Nursing and Health Care Basis of Patient Education
Language for Patient Education In Nursing and Health Care
The language of patient education continues to privilege the provider's world and marginalize the patients. Because they are legitimized by society and law as the health experts, doctors make limited attempts to enter the patient's conceptual world. Professionals remain the legitimate gatekeepers to all health services. The ideal patient is both compliant and self reliant but always judged by standards set by experts.
The majority of individuals with a chronic illness develop self management strategies that would be labeled as non compliant by health care professionals because they alter the regimen and include alternative therapies. Many health professionals do not believe that patients have the ability to make decisions on their own behalf (Wilson, 2001).
Bioethics for Patient Education In Health Care and Nursing
Bioethics has championed the right of patients to make a choice
(Benner, 2003). It has ignored other life goods such as being understood and
given the tools to reconstruct one's life. It has also focused on ethical
dilemmas precipitated by technology, with far less emphasis (except possibly
for feminists) on ethical analysis of low tech processes of care considered to
be “normal.”
Occasionally, one finds starting examples of such analysis including the one by Mardorossian (2003) describing child birth education and labor from a feminist perspective. This author takes as her starting point patient experience of being taught natural childbirth techniques in childbirth education and realizing too late that these techniques have little effect on pain.
She believes that a high percentage of couples give up on the pain control during labor. The “husband as coach,” a rarely successful process, succeeds in passing responsibility for the failure of the natural childbirth model on to the couple. According to Mardorossian, calling this function “coaching” puts labor into a male perspective and frames it as a sporting event.
Because he is not competent in carrying out the coach role or in controlling labor pain, the husband is unable to live up to the norms of controlling masculinity prescribed by the system. Interpersonal conflicts between the partners ensue as a result of unfulfilled and unrealistic expectations raised in childbirth class.
Other misleading information is thought to be common, for example, in teaching patients about risk factors. A risk factor is statistically associated with the presence of disease. Correcting it may sometimes, but not always, prevent or cure disease. The probabilities of epidemiology do not allow us to tell whether the person in front of us is one in the group concerned who will develop the illness.
Furthermore, we cannot always trust that correction of an assumed risk factor
will be safe and harmless. Practitioners who imply to a patient that his risk
of stroke will change from 100% to 0% if his blood pressure is reduced would be
advised on false premises (Hollnagel & Malterud, 2000).
These kinds of critiques of current practice are no doubt encouraged by serious self examination of the philosophy of care. With strong earlier roots but accelerating interest in the past decade, philosophies of patient centered and family centered care are gaining ascendance.
While these philosophies represent ideals with various definitions and no clear sense of how frequently they are translated into practice, both place patient education, patient self management, and family involvement front and center.
Patient Centeredness In Nursing Education and Healthcare
Patient centeredness can refer to patients' perceptions of how understood they feel; the similarity of professionals and patients' beliefs about the illness, treatment, and patient concerns, or a jointly negotiated and agreed upon plan between health professional and patient with the patient given resources needed to achieve these goals, such as information and skills.
Studies testing providers' ability to elicit and discuss patients' beliefs and ability to activate patients to take control in management of their illnesses find both of these strategies associated with patient adherence to the regimen (Michie, Miles, & Weinman, 2003) .
Other authors (Stewart et al., 2000) found
patient-centered practice to be associated with less discomfort and concern,
better mental health, and fewer diagnostic tests and referrals. Patients'
perception of finding common ground with the provider was more strongly
associated with positive outcomes than were patients' perceptions about
exploring the illness experience with the provider.
Family Centeredness In Nursing Education and Healthcare
Family centered care views a patient's family as the unit to be cared for, recognizing needs of its members as well as the important role they play during a patient's illness. Patients have a choice to include their families or not. This philosophy is most likely encountered in pediatric and critical care settings.
During a critical illness, families benefit from guidance and structure to help them cope, and they need information, reassurance, support, and the ability to be close to the patient. The American Academy of Pediatrics (2003) policy statement on family centered care is based on the understanding that the family is the child's primary source of strength and support and that its role is promoting health and well being of its children.
This statement acknowledges numerous studies showing improved
outcomes and efficiency of care provided with a family centered model, such as
family presence during health care procedures yielding decreased anxiety for
child and parents, and improved follow through when the plan of care is
developed collaboratively with families.
Family and Patient Centeredness In Nursing Education and Healthcare
Both patient and family centered care philosophies take the patient's point of view on health and health care. Evaluations of medical effectiveness occur in patients' lives rather than in doctors' hospitals. Subjective health measures are as predictive of mortality and of health care utilization as are the most objective health measures.
Sullivan (2003) notes
how hard fought the battle to bring patient subjectivity into medical
decision-making has been. Initially, bioethics forced medicine to recognize patients
as autonomous beings who are entitled to choose among medical treatments. But
the battle is still in opening stages as patients need real choices that
represent their needs, not a choice between two physician defined options.
Give your opinion if have any.