Philosophical View About Patient Education In Nursing

Patient Education In Nursing and Its Philosophical View

Historical View of Patient Education In Nursing,Patient Education and Organizational Culture,Patient Response to Health Education,Patient Education and Economical Model In Health Care.

Historical View of Patient Education In Nursing 

    The beginning of the 21st century is a fine time to take stock of the incredible progress that has occurred in patient education in the past 30 years, presumably swept along by social currents of anti-paternalism, its rise should be viewed in controvertibly as a means to create better outcomes for individuals, families, and society, and morally as evidence of respect for persons. 

    At the same time, it remains marginal. While now seen by regulatory agencies as essential for quality, standards for patient education are generally not enforced and not fully internalized by the medical community and thus the payment system.

    Because the change has been both so fast and so slow, it is important to document the cutting edge as well as the failures in use of this therapy, which can also be seen as a social and political movement. 

    This topic presents an interpretation of the status of patient education, considering its philosophical base and recent historical evolution, issues currently engaging the field, new insights in the fields of learning and human development, the evolution of areas of practice, and development of methods to ensure its validity and quality. First, a few broad brush perspectives.

Patient Education and Organizational Culture

    Each cultural institution has an educational component. Be cause health has been so dominated by a limited medical model; the educational component has been not only dramatically underdeveloped but actually thwarted by medicine's total focus on immediate enforcement of compliance with a prescribed regimen. While this position is still apparently sustainable politically, it does not pass muster morally. 

    It does not meet standards of patient autonomy and provider beneficence. Issues of justice are very difficult in the health care arena; suffice it to say that availability and quality of patient education must be at least as good as other elements of care for a particular population. 

    And because it is the key to being able to make use of health care resources, for vulnerable and oppressed patient populations, patient education must be different from and even better than other elements of care.

    There is still no vision of how educational services that are effective, patient centered, and easily available would transform the health care system in many ways. People would feel free to choose education in all the ways necessary to achieve their own life goals, be free of physician oversight and control except as negotiated, and control and cope with their illnesses so that their illnesses fade into the background. 

    In addition, lack of educational services for patients is a major source of medical errors, because people who do not seek professional care when they should unwittingly commit errors when carrying out self care regimens, and they do not catch errors made by professionals.

Patient Response to Health Education

    As further evidence of the marginality of patient education, we are unwilling to invest in it even in instances when its benefits are as good as or better than other therapies more traditionally reimbursed, such as pharmacologic treatments. In addition, we still do not think of educational progress longitudinally as we do diagnosis and treatment of disease, even though “lay” models and readiness to adopt a health behavior (which change over time) are known to be important determinants of response to a disease.

     And we are far from believing that health care should be a learning experience, ensuring satisfaction and a feeling of confidence in whatever self care is important.

Patient Education and Economical Model In Health Care

    The field still lacks a viable economic model. Several arrangements have been tried and have not been significantly sustained. First, some managed care organizations have adopted chronic disease management programs, which have shown long term savings over the cost of education. But the churn of subscribers in and out of managed care organizations means that those who have been educated are disenrolled before the savings are realized. 

    Second, although many surveys show patients are dissatisfied with the amount of information they receive about their health problems, a patient-oriented, available-when-they're-ready business model has not been developed. Thus, it is difficult to determine what patient demand there might be for direct payment for educational services or for pressing insurers to cover these services. 

    Third, free Internet access to health information and support and chat groups has proven helpful but limited by variable information quality and by its general disorganization. People frequently need the help of a teacher to organize and make sense of information as well as to gain skills. 

   Fourth, pharmaceutical companies' investment has been in direct to consumer marketing rather than in services that ensure people will use their products effectively. Finally, unlike some health care services, a global market in patient education services seems to be stymied both by local cultural and practice differences and by lack of a universal set of outcomes and measures to reliably assess them. 

    Some (Neuhauser, 2003) believe that personal empowerment will be the third health care revolution one that is just starting, both for ideological and economic reasons. Economically, the first revolution was cost cutting, the second disease management. 

    The personal empowerment revolution involves patients and families learning to care for themselves. Because nurses provide the services that prepare patients for selfcare, this movement will reduce reliance on doctors.