1. Chapter 1 Overview of Education in Health Care

2. 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.

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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.

9. Current Mandates for Nurse as Educator
Healthy People 2010 (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.

10. 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

11. 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

12. 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

13. Purpose, Benefits and Goals (cont’d)
- 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

14. Purpose, Benefits and Goals (cont’d)
Benefits of preceptor education for nursing students
prepared clinical preceptors
continuity of teaching/learning from classroom curriculum
evaluation and improvement of student clinical skills

15. Purpose, Benefits, and Goals (cont’d)
Goal: to increase self-care responsibility of clients and to improve the quality of care delivered by nurses

16. 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

17. 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

18. 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

19. 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

20. 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.

21. 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.

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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?

28. Questions (cont’d)
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 ?

29. 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?

30. Questions (cont’d) What other questions might you ask?
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?

31. 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

32. 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