Historical and Urgently Needed Development Of Patient Education in Nursing

Patient Education In Nursing and Historical and Urgently Needed Developments

Brief Historical Development Of Patient Education,Urgently Needed Development Issues In Nursing  Education.

Brief Historical Development Of Patient Education

    A historical look at patient education back to the 1970s provides perspective on its development. Popularity of learning theory has moved from behavioral to cognitive, then to social cognitive, and now to constructivism. 

    Models of health behavior used to direct educational interventions began with the Health Belief Model (emphasizing perceptual severity, susceptibility, and barriers), then to the PRECEDE model (emphasizing predict posing factors) and the trans theoretical (stage based) model of behavior change; all are currently still in use. In the 1970s description of patients' rights first occurred, very gradually beginning to displace provider dominance of the field. 

    This trend has continued with the patient- and family-centered philosophy and recognition that some things are best learned from other patients. By the 1990s JCAHO had incorporated patient education into accentuation standards, perhaps in response to a Picker Institute study that showed one third of hospital patients had not been told about clear danger signals to watch for on dis charge.

    By the end of the 1980s a significant research base had accumulated and continues to grow. During the 1990s, measurement instruments continued to be produced. Validated educational programs for each of the common chronic diseases have now morphed into well defined self management programs that cross disease entities. 

    Indeed, patient education has become more differentiated into self-management preparation, event management (such as for procedures), caregiver competency and coping, and crucial public safety issues such as communicable disease and blood donation.

    Much more developed prewired roles have also emerged as preparation for patient education practice has become well. incorporated into degree programs for nurses. Currently, nurse managed clinics for chronic diseases combine disease monitoring, case management and patient education functions very effectively. Pharmacists' roles in drug counseling and in clinical pharmacy in general added great strength. 

Urgently Needed Development Issues In Nursing  Education

    Some of the issues most urgently in need of resolution in order to professionalize patient education, are rarely addressed. Following are perhaps the several foremost issues remaining to be tackled.

1. Ability to characterize or describe the active ingredients in educational interventions in order to study their effectiveness individually or in combination, thus to replicate them clinically or in research studies. 

    In a review of studies of patient education programs for adults with asthma (77 projects with 94 interventions), Sudre, Jacquemet, Uldry, and Perneger (1999) found most reports did not specify the educational objectives (60%); duration of education (45%) and number of sessions (22%) were often not recorded. 

    It is important to note that the educational field in general has not solved this issue. Evidence to date suggests that time sufficient to achieve mastery and presence of elements social learning theory posits to increase self-efficacy are critical.

2. Use of objective measures (psychometrically sound instruments). to supplement clinical judgments in making assessments of adequacy of learning and thus of the need for and adequacy of educational interventions. 

    While examples of instruments well suited to the applied nature of patient education exist, they are rare. Most were developed for and appear to be used in research. There is little evidence of their use in routine clinical practice even though objective tests are very common in biologically based clinical medicine.

3. Outcome standards for patient education, separated from dispense outcome or more general outcomes of medical practice. Redman (2004) has shown these are strikingly absent for preparation for self-management of chronic disease. 

    In general, event management education has more well-accepted outcomes such as anxiety reduction, better preparation for diagnostic exams and quicker recovery.

4. Delivery systems that ensure outcomes that meet standards and serve all patients. This deficit is perhaps the most worried some of all. While there is widespread evidence that people with less formal education and those of disadvantaged backgrounds have fewer of the verbal and numerical skills to benefit from the usual version of patient education, there is little comprehensive evidence as to who gets access to these services and whether that access is biased against certain groups. 

    What little information exists suggests that most patient education delivery systems are haphazard. Although the Internet offers an opportunity to provide education to large numbers of individuals, Web sites are still plagued by inaccurate information presented at high reading levels, and most innovative applications are still experimental.

5. Full use of patient education to create safety. An alarming study from Norway provides an example (Lindstrom & Rosvik, 2003). It found that nearly 40% of blood donors had inadequate knowledge about the immunological window period (the period of about 3-7 weeks after contamination), during which ordinary antibody tests will not detect HIV antibodies. 

    During the window period, one is completely dependent on the donor's honest and correct understanding of the demands for donating blood. In addition, the questionnaire used to exclude donations from donors with drug abuse or multiple sexual partners, was ambiguous and could be interpreted several different ways. 

    Since it is absolutely crucial that donors are adequately informed about the risks pertaining to the immunological window period, one wonders why mandatory patient education with outcomes tested by a sophisticated measurement instrument are not required.

    A field that lacks adequate description of its interventions and outcomes and a haphazard delivery system is not yet professionalized. Clearly, people must learn to take care of their health needs. The exceedingly slow evolution of patient education does not reflect a low priority need, rather, it reflects lack of priority on this development on the part of the provider community and its institutions. 

    Because patients and families are increasingly expected to care for themselves and because significant developments in fields such as reproductive, transplantation, and genetic medicine now have significant impact on individuals, patient education is ever more critical.