Health Education

Historical Foundations for Patient Education in Health Care

Patient education has long been considered a major component in the standard of care-giving by the
nurse. Giving education to the patient was the most common intervention associated in the earliest time as
healers didn’t have a lot of effective diagnostic and treatment interventions. Nightingale taught about health
rules as well as health teaching in home.
Phases in the development of organized health care by Dreeben (2010)
1st Phase: The Formative period(mid-1800’s -20th century)
Nursing was first acknowledged as a unique discipline, the responsibility for teaching has been
recognized as an important healthcare initiative assumed by nurses. The focus of teaching efforts by nurses
was not only on the care of the sick, but also on educating other nurses for professional practice.

2nd Phase: (first 4 decades of the 2oth century)

Patient teaching has been recognized as an independent nursing function. In support of maternal and
child health in the US, the Division of Child Hygiene was established. Public nurses provide instruction to
mothers of the newborns on how to keep their infants healthy. The progress of health related practices leads
to education programs in sanitation, immunization, prevention and treatment of infectious, and a growth in
the US public health system. The National League of Nursing Education(NLNE) recognized the responsibility of
nurses for the promotion of health and the prevention of illness in such settings; schools, homes, hospitals,
and industries.
3rd Phase: (after WWII)
The time of significant scientific accomplishments and a profound change in the delivery system of
health care. Patient education continued to occur as part of clinical encounters.
Patient Education and the Hospital- a technical bulletin that identifies the nature and scope of patient
education and provided guidance to all hospital services in patient education.

The Evolution of the Teaching Role of Nurses

Health education has long been considered a standard caregiving role of the nurse. Patient teaching is
recognized as an independent nursing function. Nursing practice has expanded to include education in the
broad concepts of health and illness. Florence Nightingale, the founder of modern nursing developed the first
school of nursing in which she devoted a large portion of her career in educating those involved in the delivery
of health care. She also had emphasized the proper health care of a one’s wellbeing. By the early 1900s, public
health nurses in this country clearly understood the significance of education in the prevention of disease and
in the maintenance of health. Then, patient teaching has been recognized as an independent nursing function.
In 1918, the National League of Nursing Education(NLNE) in the US, recognized the responsibility of
nurses for the promotion of health and the prevention of illness in many. The organization then declared that
a nurse was fundamentally a teacher and an agent of health regardless of the setting in which practice
occurred. The American Nurses Association has for years promulgated statements on the functions, standards,
and qualifications for nursing practice, of which patient teaching is an integral aspect. In addition, the
International Council of Nurses has long endorsed education for health as an essential requisite of nursing care
delivery.
Today, state nurse practice acts (NPAs) universally include teaching within the scope of nursing
practice responsibilities. Nurses are expected to provide instruction to consumers to assist them to maintain
optimal levels of wellness, prevent disease, manage illness, and develop skills to give supportive care to family
members. Nurses are in the forefront of innovative strategies for the delivery of patient care.
Joint Commission on Accreditation of Healthcare Organizations (JCAHO) delineated nursing standards
for patient education as early as 1993. These standards, which take the form of mandates, are based on
descriptions of positive outcomes of patientcare. More recently, JCAHO has expanded its expectations to
include an interdisciplinary team approach in the provision of patient education as well as evidence that
patients and their significant others understand what they have been taught.

Over time, the role of the nurse as educator has undergone a paradigm shift. In patient education, the
provider teaching role has evolved from what once was a disease-oriented approach to a more prevention-
oriented approach. Now and in the future, the focus will be on teaching for the promotion and maintenance
of health.

Social, economic, and political trends affecting health care

In addition to the professional and legal standards put forth by various organizations and agencies,
there has arisen an increasing emphasis on nurses’ potential role in teaching activities as a result of social,
economic, and political trends nationwide affecting the public’s health.
Nurses recognize the need to develop their expertise in teaching to keep pace with the demands of
patient and staff education. In turn, nurses are in a key position to carry out health education. They are the
healthcare providers who have the most continuous contact with patients and families, are usually the most
accessible source of information for the consumer, and are the most highly trusted of all health professionals.
Patient teaching is becoming an increasingly important function within the scope of nursing practice.

