared to the individual mailbox
message in listserv.

News reader software

- Special programs, may be necessary for individuals to read e-
mails sent to a news group( Mascara, Czar, & Hebba , 1999)
Example: News group of interest to nurses is
sci.med.nursing, - A group discussing all kinds of nursing
issues.
- Both news groups and listservs are also used for online
support groups for people suffering from various diseases
and conditions or for people who care for them.
Example: Development of groups for caregivers of
Alzheimer’s patients. Caregiver often cannot leave their
homes to attend community support groups, so online
option is very attractive (White & Dorman)
 World Wide Web
- The Internet also provides access to the World Wide Web.
WWW – a collection of millions of documents found on Web
pages that interface to the Internet.
 Kisers( 1999) asserts that educators should consider using
the Internet and WWW in the classroom when information
that is required not in the textbook or the library.
 Nurse Educators and learners may use the Internet to search
for Web sites containing full text articles or abstracts, when
doing a literature search.
 Nurse educators and staff nurses can teach people to use
Web sites for information and supply them with quality
sources.
2 Problems in using the WWW and teaching others to use it:
1. The difficulty in finding the Web sites pertinent to your
purpose.
2. Lack of Web sites

Virtual Reality
- Is a computer based, stimulated three dimensional
environment in which the participants interacts with a
virtual world.
- The learner does not just watch or read a stimulation, but
participates in it as if this were a real world actually
experience (Pantelids, 1993)
- The initial virtual reality programs were written for the
military ( flight training stimulators)or for Hollywood- type
applications.
 Virtual reality developed for medical schools are used to
teach dissection and surgery
Example: Surgical Stimulator - Allows medical students to
see first how a surgical procedure is performed by an
experienced surgeon and then use the instruments to
virtually perform the surgery themselves(Virtual Reality,
1991)
 A newer form of virtual reality program in nursing uses
multimedia and CD- ROM technology with an embedded
virtual reality component.
 A program to teach the 12 lead electrocardiogram (ECG) has
been developed by Jerries (1999).
Advantages of Virtual Reality
 Ability to practice invasive procedures in a lifelike scenario
 Ability to practice complex and dangerous skills in a safe
environment.
Disadvantages of Virtual Reality
 High cost of developing, operating and maintaining a virtual
reality system.
 The people assumed that of they learn a skill via virtual
reality , they will automatically perform well in a real
setting.(McNamara, 1996)