Chapter 1
Overview of Education in
Health Care
Historical Foundations of the
Nurse Educator Role
• Health education has long been
considered a standard care-giving role
of the nurse.
• Patient teaching is recognized as an
independent nursing function.
• Nursing practice has expanded to
include education in the broad concepts
of health and illness.
Historical Foundations (cont’d)
Organizations and Agencies Promulgating
Standards and Mandates:
1. NLNE (NLN)
– first observed health teaching as an
important function within the scope of
nursing practice
– responsible for identifying course content
for curriculum on principles of teaching and
learning
Historical Foundations (cont’d)
2. ANA
- responsible for establishing standards and
qualifications for practice, including patient
teaching
3. ICN
- endorses health education as an essential
component of nursing care delivery
Historical Foundations (cont’d)
4. State Nurse Practice Acts
- universally includes teaching within the scope
of nursing practice
5. JCAHO
- accreditation mandates require evidence of
patient education to improve outcomes
6. AHA
- Patient’s Bill of Rights ensures that clients
receive complete and current information
Historical Foundations (cont’d)
7. Pew Health Professions Commission
- puts forth a set of health profession
competencies for the 21st century
- over one-half of recommendations pertain to
importance of patient and staff education
Trends Affecting Health Care
Social, economic, and political forces that
affect a nurse’s role in teaching:
• federal initiatives outlined in Healthy People
2010
• growth of managed care
• increased attention to health and well-being of
everyone in society
• cost containment measures to control
healthcare expenses
• concern for continuing education as vehicle to
prevent malpractice and incompetence
Trends (cont’d)
• expanding scope and depth of nurses’
practice responsibilities
• consumers demanding more knowledge and
skills for self-care
• demographic trends influencing type and
amount of health care needed
• recognition of lifestyle related diseases which
are largely preventable
• health literacy increasingly required
• advocacy for self-help groups
Purpose, Benefits, and Goals of
Patient, Staff and Student Education
Purpose: to increase the competence and
confidence of patients to manage their
own self-care and of staff and students
to deliver high-quality care
Benefits of education to patients:
- increases consumer satisfaction
- improves quality of life
- ensures continuity of care
Purpose, Benefits and Goals (cont’d)
- reduces incidence of illness complications
- increases compliance with treatment
- decreases anxiety
- maximizes independence
Benefits of education to staff:
- enhances job satisfaction
- improves therapeutic relationships
- increases autonomy in practice
- improves knowledge and skills
Purpose, Benefits and Goals (cont’d)
Benefits of preceptor education for
nursing students
• prepared clinical preceptors
• continuity of teaching/learning from
classroom curriculum
• evaluation and improvement of student
clinical skills
Purpose, Benefits, and Goals (cont’d)
Goal: to increase self-care responsibility
of clients and to improve the quality of
care delivered by nurses
The Education Process
Definition of Terms
Education Process: a systematic, sequential,
planned course of action on the part of both
the teacher and learner to achieve the
outcomes of teaching and learning
Teaching/Instruction: a deliberate intervention
that involves sharing information and
experiences to meet the intended learner
outcomes
The Education Process (cont’d)
Learning: a change in behavior
(knowledge, skills, and attitudes) that can
be observed and measured, and can
occur at any time or in any place as a
result of exposure to environmental
stimuli
The Education Process (cont’d)
Patient Education: the process of helping
clients learn health-related behaviors to
achieve the goal of optimal health and
independence in self-care
Staff Education: the process of helping
nurses acquire knowledge, attitudes,
and skills to improve the delivery of
quality care to the consumer
ASSURE Model
A useful paradigm to assist nurses to organize
and carry out the education process.
Analyze the learner
State objectives
Select instructional methods and materials
Use teaching materials
Require learner performance
Evaluate/revise the teaching/learning process
Role of the Nurse As Educator
• Nurses act in the role of educator for a
diverse audience of learners—patients
and their family members, nursing
students, nursing staff, and other
agency personnel.
• Despite the varied levels of basic
nursing school preparation, legal and
accreditation mandates have made the
educator role integral to all nurses.
Role of Nurse As Educator (cont’d)
• Nurses function in the role of educator as:
- the giver of information
- the assessor of needs
- the evaluator of learning
- the reviser of appropriate methodology
• The partnership philosophy stresses the
participatory nature of the teaching and
learning process.
Barriers to Teaching
Barriers to teaching are those factors
impeding the nurse’s ability to optimally
deliver educational services.
Major barriers include:
• lack of time to teach
• inadequate preparation of nurses to assume the
role of educator with confidence and competence
• personal characteristics
• low-priority status given to teaching
Barriers to Education (cont’d)
• environments not conducive to the reachinglearning process
• absence of 3rd party reimbursement
• doubt that patient education effectively
changes outcomes
• inadequate documentation system to allow
for efficiency and ease of recording the
quality and quantity of teaching efforts
Obstacles to Learning
Obstacles to learning are those factors that
negatively impact on the learner’s ability
to attend to and process information.
Major obstacles include:
• limited time due to rapid discharge from care
• stress of acute and chronic illness, anxiety,
sensory deficits, and low literacy
• functional health illiteracy
Obstacles (cont’d)
• lack of privacy or social isolation of health-care
environment
• situational and personal variations in readiness
to learn, motivation and compliance, and
learning styles
• extent of behavioral changes (in number and
complexity) required
Obstacles (cont’d)
• lack of support and positive reinforcement from
providers and/or significant others
• denial of learning needs, resentment of
authority and locus of control issues
• complexity, inaccessibility, and fragmentation,
of the healthcare system
Questions To Be Asked
The following questions can be posed about the
elements of the education process, the role of
the nurse as educator, and the principles of
teaching and learning:
• How can the healthcare teams work together
more effectively to coordinate educational
efforts?
• What are the ethical, legal, and economic
issues involved?
Questions (cont’d)
• Which theories and principles support the
education process?
• What assessment methods and tools can be
used to determine learning needs, readiness
and styles?
• Which learner attributes positively and
negatively influence education efforts?
• What can be done about the inequities in the
delivery of education services ?
Questions (cont’d)
• Which elements need to be taken into account
when developing and implementing teaching
plans?
• Which instructional methods and materials are
available to support teaching efforts?
• Under which conditions should certain
teaching methods and tools be used?
• How can teaching be tailored to meet the
needs of specific clientele?
Questions (cont’d)
• What are the common mistakes made in the
teaching of others?
• How can teaching and learning best be
evaluated?
What other questions might you ask?
Perspectives on Research in Patient
and Staff Education
• most non–research-based literature focuses on
“how to do” patient teaching
• more attention is given to the needs of learners
who have acute, short-term problems than to
those who have chronic, long-term conditions
• more research is needed on new teaching
technologies, especially computer-assisted
modalities, distance education, and Internetbased health information sites
Perspectives on Research (cont’d)
• further investigation is needed on the costeffectiveness of education efforts
• future research must address:
– gender issues
– measurement of behavioral outcomes
– effects of educational interventions
– theoretical basis for education in practice
– cost-effectiveness of educational efforts