health education

1. PATIENT EDUCATION
UNIT- XIII

2. Unit- XIII
• Patient education
• Patient Teaching – Importance, Purposes,
• Process
• Integrating nursing process in patient teaching

3. Definition
•Patient education can be defined as the process of influencing
patient behavior and producing the changes in knowledge,
attitudes and skills necessary to maintain or improve health.
•‘Patient Education is any set of planned, educational activities
designed to improve patients’ health behaviors and/or health
status’ Lorig et al (1996)

4. Contd…
•The process may begin with the imparting of information, but
also includes interpretation and integration of the information in
such a manner as to bring about attitudinal or behavioral
changes.
•Goal of educating others about their health is to help individuals,
families or communities achieve optimal levels of health.
•Patient education is an essential component of providing safe,
patient –centered care

5. Patient teaching
•Patient teaching refers to activities aimed at improving
knowledge of the patient. It refers to only one component of the
patient education that is the process of actual imparting of
information to the patient.
•Changes in knowledge level may be necessary before we can
change behaviors or health status
BUT
• The transfer of knowledge that takes place with patient
teaching alone does not ensure behavioral change.

6. Patient teaching

7. Factors influencing behavioural change
•Willingness to make a change
•Believe that a behavioural change will have a beneficial effect
•Believe that you have the ability to execute the change

8. Theory Underpinning Patient Education
•Self Efficacy Theory (Bandura, 1986)
•Stress and coping theory (Lazarus and Folkman, 1984)
•Health belief model (Becker, 1974)
•Health promotion model (Becker, 1974)
•Learned Helplessness (Seligman, 1975)

9. Health Belief Model
Developed by Rosenstock to explain individual decisions for health
screening opportunities, the three primary points of this model are:
1. The individual’s perception of his/her susceptibility to and the
severity of the disease are the primary motivators to learn and
change behavior.
2. A belief must exist that the illness can be avoided and that taking
action can reduce the risk.
3. The individual must also believe that he/she is capable of
making the necessary changes.

10. Health Promotion Model
Developed by Pender, this model depicts a complex process associated
with behavioral change for health promotion.
 Focus is on optimizing wellness versus avoiding disease.
 Patient motivation is influenced by social support and competing
priorities.
 Patient perceptions of benefit and the ability to succeed affect
outcomes.

11. Importance of patient education
•Patient education is one of the vital and most important component
of the nursing intervention in any health care setting.
•It is critically important because the leading causes of death in
modern world (i.e, heart &lung disease, cancer, stroke, injuries) are
closely associated with unhealthy lifestyles.
•There is strong evidence that counseling and providing complete
and current information creates an atmosphere of trust, enhances
the nurse-patient relationship and empowers patients to participate
in their own health care.

12. Contd…
• This results in better health, fewer complications, fewer rate of
hospitalization or visit to health care providers/ hospitals/ emergency
department.
• Effective patient education also ensures that patients have sufficient
information and understanding to make informed decisions regarding
their care, become healthier and more independent.

13. Benefits of patient education
• Patient education enables patients to assume better responsibility for
their own health care
• Provides opportunities to choose healthier lifestyles and practice
preventive medicine
• Patient education attracts patients to the provider and increases
patients’ satisfaction with their care, better patient – provider
relationship and at the same time decreasing the provider’s risk of
liability

14. Contd…
•Patient education promotes patient- centered care and as a
result, patients’ active involvement in their plan of care.
•Patient education increases adherence to medication and
treatment regimens, leading to a more efficient and cost-
effective health care delivery system.
•It ensures continuity of care and reduces the complications
related to illness and incidence of disorder/disease.

15. Contd…
•Patient education maximizes the individual’s independence
•Results in increased Patient Satisfaction - faster recovery time,
less visits to the provider
• Results in increased Patient Safety -Less injuries due to patient
lack of knowledge, medication errors, compliance with treatment

16. Purposes of Patient Teaching
To help patients and families to develop the self-care abilities
(knowledge, attitude, skills) required to maximize their functioning
and quality of life (or to have a dignified death). For eg, a patient
newly diagnosed with diabetes must acquire knowledge about
diabetes as a disease and its management & self care (knowledge),
value own health to make certain lifestyle modifications (attitude)
and master certain skills, such as self administration of insulin.