Purposes, goals, and benefits of patient and nursing staff/student education

The purpose of patient education is to increase the competence and confidence of clients for self-
management. Our goal is to support patients through the transition from being invalids to being independent
in care; from being dependent recipients to being involved participants in the care process; and from being
passive listeners to active learners. The single most important action of nurses as caregivers is to prepare
patients and their families for self-care.
Patient education has demonstrated its potential to:
• Increase consumer satisfaction
• Improve quality of life
 • Ensure continuity of care
• Decrease patient anxiety
• Effectively reduce the incidence of complications of illness
• Promote adherence to healthcare treatment plans
• Maximize independence in the performance of activities of daily living
• Energize and empower consumers to become actively involved in the planning of their care
In turn, the educator role of nurses enhances their job satisfaction when they recognize that their
teaching actions have the potential to forge therapeutic relationships with patients, allow for greater patient–
nurse autonomy, increase their accountability for practice, and create change that really makes a difference in
the lives of others.
The purpose of staff education is to increase the competence and confidence of nurses to function
independently in providing quality care to the consumer. Nurses play a key role in improving the nation’s
health, and they recognize the importance of lifelong learning to keep their knowledge and skills current
(DeSilets, 1995). Our primary aims, then, as educators should be to nourish clients as well as mentor staff. We
must value education and make it a priority for both our patients and our fellow colleagues.

The education process defined

The education process is a systematic, sequential, planned course of action consisting of two major
interdependent operations, teaching and learning. This process forms a continuous cycle that also involves
two interdependent players, the teacher and the learner. It has always been compared to the nursing process
because the steps of each process run parallel to one another, although they have different goals and
objectives. It’s because education process like the nursing process, consists of the basic elements of
assessment, planning, implementation, and evaluation. The nursing process and the education process are
logical, scientifically-based frameworks for nursing. Both processes provide a rational basis for nursing practice
rather than an intuitive one.
It should be noted that the actual act of teaching is merely one component of the education process.
Education, as the broad umbrella process, includes the acts of teaching and instruction. Teaching is a
deliberate intervention that involves the planning and implementation of instructional activities and
experiences to meet intended learner outcomes according to a teaching plan. Instruction, a term often used
interchangeably with teaching, is one aspect of teaching. It is a component of teaching that involves the
communicating of information about a specific skill in the cognitive, psychomotor, or affective domain.
Teaching and instruction are often formal, structured, organized activities prepared days in advance, but they
can be performed informally on the spur of the moment during conversations or incidental encounters with
the learner. Learning is defined as a change in behavior (knowledge, skills, and attitudes) that can occur at any
time or in any place as a result of exposure to environmental stimuli. Specifically, patient education is a
process of assisting people to learn health-related behaviors (knowledge, skills, attitudes, and values) so that
they can incorporate those behaviors into everyday life. Staff education, by contrast, is the process of
influencing the behavior of nurses by producing changes in their knowledge, attitudes, values, and skills.
A useful paradigm to assist nurses to organize and carry out the education process is the ASSURE
model (Rega, 1993). The acronym stands for:
 • Analyze learner
• State objectives
• Select instructional methods and tools
• Use teaching materials
• Require learner performance
• Evaluate/revise the teaching and learning process.

The contemporary role of the nurses as educator

Having a solid foundation in the principles of teaching and learning is a way for a nurse to fulfill the role
of an educator. It is vital that the nurse educators recognize the theories in nursing and educational
psychology that provide the frameworks to guide them in understanding how and why people change their
health related behaviors.
The role of an educator is not primarily to teach but rather to promote learning and provide for an
environment conducive to learning. A nurse needs great knowledge and skill to carry out the role of educator
with efficiency and effectiveness. Both the educator and the learner should participate in the assessment of
learning needs, the design of teaching plan, the implementation of teaching methods and instructional
materials, and the evaluation of teaching and learning.
Instead of the teacher teaching, the new educational paradigm focuses on the learner learning. That is,
the teacher becomes the guide while/in assisting the learner in his/her effort to determine objectives and
goals for learning, with both parties being active partners in decision making throughout the learning process.

Nursing education transformation

Stuphen, Leonard, and Day completed a study of the national trends causing the nursing shortage and
the increased complexity of demands on nursing practice. These trends have led to a significant gap between
nursing education and practice.
Another transmission movement is the awareness of the importance of the inter-professional
education for the redesign of patient care delivery. The RWJF has focused to build a Culture of Health by
engaging people from diverse fields of expertise who can bring creative and innovative perspectives to solve
many challenges facing the nation’s health care system.

