CHAPTER 1: EDUCATION IN HEALTH - American Public Health Association

CARE formed the Committee on

Educational Tasks in Chronic Illness
HISTORICAL FOUNDATIONS FOR in 1968
PATIENT EDUCATION IN HEALTH CARE • Developed a model that defined
- Patient education has long been a the educational processes
common intervention used in health necessary for patient and family
care. education
- It has THREE PHASES - President Nixon and the concept of
FIRST PHASE patient education
- Mid-1800s to the turn of the 20th - U.S. Department of Health,
century Education, and Welfare
- Emergence of nursing and other - American Hospital Association’s
health professions Statement on a Patient’s Bill of
- Technological developments Rights
- Spread of communicable diseases • Outlines patients’ rights to receive
- Growing interest in the welfare of current information about their
mothers and children diagnosis, treatment, and prognosis
- Florence Nightingale’s Health • Guarantees a patient’s right to
Teaching in Towns and Villages respectful and considerate car
SECOND PHASE - The Joint Commission’s
- First four decades of the 20th Accreditation Manual for Hospitals
century • Broadened the scope of patient
- Division of Child Hygiene education and specified that criteria
established for patient education be established
- Diagnostic tools, scientific - – Healthy People 2000, Healthy
discoveries, new vaccines and People 2010, and Health People
antibiotic medications, and effective 2020 established educational and
surgery and treatment practices community-based programs.
- National League of Nursing - Pew Health Professions
Education (NLNE) recognized that Commission
public health nurses were essential • Published a broad set of
THIRD PHASE competencies for the 21st century
- Began after World War II • Many competencies focus on the
- Significant scientific teaching role of health professional
accomplishments • Role of the nurse as educator has
- Profound changes in health care evolved from a disease-oriented
delivery approach to a more prevention-
- Mid-1960s, health care became a oriented approach
right and not a privilege for all • Emphasis now on empowering
Americans patients to use their potentials,
- Titles XVIII and XIX of the Social abilities, and resources to the fullest
Security Act and the creation of
Medicare and Medicaid
 THE EVOLUTION OF THE – Federal government and Healthy People
TEACHING ROLE OF NURSES 2020
- In nursing, patient education – Recommendations from the Institute of
has long been a major Medicine
component. – The Affordable Care Act (ACA)
• Florence Nightingale, the – Growth of managed care
ultimate educator – Emphasis on public education for disease
• National League of Nursing prevention and health promotion
Education (NLNE), now the – Importance of health education to reduce
National League for Nursing the high costs of health services
(NLN) – Concern for continuing education as
– Observed in 1918 that vehicle to prevent malpractice and
health teaching is an incompetence
important function within the – Expanding scope and depth of nurses’
scope of nursing practice practice responsibilities
• American Nurses – Consumers demanding more knowledge
Association (ANA) and skills for self-care
– Responsible for – Increasing number of self-help groups
establishing standards and – Demographic trends influencing type and
qualifications for practice, amount of health care needed
including patient teaching – Incidents of medical harm
• International Council of – Increased prevalence of chronic
Nurses (ICN) conditions
– Endorses health education – Impacts of advanced technology
as an essential component of – Health literacy increasingly required
nursing care delivery – Research findings that client education
• State Nurse Practice Acts improves compliance
– Universally include – Advocacy for self-help groups
teaching within the scope of – Increased use of online technologies
nursing practice – Screenings occasioned by advances in
– Nursing career ladders genetics and genomic
often incorporate teaching PURPOSE, GOALS, AND BENEFITS OF
effectiveness as a measure CLIENT AND STAFF EDUCATION
of excellence in practice. • Purpose: to increase the competence and
• Professional nurses are confidence of clients for self-management
responsible for: • Primary goal: to increase the responsibility
– Educating colleagues and independence of clients for self-care
– Serving as a clinical • Benefits of education to clients:
instructor for students in the – Increases consumer satisfaction
practice setting – Improves quality of life
SOCIAL, ECONOMIC, AND POLITICAL – Ensures continuity of care
TRENDS AFFECTING HEALTHCARE – Decreases client anxiety