17. Contd…
•To help the patients to achieve health goals.
•To provide the knowledge that the patient needs to make
informed health care decisions and to implement a care plan.
•To encourage the patient to participate actively in self-care and
to facilitate their coping with their circumstances.

18. Goals of Patient Teaching
Three important goals of patient education are directed toward
promotion, maintenance, and restoration of health and
adaptation to the residual effects of illness.
1. To promote health and prevent illness
2. To restore the patient’s health,
3. To facilitate coping with their condition.

19. To promote health and prevent illness
Promoting health and preventing illness is a major theme in health
teaching and counseling. Nurses can help patients value health and to
develop specific health practices that promote wellness. Health
teaching related to health promotion is varied, It may takes many
forms. Eg.
• Counselling women of childbearing age about health practices that
promote optimal fetal development

20. Contd…
•Teaching parents how to make their home safe for a toddler
•Counselling people at high risk for diabetes for dietary
modifications and exercises
•Explain benefits of preventive health screening to adults.
•Demonstrating passive exercises to a patient with left-sided
paralysis
•Designing a safe exercise program for a young athlete
•To teaching cooking for good nutrition food to a group of
mothers of preschool children

21. To restore the patient’s health
Here the focus is teaching and counseling a sick person to develop
self-care practices that promote recovery. Eg.-
•Teaching about anatomy and physiology of organ, disease
process, cause, significance of signs and symptoms, management
and prognosis.
•Pre and postoperative teaching
•Counseling for limitation in physical activities for a patient
recovering from a myocardial infarction
•Lifestyle counseling for a patient with an colostomy

22. To facilitate coping
•Adjusting with developmental changes, lifestyle changes, and
acute, chronic, and terminal illness all place demands on patients
and families, that may become overwhelming.
•Secondly, not all patients fully recover from their illness or injury.
Many patients will need to learn to cope with permanent health
alterations caused by illness or its treatment.
)

23. Contd…
It includes
•Stress management
•Environmental alterations
•Community resources
•Appropriate referrals(physio & occupational therapy,
selfhelp groups, counselor
•Grief and bereavement counseling

24. Contd…
Nurses help not only the patients but also with their families and
friends to adjust with changes in health status and required lifestyle
modifications. They take measures that maximize independence and
enhance self concept.
It includes
• Stress management
• Environmental alterations
• Community resources
• Appropriate referrals(physio & occupational therapy, selfhelp groups, counselor)
• Grief and bereavement counseling

25. Goals of patient education
Adapt to illness/disability: Patient education helps chronic people to
develop ways of coping with their impairments and live life to the
maximum potential.
Cooperate with the prescribed therapy: Patient education will assist patients
who needs dialysis to learn ways to be cooperative and still maintain their
sense of self
Learn to solve problems when confronted with new situations: Patient
education teaches patients the skill of problem solving so that they can
figure out solutions when they are alone and at home. e.g: takes sweet if
they feel symptoms of hypoglycemia
Prevent hospitalization or re-hospitalization: The ultimate goal of patient
education is to help the patient to be as fully functioning a person as
possible in his/her home and community and it reduce re-hospitalized.

26. Types
•Patient Teaching can be planned/ incidental.
•Incidental teaching can be performed on the spot or when it is
required. Every encounter with the patient is an opportunity to
teach.
•Planned teaching- Teaching can be more fruitful if it is planned
properly after the assessment of clients needs, his educational,
cultural and socioeconomic background, his perception about
health , illness, disease condition etc.

