MODULE 1

OVERVIEW OF EDUCATION IN HEALTH CARE

A. INTRODUCTION
Education in health care today – both patient education and nursing staff/student
education Is a topic of utmost interest to nurses in every setting in which they practice. Teaching
is an important aspect of the nurse’s professional role (Anderson, Svanstrom, Ek., Rosen, and
Berglund, 2015), whether it be educating patients and their family members, colleagues, or
nursing students.
According to Friberg and colleagues (2012), patient education is an issue in nursing
practice and will continue to be a significant focus in the healthcare environment.
Nurses in the role of education must understand the forces, both historical evolution of
patient education and present day, that has influenced and continues to influence their
responsibilities in practice
This module will clarify the broad purposes, goals, and benefits of the teaching-learning
process; focuses on the philosophy of the nurse-client partnership. It focuses on the overall role
of the nurse in teaching and learning, no matter who the audience of learners might be.

B. LEARNING OUTCOMES
After completing this module, the student will
1. Define Health Education and discuss the evolution of patient education in healthcare
and the teaching role of nurses.
2. Recognize trends affecting the healthcare system in general and nursing practice in
particular.
3. Identify the purposes, goals, and benefits of patient and nursing staff/student
education.
4. Identify why patient and staff/student education is an important duty for nurses.
5. Discuss the barriers to teaching and the obstacles to learning.

C. STUDY SCHEDULE AND STRUCTURE

Study Topic Learning Activities Learning Resources Assessment

Period
1. Definition of Learning Activity 1 pg. 3-10 Learning
Health a. Make a timeline Activity output
Education on the historical 1a
2. Historical foundation of 1b
Foundations patient education
for Patient from 1970 to the
Education in present.
Health Care b. Why is patient
3. The evolution teaching
of the important in
Teaching role Nursing?
 of Nurses
4. Social Learning Activity 2 pg. 10-13 Learning
Economic c. What is the Activity output
and political current focus and
trends orientation of
Affecting patient
health Care education?
5. Purposes, d. What is the
Goals, and current focus and
Benefits of orientation of
patient and patient
Nursing education?
Staff/Student
Education pg. 21-28
6. Barriers to
teaching and
Obstacles to
Learning

D. OVERVIEW OF EDUCATION IN HEALTHCARE

TOPIC 1 HISTORICAL FOUNDATIONS FOR PATIENT EDUCATION IN HEALTH CARE

“Health Education” is a process concerned with designing, implementing, and evaluating

educational programs that enable families, groups, organizations, and communities to play
active roles in achieving, protecting, and sustaining health. ‘Teaching Strategies in Health
Education, Cecilia Estrada-Castro, 2009, 1 st edition, p 11.

Health education is also defined as “any combination of learning and experience designed to
facilitate voluntary adaptations of behavior conducive to health (Green et al, 1980).

Health Education s any combination of learning experiences designed to help individuals and
communities improve their health, by increasing their knowledge or influencing their attitudes
(WHO).

Aims of Health education (Dr. Awatif Alam)

1. To develop a sense of responsibility for health conditions, as individuals, as members of
families and communities. (promotion, prevention of disease and early diagnosis and
management).
2. To promote and wisely use the available health services
3. To be part of all education and to continue throughout the whole span of life.

Changing Concepts in Health education

Historically health education has been committed to disseminating information and changing human
behavior. Following the Alma-Ata declaration adopted in 1978, the emphasis has shifted from:
 1. Prevention of disease to promotion of healthy lifestyles;
2. The modification of individual behavior to modification of “social environment” in which
individual lives
3. Community participation to community involvement; and
4. Promotion of individual and community self-reliance.

3 PHASES OF HISTORICAL FOUNDATION FOR PATIENT EDUCATION IN HEALTH CARE

First Phase (Formative period) Mid- 1800s through the turn of 20 th Century
 "patient education has been a part of health care since the first healer gave the first
patient advice about treating his(her) ailments" (May 1999, p3)
 Early healers, physicians, herbalists, midwives, and shamans- did not have a lot of
effective diagnostic and treatment interventions, education was likely, the most
common interventions (Bartlett, 1986)
 The first phase in the development of organized care, several key factors influenced the
growth of patient education
o The emergence of nursing and other health professions
o Technological developments
o Emphasis on patient-caregiver relationship
o The spread of tuberculosis ad other communicable diseases
o The growing interest in the welfare of mother and children
Florence Nightingale emerged as a resolute advocate of the educational responsibilities of
district public health nurses and authored Health Teachings in Towns and Villages, which
advocate for school teaching of health rules as well as health teaching in the home. (Monterio,
1985).
Florence Nightingale – she developed a large portion of her career to teaching nurses,
physicians, and health officials about the importance of proper conditions in the hospitals and
homes to improve the health of people. Emphasized the importance of teaching patients the need
for adequate nutrition, fresh air, exercise, and personal hygiene to improve their well-being.

