Historical Foundation

of Health Education/
Patient Education
Facilitated by:
Roberto C. Sombillo RN, PhD
Patient Education

• Patient education has long been considered a major component in the

repertoire of standard care-giving by the nurse.
• The role of the nurse as educator is deeply entrenched in the heritage
and development of the profession.
 • The mid-1800s, was when nursing was first
acknowledged as a unique discipline, the
responsibility for teaching has been
recognized as an important healthcare
initiative assumed by nurses.
Milestones in
• Shift was not only on the care of the sick,
Patient Education: but also on educating other nurses for
professional practice
Recognition of the • Nightingale taught nurses, physicians, and
health officials about the importance of
Nurse as an proper conditions in hospitals and homes
Educator to assist patients in maintaining adequate
nutrition, fresh air, exercise, and personal
hygiene to improve their well-being.
• Nightingale was the ultimate educator
 • Early 1900s, public health nurses
clearly understood the significance of
Milestones in education in the prevention of disease
and in the maintenance of health.
Patient • Patient teaching has been recognized
Education: as an independent nursing function.
• Nurses have always educated others-
patients, families, and colleagues-and it
An Independent is from these roots that nurses have
expanded their practice to include the
Nursing Function broader concepts of health and illness
 • National League for Nursing (NLN)
observed the importance of
health teaching as a function

Nurse as within the scope of nursing

practice.

Teacher
• Two decades later, the NLNE
declared that a nurse was
fundamentally a teacher and an
agent of health regardless of the
setting in which practice occurred
Milestones in • By 1950, the NLNE had identified
course content dealing with teaching
Patient Education: skills, developmental and educational
psychology, and principles of the
Integration of educational process of teaching and
learning as areas in the curriculum
teaching and common to all nursing schools
learning principles in
nursing curriculum
Implications
• 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.
• Thus, curricular programs must
prepare nurses to teach
 • Nursing career ladders often incorporate
teaching effectiveness as a measure of
excellence in practice.
• The teaching of patients and families as well
Implications as healthcare personnel is the means to
accomplish the professional goals of
providing cost-effective, safe, and high-
quality care. In recognition of the
importance of patient education by nurses
Milestones in
• By 1933, Joint Commission on
Patient Accreditation of Healthcare
Education: Organizations (JCAHO) delineated
nursing standards for patient
education.
Delineation of
Standards
 • The form of mandates from the JCAHO, are
based on descriptions of positive outcomes of
patient care.
Standards
• They are to be met through teaching activities by
nurses that must be patient and family-oriented.
• Required accreditation standards have provided
the impetus for nursing service managers to put
greater emphasis on unit-based clinical
education activities for staff to improve nursing
interventions relating to patient education for
the achievement of these client outcomes
Standards

JCAHO 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.

It must consider the literacy level, educational background, language skills, and
culture of every client during the education process
Milestones • By 1970s the American Hospital Association
in Patient and adopted by hospitals nationwide, has
established the rights of patients to receive
Education: complete and current information
concerning diagnosis, treatment, and
prognosis in terms they can reasonably be
Patient expected to understand.
Education as
a Right
 • In 1995, the Pew Health Professions
Milestone in Commission, influenced by the
Patient Education: dramatic changes currently
surrounding health care, published a
broad set of competencies that it
Competencies in believes will mark the success of the
health professions in the twenty-first
Patient Education century
Recommendations

• More than one half of them pertain to the importance of patient and staff
education and to the role of the nurse as educator. These are:
a. Provide clinically competent and coordinated care to the public
b. Involve patients and their families in the decision-making process regarding
health interventions
c. Provide clients with education and counseling on ethical issues
d. Expand public access to effective care
e. Ensure cost-effective and appropriate care for the consumer
f. Provide for prevention of illness and promotion of healthy lifestyles for all
Americans
 • Teaching role has evolved from what once was a
disease-oriented approach to a more prevention-
Paradigm oriented approach.
• Now and in the future, the focus will be on
Shift teaching for the promotion and maintenance of
health.
Milestones in
• In 1980s, greater recognition has been given
Patient to client education as a healthcare activity.
Education: Once done as part of discharge plans at the
end of hospitalization, patient education
efforts have expanded to become integrated
Integration into into a comprehensive plan of care that
occurs throughout the healthcare delivery
comprehensive process
a plan of care
 DOPE • This transition toward wellness
has entailed a progression “from
to POPE disease- oriented patient
education (DOPE) to prevention-

to
oriented patient education (POPE)
to ultimately become health-
oriented patient education

HOPE (HOPE)”
 • This metamorphosis has changed the
role of educator from one of wise
healer to expert advisor/teacher to
Evolution of facilitator of change.
• Instead of the traditional aim of simply
the Role imparting information, the emphasis is
now on empowering patients to use
their potentials, abilities, and resources
to the fullest
Present Role • The role of today’s educator is one of “training
the trainer”—that is, preparing nursing staff
through continuing education, in-service
programs, and staff development to maintain
and improve their clinical skills and teaching
abilities
Validation Check
The role of the
nurse from
taking care of • A. True
the sick has • B. False
evolved into • C. Neither A or B
teaching other • D. None of the above
nurses. This
statement is:
Nightingale as
• A. Importance of proper
the ultimate conditions in hospitals and homes
educator have • B. To assist patients in maintaining
taught adequate nutrition, fresh air,
exercise
professionals
• C. Perform personal hygiene to
on the improve their well-being
following • D. Positioning of patients
except:
 A. Dependent B. Independent
Patient
Education is a
function of the
nurse that is: C. Interdependent
D. None of the
Above
As the role of the nurse • A. teaching skills
evolves, as early as • B. developmental and educational
1950, the following are psychology
included in the • C. principles of the educational process
curricular offering of of teaching and learning
the the nursing
• D. All of the above
program
The nurse when providing patient education must
ensure to be guided by the standards of care. The
following are the standards in patient education except:

