DICHOSO, JOSHUA C.

HE (W 9:00 - 12:00)

1BSN-3

CHAPTER 1

HISTORICAL FOUNDATIONS FOR PATIENT EDUCATION IN HEALTH CARE

“Patient education has been a part of health care since the first healer gave the
first patient advice about treating his/her ailments (May, 1999, p3). Although the term
patient education was not specifically used, considerable efforts by the earliest
healers to inform, encourage, and caution patients to follow appropriate hygienic
and therapeutic measures occurred even prehistoric times (Barlett, 1986).

The early healers’, physicians, herbalist, midwives, and shamans did not have a
lot of effective diagnostic and treatment interventions, it is likely that education,
was in fact one of the most common interventions.

Dreeben (2010) the first phase from mid-1800 through the turn of 20th century
described as the formative period and the first phase in the development of organized
health care.

 Emergence of nursing and other professions

 Technological developments
 Patient-caregiver relationship

Florence Nightingale
 emerge as a resolute advocate of the educational responsibilities of district public
health nurses
 Health Teachings in Towns and Villages

The second phase in the development of organized health care, 1907, nurses
provided instructions to the mothers of newborn babies on how they are going to
keep their infants healthy. They also improved their diagnostic tools, scientific
discoveries, new vaccines, antibiotic medications, and effective surgery and
treatment practice led to education programs in sanitation, immunization,
prevention and treatment of infectious diseases.

The National League of Nursing Education (NLNE) recognized public health nurses
were essential to the well-being of communities and the teaching they provided to
individuals, families, groups was considered “a precursor to modern patient and
health education”.

Third phase in the development of organized health care began after WWII. From
the late 1940s-1950s, is described as the time where health teaching become more
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technological orientation of health care. In the 1960s to 1970s, the focus now is to
educate individuals than providing general public health education. In the
1980s and 1990s, the focus now of health education is about on disease prevention
and health promotion. Simply, the education progression was from "disease-
oriented patient education" (DOPE) to "prevention-oriented patient education"
(POPE) to ultimately become "health-oriented patient education" (HOPE)

THE EVOLUTION OF THE TEACHING ROLE OF NURSES

For decades that has passed, patient teaching has been recognized as an
independent nursing function. From mid-1800s when nursing was fully acknowledged as
a unique discipline, the responsibility and the role of health teaching has been
recognized Florence Nightingale emphasized the importance of teaching patients for
adequate nutrition, fresh air, exercise and personal hygiene to improve their well-being.
In early 1900s, the public health nurses of US clearly understood the importance of the
role of nurse as a teacher in preventing diseases and maintaining the health of society.

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-
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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

There are many forces that influenced nursing practice. From health care providers,
health professionals, consumers, politicians, different fields, the use of online
technologies in nursing education, current trends. Nurses recognized that they need to
develop continuously their expertise so they can get on the pace of demands of patient,
staff and student education.

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. Increase consumers’ satisfaction
Improve quality of life
Ensure continuity of care
Decrease patient anxiety
Promote adherence in 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

Nurses play a key role in improving the nation's health. In turn, the benifit for nurses is
the satisfaction in their part, and to know that they have the opportunity to make change
in the lives of others. The primary goal of nurse educators is to nourish their clients,
mentor staff, clinical instructors for nursing students. As the ancient Chinese proverb,
"provide a man a fish and he may eat for a day. Teach a man to fish and he may eat for
a lifetime".

THE EDUCATION PROCESS DEFINED

Education process is a systematic, sequential, logical, scientifically based, plannes

course of action consisting of two major interdependent operations: teaching and
learning. Education process is like nursing process. They both consist of basic
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elements such as assessment, planning, implementation, evaluation. Learning is
defined as change in behavior (knowledge, attitude, and skills) that can be observed or
measured and that occurs in any time or any place resulting from exposure to
environmental stimuli. Patient education is a process of assisting people to learn
health related behaviors that they can incorporate into everyday life with the goal of
achieving of optimal health and independence in self-care. The Staff education is the
process of influencing the behavior of nurses by producing in their knowledge, attitudes
and skills to help them improve and maintain competencies for the delivery of high-
quality care to clients.

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 NURSE AS A EDUCATOR

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Instead of the teacher teaching, the new educational paradigm focuses on learner
learning. The teacher becomes the guide on the side, assisting the learner in his or her
effort to determine objectives and goals for learning. To increase comprehension, recall
and application of information, clients must be actively involved in the learning
experience.

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.

Nursing Education Transformation

Nursing educathas transformed, redesigned. To best serve consumers of health care,

professionals need to work more closely to deliver appropriate and cost-effective
healthcare system.

Patient Engagement

Berwick outlined that health care needed to improve on and in the current levels of
performance in all six areas: Safety, Effectiveness, Patient-centeredness, Timeliness,
Efficiency, Equity.

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 Education in Nursing

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This is very important to practice of each nursing students. So that we can provide safety
and high health care quality to patients. Knowledge, skills and attitudes is very important
to improve the safety and quality of healthcare delivery.

The Institute of Medicine Report: The Future of Nursing

The four key messages:

1. Nurses should practice to the full extent of their education and training.
2. Nurses should achieve higher levels of education and training.
3. Nurses should be full partners with health professionals in redesigning health care.
4. Effective workforce planning and policy making require better data collection.

 BARRIERS TO TEACHING AND OBSTACLES TO LEARNING

Barriers to teaching are defined as those factors that impede the nurses ability to deliver
educational services. Obstacles to learning are defined as those factors that negatively
affect the ability of the learner to pay attention to and process information.

Factors Affecting the Ability to Teach

o Lack of time
o Low priority status of client education
o Lack of confidence and competence
o Questionable effectiveness of client education
o Documentation difficulties
o Absence of third party reimbursement
o Negative influence of environment (lack of space and privacy, noise)
o Lack of motivation and skill

Factors Affecting the Ability to Learn

o Lack of time (rapid discharge or episodic care)

o Stress of illness
o Readiness to learn issues (motivation and adherence)
o Complexity, fragmentation, and inconvenience of healthcare system
o Denial of learning needs
o Lack of support from health professionals or significant others
o Extent of needed behavior changes
o Negative influence of environment
o Literacy problems
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