Second Phase first 4 decades of the 20th century

 Division of Child Hygiene was established in New York City in 1908
o Public health nurses provided instructions to mothers of newborns on how to
keep infant healthy
o Diagnostic tools and scientific discoveries, new vaccines and antibiotic
medications, and effective surgery.
o Treatment practices lead to an education program in sanitation, immunization,
prevention, and treatment of infectious disease
o Growth in the public health system in the US
 National League of Nursing Education (NLNE) recognized the public health nurses were
essential to the well-being of communities and the teaching they provided to
individuals, families, and groups was considered “a precursor to modern patient and
health education”
Third Phase after WWII
  1940-1950- patient education began to be seen as a specific task where the emphasis
was placed on educating individual patients rather than providing general public health
education
 !960s,
o Voluntary agencies and the US public health service funded several patient and
family education projects dealing with Congestive heart failure, stroke, cancer,
and renal dialysis.
o Patients were recognized as healthcare consumers and society adopted the new
perspective that health care was a right and not a privilege for all Americans.
o Social security act that created respectively the Medicare and Medicaid plan to
provide health care to indigent persons, older adults, and people with medical
disabilities.
o Recommendations of a more formal approach to patient education-to allow
patient to participate in their health
o Teaching on an individual patient should be included as part of the patient's
record(documentation of patient education)
 The 1970s
 The 1980s-1990s

E. LEARNING ACTIVITIES
LEARNING ACTIVITY 1a
Make a timeline on the historical foundation of patient education from 1970 to the present.
Year Significant Event-related to Health Education

1970
1980
1990
2000
2020

EVOLUTION OF THE TEACHING ROLE OF NURSES

 Mid- 1800's –nursing was recognized as a unique discipline. Teaching has been recognized as an
important health care initiative assumed by the nurses.
 Focus is not only on the care of the sick but also on educating other nurses for professional
practice.  Florence nightingale is the ultimate educator because she dedicated a large portion
of her career in educating those who are involved in the delivery of health care (Physicians,
nurses, health officials)  Teaching today is now within the scope of nursing practice
responsibilities.
 Nurses are expected to provide instruction to assist the consumers in:  Maintaining an optimal
level of wellness  Prevention of diseases, manage illness, and  Develop skills to give
supportive care to family members.
  From disease-oriented... we now focus on prevention-oriented patient education to ultimately
become health-oriented patient education. The role of nurse educator evolved from the healer
to an expert advisor/teacher to facilitator of change. Another role of nurses' educator is training
the trainer.
 Early 1900 – public health nurses in the US began to understand the importance of education in
the prevention of disease and maintenance of health  1918 – NLNE (National League for
Nursing Education) observed the importance of health teaching as a function within the scope of
nursing practice.
 1950 – NLNE identified the course content dealing with teaching skills, developmental and
educational psychology, and principles of the educational process of teaching and learning as
areas in the curriculum common to all nursing schools.
 Today – state nurse practice acts (NPAs) universally include teaching within the scope of nursing
practice.
 Nurse Educator's role evolved from a Disease-oriented approach to a Prevention-oriented
approach Wise healer to expert advisor/teacher to facilitator of change.

Learning Activities Please answer the questions briefly (50-100 words) or in for

LEARNING ACTIVITY 1b

Why is patient teaching important in Nursing?

SOCIAL, ECONOMIC AND POLITICAL TRENDS AFFECTING HEALTH

Healthy People 2020

A document that set forth national health goals and objectives in the next decade. Achieving
these national priorities would dramatically cut the costs of health care. Nurses as the largest group of
health professionals play importance in making a real difference by teaching clients to attain and
maintain healthy lifestyles.

Institute of Medicine (2011)

Established recommendations designed to enhance the role of nurses functioning to the full
extent of their education and scope of practice. Patient and family education is a key component of the
nurse's role.

(Read More Nurse as Health Educators by Susan Bastable p. 10-12)

Read SDG 17 goals particularly SDG 3 Good Health and Well- Being

Learning Activities Please answer the questions briefly (50-100 words) or in bullets form.

LEARNING ACTIVITY 1C
What is the current focus and orientation of patient education?

