Health Care and Patient Education
Patient and Staff Education
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 (Andersson, Svanström , Ek, Rosén, & Berglund, 2015; Friberg, Granum, & Bergh, 2012), whether it be educating patients and their family members, colleagues, or nursing students.
Trends In Health Care Regarding Patient Education
The current trends in health care are making it essential that patients be prepared to assume responsibility for self care management and that nurses in the workplace be accountable for the delivery of safe, high-quality care (Hines & Barndt Maglio, 2011; Lockhart , 2016; Shi & Singh, 2015; US Department of Health and Human Services [USDHHS], 2015).
The focus of modern health care is on outcomes that demonstrate the extent to which patients and their significant others have learned essential knowledge and skills for independent care or to which staff nurses and nursing students have acquired the up-to-date knowledge and skills needed to competently and confidently render care to the consumer in a variety of settings (Adams, 2010; Committee on Quality of Health Care in America & Institute of Medicine [IOM], 2001; Doyle, Lennox, & Bell, 2013).
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. Because so many changes are occurring in the healthcare system, nurses are increasingly finding themselves in challenging, constantly changing, and highly complex positions (Gillespie & McFetridge, 2006). Nurses in the role of educators must understand the forces, both historical and present day, that have influenced and continue to influence their responsibilities in practice.
Historical Foundations for Patient Education in Health Care
“Patient education has been a part of health care since the first healer gave the first patient advice about treating his (or her) illnesses” (May, 1999, p. 3). Although the term patient education was not specifically used, considerable efforts by the earliest healers to inform, encourage, and caution patients to follow appropriate hygienic and therapeutic measures occurred even in prehistoric times (Bartlett, 1986), Because these early healers physicians, herbalists , midwives, and shamans did not have a lot of effective diagnostic and treatment interventions, it is likely that education was, in fact, one of the most common interventions (Bartlett, 1986).
Three Phases In The History of Patient Education
From the mid 1800s through the turn of the 20th century, described as the formative period by Bartlett (1986) and as the first phase in the development of organized health care by Dreeben (2010), several key factors influenced the growth of patient education . The emergence of nursing and other health professions, technological developments, the emphasis on the patient caregiver relationship, the spread of tuberculosis and other communicable diseases, and the growing interest in the welfare of mothers and children all had an impact on patient education (Bartlett , 1986; Dreeben, 2010).
In nursing, Florence Nightingale emerged as a resolute advocate of the educational responsibilities of district public health nurses and 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).Dreeben (2010) describes the first 4 decades of the 20th century as the second phase in the development of organized health care.
In support of maternal and child health in the United States, the Division of Child Hygiene was established in New York City in 1908 (Bartlett, 1986). Under the auspices of this organization, public health nurses provided instruction to mothers of newborns in the Lower East Side on how to keep their infants healthy. 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 US. public health system.
The National League of Nursing Education (NINE) recognized that 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” (Dreeben, 2010, p.11).
The third phase in the development of organized health care began after World War II. It was a time of significant scientific accomplishments and a profound change in the delivery system of health care (Dreeben, 2010). From the late 1940s through the 1950s is described as a 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).
Emergence of Patient Education In History
The first references in the literature to patient education began to appear in the early 1950s (Falvo, 2004). In 1953, Veterans Administration (VA) hospitals issued a technical bulletin titled Patient Education and the Hospital Program. This bulletin identified the nature and scope of patient education and provided guidance to all hospital services involved in patient education (Veterans Administration, 1953).
In the 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 and education. Developments during this time, such as the civil rights movement, the women's movement, and the consumer and self-help movement, all affected patient education (Bartlett,1986: Nyswander, 1980; Rosen , 1977).
In the 1960s, 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, and hospitals in a variety of states became involved in various education programs and projects (Public Health Service, 1971). By the mid 1960s, patients were recognized as health-care consumers and society adopted the new perspective that health care was a right and not a privilege for all Americans.
In 1965, the US 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, 2010).
Concerned that patient education was being provided only occasionally and that patients were not routinely being given information that would allow them to participate in their own health care, the 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 (Public Health Service, 1971).
