Overview of education in health care Chapter 1 1

Overview of education in health care Historical foundations of nurses teaching role Historical foundations of nurses teaching role Social & economic trends impacting health care Social & economic trends impacting health care Purpose of patient and staff education Purpose of patient and staff education Education process Education process Role of the nurse as educator Role of the nurse as educator Barriers to education Barriers to education Perspective on research in patient education Perspective on research in patient education 2

Introduction Teaching is a major aspect of the nurse's professional role Teaching is a major aspect of the nurse's professional role Patient and staff education are important in nursing practice Patient and staff education are important in nursing practice Families and patients must be prepared to assume responsibility for self care Families and patients must be prepared to assume responsibility for self care Demand for nursing and nurse as educator continues in a changing health care system Demand for nursing and nurse as educator continues in a changing health care system 3

Historical foundations for teaching role of nurses Education is not a new thing Education is not a new thing Patient teaching is an independent nursing functions Patient teaching is an independent nursing functions Florence Nightingale devoted her career to educating others about importance of nutrition, exercise, ….etc. Florence Nightingale devoted her career to educating others about importance of nutrition, exercise, ….etc. 4

Historical foundations for teaching role of nurses cont. … the NLN observed the importance of health teaching as a function within the scope of nursing practice the NLN observed the importance of health teaching as a function within the scope of nursing practice identified course content dealing with teaching skills, developmental and educational psychology, principles of education common for all nursing schools identified course content dealing with teaching skills, developmental and educational psychology, principles of education common for all nursing schools. Currently teaching is included within the scope of nursing practice responsibilities (Nursing Practice Act NPAs) Currently teaching is included within the scope of nursing practice responsibilities (Nursing Practice Act NPAs) 5

Historical foundations for teaching role of nurses cont. ….. JCAHO (Joint Commission on Accreditation of Healthcare Organization) established nursing standards for patient education as earl as 1993 JCAHO (Joint Commission on Accreditation of Healthcare Organization) established nursing standards for patient education as earl as 1993 Patient ’ s bill of rights established the patient's right to receive complete and current information about diagnosis, treatment, prognosis, in an understandable way. Patient ’ s bill of rights established the patient's right to receive complete and current information about diagnosis, treatment, prognosis, in an understandable way. To accomplish these goals, nurses need to be trained and prepared to provide patient education. To accomplish these goals, nurses need to be trained and prepared to provide patient education. 6

Historical foundations for teaching role of nurses cont. ….. Since 1980s the role of the nurse as a teacher has evolved from a disease-oriented approach to more prevention-oriented approach. Since 1980s the role of the nurse as a teacher has evolved from a disease-oriented approach to more prevention-oriented approach. This transition toward wellness has progressed “from disease- oriented patient education (DOPE) to prevention-oriented patient education (POPE)”. This transition toward wellness has progressed “from disease- oriented patient education (DOPE) to prevention-oriented patient education (POPE)”. This new approach has changed the role of the nurse from one of wise healer to expert advisor/teacher to facilitator of change This new approach has changed the role of the nurse from one of wise healer to expert advisor/teacher to facilitator of change 7

Social, economic and political trends affecting heath care National health care goals (healthy people 2000). National health care goals (healthy people 2000). Established objectives to develop effective health education programs to assist individuals : Established objectives to develop effective health education programs to assist individuals : recognize and change risk behaviors, recognize and change risk behaviors, adopt and maintain protective health practices, adopt and maintain protective health practices, make appropriate use of health care delivery system make appropriate use of health care delivery system 8

Social, economic and political trends affecting heath care Nurses can play a role in educating people about healthy and protective lifestyles. Growth of managed care, shift in payer coverage, led to emphasis on outcome measures, which is achieved by patient education Growth of managed care, shift in payer coverage, led to emphasis on outcome measures, which is achieved by patient education Importance of economic and social values in preventive measures Importance of economic and social values in preventive measures Political emphasis on reducing costs of health care delivery, through preventive measures. Political emphasis on reducing costs of health care delivery, through preventive measures. 9

