Health Education and Health Promotion Chapter 2 Health Education and Health Promotion

Health Education An independent function of nursing practice and a primary nursing responsibility Nurses must use opportunities in all health care settings to promote wellness. Every contact an RN has with a health care consumer, whether or not that person is ill, should be considered an opportunity for health teaching People with chronic illnesses and disabilities are among those most in need of health education.

Trends in Health Education Patients are being encouraged to play an active role in the care and information they receive Supported by numerous programs Goal of patient and family education is to improve patient outcomes Often through encouraging adherence Especially important for those with chronic health problems

Readiness to Learn This must be assessed prior to teaching Health literacy: “a complex group of reading, listening, analytical, and decision-making skills, and the ability to apply these to health situations” (NNLM, 2010) As many as 90 million people in the United States lack these skills Especially among older adults, immigrants, low- income individuals, those with chronic diseases See Box 2-1 for strategies to implement with older adults.

REALM-SF Rapid Estimate of Adult Literacy in Medicine- Short Form Give pt copy of form, instruct them to read as many words as they can from this list. Begin with the first word and read aloud. When you come to a word that you cannot read, do the best you can or say “blank” and go to the next one RN marks words (+)(-) to the word. Count the number of correct words for each list and record the number and grade.

Adult words samples Menopause Antibiotics Exercise Jaundice Rectal Anemia Behavior

7 words Electronarcosis Pancreaticoduodenal Neuroarthropathy Epileptogenic Dopaminergic receptor Xenodiagnosis retrognathia

Scores and Grades for REALM-SF 0 Third grade and below; will not be able to read most low-literacy materials; will need repeated oral instructions, materials composed primarily of illustrations, or audio or video tapes. 1-3 4-6 grade will need low-literacy materials, may not be able to read prescription labels. 4-6 7-8 grade will struggle with most patient education materials; will not be offended by low-literacy materials. 7 high school; will be able to read most patient educaiton materials.

Question Older adults often do not adhere to a therapeutic regimen. What strategy is most likely to promote adherence to an older patient’s therapeutic regimen after surgery? Demonstrate a dressing change and allow the patient to practice Provide a pamphlet on a dressing change Verbally instruct the patient how to change a dressing Have a family member change the dressing

Answer A. Demonstrate a dressing change and allow the patient to practice Rationale: Health education that includes visual, tactile and interactive elements is most likely to result in learning, especially among older adults. Engaging the patient himself or herself is more beneficial than deferring to a family member.

Nursing Process: Patient Teaching The health education process utilizes the nursing process: Begin by assessing learning readiness Identify any potential barriers to communication Identify relevant nursing diagnoses

Nursing Process: Patient Teaching (cont’d) Planning Identify goals, strategies, and desired outcomes. Choose an appropriate setting and appropriate timing.

Nursing Process: Implementation Utilize a variety of techniques to maximize learning: Lecture Discussion Group learning Multimedia Written material Demonstration

Question The nurse is planning to teach a patient about administering her new asthma medication. How can the nurse enhance the patient's ability to learn? Provide a list of websites that contain information related to the medication Exclude family members from the session to minimize distractions Use color-coded materials Make the information relevant to the patient’s condition and needs

Answer D. Make the information relevant to the patient’s condition and needs Rationale: Identifying a link between the patient’s interests and the material to be taught enhances learning. Family members should not normally be excluded from health education. Websites can be a useful source of information, but providing a list of these does not enhance learning.

Nursing Process: Patient Teaching Evaluation It cannot be assumed that patients have learned just because teaching has occurred Apply measurements—ideally more than one

Question Is the following statement true or false? The most accurate way to evaluate whether learning has taken place is to observe for a change in the patient’s behavior.

Answer True Rationale: An observable change in a patient’s behavior is often the most clear indication that the patient has learned and integrated new information.

Health Promotion Defined as “the process of enabling people to increase control over their health and its determinants thereby improving their health” (WHO, 2009) The concept has evolved because of a changing definition of health and an awareness that wellness exists at many levels of functioning Includes an element of self-responsibility Health promotion occurs throughout the lifespan and activities should be planned accordingly

Question Which of the following is the best example of health promotion teaching? Demonstrating an injection technique to a patient for anticoagulant therapy Explaining the side effects of a medication to an adult patient Discussing the importance of preventing sexually transmitted infections to a group of high school students Instructing an adolescent patient about her allergies

Answer C. Discussing the importance of preventing sexually transmitted infections to a group of high school students Rationale: Disease prevention through lifestyle changes is a key focus of health promotion. Education about medications and diagnoses is important for many individuals, but this does not clearly demonstrate the proactive focus of health promotion.