Report on the Needs Assessment

2.8 Some specific challenges of patient teaching

This section captures some observations made during interviews that add depth to the understanding of the issue. They are not presented as findings and not subjected to analysis.

One health care professional noted that the Dialysis patient population in general is older, passive and difficult to reach. Patients ask for a lot, listen more or less and often have a compliance problem. The family is often present at the start of treatment to take care of transport and other logistics, but then disappears, and nurses do not see them anymore. Many families remain ignorant of the patient's treatment, which seriously limits the information and education process of hard-to-reach patients. After treatment, patients are in a hurry to leave the hospital and return home, where often little awaits them. According to this informant, the challenge is to break the passivity of patients in general and increase their motivation to learn and become involved.

Oncology Hematology patients face other barriers to learning: high anxiety and information overload. A lot of the teaching by nurses is done on the first day of treatment when patients are generally not in a good frame of mind for learning. Information overload is also a problem. Too many different health care professionals, medical specialists, nurses, pharmacists, all give out a lot of information on that same day.

In all three units, health care workers are trying to inform and teach seniors who have memory problems, lack concentration, have weak eyesight, or can be passive and/or too anxious to learn.

The CLSC Côte-des-Neiges takes in clients who are poor, without health insurance, illegal immigrants, refugees, unaccompanied children who arrive in Canada with nothing, pregnant women "visiting" Canada, etc. These clients suffer from post-traumatic syndrome, panic attacks and high stress levels. They are often frightened of being refused by immigration authorities and expelled from Canada. Their priorities are staying in Canada, eating and finding money. Health is not a priority; these clients are not in a mental state to learn about health. Low compliance is a problem. If a patient experiences side effects, he or she often stops the medication. According to health care workers, it is a challenge to inform and teach these clients.

Many clients at both CLSCs are afraid of illness and do not want to participate in prevention programs (e.g. screening for breast cancer). According to interviewed health care workers, some have a low motivation to learn. Pre-natal classes have a high dropout rate. Clients are often not comfortable in a group. It is hard to attract them to information sessions or workshops. However, these are more attractive if offered in their language, with an interpreter. Invitations at large in the community do not work. Medical staff must develop relationships with clients and then invite them to information sessions. Also patients can be approached through their ethnic community.

It is a challenge for health care professionals to teach and validate their teaching when patients face a serious language or cultural barrier, when the patient cannot communicate or when the patient gives little or no feedback. Medical staff are not always aware that hard-to-reach patients are afraid and hesitant to ask questions. In some cases, these patients do not want to bother nurses. They believe that their question might be about something that has already been explained. Interviewed health care workers say that the key is to keep in contact with the patient and develop a strong human relationship. Building trust with hard-to-reach patients is very important, and you gain trust over time.