Patient engagement
6 following areas that Berwick outlined in the report Crossing the Quality Chasm. A report called for
urgent and fundamental change to close the quality gap by redesigning the healthcare system in the united
states.
1. Safety- not harming people with acre that is rendered.
2. effectiveness- avoiding overuse of things that do not help and ensuring the use of things that do help.
3. Patient centeredness- people have the control of their won care by making decisions about what affects
them.
4. Timeliness- avoiding delays.
5. Efficiency- avoiding waste by reducing application of test and procedures, etc.
6. Equity- closing the gap in justice as it relates to who receives health care type and extent.
4 goals to support excellence in the delivery of health care;
1. Consumer centered health care
2. Performance
3. Advocacy
4. Leadership

Quality and safety of education in nursing

Quality and safety of education in nursing (QSEN) is a national study funded by RWJF. Its goal is to
address the challenges in preparing nursing students with the knowledge, skills, and attitudes to improve the
safety and quality of healthcare delivery.
3 Phases of QSEN
On the first phase, 6 competencies were developed by the 17 national leaders in nursing education.
The patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement,
informatics, and safety. RWJF funded the second phase that includes the launching of website dedicated to
teaching strategies and resources. Lastly, the third phase has been funded by American Association of Colleges
of Nursing. The goal was to develop the faculty expertise needed to teach the competencies, implement
innovative teaching techniques, incorporate the competencies in textbooks, and assist in the licensure and
accreditation processes.

The institute of medicine report: the future of nursing

2010- Pres. Obama signed into law the Affordable Care Act, a comprehensive healthcare reform
legislation.
2011- the RWJP and the Institute of Medicine partnered to establish recommendations designed to
enhance the role of nurses in the delivery of health care in 20
4 keys messages in response to US Health CARE and 8 recommendations in transforming education
and practice:
1. Nurses should practice to the full extent of their education and training.
-remove scope and practice barriers.
 -implement nurse residency programs.
2. Nurses should achieve higher education and training.
-increase the proportion of nurses with baccalaureate degrees to 80% by 2020.
-double the number of Nurses with doctorate by 2020.
-ensure that nurses engage in lifelong learning.
3. Nurses should be full partners with health professionals in redesigning health care.
-expand opportunities for nurses to lead in collaborative improvement efforts.
-prepare and enable nurses to lead change to advance health.
4. effective workplace planning and policymaking require better data collection.
-build an infrastructure for the collection and analysis of data.

Barriers to teaching and obstacles to learning

The educator should not limit learning to the information that is intended but should clearly make
possible the potential for informal, unintended learning that can occur each and every day with each and
every teacher–learner encounter (Redman, 1975). The barriers confront nurses in carrying out their
responsibilities for educating clients and a variety of obstacles can potentially interfere with learning. Barriers
to education are those factors impeding the nurse’s ability to deliver educational services. Obstacles to
learning are those factors that negatively affect the ability of the learner to attend to and process information.

Factors affecting the ability to teach

Barriers that may interfere with the ability of nurses to carry out their roles as educators;
1. Lack of time to teach is cited by nurses as the greatest barrier to being able to carry out their educator role
effectively.
2. Many nurses and other healthcare personnel are traditionally ill prepared to teach.
3. Personal characteristics of the nurse educator play an important role in determining the outcome of a
teaching–learning interaction.
4. Low priority was often assigned to patient and staff education by administration and supervisory personnel.
Factors affecting the ability to learn
5. the lack of space and privacy in various environmental settings where nurses are expected to teach and
learners are expected to learn is not always conducive to carrying out the teaching–learning process.
6. An absence of third-party reimbursement to support patient education programs relegates teaching and
learning to less than high-priority status.
7. Some nurses and physicians question whether patient education is effective as a means to improve health
outcomes.
8. The type of documentation system used by healthcare agencies has an effect on the quality and quantity of
patient teaching recorded. Inadequate recording of teaching efforts impedes communication among
healthcare providers regarding what has been taught, diminishes the attention paid to the education efforts
by nurses, and raises the very real possibility of legal liability of professionals.

Factors affecting the ability to teach

1. Lack of time to learn due to rapid patient discharge from care can discourage and frustrate the learner,
impeding the ability and willingness to learn.
2. The stress of acute and chronic illness, anxiety, sensory deficits, and low literacy in patients are just a few
problems that can diminish learner motivation and interfere with the process of learning.
3. Low literacy and functional health illiteracy have been found to be significant factors in the ability of clients
to make use of the written and verbal instructions given to them by providers.
4. The negative influence of the hospital environment itself, resulting in loss of control, lack of privacy, and
social isolation, can interfere with a client’s active role in health decision making and involvement in the
teaching–learning process.
5. Personal characteristics of the learner have major effects on the degree to which predetermined behavioral
outcomes are achieved.
6. The extent of behavioral changes needed, both in number and in complexity, can overwhelm learners and
dissuade them from attending to and accomplishing learning objectives and goals.
7. Lack of support and ongoing positive reinforcement from the nurse and significant others serves to block
the potential for learning.
8. Denial of learning needs, resentment of authority, and lack of willingness to take responsibility.
9. The inconvenience, complexity, inaccessibility, fragmentation, and dehumanization of the healthcare
system often result in frustration and abandonment of efforts by the learner to participate in and comply with
the goals and objectives for learning.