Chapter 1 Overview of Education in Health Care

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Chapter 1Overview of Education in Health Care
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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.

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Historical Foundations (contd)

• 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

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Historical Foundations (contd)

• 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

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Historical Foundations (contd)

• 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
• - Patients Bill of Rights ensures that clients
  receive complete and current information

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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

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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

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Institute of Medicine 2001CROSSING THE QUALITY
CHASM A NEW HEALTH SYSTEM FOR The 21ST
CENTURY

• Faced with such rapid changes, the nations
  health care delivery system has fallen far short
  in its ability to translate knowledge into
  practice and to apply new technology safely and
  appropriately.

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Institute of Medicine 2001REDESIGN 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

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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

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Joint CommissionPatient 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.

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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.

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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

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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

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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

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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

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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

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Purpose, Benefits, and Goals (contd)

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

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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

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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

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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

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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

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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.

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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.

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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

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Barriers to Education (contd)

• 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

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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

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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

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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

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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?

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Questions (contd)

• 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 ?

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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?

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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?

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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
  Internet-based health information sites

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Perspectives on Research (contd)

• 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

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The Education Process Parallels the Nursing
Process