PURPOSES, GOALS, AND BENIFITS OF PATIENTS AND NURSING STAFF/STUDENT EDUCATION

The purpose of patient education is to increase the competence and confidence of clients for
self-management. The primary goal is to increase the responsibility and independence of clients for self-
care. This can be achieved by supporting patients through the transition from being dependent on
others to being self-sustaining in managing their care and from being passive learners to active learners.
The single most important action of nurses as educators is to prepare patients for self-care. If the
patient cannot independently maintain or improve their health status on their own, nurses have failed
to help them reach their potential.
Effective teaching can do the following:
1. Increased consumer satisfaction
2. Improve the quality of life
3. Ensure continuity of care
4. Decrease patient anxiety
5. Effectively reduce the complications of illness and the incidence of the disease
6. Promote adherence to treatment plans
7. Maximum independence in the performance of activities of daily living
8. Energize and empower consumers to become actively involved in the planning of their care
"Illness can become an educational opportunity, a teachable moment when ill health suddenly
encourages (patients) to take a more active role in their care" (Orr 1990)
Patients must handle many health needs and problems at home, people must be educated on how to
care for them that are both to get well and to stay well. Illness is a natural life process, but so is
humankind's ability to learn. Along with the ability to learn comes a natural curiosity that allows people
to view new and difficult situations as challenges rather than defeats.
Numerous studies have documented the fact that informed clients are more likely to comply with
medical treatment plans, more likely to find innovative ways to cope with illness and less likely to
experience complications
The purpose of staff and student education is to increase the competence and confidence of nurses to
function independently in providing care to the consumer.
The goal of education efforts is to improve the quality of care delivered by nurses. Nurses play a key role
in improving the nation's health, and lifelong learning is essential to keep their knowledge and skills
current (DeSilets, 1995; Kelliher, 2013; Witt, 2011)
The benefits to nurse's in their role as educators include increased job satisfaction when they recognize
that their teaching actions have the potential to forge a therapeutic relationship with clients, enhanced
patient-nurse-autonomy, increased accountability in practice, and the opportunity to create change that
makes a difference in the lives of others.
The Primary Aim of nurse educators, then, should be to nourish clients, mentor staff, and serve as
teachers, clinical instructors, and preceptors for nursing students. They must value their role in
educating others and make a priority for their patients, colleagues, and future members of the
profession.
“Provide a man a fish and he may eat for a day. Teach a man to fish and he may eat for a lifetime” this
mantra according to Johaun Jackson (2015) speaks to the sacred and honorable act of teaching-
imparting knowledge to others and empowering them to no end-and there can be no higher calling than
that of an educator.

Barriers to Teaching and Obstacles to Learning (Nurse as Educator, Susan Bastable 5 th Edition))
The educator should not limit learning to the information that is intended but should make
possible the potential for informal, unintended learning that can occur each day with every teacher-
learner encounter.
The teachable moments are not necessarily unplanned or that a coordinated set of circumstances will
always lead to positive health change. Instead, it is the interaction between learner and teacher that Is
central to the development of a teachable moment, regardless of the obstacles or barriers that may be
encountered
Unfortunately, nurses must confront many barriers in carrying out their responsibilities for
educating others. Learners face a variety of potential obstacles that can interfere with their learning.
Conditional factors, such as the environment, the organization’s factors, such as the
environment, the level of cooperation between the disciplines, beliefs and knowledge of the team
members, type of patient education activities, and the patient population can either enable or hinder
the teaching-learning process.
Barriers to teaching are defined as those factors that impede the nurse’s ability to deliver
occupational services
Obstacles to learning are defined as those factors that negatively affect the ability of the learner
to pay attention to and process information.

Factors affecting the Ability to Teach

Required Readings: Please read Factors Affecting the Ability to Teach (S. Bastable, Nurse as Educator,
5th edition, 2019, pp 21-24)

Factors Affecting the Ability to Learn

Required Readings: Please read Factors Affecting the Ability to Learn (S. Bastable, Nurse as Educator,
5th edition, 2019, pp 25-28)
Learning Activities Please answer the questions briefly (50-100 words) or in bullets form .
 H. LEARNING ACTIVITY 1d

What is the current focus and orientation of patient education?

I. ASSIGNMENT TASK 1
1. Which Key factor influenced the growth of patient Education during its
Formative Years?
2. Which legal mandate includes teaching as a responsibility of nurses?

J. REFERENCE
Bastable, S. (2019): Nurse as Educator: Principles of Teaching and Learning for Nursing Practice. 5th ed
Jones and Bartlett Publishers, Sudbury.