Role of Ethical Education for Patient and Nurse
Ethical Values and Evidence Based Practices
Embrace a personal ethic of social responsibility and service Provide evidence based, clinically competent care Incorporate the multiple determinants of health in clinical care. Rigorously practice preventive health care Improve access to health care for those with 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 for the 21st century, the Institute for Health care Improvement announced the 5 Million Lives campaign in 2006.This campaign's objective was to reduce the 15 million incidents of medical harm that occur in US hospitals each year. Such an ambitious campaign has major implications for teaching patients and their families as well as teaching staff and students the ways they can improve care to reduce injuries, save lives, and decrease costs of health care (Berwick, 2006).
Nursing Education and Cultural Ethical Values
Another initiative was the formation of the Sullivan Alliance to recruit and educate health professionals, including nurses, to deliver culturally competent care to the public they serve. Effective health care and health education of patients and their families depend on a sound scientific base and cultural awareness in an increasingly diverse society. This organization's goal is to increase the racial and cultural mix of health professional faculty, students, and staff, who are sensitive to the needs of clients of diverse backgrounds (Sullivan & Bristow, 2007).
Also, following on the heels of Healthy People 2000, Healthy People 2010 built on the previous two initiatives and provided an expanded framework for health prevention for the nation (USDHHS, 2000). Specific goals and objectives included the development of effective health education programs to assist individuals to recognize and change risk behaviors, to adopt or maintain healthy practices, and to make appropriate use of available services for health care (USDHHS, 2010).
As the latest iteration of the Healthy People initiative, Healthy People 2020 is the product of an extensive evaluation process by stakeholders. Its 40 topic areas support four overarching goals: attaining high-quality and longer lives; achieving health equity and eliminating disparities; creating social and physical environments that promote good health for all; and promoting quality of life, healthy development, and behaviors across the entire life span (USDHHS, 2010).
Patient education is a fundamental component of these far-reaching national initiatives. Presently, the Secretary of Health and Human Services is in the process of establishing an advisory committee, informed by the latest scientific evidence, for the development and implementation of recommendations on national health promotion and disease prevention objectives for Health People 2030 (USDHHS, 2017) .
Thus, since the 1980s the role of the nurse as educator has undergone a paradigm shift, evolving from what once was a disease oriented approach to a more prevention oriented approach. In other words, the focus is on teaching for the promotion and maintenance of health (Roter) et al., 2001). Education, which was once done as part of discharge planning at the end of hospitalization, has expanded to become part of a comprehensive plan of care that occurs across the continuum of the healthcare delivery process (Davidhizar & Brownson, 1999).
DOPE and POPE for Disease Preventive Education
As described by Grueninger (1995), this transition toward wellness entails a progression “from disease oriented patient education (DOPE) to prevention oriented patient education (POPE) to ultimately become health oriented patient education (HOPE)” (p. 53 ). Instead of the traditional aim of simply imparting information, the emphasis is now on empowering patients to use their potentials, abilities, and resources to the fullest (Glanville, 2000; Kelliher, 2013).
Along with supporting patient empowerment, nurses must be mindful to continue to ensure the protection of “patient voice and the therapeutic relationship in patient education against the backdrop of ever-increasing productivity expectations and time constraints (Liu, Yu, & Yuan, 2016; Roter et al., 2001). The Evolution of the Teaching Role of Nurses Nursing is unique among the health professions in that patient education has long been considered a major component of standard care given by nurses.
Since the mid 1800s, when nursing was first recognized as a unique discipline, the responsibility for teaching has been recognized as an important role of nurses as caregivers. The focus of nurses' teaching efforts is on the care of the sick and promoting the health of the public.Florence Nightingale, the founder of modern nursing, was the ultimate educator. Not only did she develop the first school of nursing, but she also dedicated a large portion of her career to teaching nurses, physicians, and health officials about the importance of proper conditions in hospitals and homes to improve the health of people.
Importance of Patient Teaching
Nightingale also emphasized the importance of teaching patients the need for adequate nutrition, fresh air, exercise, and personal hygiene to improve their well being. By the early 1900s, public health nurses in the United States clearly understood the significance of the role of the nurse as teacher in preventing disease and in maintaining the health of society ( Chachkes & Christ, 1996; Dreeben, 2010).
For, then, patient teaching has been recognized for decades as an independent nursing function. Nurses have always educated others patients. families, colleagues, and nursing students. It is from these roots that nurses have expanded their practice to include the broader concepts of health and illness (Glanville, 2000).
Education and Scope In Nursing Education
As early as 1918, the NLNE in the United States, now known as the National League for Nursing (NLN), observed the importance of health teaching as a function within the scope of nursing practice. Two decades later, this organization recognized nurses as agents for the promotion of health and the prevention of illness in all settings in which they practiced (NLNE, 1937). By 1950, the NLNE had identified course content in nursing school curricula to prepare nurses to assume the role.