Social, economic and political trends affecting heath care Consumers are demanding an increase in knowledge and skills on how to care for themselves and how to prevent disease. Consumers are demanding an increase in knowledge and skills on how to care for themselves and how to prevent disease. The increase in chronic and incurable conditions requires that individuals and families become informed participants to manage their own illnesses The increase in chronic and incurable conditions requires that individuals and families become informed participants to manage their own illnesses Increase in the number of older people, created the need for consumers to rely more on self care to maintain health. Increase in the number of older people, created the need for consumers to rely more on self care to maintain health. 10

Social, economic and political trends affecting heath care Major causes of death are diseases that are lifestyle related and can be prevented through health education Major causes of death are diseases that are lifestyle related and can be prevented through health education Advance technology increased complexity of care, and gave clients ability to move away from health care setting Advance technology increased complexity of care, and gave clients ability to move away from health care setting Nurses are defining their role with a focus on patient education as central to the practice of nursing Nurses are defining their role with a focus on patient education as central to the practice of nursing 11

Social, economic and political trends affecting heath care Early hospital discharge made families and client more self reliant. Early hospital discharge made families and client more self reliant. Patient education is believed to improve compliance and thus improve health status. Patient education is believed to improve compliance and thus improve health status. Emergence of successful self help groups led to the public and nurse involvement and support for educational activities Emergence of successful self help groups led to the public and nurse involvement and support for educational activities 12

Purpose, benefits, goals of patient and staff education Benefits of patient education Benefits of patient education Increase consumer satisfaction Increase consumer satisfaction improve quality of life improve quality of life ensure continuity of care, ensure continuity of care, decrease patient anxiety, decrease patient anxiety, Effectively reduce the incidence of complications of illness, Effectively reduce the incidence of complications of illness, maximize independence in performing daily activity life. maximize independence in performing daily activity life. Energizes & empowers people to be involved in the planning of their care Energizes & empowers people to be involved in the planning of their care 13

Purpose, benefits, goals of patient and staff education The purpose of patient education is to increase competence and confidence of clients for self management The purpose of patient education is to increase competence and confidence of clients for self management The role of the nurse is to support patients through the transition from The role of the nurse is to support patients through the transition from  Being invalids to being independent, active learners, and participants in the care 14

Purpose, benefits, goals of patient and staff education Purpose, benefits, goals of patient and staff education Nurses role as educators enhances job satisfaction because of the benefits the patient gets. Nurses role as educators enhances job satisfaction because of the benefits the patient gets. “illness can become an educational opportunity…a ‘teachable moment’ when ill health suddenly encourages [patient] to take a more active role in their care” “illness can become an educational opportunity…a ‘teachable moment’ when ill health suddenly encourages [patient] to take a more active role in their care” Staff development is important to keep nurses up to date with new information so that they can do their job successfully. Staff development is important to keep nurses up to date with new information so that they can do their job successfully. 15

Education process defined A systematic, sequential, planned, course of action consisting of two major interdependent operations, teaching and learning, which form a continuous circle. A systematic, sequential, planned, course of action consisting of two major interdependent operations, teaching and learning, which form a continuous circle. Process includes the teacher and the learner. Process includes the teacher and the learner. Education process should be mutual. Education process should be mutual. The instruction content is based on assessment and prioritization of the client ’ s learning needs, readiness to learn, learning styles. The instruction content is based on assessment and prioritization of the client ’ s learning needs, readiness to learn, learning styles. 16

Education process defined Education process includes assessment, planning, implementation, and the evaluation. Education process includes assessment, planning, implementation, and the evaluation. Teaching: is a deliberate intervention that involves the planning and implementation of instructional activities and experiences to meet intended learner outcomes according to the teaching plan. Teaching: is a deliberate intervention that involves the planning and implementation of instructional activities and experiences to meet intended learner outcomes according to the teaching plan. Learning: a change in behavior (knowledge, skills, attitudes) the result from exposure to environmental stimuli. Learning: a change in behavior (knowledge, skills, attitudes) the result from exposure to environmental stimuli. 17

