Developing a Health Education Plan for Mrs. Gamble on Warfarin Therapy

This assignment focuses on formulating a safe and suitable health education plan for Mrs. Gamble who is on warfarin therapy. It discusses her knowledge deficits, aids and barriers to learning, goals and learning objectives, teaching aids and preparation of the environment, breakdown of content and sequence of delivery, and critical appraisal of educative materials.

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NURSING ASSIGNMENT

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Nursing assignment
Introduction
This assignment is done to formulate a safe and suitable health education plan for Mrs. Gamble
who is on warfarin therapy. Development of a health education plan is a sequential process
which begins by understanding the knowledge deficits of the learner who is Mrs. Gamble in the
given case study. Next, aids and barriers in her learning are identified to understand her strengths
and weaknesses. Further, goals and learning objectives are defined for Mrs. Gamble. The
assignment will also outline the teaching aids that can be used along with the content of the
educative material in logical order. Lastly, two educative materials are critically appraised in
order to find out the best suited for Mrs. Gamble’s learning needs.
Mrs. Gamble’s knowledge deficit
1. Warfarin prescription
Mrs. Gamble is unaware of the reasons for which she has been prescribed warfarin. Her
knowledge of the drug and its prescription for her is deficient.
2. Warfarin administration
Mrs. Gamble demonstrated a knowledge deficit of warfarin usage. Warfarin therapy is provided
by giving the lowest optimal dose of warfarin to maintain the desired international normalized
ratio (INR). Mrs. Gamble was confused in picking the correct dose of warfarin from her three
bottles of 1mg, 2mg and 5mg Coumadin tablets. It is a cause of concern as taking lesser or more
strengths of warfarin than required to maintain the target INR can result in severe complications
of formation of clots or risk of bleeding, respectively (The Nurse Practitioner, 2009).
3. Diet regimen with warfarin
Maintaining diet regime with warfarin is essential as certain foods interact with the drug and can
interfere with the treatment and dose. Mrs. Gamble only remembers that she was instructed to
not eat green leafy vegetables and broccoli but she does not know or remember the reason behind
this. Green leafy vegetables have high content of Vitamin K which is used by the body to assist
in clotting (American Heart Association, 2016).

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Nursing assignment
Aids and Barriers to Mrs. Gamble’s learning
Various barriers to Mr. Gamble’s learning are:
 Old age- Mrs. Gamble is 78 years old, it becomes difficult to learn new things at this age.
 Cognitive impairments- In case study, it is demonstrated that she is experiencing
cognitive impairments as she is unable to remember or recall.
 Poor education level-She only had basic education
 Information overload for patients- Warfarin is a challenging drug to manage and at times
it may get difficult for patients to understand all the information, considering she has
preposterous medical history.
Various aids to Mr. Gamble’s learning are:
 She is eager to know more about the drug
 A supportive son who can help in the learning process
Goals of the teaching-learning process for Mrs. Gamble
Goal of the teaching-learning process for Mrs. Gamble is to remove the three identified
knowledge deficits in her case that are, warfarin prescription, warfarin, administration and diet
regimen with warfarin so that her warfarin therapy is maintained adequately.
The rationale behind this goal is that various studies have found that patient information and
education is one of the significant contributing factors in effective warfarin therapy. Elderly
people and their carers approve warfarin therapy but adequate information provision is essential
for long-term management of warfarin (Bajorek, Ogle, Duguid, Shenfield, & Krass, 2009).
Patient education has been identified as a vital element of medication safety, as it will improve
Mrs. Gamble’s knowledge of her disease and how to manage her warfarin therapy (Bajorek,
2011).
Learning objectives for Mrs. Gamble

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Nursing assignment
By the end of the health education teaching, Mrs. Gamble will be able to recall the warfarin
prescription, administration and the required diet regime.
By the end of the health education teaching, Mrs. Gamble will be able to interpret the significance of
warfarin therapy to accomplish effective health outcomes for her.
By the end of the health education teaching, Mrs. Gamble will be able to calculate and use
accurate doses of warfarin as prescribed to her based on her target INR range.
By the end of the health education teaching, Mrs. Gamble will be able to determine and choose
suitable lifestyle for her, in context of warfarin therapy, that is limited intake of Vitamin K high
food and alcohol.
By the end of the health education teaching, Mrs. Gamble will be able to modify her warfarin
doses based on her blood reports (however, it will be preferred that the appointed health
professional performs the dose titration as Mrs. Gamble experiences cognitive deficits.) (Garcia-
Alamino, et al., 2010)
Teaching aids and preparation of the environment
It is essential to educate the patients on anticoagulation therapy in the right manner in order to
prevent complications related to the drug therapy (Tideman, Tirimacco, John, & Roberts, 2015).
The conventional method of delivering patient education on warfarin therapy has on an
individual basis. But the approach can be affected by the time constraint and repetitive nature.
Various kind of educative material such as narrative or statistical have been used for patient
education. Each material come with their own strengths and limitations. Mrs. Gamble can also
benefit from periodic educational sessions strengthening fundamental medication safety
information, after early education and ongoing evaluation.
After recognizing the knowledge deficits of Mrs. Gamble, a range of structured and
interventional teaching aids regarding warfarin therapy can be used in her case:
Individual face-to-face patient education session is the frequently used strategy adopted by the
health professional to deliver knowledge about warfarin. This method can also be useful in Mrs.
Gamble’s case as it will be convenient for her, easy to deliver for health professional and it will