A. description of
B. teaching activities
outcomes

C. interdisciplinary D. Comfort of
team approach patient
The paradigm shift in patient education was
noted from:

• A. disease- oriented patient education (DOPE) to prevention-oriented

• B. patient education (POPE) to ultimately become health-oriented patient
education (HOPE)
• C. A and B
• D. B only
 The
contemporary
• A. True
role of the nurse • B. False
in patient • C. Neither A or B
education is a • D. Either A or B
trainer of the
other nurses
Evolution of the Role of
the Nurse as Educator
Requirement
to fulfill the • For nurses to fulfill the role of educator, no
Role: matter whether their audience consists of
patients, family members, nursing students,
nursing staff, or other agency personnel,
Solid they must have a solid foundation in the
principles of teaching and learning.
Foundation in
Teaching and
Learning
 • Teaching is a function involving complex
concepts (Knowles et al., 1998)
Challenges of • Special Training: Teaching requires special
the Role training in instructional skills if education
programs conducted by nurses are to be
successful
• Educational Preparation: It is unreasonable to
expect every nurse to take responsibility for
teaching patients when the majority of nursing
practitioners have had only a basic nursing
education background from diploma or
associate’s degree–level programs
 • Learning Requirement and
Difficulties: Patients, by virtue of
their illnesses, may have special
Challenges learning difficulties that require
teaching interventions to be
carried out by nurses who are well
grounded in the principles of
teaching and learning.
 • Make teaching the sole responsibility of, at
minimum, baccalaureate-degree graduates.
• The educator role should be delegated to
Solution: master’s- prepared nurses—particularly the
advanced practice nurses such as clinical
nurse specialists and nurse practitioners—
Distinction of who have both the interest and the
knowledge base to make them expert
the Role patient and staff educators
• Distinction of patient teaching and patient
education
Solution

• Patient Teaching “implies a didactic information giving approach,”

whereas patient education “implies something more comprehensive, for
which specialist skills are required”.
• To ensure that patient education programs are clinically accurate and
educationally sound, it advocated that nurses with minimal basic
education be excluded from the education process
 • Legal and Accreditation mandates
as well as professional nursing
standards of practice have made
patient education an integral part
Other of high-quality care to be delivered
Developments by all registered nurses
 • The role of educator is not primarily to
teach, but to promote learning and
provide for an environment conducive
to learning—to create the teachable
moment rather than just waiting for it
to happen.

Emergent Role • The role of the nurse as teacher of

patients and families, nursing staff, and
students certainly should stem from a
partnership philosophy. The provision
of information to the learner, whoever
that learner may be, should stress the
fact that teaching and learning are
participatory processes.
Role of the Nurse • The nurse should act as a facilitator, creating
an environment conducive to learning—one
that motivates individuals to want to learn
and makes it possible for them to learn.
• The assessment of learning needs, the
planning and designing of a teaching
program, the implementation of instructional
methods and materials, and the evaluation of
teaching and learning should involve both the
educator and the learner
 • The emphasis should be on the
facilitation of learning from a
Role of nondirective rather than a didactic
teaching approach

the • Role alteration requires skill in

needs assessment as well as the
ability to involve learners in
Nurse planning, link learners to learning
resources, and encourage learner
initiative
 • Instead of the teacher teaching, the new
educational paradigm focuses on the learner
learning.
Role of the • That is, the teacher becomes “the guide on the
side,” assisting the learner in his or her effort to
Nurse determine objectives and goals for learning,
with both parties being active partners in
decision making throughout the learning
process
 • Patient education requires a collaborative effort
among healthcare team members, all of whom
play more or less important roles in teaching.
• The respect and trust traditionally bestowed on
them by healthcare consumers provides
opportunity for nurses to position themselves as
Role of the client advocates, clarifying confusing information
and making “sense out of nonsense.”

Nurse • Amidst a fragmented healthcare delivery system

involving many providers, the nurse also needs to
serve as coordinator of teaching efforts.
• By ensuring consistency of information, nurses can
support the patients and family members in their
efforts to achieve the goal of optimal health.
Validation Check
The evolution of
the role of the
• A. teaching requires special training
nurse as patient
• B. educational preparation of the nurses are
educator has varied
been based on • C. legal and accreditation mandates
challenges. • D. partnership philosophy
Among these
are except:
The following
are the roles
of the nurse
• A. Facilitator
• B. Patient Advocate

in patient • C. Counsellor
• D. Process Designer

education
except:
As the evolution of
the role of the nurse
in patient education • A. ability to transmit content or information
• B. ability to plan learning content and resources
becomes critical, the • C. determine objectives and goals
following are crucial • D. decision maker in patient education session
role alteration of the
nurse except:
Accreditation A. Outcomes
standards in
patient care
involves the B. Activities
following
consideration C. Collaboration
in patient
education
except: D. Patient Preference
Thank you!
Questions?