Nursing process Nursing process Appraising physical & psychological needs Develop care plan based on mutual goal setting to meet individual needs Carryout nursing care interventions using standard procedures Determine physical & psychosocial outcomes Education process Ascertain learning needs, readiness to learn, & learning style Develop teaching plan based on mutually predetermined behavioral outcomes to meet individual needs Perform the act of teaching using specific instructional methods & tools Determine behavior changes (outcomes) in knowledge, attitudes, & skills ASSESSMENT PLANNING IMPLEMNTATION EVALUATION 18

Education process defined Patient education : a process of assisting people to learn health-related behaviors in order to incorporate those behaviors into everyday lifestyle. a process of assisting people to learn health-related behaviors in order to incorporate those behaviors into everyday lifestyle. The purpose of pt. education is to help clients to achieve the goal of optimal health and independence in self-care. The purpose of pt. education is to help clients to achieve the goal of optimal health and independence in self-care. 19

Education process defined ASSURE model is a paradigm that can assist nurses to recognize and carry out the education process ASSURE model is a paradigm that can assist nurses to recognize and carry out the education process Analyze learner Analyze learner State objectives State objectives Select teaching methods and instructional materials Select teaching methods and instructional materials Use teaching methods and instructional materials Use teaching methods and instructional materials Require learner performance Require learner performance Evaluate the teaching plan and revise as necessary. Evaluate the teaching plan and revise as necessary. 20

The Teaching Role of The Nurse Nurses play a major role in patient education Nurses play a major role in patient education Nurses must be trained in instructional skills in order to have successful educational programs Nurses must be trained in instructional skills in order to have successful educational programs Some suggest that education should be done only by specialized nurses, or nurses who have a higher level of education Some suggest that education should be done only by specialized nurses, or nurses who have a higher level of education Nurses must have a solid foundation in the principles of teaching and learning Nurses must have a solid foundation in the principles of teaching and learning 21

The Teaching Role of The Nurse Effective education and learner participation go hand in hand. Effective education and learner participation go hand in hand. Nurse can act as a facilitator, motivate individual to learn, create a positive environment for learning. Nurse can act as a facilitator, motivate individual to learn, create a positive environment for learning. Nurse can act as a coordinator of teaching efforts and client advocate (support) Nurse can act as a coordinator of teaching efforts and client advocate (support) The teaching role is a unique part of our professional domain The teaching role is a unique part of our professional domain 22

Barriers to education and obstacles to learning Barriers to education: Barriers to education: are those factors that interfere with the nurse ’ s ability to deliver educational services. Obstacles to learning: Obstacles to learning: are factors that negatively affect the ability of learner to pay attention to and process information. 23

Barriers to teaching Lack of Time to teach is cited by nurses Lack of Time to teach is cited by nurses Lack of competency & ability of the nurses Lack of competency & ability of the nurses Low priority is often assigned to patient education by administrators Low priority is often assigned to patient education by administrators Lack of proper environment Lack of proper environment An absence of third-party reimbursement to support pt education pt. An absence of third-party reimbursement to support pt education pt. Some nurses and physician question whether pt. education is effective as a mean to improve health outcomes. Some nurses and physician question whether pt. education is effective as a mean to improve health outcomes. Lack of documentation of patient education Lack of documentation of patient education 24

Obstacles to learning Obstacles to learning Lack of time because of rapid patient discharge Lack of time because of rapid patient discharge The stress and anxiety of the disease affects learners ability to learn The stress and anxiety of the disease affects learners ability to learn The negative environment of the hospital, lack of control, lack of privacy, social isolation affect the patient ’ s active role in decision making & involvement in the teaching- learning process. The negative environment of the hospital, lack of control, lack of privacy, social isolation affect the patient ’ s active role in decision making & involvement in the teaching- learning process. 25

Obstacles to learning cont. Obstacles to learning cont. Learner ’ s characteristics like readiness to learn, motivation, and compliance Learner ’ s characteristics like readiness to learn, motivation, and compliance The amount of change needed from the learner can dissuade (discourage) from accomplishing objectives The amount of change needed from the learner can dissuade (discourage) from accomplishing objectives Lack of support Lack of support Inconvenience, complexity of the health care system results in frustration and abandonment of the learning and the learning objectives Inconvenience, complexity of the health care system results in frustration and abandonment of the learning and the learning objectives 26