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Nursing assignment
allow the professional to focus on Mrs. Gamble’s individual requirements, deficits and
preferences.
In a hospital or care home or in any other settings where a group can be formulated, group-based
warfarin education session is also a way teaching about warfarin therapy. The health professional
can prepare for patient education by being prepared with a recorded information in the form of
audio or video. This aid is beneficial for the health professional in terms of saving time, at the
same time it is beneficial for Mrs. Gamble as well as she can make use of peer support and learn
about alternative aspects of her therapy from her peers.
Another commonly used teaching aid about warfarin therapy is the written information, either in
printed format or through the internet. However, due to old age Mrs. Gamble find difficulty in
reading, understanding or find the interest in reading the written material. In addition, studies
have also found that health professionals as well patients find the existing written materials as
suboptimal with regards to content about day-to-day warfarin management issues (Bajorek,
Ogle, Duguid, Shenfield, & Krass, 2009). Therefore, a more comprehensive and more usable
written information can be developed for Mrs. Gamble education. Preparation can be done by
designing specifically, written materials which will include suitable figures, pictograms, bigger
font size, and other formatting features that can increase the clarity of the written materials for
Mrs. Gamble. Alternatively, cue cards which have short but significant sections of information
can also be used to teach Mrs. Gamble.
Another teaching aid can be the audiovisual media. These AV media usually depict health
professional in a dialogue with the patient regarding their warfarin therapy. Apart from relieving
the health professionals from repeating the same information and investing time in educative
sessions, this teaching aid is also beneficial for patients as well. Mrs. Gamble can get adequate
time to process the information during these education sessions. In addition, the audiovisual aid
can be repeated at her convenience.
Breakdown of content and sequence of delivery
A range of aspects are essential in while educating Mrs., Gamble such as quality information,
graphics and illustrations relevant to warfarin therapy, logical sequence of content, balanced and

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Nursing assignment
unbiased information and many more. Some of the challenging content areas of warfarin
education are identified in literature which will be focused particularly in Mrs. Gamble’s
education plan. These areas include dietary interactions, evaluation and management of INR,
possible drug interactions, risks related to warfarin therapy, and the dose and administration of
warfarin therapy (Nasser, Mullan, & Bajorek, 2012). Another study established the effectiveness
of structured warfarin patient education programme as opposed to unstructured programme, in
terms of patient’s knowledge and satisfaction levels, occurrence of complications of warfarin
therapy. Therefore, a structured education plan will be developed for Mrs. Gamble to achieve
removal of Mrs. Gamble’s knowledge deficit and gain safe and effective warfarin therapy.
An effective warfarin education program will minimally include a range of fundamental aspects
which will target Mrs. Gamble’s knowledge and understanding regarding warfarin therapy.
Determination and inclusion of the information about warfarin in the patient education programs
must be done by the health care professional giving the education based on patient’s needs.
The content of education plan in order will be:
 Name of the drug
 Description of INR, required target range for atrial fibrillation and regular testing
 Mechanism of action of warfarin in a lay language that Mrs. Gamble’s understands
 Cause of treatment as she doesn’t seem to remember why was she still taking warfarin
 Adherence (Mrs. Gamble’s will be instructed to continue to maintain diary for noting
down INRs and doses)
 Adverse events- Mrs. Gamble will be familiarized with the possible complications of
taking warfarin so that if those complications develop, she can recognize them initially.
 Warfarin interactions with other drugs such as NSAIDs, laxatives, etc.
 Warfarin interactions with foods, with special focus on Vitamin K, and the significance
of consistency in conext to Vitamin K rich foods in the diet, instead of avoiding them
completely in the diet.
 Lifestyle behavioral adjustments such as restricted alcohol intake, avoiding high risk
activities related to the likelihood of physical trauma

