CHAPTER 1: OVERVIEW OF EDUCATION IN HEALTH CARE

Historical
Foundations for
Patient Education
in Health Care
 mid-1800s - formative period by Bartlett (1986)
20th century
first phase in the development of organized health care by Dreeben (2010)
Florence Nightingale - emerged as a resolute advocate of the educational responsibilities of
district public health nurses

- authored Health Teaching in Towns and Villages, which advocated for

school teaching of health rules as well as health teaching in the home
(Monterio, 1985)

 first 4 second phase in the development of organized health care

decades of
the 20th
century
Diagnostic tools, scientific discoveries, new vaccines and antibiotic medications,
and effective surgery and treatment practices led to education programs in
sanitation, immunization, prevention and treatment of infectious diseases, and a
growth in the U.S. public health system.

National League of recognized that public health nurses were essential to the well-being of
Nursing Education communities and the teaching they provided to individuals, families, and groups
(NLNE) was considered “a precursor to modern patient and health education”

 after World third phase in the development of organized health care

War II
1940s - 1950s time when patient education continued to occur as part of
clinical encounters, but often it was overshadowed by the increasingly more
technological orientation of health care (Bartlett, 1986).

1953 Veterans Administration (VA) hospitals issued a technical bulletin titled Patient
Education and the Hospital Program.

Patient Education the nature and scope of patient education and provided guidance to all hospital
and the Hospital services involved in patient education.
Program.
1960s and 1970s - patient education began to be seen as a specific task where emphasis was
placed on educating individual patients rather than providing general
public health education.

- Developments during this time, such as

o the civil rights movement
o the women’s movement, and
o the consumer and self-help movement,
all affected patient education.
mid-1960s 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.
1965 the U.S. Congress passed Titles XVIII and XIX of the Social Security Act that created
respectively the
Medicare and Medicaid plans to provide health
care to indigent persons, older adults, and people with medical disabilities
(Dreeben, 201

1968 American Public Health Association formed a multidisciplinary Committee on

Educational Tasks in Chronic Illness in 1968
that recommended a more formal approach to patient education

1971 two significant events occurred:

(1) A publication from the U.S. Department of
Health, Education, and Welfare, titled The Need
for Patient Education, emphasized a concept of
patient education that provided information
about disease and treatment as well as teaching patients how to stay
healthy,

(2) President Richard Nixon issued a message to Congress using the term
health education

early 1970s patient education was a significant part of the AHA’s Statement on
a Patient’s Bill of Rights, affirmed in 1972 and
then formally published in 1973

The Patient’s Bill of guarantees a patient’s right to respectful and considerate care.
Rights
1976 edition of the Accreditation Manual for Hospitals published by
the Joint Commission on Accreditation of Healthcare Organizations, now known
as The Joint Commission (Falvo, 2004).
Accreditation This manual broadened the scope of patient education to include both outpatient
Manual for Hospitals and inpatient services and specified that criteria for patient education should be
established

1980s and 1990s national health education programs once again became popular as healthcare
trends focused on disease prevention and health promotion.

1993. recognition of the importance of patient education by nurses,

The Joint Commission (TJC), formerly the Joint Commission on Accreditation of
Healthcare Organizations (JCAHO), established nursing standards for patient
education.

mid-1990s the Pew Health Professions Commission (1995), influenced by the dramatic
changes surrounding health care, published a broad set of competencies it
believed would mark the success of the health professions in the 21st century.

competencies for ■ Embrace a personal ethic of social responsibility and service

the practice of ■ Provide evidence-based, clinically competent
health care include care
the need for all ■ Incorporate the multiple determinants of health in clinical care
health ■ Rigorously practice preventive health care
professionals to do ■ Improve access to health care for those with
the following: unmet health needs
■ Practice relationship-centered care with
individuals and families
■ Provide culturally sensitive care to a diverse
society
■ Use communication and information technology effectively and
appropriately
■ Continue to learn and help others learn
Healthy People 2020 - the product of an extensive evaluation process
by stakeholders.
- Its 40 topic areas support four overarching goals:
1. attaining high-quality and longer lives;
2. achieving health equity and eliminating disparities;
3. creating social and physical environments that promote good health
for all;
4. promoting quality of life, healthy development, and behaviors across
the entire life span
Patient education is a fundamental component of these far-reaching
national initiatives.
Grueninger (1995) “From disease-oriented patient education
(DOPE) to prevention-oriented patient education (POPE) to ultimately become
health-oriented patient education (HOPE)
Purposes, Goals,
and Benefits of
Patient and
Nursing
Staff/Student
Education
purpose of patient is to increase the competence and confidence of clients for self-management.
education
primary goal is to increase the responsibility and independence of clients
for self-care.

effective teaching by ■ Increase consumer satisfaction

the nurse can do the ■ Improve quality of life
following: ■ Ensure continuity of care
■ Decrease patient anxiety
■ Effectively reduce the complications of
illness and the incidence of disease
■ Promote adherence to treatment plans
■ Maximize independence in the performance
of activities of daily living
■ Energize and empower consumers to become actively involved in the
planning of their care.

Chinese (author “Provide a man a fish and he may eat for a day. Teach a man to fish and he may
unknown) proverb eat for a lifetime.”
The Education
Process
Defined
Education Process - is a systematic, sequential, logical, scientifically based, planned course of
action consisting of two major interdependent operations: teaching and
learning.
 - his process forms a continuous cycle that also involves
two interdependent players: the teacher and the learner.
Teaching and - terms that are often used interchangeably—are deliberate interventions
instruction that involve sharing information and experiences to meet intended learner
outcomes in the cognitive, affective, and psychomotor domains according
to an education plan.
- Whether formal or informal, planned well in advance or spontaneous,
teaching and instruction are nevertheless deliberate and conscious acts
with the objective of producing learning.
FIGURE 1-1 page 14

Learning defined as a change in behavior (knowledge, attitudes, and/or skills) that can be
observed or measured and that occurs at any time or in any place resulting from
exposure to environmental stimuli.

Patient education is a process of assisting people to learn health-related behaviors that they can
incorporate into everyday life with the goal of achieving optimal health and
independence in self-care.
Staff education by contrast, is the process of influencing the behavior of nurses by producing
changes in their knowledge, attitudes, and skills to help them maintain and
improve their competencies for the
delivery of high-quality care to the consumer.
ASSURE model This model is appropriate for all health professional educators.

A nalyze the learner

S tate the objectives
S elect the instructional methods and materials
U se the instructional methods and materials
R equire learner performance
E valuate the teaching plan and revise as necessary
Barriers to
Teaching and
Obstacles to
Learning
Barriers to teaching are defined as those factors that impede the nurse’s ability to deliver educational
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

Factors Affecting the

Ability
to Learn