27. Domains of patient teaching
Learning domains refer to the type of learning in which a
learner will be engaged. The three domains are:
•Cognitive: increasing knowledge
•Psychomotor: developing or improving a skill
•Affective: changing or influencing attitudes

28. Application of Learning Domains
Select one everyday living topic from the box below, and discuss
how you would teach a class incorporating each of the three
domains — cognitive, psychomotor, and affective.
• Dog grooming
• Baking a cake
• Carpet cleaning
• Rotating tires
• Mixing cement
• Web page design
• Sewing a shirt
• Fertilizing a lawn
• Stripping and staining furniture
• Painting a room

29. Application of learning domains
Select one health-related topic from the box below, and discuss how
you would teach a class incorporating each of the three domains—
cognitive, psychomotor, and affective.
• Reducing intake of sugary soda
• Having a mammogram to screen
for breast cancer
• Increasing intake of fruits and
vegetables
• Protecting skin from sun
exposure
• Getting adequate sleep
• Reducing plaque on teeth
through brushing and flossing

30. Prerequisites(Preliminary assessment) of Patient Education
Nurse must assess clients needs, his educational, cultural and socioeconomic
background, perception about health, illness, disease condition etc.
The nurse must always assess the patient to see what type of environment will be
most beneficial for them and factors that may interfere.
Another component to consider about environment is appropriate lighting &
temperature.
Comfort
Along with comfort, it is important to always asses the patient for any pain before
proceeding. Pain would interfere with patient’s necessary level of strength in order
to perform learned skills and distract them from the learning material.

31. Contd…
Also she should be well-rested in order to stay alert and fully
engaged in discussions for maximum learning.
The patient should always be assessed for coordination and sensory
acuity as well in order for them to perform certain motor skills and
receive and respond to messages being taught.
Lastly, the nurse must take into consideration their condition and
how it may interfere with the learning process

32. Process of Patient Teaching/Education
The process of patient teaching refers to the steps follow to provide teaching
and to measure learning. The steps involved in the teaching-learning process
are:
• Assessing learning needs and learning readiness
• Diagnosing learning needs
• Developing learning objectives / outcomes
• Develop a teaching plan
• Implementing patient teaching plan or strategies
• Evaluating patient learning

33. Assessing and diagnosing the Learning
needs
Learning needs between patients and for same patient also
according to his health status, time during his stay in the hospital
and even after the follow up visits.
e.g.
• On admission the patient teaching would include the ?????
• Before starting of the treatment patient would want to know???
• Before the surgery or during any special treatment or
investigation patient must understand it…….

34. Developing learning objectives
What you want to achieve at the end of the teaching should
reflect in the learning objectives of the patient...
• Objectives should be achievable and measurable...
• Mention clearly what is expected form the patient in relation
to his attitude, lifestyle, understanding etc.

35. Planning patient teaching
• Always be ready for patient teaching.
• It can be more fruitful if it is well planned and organized.
• Planning is done according to the need of the patient.
• Environment, time of the patient teaching, patients health
status has be taken into consideration.
• Good to take an appointment with the patient and fix the
time of the patient teaching, and also tell the approximate
time you are going to require.

36. Implementing patient teaching
Use of charts, flash cards, posters can be useful.
Introduce the topic and also don't forget to tell the patient and
the family that they may stop you anytime during the patient
teaching to clear their doubt.
Before ending the patient teaching confirm that client
understood the topic and also whether the objectives of the
patient teaching are achieved.

37. Evaluating the patient teaching
Evaluate the patient teaching according to the objectives
met/unmet/needs more time to achieve eg changing the attitude of the
patient.
Take feed back from the patient, family members, and others who
were attending the patient teaching.
Document the patient teaching, along with the topic, time, patients
response and number of participants who attended the patient
teaching. It will avoid repetition for the patient & health care
professional. It is safe for the nurse because client may admit some
time that he was unaware about the facts that created harmful
situation for him or others(Oxygenation –safety precautions)

38. Role of Nurse in Patient Teaching
•When focusing on patients learning needs, before begin the
teaching process, must ask a number of questions and perform
specific assessments.
•This is important to determine her readiness and ability to learn.
•The very first thing that must ask is if patient is willing or able to
accept the reality of her illness.
•So the next step need to do is introduce a teaching plan.
•In order to provide an effective teaching plan you must consider
the developmental and physical factors of patient.