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Nursing assignment
 Importance of good adherence so that she puts efforts in adhering to the prescribed
medicine and lifestyle regime.
 Managing emergency scenarios like missed or underdoses/overdoses
 Recognizing signs of bleeding complications.
 Suitable action Mrs. Gamble must take in case of adverse events
 Whom to call in case of adverse events
 Instructions regarding the importance of carrying identification such as medical alert
bracelet or necklace.
Critical appraisal
Joanna Briggs Institute Critical Appraisal tools is used to appraise both the materials:
First educational material on warfarin therapy is titled “Patient education: Warfarin (Coumadin)
(Beyond the Basics)” (Hull, Garcia, & Vazquez, 2018)
Source- The sources of the opinion are clearly identifiable along with their credentials.
Source expertise- The author as well as the editors of the opinion are specialized in the field of
healthcare as per their qualifications.
Central focus- Central focus of the opinion is the education of patient about warfarin therapy.
Logic in opinion- The opinion is expressed in a logical and coherent manner.
Reference- Reference to the extant literature is provided in the text however, majority of them
are old which can be considered as a weakness of the text.
Second educational material on warfarin therapy is a journal article titled “Challenges of Older
Patients’ Knowledge About Warfarin Therapy” (Nasser, Mullan, & Bajorek, 2011).
Review question- The review question of the article indeed provided an vague understanding of
what the article deals with but it could not specify the nature of the challenges which were
patient knowledge, access to warfarin education, and education resources.
Inclusion criteria- The inclusion criteria were appropriate for the review question.

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Nursing assignment
Search strategy- The search strategy was comprehensive. Logical and relevant keywords and
terms along with MeSH headings were used in the search. 20 year date limit was set which is
justified as majority of the pivotal studies concerning the research question were conducted
during this period. Other limits were English language, studies involving human subjects,
patients aged 65 years or older, and original articles and review papers.
Sources and resources- Sources and resources utilized to search for studies were adequate.
Multiple electronic databases were searched.
Critical appraisal- Research pharmacist principally conducted the literature search, data
extraction, and evaluation but, the review procedure was confirmed by two researchers to
conform the reliability and accuracy of the search procedure.
Specific directives for future research are mentioned.
First material will be most suitable for Mrs. Gamble as it is concise and delivers most of the
information that she is required to know. It has specific sections for all the aspects of Warfarin
therapy management and Mrs. Gamble can conveniently refer to these based on her needs.
Conclusion
An appropriate educative plan is developed for Mrs. Gamble considering her knowledge needs
and aids and barriers to learning. By following this plan, Mrs. Gamble will be able to manage her
Warfarin therapy in a better way and gain improved health outcomes for herself.
References
American Heart Association. (2016). A Patient's Guide to Taking Warfarin. Dallas: AHA.
Retrieved April 19, 2019, from
https://www.heart.org/en/health-topics/arrhythmia/prevention--treatment-of-arrhythmia/
a-patients-guide-to-taking-warfarin
Bajorek. (2011). A review of the safety of anticoagulants in older people using the medicines
management pathway: weighing the benefits against the risks. Ther Adv Drug Saf, 2, 45-
58.

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Bajorek, B. V., Ogle, S. J., Duguid, M. J., Shenfield, G. M., & Krass, I. (2009). Balancing risk
versus benefit: the elderly patient’s perspective on warfarin therapy. Pharm Pract
(Granada), 7(2), 113-123.
Garcia-Alamino, Ward, Alonso-Coello, Perera, Bankhead, & Fitzmaurice. (2010). Self-
monitoring and self-management of oral anticoagulation. Cochrane Database Syst Rev, 4.
Hull, R. D., Garcia, D. A., & Vazquez, S. R. (2018, February 9). Patient education: Warfarin
(Coumadin) (Beyond the Basics). Retrieved from
https://www.uptodate.com/contents/warfarin-coumadin-beyond-the-basics
Nasser, S., Mullan, J., & Bajorek, B. (2011). Journal of Primary Care & Community Health.
Journal of Primary Care & Community Health, 3(1), 65-74.
Nasser, S., Mullan, J., & Bajorek, B. (2012). Educating patients about warfarin therapy using
information technology: A survey on healthcare professionals’ perspectives. Pharm
Pract (Granada), 10(2), 97-104.
The Nurse Practitioner. (2009). Guide to Care for Patients: Warfarin Therapy. The American
Journal of Primary Healthcare, 34(3), 49-50.
Tideman, P. A., Tirimacco, R., John, A. S., & Roberts, G. W. (2015). How to manage warfarin
therapy. Aust Prescr, 38(2), 44-48.