Nursing Care and Patient Education
Patient Education
Patient education is defined as a planned learning experience using a combination of methods such as teaching, counseling, and behavioral strategies that influence the patient's knowledge and behavior (Bartlett, 1985).
Since the mid-19th century patient education has been a fundamental cornerstone of health care and today it is an integral component of professional standards of care issued by nursing organizations, such as “A Patient's Bill of Rights” published by the American Hospital Association, and the regulations of the Joint Commission on Accreditation of Healthcare Organizations.
Its importance rests on the fact that the well-being of individuals, whether or not they have a diagnosed disease, often is dependent on health-related actions those individuals take on their own behalf.
In the managed care environment of today, with its concomitant decrease in the incidence and length of hospitalizations for specific health problems, and the shortening of time allocated to outpatient office visits to a health practitioner, patient's and family's responsibility has increased while the time to provide traditional face-to-face patient education has decreased.
Innovative strategies for delivering patient education, such as the use of electronically mediated technologies, need to be explored (eg CD-ROM or Internet-based education, or education as a component of telehealth).
Strategies to increase effective self-management such as patient empowerment, collaborative goal setting, and problem-solving skills (Wagner, Davis, Schaefer, Von Korff, & Austin, 2002) may need to be added to traditional didactic content.
Effect of Patient Research
Research on the effect of patient education began in the early 1960s, and in the late 1980s meta-analyses of this research began to be published.
Major researchers in this area and the patient population that was the focus of their review(s) include: AC Bernard-Bonnin and associates, and JP Guev ara and associates (children/adolescents with asthma); SA Brown, and Gary and associates (adults with diabetes); EC Devine and associates:
(1) adults having surgery
(2) adults with hypertension
(3) adults with cancer
(4) adults with chronic obstructive pulmonary disease
(5) adults with asthma):
E. Monninkhof and associates (adults with chronic obstructive pulmonary disease); WJ Huestron and associates (women at risk for preterm birth); PD Mullen and associates:
(1) adults with coronary disease
(2) adults with arthritis
(3) pregnant women who smoke); and AM Peterson (medication
adherence).
Benefits of Patient Education
Many but not all of the meta-analyses of the effect of patient education have found that it is beneficial for the patients receiving it.
These beneficial effects have included not only increased patient knowledge, but also positive effects on a wide range of disease specific outcomes (eg, blood pressure control among individuals with hypertension [Devine & Reifschneider, 1995]
Pin among cancer patients [Devine , 2003]; blood sugar control at 6 months postintervention among adults with diabetes [Brown, SA, 1992]), and lung function, school absenteeism, and number of visits to the emergency department in children and adolescents (Guevara, Wolf, Grum, & Clark, 2003). However, statistically significant positive effects have not always been found.
For example, there was not a consistent beneficial effect of patient education on hospital admissions and lung function among adults with chronic obstructive pulmonary disease, although there was a decrease in the need for rescue medication (Monninkhof et al., 2003).
Preterm-birth prevention education did not decrease the pre-term delivery or the neonatal death rates among high-risk women (Hueston, Knox, Eilers, Pauwels, & Lonsdorf, 1995).
There were short-term but not long-term effects on both blood sugar levels in diabetics (Brown, 1992) and on disability, joint counts, psychological status, and depression in adults with rheumatoid arthritis (Riemsma, Kirwan, Taal, & Rasker, 2003).
Clinicians wanting to apply patient education research
findings in their practice will need to review the research carefully to find
primary research or meta-analyses of research that match both their client
group and the outcomes they want to affect.
Critical Issues Related to Patient Education
Critical issues for the profession remain. These include: What combinations of treatment components and modes of treatment delivery are the most effective? To what extent have educational interventions been tested in minority populations?
Are culturally specific interventions needed with
minority populations? How do we adapt patient education for nonliterate
populations? How do we make the best use of newer computer-based technologies
(eg, the Internet)? How do we educate patients to evaluate and make good use of
Internet-based information?
Benefits of Patients Education
While many of the reviews of patient education research suggested that patient education is beneficial for patients, the research was less clear about which specific types of patient education and which modes of treatment delivery are the most effective for which types of patients. This limitation arises from three problems.
First, it is common for patient education researchers to contrast the experimental patient education program with usual health care for the setting, and yet they rarely described the patient education included in usual care. Second, very few studies contrasted different types of patient education or different modes of treatment delivery in the same study.
Third, many studies failed to provide detailed descriptions of the
subjects included in their sample. Because of these limitations, it is
difficult to make causal inferences about which types of content and which
modes of treatment delivery are the most effective ones for which types of
patients. More research in this area is needed.
Patient Education and Opportunity
Clinicians and researchers interested in patient education will face many new opportunities and challenges as use of the Internet increases. Many patients, from their homes or local libraries, can use the Internet to access an almost limitless amount of health-related information (eg, from literature searches, professional or consumer organizations, support groups, and disease-specific chat groups ).
This provides an opportunity for clinicians and researchers to provide patient education in innovative ways that allows the patient to have some control over the topic, timing, and pacing of the education.
Some innovative educational programs also allow patients to submit questions using electronic mail and receive a response from their health care provider. The Internet will also provide many challenges to clinicians and researchers. Patients may receive inaccurate information over the Internet and be ill-equipped to judge its trustworthiness.
In some situations patients may become aware of the latest research findings (eg, on treat. ment options for their health problem) before their nurses and doctors. Clinicians and researchers should determine if their patients are using the Internet to seek health related information, and be prepared to help their patients make good use of this resource.
When appropriate, they also should direct them to authoritative sources of information that are appropriate for health care consumers (eg, http://www.nlm.nih.gov/medline plus.html).Given the research base for patient education and the professional standards that dictate its use, clearly the question is no longer simply: Does research suggest that systematic patient education should be provided?
The many remaining researchable questions are at
a finer level such as: Is it possibly to improving patient education through
the use of technology, or are culturally-specific education programs more
effective in underserved groups?
Ethical Issues for Patient Education
There are ethical and professional mandates to educate patients so that they can make informed decisions about their health. These mandates are undoubtedly over time helping to change the patient education included in usual care.
This dynamic nature of care makes it even more important for researchers
and clinicians to be aware of the patient education typically provided as part
of usual care in their setting.
Give your opinion if have any.