39. Contd…
•For eg nurse assess patient before planning to use flash cards
that patient is able to read and write.
Another consideration need to take is patient’s age.
For example for an elderly patient, the best teaching approach
would be in short sessions and making sure he is involved in
discussions.
According to LeCroy (2009), “To decrease frustration in the
learning process, information should be given in an easy-to-
understand format since the learner’s attention can wane after
only 10 minutes”.

40. Contd…
Next you have to consider their physical capability
Finally after all these components are evaluated and you have taught
your patient the material needed, you must evaluate what they have
learned.
As stated by Hohler (2004), “To assess what your patient has
learned and determine whether he needs more teaching, ask open-
ended questions or have him explain what he’s learned”.
Then you can evaluate what the patient absorbed and what needs
more work.

41. Learning readiness- Physical, emotional, motivational
1. Assist the patient in physical readiness to learn
• Try to alleviate physical distress pain, discomfort that may distract the patient's attention and prevent effective learning.Also, ensure the physical
environment is as free of distractions as possible to help promote learning. Involve family members, spouse, or friend if requested by the patient
• Assess and promote the patient's emotional readiness to learn . In some patient’s with life threatening conditions, emotional readiness will only
occur after the patient has progress through some of the stages of grief – Denial, Anger, Bargaining, Depression, and Acceptance. When educating
your patient, be careful not to overwhelm the patient with volumes of information, but be concise, accurate, and relevant. Be aware of your patient’s
emotions.
2. Motivation to learn: it depends on many factors, including the
• Acceptance of the illness or that illness is a threat to the patient’s health
• Recognition/ acknowledgement of the need to learn
• Values related to social and cultural background
• Therapeutic regimen compatible with the patient's lifestyle

42. To facilitate motivational readiness
• Promote an atmosphere that is warm, non- judgmental, accepting, and open to
cultural practices
• Assess the Patient’s Values - To have a better outcome, educate yourself and be
culturally sensitive to your patient. Some cultures practice alternative forms of
medicine, and your patient may want to incorporate those practices into their
plan of care.
• When developing a teaching plan, address your patient‘s current social and
lifestyle. Educate about unhealthy practices, and reinforce or encourage healthy
practices.
• Encourage the patient to participate in the establishment of acceptable, realistic,
and attainable learning goals
• Provide constructive feedback about progress

43. 4. Assess and promote the patient's experiential readiness to learn.
• Determine the following:
• what experiences the patient has had with health and illness
• what success or failure the patient has had with learning
• what basic knowledge the patient has on related topics
• Provide the patient with prerequisite knowledge necessary to begin the learning
process

44. TEACHING STRATEGIES
• Patient education can occur at any time and in any setting.
Consider the following:
• How conducive the environment is to learning?
• How much time you are able to schedule?
• What other family members can attend the teaching session?
• Use a variety of techniques that are appropriate to meet the needs of each individual
• A teaching plan can be well- written, however, it is ineffective if the patient and/or the patient’s family does not understand it. Even some of
the smartest people have trouble understanding medical processes. Keep it simple. Put terms in everyday language – for example, use “pill”
instead of medication, “cream” instead of ointment, and “use” instead of utilize. Check for accuracy, i.e., such as resources have correct
telephone numbers and addresses.

45. • Lecture or Explanation • Should include discussion or a question-and-answer session
• Group Discussion • Effective for individuals with similar needs • Participants
commonly gain support, assistance, and encouragement from other members
• Demonstration and Practice • Should be used when skills need to be learned • Ample
time should be allowed for practice and return demonstration

46. • Teaching aids
Books, pamphlets, pictures, slides, videos, tapes, and models
Should serve as supplements to verbal teaching
Can be obtained from government agencies, nonprofit groups, various internet health
web sites, pharmaceutical and insurance companies

47. • Reinforcement and follow-up sessions
Offer time for evaluation and additional teaching, if necessary • Can greatly increase the effectiveness of teaching
• Documentation
Document patient teaching:
• What was taught?
• How the patient responded?
• Use standardized patient teaching checklists if available
A key component to determine if patient teaching is effective is to have the patient explain the information you gave them back to you in their own words. Another component to determine the
effectiveness of patient teaching is the number of readmissions due to patient misunderstanding of medications and treatment.