Chapter 1

Overview of Education in
Health Care

Historical Foundations of the

Nurse Educator Role
Health education has long been
considered a standard care-giving 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.

Historical Foundations (contd)

Organizations and Agencies Promulgating
Standards and Mandates:
1. NLNE/NLN (National League of Nursing)
first observed health teaching as an
important function within the scope of
nursing practice
responsible for identifying course content
for curriculum on principles of teaching and
learning

Historical Foundations (contd)

2. ANA (American Nurses Association)
- responsible for establishing standards and
qualifications for practice, including patient
teaching
3. ICN (International Council for Nurses)
- endorses health education as an essential
component of nursing care delivery

Historical Foundations (contd)

4. State Nurse Practice Acts
- universally includes teaching within the scope
of nursing practice
5. JCAHO (Joint Commission on Accreditation of
Healthcare Organizations)
- accreditation mandates require evidence of
patient education to improve outcomes
6. AHA
- Patients Bill of Rights ensures that clients
receive complete and current information

Historical Foundations (contd)

7. Pew Health Professions Commission
- puts forth a set of health profession
competencies for the 21st century
- over one-half of recommendations pertain to
importance of patient and staff education

Current Mandates for

Nurse as Educator

Institute of Medicine 2001

CROSSING THE QUALITY CHASM:
A NEW HEALTH SYSTEM FOR THE
21ST CENTURY
focuses more broadly on how the health system
can be reinvented to foster innovation and improve
the delivery of care.

Six Aims for Improvement

"First, do no harm," which makes it the
individual caregivers responsibility to
somehow try extra hard to be more
careful (a requirement modern human
factors theory has shown to be
unproductive).

 Second, health care must beeffective.

It should match science, with neither
underuse nor overuse of the best
available techniques every elderly
heart patient who would benefit from
beta-blockers should get them, and no
child with a simple ear infection should
get advanced antibiotics.

 Third, health care should be patientcentered. The individual patients

culture, social context, and specific
needs deserve respect, and the patient
should play an active role in making
decisions about her own care. That
concept is especially vital today, as
more people require chronic rather than
acute care.

 Fourth, care should be timely.

Unintended waiting that doesnt provide
information or time to heal is a system
defect. Prompt attention benefits both
the patient and the caregiver.

 Fifth, the health care system should

be efficient,constantly seeking to
reduce the waste and hence the cost
of supplies, equipment, space,
capital, ideas, time, and opportunities.

 Sixth, health care should be equitable.

Race, ethnicity, gender, and income
should not prevent anyone in the world
from receiving high-quality care.

Ten Rules for Redesigning and

Improving Care
Private and public purchasers, health
care organizations, clinicians, and
patients should work together to
redesign health care processes in
accordance with the following rules.

1. Care should be based on continuous healing

relationships. Patients should receive care whenever they
need it and in many forms, not just through face-to-face visits.
The health care system should be responsive at all times (24
hours a day, every day), and access to care should be
provided over the Internet, by telephone, and by other means
in addition to face-to-face visits.
2. Care should be customized based on the patient's needs
and values. The system of care should be designed to meet
the most common needs but should have the flexibility to
respond to an individual patient's choices and preferences.
3. The patient should be in control. Patients should be given
necessary information and the opportunity to exercise as much
control as they choose over health care decisions that affect
them. The health system should be able to accommodate
differences in patient preferences and should encourage
shared decision making.

4. The system should encourage shared knowledge and the free

flow of information. Patients should have unfettered access to their
own medical information and to clinical information. Clinicians and
patients should communicate effectively and share information.
5. Decision making should be evidence-based. Patients should
receive care based on the best available scientific knowledge. Care
should not vary illogically from clinician to clinician or from place to
place.
6. Safety should be a property of the system. Patients should be safe
from injury caused by the care system. Reducing risk and ensuring
safety will require systems that help prevent and mitigate errors.
7. The system should be transparent. The health care system should
make information available to patients and their families that allows
them to make informed decisions when selecting a health plan, a
hospital, or a clinical practice or when choosing among alternative
treatments. Patients should be informed of the system's performance
on safety, evidence-based practice, and patient satisfaction.

8. The system should anticipate patients'

needs. The health system should be
proactive in anticipating a patient's needs,
rather than simply reacting to events.
9. The system should constantly strive to
decrease waste. The health system should
not waste resources or patients' time.
10. The system should encourage
cooperation among clinicians. Clinicians
and institutions should actively collaborate
and communicate with each other to ensure
that patients receive appropriate care.

Joint Commission:
Patient and Family Education
The organization provides education that
supports patient and family participation in
care decisions and care processes.
Education and training help meet patients
ongoing health needs.
Education methods consider the patients and
familys values and preferences and allow
sufficient interaction among the patient,
family, and staff for learning to occur.

Current Mandates for

Nurse as Educator

HealthyPeople2010(United States
Department of Health and Human
Services)
Federalinitiativesoutlined:
To increase the quality & years of healthy life
To eliminate health disparities among different
segments of the population
*Requires the nurse as educator to use theory
and evidenced based strategies to promote
desirable health behavior.

