My teaching plan for Mr. M would begin with a simple introduction of myself and the purpose of the lesson that I would be teaching him that day. I would use a printed out sheet with pictures rather than many words that help to explain the process for each of his four medications; these highly-visual and easy to follow sheets can be used to explain his medications, how to take them, when to take them, how much to take, and when he should call for help. As Cowan (2004) points out, it is important for patients who have low literacy to still have a way to understand their medication processes in clear and certain terms. These sheets would serve as teaching guides as I move along in the teaching plan for Mr. M. The following steps in the process would
Step 1: Make Sure the Patient Knows Why He is Taking the Medication
Each of Mr. M’s medications should be explained to him so that he knows what it is meant to be treating. The medications should be explained in the context of his recent hospitalization for uncontrolled hypertension and hypercholesterolemia. I would explain to Mr. M. that these medications are to help him control his stress and his cholesterol levels so that he can maintain his health better. The next step would be to explain how each of his medications helps achieve that goal.
Step 2: Review the Medications
· Metoprolol 75mg PO BID—one pill, by mouth, twice a day (recommend taking a pill after main meals, breakfast and dinner)
· Used to treat hypertension and chest pain
· Take twice daily, one pill after eating main meals—either breakfast and dinner or some other combination of meals
· Avoid mixing with alcohol
· Lipitor® 20mg PO QHS—one pill, by mouth, at bedtime
· Used to treat high cholesterol
· Terazosin 2mg PO QHS—one pill, by mouth, at bedtime
· Used to treat hypertension
· Nitroglycerin 0.4mg SL x3 PRN for chest pain—up to 3 pills over a 15 min. period when necessary…call 911 if after three pills in 15 minutes, the pain is not eased.
· Used to treat angina—chest pain
Step 3: Brief the Patient about other Medications
· Make sure the patient knows to contact his physician before mixing other medications with his prescriptions.
It is also important to go over the costs of the medication so that Mr. M. knows that he must set aside “x” amount of dollars for each filling of the prescriptions. Knowing that there is a cost associated with care will help Mr. M. understand the importance of this plan. Try to gauge whether Mr. M. will have problems funding his prescriptions without being too direct or embarrassing the patient. I may say something like, “These medications will be an additional expense for you when the prescription has to be renewed. How will that fit into your finances?” An open-ended question like this will give Mr. M. room to think about it and respond appropriately. If he shows signs of not being sure whether there is room in his budget for them, schedule a follow-up call with Mr. M. with someone from financing.
Step 5: Keep the Medication Someplace Where It Will Not be Forgotten
· In the bathroom near the toothbrush is a good place
· On the window sill over the sink is another
· Or on the nightstand by the bed (for bedtime medications)
· Somewhere where it will be seen throughout the course of the day
It will also be helpful to teach Mr. M about the importance of getting into a habit or routine of taking the medications every day at a set time. Once the routine is established and the habit formed, Mr. M. will automatically take his medications without requiring much effort to think about it. This can be…
References
Cowan, C. F. (2004). Teaching patients with low literacy skills. Fuszard’s innovative teaching strategies in nursing, 278.
Makaryus, A. N., & Friedman, E. A. (2005, August). Patients' understanding of their treatment plans and diagnosis at discharge. In Mayo Clinic Proceedings (Vol. 80, No. 8, pp. 991-994). Elsevier.
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