• Significant forces influencing nursing – Reduces complications of illness and
practice: incidences of disease
 – Promotes adherence to treatment plans – Evaluate/revise the teaching plan
– Maximizes independence
– Empowers consumers to become involved THE CONTEMPORARY ROLE OF THE
in planning their own care NURSE AS EDUCATOR
• Benefits of education to staff: • Nurses act in the role of educator for a
– Enhances job satisfaction diverse audience of learners—patients and
– Improves therapeutic relationships their family members, nursing students,
– Enhances patient-nurse autonomy nursing staff, and other agency personnel.
– Increases accountability in practice • Despite the varied levels of basic nursing
– Provides opportunity to create change that school preparation, legal and accreditation
matter mandates have made the educator role
THE EDUCATION PROCESS DEFINED integral to all nurses
• Education Process: a systematic, • The new educational paradigm focuses on
sequential, planned course of action on the the learner learning
part of both the teacher and learner to – Instead of the teacher teaching
achieve the outcomes of teaching and – The nurse becomes the“guide on the
learning side”
• Teaching/Instruction: a deliberate • Nursing education transformation
intervention that involves sharing – Gap between nursing education and
information and experiences to meet the practice
intended learner outcomes • Patient engagement
• Learning: a change in behavior – Nursing Alliance for Quality Care
(knowledge, attitudes, and/or skills) that can (NAQC) goals: Consumer-centered health
be observed or measured, and that can care, performance measurement and public
occur at any time or in any place as a result reporting, advocacy, and leadership
of exposure to environmental stimuli • Quality and safety education in nursing
• Patient Education: the process of helping – Robert Wood Johnson Foundation
clients learn health-related behaviors to (RWJF) Quality and Safety Education in
achieve the goal of optimal health and Nursing (QSEN) competencies:
independence in self-care • Patient-centered care
• Staff Education: the process of helping • Teamwork and collaboration
nurses acquire knowledge, attitudes, and • Evidence-based practice
skills to improve the delivery of quality care • Quality improvement
to the consume • Informatics
ASSURE MODEL • Safety
• A useful paradigm to assist nurses to
organize and carry out the education • Institute of Medicine report: The future of
process nursing
– Analyze the learner – Written in response to the Affordable Care
– State the objectives Act
– Select instructional methods and – Describes the role of nursing in a
materials transformed healthcare system
– Use instructional methods and materials
– Require learner performance
• Institute of Medicine (cont’d) – Low literacy and functional health illiteracy
– The Future of Nursing recommendations: – Negative influence of hospital
• Remove scope of practice barriers. environment
• Expand opportunities for nurses to lead in – Variations in readiness to learn,
collaborative efforts. motivation and compliance, and learning
• Implement nurse residency programs. style
• Increase proportion of nurses with – Extent of behavioral changes (in number
baccalaureate degrees to 80% by 2020. • and complexity) required
Double number of nurses with a doctorate – Lack of support and positive
by 2020 reinforcement from providers and/or
• Ensure that nurses engage in lifelong significant others
learning. – Denial of learning needs, resentment of
• Prepare and enable nurses to lead change authority, and locus of control issues
to advance health. – Inconvenience, complexity, inaccessibility,
• Build infrastructure for the collection and fragmentation, and dehumanization of the
analysis of data healthcare system

BARRIERS TO TEACHING AND

OBSTACLE TO LEARNING
• Barriers to teaching are those factors
impeding the nurse’s ability to deliver
educational services.
• Obstacles to learning are those factors
that negatively impact the learner’s ability to
pay attention and process information.
• Factors affecting the ability to teach:
– Lack of time to teach
– Inadequate preparation of nurses to
assume the role of educator with confidence
and competence
– Personal characteristics
– Low-priority status given to teaching
– Environments not conducive to the
teaching–learning process
– Absence of third-party reimbursement
– Doubt that patient education effectively
changes outcomes
– Inadequate documentation system to
allow for efficiency and ease of recording
the quality and quantity of teaching effort
– Limited time due to rapid discharge from
care
– Stress of acute and chronic illness,
anxiety, sensory deficits, and low literacy