Trends Affecting Health Care

Social, economic, and political forces
that affect a nurses role in teaching:
growth of managed care
increased attention to health and well-being of
everyone in society
cost containment measures to control
healthcare expenses
concern for continuing education as vehicle to
prevent malpractice and incompetence

Trends (contd)
expanding scope and depth of nurses
practice responsibilities
consumers demanding more knowledge and
skills for self-care
demographic trends influencing type and
amount of health care needed
recognition of lifestyle related diseases which
are largely preventable
health literacy increasingly required
advocacy for self-help groups

Purpose, Benefits, and Goals of

Patient, Staff and Student Education
Purpose: to increase the competence and
confidence of patients to manage their
own self-care and of staff and students to
deliver high-quality care
Benefits of education to patients:
- increases consumer satisfaction
- improves quality of life
- ensures continuity of care

Purpose, Benefits and Goals (contd)

- reduces incidence of illness complications
- increases compliance with treatment
- decreases anxiety
- maximizes independence

Benefits of education to staff:

- enhances job satisfaction
- improves therapeutic relationships
- increases autonomy in practice
- improves knowledge and skills

Purpose, Benefits and Goals (contd)

Benefits of preceptor education for
nursing students
prepared clinical preceptors
continuity of teaching/learning from
classroom curriculum
evaluation and improvement of student
clinical skills

Purpose, Benefits, and Goals (contd)

Goal: to increase self-care responsibility
of clients and to improve the quality of
care delivered by nurses

The Education Process

Definition of Terms
Education Process: a systematic, sequential,
planned course of action on the part of both
the teacher and learner to achieve the
outcomes of teaching and learning
Teaching/Instruction: a deliberate intervention
that involves sharing information and
experiences to meet the intended learner
outcomes

The Education Process (contd)

Learning: a change in behavior
(knowledge, skills, and attitudes) that can
be observed and measured, and can
occur at any time or in any place as a
result of exposure to environmental
stimuli

The Education Process (contd)

Patient Education: the process of helping
clients learn health-related behaviors to
achieve the goal of optimal health and
independence in self-care
Staff Education: the process of helping
nurses acquire knowledge, attitudes,
and skills to improve the delivery of
quality care to the consumer

ASSURE Model
A useful paradigm to assist nurses to organize
and carry out the education process.
Analyze the learner
State objectives
Select instructional methods and materials
Use teaching materials
Require learner performance
Evaluate/revise the teaching/learning process

Role of the Nurse As Educator

Nurses act in the role of educator for a
diverse audience of learnerspatients
and their family members, nursing
students, nursing staff, and other
agency personnel.
Despite the varied levels of basic
nursing school preparation, legal and
accreditation mandates have made the
educator role integral to all nurses.

Role of Nurse As Educator (contd)

Nurses function in the role of educator as:
- the giver of information
- the assessor of needs
- the evaluator of learning
- the reviser of appropriate methodology

The partnership philosophy stresses the

participatory nature of the teaching and
learning process.

Barriers to Teaching
Barriers to teaching are those factors
impeding the nurses ability to optimally
deliver educational services.
Major barriers include:
lack of time to teach
inadequate preparation of nurses to assume the
role of educator with confidence and competence
personal characteristics
low-priority status given to teaching

Barriers to Education (contd)

environments not conducive to the reachinglearning process
absence of 3rd party reimbursement
doubt that patient education effectively
changes outcomes
inadequate documentation system to allow
for efficiency and ease of recording the
quality and quantity of teaching efforts

Obstacles to Learning
Obstacles to learning are those factors that
negatively impact on the learners ability
to attend to and process information.
Major obstacles include:
limited time due to rapid discharge from care
stress of acute and chronic illness, anxiety,
sensory deficits, and low literacy
functional health illiteracy

Obstacles (contd)
lack of privacy or social isolation of health-care
environment
situational and personal variations in readiness
to learn, motivation and compliance, and
learning styles
extent of behavioral changes (in number and
complexity) required

Obstacles (contd)
lack of support and positive reinforcement from
providers and/or significant others
denial of learning needs, resentment of
authority and locus of control issues
complexity, inaccessibility, and fragmentation,
of the healthcare system

Questions To Be Asked
The following questions can be posed about the
elements of the education process, the role of
the nurse as educator, and the principles of
teaching and learning:
How can the healthcare teams work together
more effectively to coordinate educational
efforts?
What are the ethical, legal, and economic
issues involved?

Questions (contd)
Which theories and principles support the
education process?
What assessment methods and tools can be
used to determine learning needs, readiness
and styles?
Which learner attributes positively and
negatively influence education efforts?
What can be done about the inequities in the
delivery of education services ?

Questions (contd)
Which elements need to be taken into account
when developing and implementing teaching
plans?
Which instructional methods and materials are
available to support teaching efforts?
Under which conditions should certain
teaching methods and tools be used?
How can teaching be tailored to meet the
needs of specific clientele?

Questions (contd)
What are the common mistakes made in the
teaching of others?
How can teaching and learning best be
evaluated?

What other questions might you ask?

Perspectives on Research in Patient

and Staff Education
most nonresearch-based literature focuses on
how to do patient teaching
more attention is given to the needs of learners
who have acute, short-term problems than to
those who have chronic, long-term conditions
more research is needed on new teaching
technologies, especially computer-assisted
modalities, distance education, and Internetbased health information sites

Perspectives on Research (contd)

further investigation is needed on the costeffectiveness of education efforts
future research must address:
gender issues
measurement of behavioral outcomes
effects of educational interventions
theoretical basis for education in practice
cost-effectiveness of educational efforts