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 (cont’d) Organizations and Agencies Promulgating Standards and Mandates: 1. NLNE (NLN) –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 (cont’d) 2. ANA - responsible for establishing standards and qualifications for practice, including patient teaching 3. ICN - endorses health education as an essential component of nursing care delivery

Historical Foundations (cont’d) 4. State Nurse Practice Acts - universally includes teaching within the scope of nursing practice 5. JCAHO - accreditation mandates require evidence of patient education to improve outcomes 6. AHA - Patient’s Bill of Rights ensures that clients receive complete and current information

Historical Foundations (cont’d) 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  Ten Rules for Redesign

Institute of Medicine 2001 CROSSING THE QUALITY CHASM: A NEW HEALTH SYSTEM FOR The 21ST CENTURY Faced with such rapid changes, the nation’s health care delivery system has fallen far short in its ability to translate knowledge into practice and to apply new technology safely and appropriately.

Institute of Medicine 2001 REDESIGN IMPERATIVES: SIX CHALLENGES Reengineered care processes Effective use of information technologies Knowledge and skills management Development of effective teams Coordination of care across patient- conditions, services, sites of care over time

Six Aims for Improvement  Safe: avoiding injuries to patients  Effective: providing services based on scientific knowledge to all who could benefit  Patient-centered: providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.  Timely: reducing waits and sometimes harmful delays for both those who receive and those who give care.  Efficient: avoiding waste, including waste of equipment, supplies, ideas, and energy.  Equitable: care that does not vary in quality because of personal characteristics

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 patient’s and family’s values and preferences and allow sufficient interaction among the patient, family, and staff for learning to occur.

Current Mandates for Nurse as Educator Healthy People 2020 (USDHHS) Federal initiatives outlined: 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 nurse’s 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 (cont’d) 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 Education Benefits of education to patients:  increases consumer satisfaction  improves quality of life  ensures continuity of care  reduces incidence of illness complication  increases compliance with treatment  decreases anxiety  maximizes independence

Purpose, Benefits, and Goals of Education Benefits of education to staff:  enhances job satisfaction  improves therapeutic relationships  increases autonomy in practice  improves knowledge and skills

Purpose, Benefits, and Goals of Education 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 (cont’d) 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 (cont’d) 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 (cont’d) 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. A nalyze the learner S tate objectives S elect instructional methods and materials U se teaching materials R equire learner performance E valuate/revise the teaching/learning process

Role of the Nurse As Educator Nurses act in the role of educator for a diverse audience of learners—patients 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 (cont’d) 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 nurse’s 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 (cont’d) environments not conducive to the reaching- learning 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 learner’s 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 (cont’d) 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 (cont’d) 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 (cont’d)  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 (cont’d)  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 (cont’d)  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 non–research-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 Internet- based health information sites

Perspectives on Research (cont’d) further investigation is needed on the cost- effectiveness 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

The Education Process Parallels the Nursing Process