Most recently, the NLN (2006) developed the first Certified Nurse Educator (CNE) exam to raise “the visibility and status of the academic nurse educator role as an advanced professional practice discipline with a defined practice setting (Klestzick, 2005, p . 1 ).In similar fashion, the American Nurses Association (ANA, 2015) has for years issued statements on the functions, standards, and qualifications for nursing practice, of which patient teaching is a key element.
In addition, the International Council of Nurses (ICN, 2012) has long endorsed the nurse's role as patient educator to be an essential component of nursing care delivery. Today, all state nurse practice acts (NPAs) include teaching within the scope of nursing practice responsibilities. Nurses, by legal mandate of their NPAs, are expected to provide instruction to consumers to assist them to maintain optimal levels of wellness and manage illness.
Nursing career ladders often incorporate teaching effectiveness as a measure of excellence in practice ( Rifas , Morris, & Grady, 1994). By teaching patients and families, nurses can achieve the professional goal of providing cost-effective, safe, and high-quality care (Santo, Tanguay, & Purden, 2007: Shi & Singh, 2015).A variety of other health professions also identify their commitment to patient education in their professional documents (Falvo, 2004).
Standards of practice, practice frameworks, accreditation standards, guides to practice, and practice acts of many health professions outline the educational responsibilities of their members. In addition, professional workshops and continuing education programs routinely address the skills needed for high-quality patient and staff education. Although specific roles vary according to profession, directives related to contemporary patient education clearly echo Bartlett's (1986) assertion that it “must be viewed as a fundamentally multidisciplinary enterprise” (p. 146).
In addition to providing patient education, professional nurses are responsible for educating their colleagues. Another role of today's nurse educator is one of training the trainer that is, preparing nursing staff through continuing education, in service programs, and staff development to maintain and improve their clinical skills and teaching abilities. Nurses must be prepared to effectively perform teaching services that meet the needs of many individuals and groups in different circumstances across a variety of practice settings.
The key to the success of our profession is for nurses to teach other nurses. We are the primary educators of our fellow colleagues and other healthcare staff personnel (Donner, Levonian, & Slutsky, 2005; Lockhart, 2016; McKinley, 2009). In addition, the demand for educators of nursing students is at an all-time high (American Association of Colleges of Nursing, 2015).
Another very important role of the nurse as educator is serving as a clinical instructor for students in the practice setting. Many staff nurses function as clinical preceptors and mentors to ensure that nursing students meet their expected learning outcomes. However, evidence indicates that nurses in the clinical and academic settings feel inadequate as preceptors and mentors as a result of poor preparation for their role as teachers.
This challenge of relating theory learned in the classroom setting to the practice environment requires nurses not only to keep up to date with clinical skills and innovations in practice but also to possess knowledge and skills related to the principles of teaching and learning. Knowing the practice field is not the same thing as knowing how to teach the field.
The role of the clinical educator is a dynamic one that requires the teacher to actively engage students to become competent and caring professionals (Billings, & Hallstead, 2016; Cangelosi, Crocker, & Sorrell. 2009; Gillespie & McFetridge, 2006; Salminen, Stolt , Koskinen, Katajisto, & Leino- Kilpi , 2013).Social, Economic, and Political Trends Affecting Health Care.
In addition to the professional and legal standards various organizations and agencies have put forth, many social, economic, and political trends nationwide that affect the public's health have focused attention on the role of the nurse as teacher and the importance of client, staff , and student education.
The following are some of the significant forces influencing nursing practice, in particular, and healthcare practice, in general (Ainsley & Brown, 2009; Berwick, 2006: Birchenall, 2000; Bodenheimer, Lorig, Holman, & Grumbach, 2002; Cipriano , 2007 ; Committee on Quality of Health Care in America & IOM, 2001; Gantz et al. 2012; Glanville, 2000; Hines & Barndt Maglio, 2011; IOM, 2011; Lea, Skirton, Read, & Williams, 2011; Lockhart , 2016 ; Osborne, 2005; USDHHS, 2010; Shi & Singh, 2015; Zikmund-Fisher, Sarr, Fagerlin, & Ubel, 2006):
The federal government, as discussed earlier, published Healthy People 2020, a document that set forth national health goals and objectives for the next decade. Achieving these national priorities would dramatically cut the costs of health care. prevent the premature onset of disease and disability, and help all Americans lead healthier and more productive lives.
Among the major causes of morbidity and mortality are those diseases now recognized as being lifestyle related and preventable through educational intervention. Nurses, as the largest group of health professionals, play an important role in making a real difference by teaching clients to attain and maintain healthy lifestyles.
The Institute of Medicine (2011) established recommendations designed to enhance the role of nurses in the delivery of health care. This includes 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. The US. Congress passed into law in 2010 the Affordable Care Act (ACA), a comprehensive healthcare reform legislation.
The ACA is designed to provide cost-effective, accessible, equitable, high-quality health care to all Americans with the intent of improving their health outcomes. Universal accessibility to health care has the potential to transform the healthcare system, and nurses will play a greater role in meeting the demands and complexities of this increasing population of patients.
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