Educational Approach
Despite HZ being common, many patients do not understand their risk, complications, treatments, or prevention. Often, patients are amazed to learn that they can get HZ even if they had it previously or have received the Zostavax vaccine. NPs have an obligation to educate their patients, debunk any myths, and provide informational resources as part of the treatment plan. Patients report higher patient satisfaction when they have discussed health education and treatment plans with their medical provider. It is prudent to first assess what your patient already knows about HZ and the accuracy of the patient's preexisting knowledge. Older adults may use the Internet to seek health information, yet they still rely on friends' or family members' experiences with HZ. In the case example, Mr. E's wife reported having HZ twice, although her rash was neither in the same location nor as large in size either time. Lanacane cream was effective to relieve her pain; thus, Mr. E had tried that treatment. However, it did not yield any pain relief, so he sought his medical provider's expertise. Mr. E also had misinformation regarding the epidemiology of HZ. Listening carefully to patient's or their family's comments will provide clues about misinformation that needs to be corrected.
Realistically, it is impossible to cover all information about HZ within the brief clinic time of 10 to 15 minutes with the patient. We suggest tailoring educational content by phases of patients' needs and discussing only that educational content that is most relevant to the patient at each visit. The initial sick clinic visit or acute care phase of educational content should cover what is shingles; risk factors; symptoms; and progression of lesions, treatment options, and self-care. The second visit should include complications (eg, PHN, duration of PHN, and treatment options). The third visit should include prevention such as Zostavax benefits and risks. This phasing strategy will maximize adult learning principles because patients are more motivated to learn in real-life context. From personal experiences, patients often call after they return home because they have forgotten what you discussed with them in the clinic. They will remember more information if given the handout at the time you discuss those pertinent care points and briefly read it together. People only retain 10% of auditory information but retention increases to 30% to 40% when using both auditory and visual senses. Provide your patient a handout, preferably printed on colored paper with contrasting color print in large font so it is easy to read. This information will serve as a reminder of the important care points. Patients appreciate that you hand tangible information directly to them because it serves as a symbolic reassurance that "your concern [for them] goes beyond the clinic door," as 1 patient remarked. Some NPs even sign a short note or draw a symbol like a flower or smile to personalize the handout. NPs can find patient handouts from the Web sites listed later.