One of the committee's seven basic premises was an educational prescription that would base teaching on individual patient needs and be included as part of the patient's record. This recommendation represented one of the earliest mentions of the documentation of patient education (Falvo, 2004). The committee ultimately developed a model that defined the educational processes necessary for patient and family education that could be used with any illness by any member of the healthcare team (Health Services and Mental Health Administration, 1972).
Important Events of 1971
In 1971, two significant events occurred:
(1) A publication from the US 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 (Falvo, 2004). Nixon later appointed the President's Committee on Health Education, which recommended that hospitals offer health education to families of patients (Bartlett, 1986; Weingarten, 1974).
Although the terms health education and patient education were used interchangeably, this recommendation had a great impact on the future of patient education because a health education focal point was established in what was then the US Department of Health, Education, and Welfare (Falvo, 2004 ).
Resulting from this committee's recommendations, the American Hospital Association (AHA) appointed a special committee on health education (Falvo, 2004). The AHA committee suggested that it was a responsibility of hospitals as well as other healthcare institutions to provide educational programs for patients and that all health professionals were to be included in patient education (AHA, 1976). Also, the healthcare system began to pay more attention to patient rights and protections involving informed consent (Roter, Stashefsky Margalit, & Rudd, 2001).
Also in the 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 (AHA, 1973). This document outlines patients' rights to receive current information about their diagnosis, treatment, and prognosis in understandable terms as well as information that enables them to make informed decisions about their health care. The Patient's Bill of Rights also guarantees a patient's right to respectful and considerate care.
The adoption of this bill of rights promoted additional growth in the concept of patient education , which reinforced the concept as a “patient right ” as well as it being seen an obligation and legal responsibility of health professionals. In addition, patient education was recognized as a condition of high-quality care and as a factor that could affect the efficiency of the health-care system (Falvo, 2004). Furthermore, during the 1970s, insurance companies began to deal with issues surrounding patient education, because they saw how patient education could positively influence the costs of health care (Bartlett, 1986).
Further support for and validation of patient education as a right and expectation of high-quality health care came in the 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). This manual broadened the scope of patient education to include both outpatient and inpatient services and specified that criteria for patient education should be established.
Patients had to receive information about their medical problem, prognosis, and treatment, and evidence had to be provided indicating that patients understood the information they were given (Joint Commission on Accreditation of Healthcare Organizations, 1976). In the 1980s and 1990s, national health education programs once again became popular as healthcare trends focused on disease prevention and health promotion. This evolution represented a logical response to the cost containment efforts occurring in health care at that time (Dreeben, 2010).
The US Department of Health and Human Services' Healthy People 2000: National Health Promotion and Disease Prevention Objectives, issued in 1990 and building on the US Surgeon General's Healthy People report of 1979, established important goals for national health promotion and disease prevention in 22 areas (USDHHS, Office of Dis-ease Prevention and Health Promotion, 2000). Establishing educational and community-based programs was one of the priority areas identified in this document.
Also, in recognition of the importance of patient education by nurses, The Joint Commission (TIC), formerly the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), established nursing standards for patient education as early as 1993. These standards, known As mandates, it describes the type and level of care, treatment, and services that agencies or organizations must provide to receive accreditation.
Required accreditation standards have provided the impetus for nursing service managers to emphasize unit-based clinical staff education activities for the improvement of nursing care interventions to achieve expected client outcomes (JCAHO, 2001). These standards required nurses to achieve positive outcomes of patient care through teaching activities that must be patient centered and family oriented. More recently, TJC expanded its expectations to include an interdisciplinary team approach in the provision of patient education as well as evidence that patients and their significant others participate in care and decision making and understanding what they have been taught.
This requirement means that all healthcare providers must consider the literacy level, educational background, language skills, and culture of each client during the education process (Cipriano, 2007; Davidhizar & Brownson, 1999; JCAHO, 2001).In the mid-1990s, the Pew Health Professions Commission (1995), influenced by the dramatic changes surrounding health care, published a broad set of competencies that believed would mark the success of the health professions in the 21st century.
Shortly thereafter, the commission released a fourth report as a follow up on health professional practice in the new millennium (Pew Health Professions Commission, 1998). This report offered recommendations pertinent to the scope and training of all health professional groups, as well as a new set of competencies for the 21st century. Many of the competencies deal with the teaching role of health professionals, including nurses. These competencies for the practice of health care include the need for all health professionals to do the following.
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