1. Chapter 1
Overview of Education in
Health Care

2. Historical Foundations of the
Nurse Educator Role
• Health education has long been considered
a standard caregiving 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.

3. Historical Foundations (cont’d)
• American Hospital Association (AHA)
– Patient’s Bill of Rights ensures that clients
receive complete and current information.
– Patient education was a significant part of
Patient’s Bill of Rights.
• The Joint Commission (TJC)
– Accreditation mandates require evidence of
patient education to improve outcomes.

4. Historical Foundations (cont’d)
• Healthy People 2000, Healthy People 2010, and
Health People 2020 established educational
programs.
• Pew Health Professions Commission
– Put forth a set of health profession
competencies for the 21st century
– Many of the competencies deal with teaching.

5. Evolution of the Teaching Role of
Nurses
• In nursing, patient education has long been a
major component.
• Florence Nightingale was the ultimate educator.
• National League of Nursing Education (NLNE),
now the National League for Nursing (NLN)
– Observed in 1918 that health teaching is an
important function within the scope of
nursing practice

6. Evolution of Teaching Role (cont’d)
• American Nurses Association (ANA)
– Responsible for establishing standards and
qualifications for practice, including patient
teaching
• International Council of Nurses (ICN)
– Endorses health education as an essential
component of nursing care delivery

7. Evolution of Teaching Role
(cont’d)
• State Nurse Practice Acts
– Universally include teaching within the scope
of nursing practice
– Nursing career ladders often incorporate
teaching effectiveness as a measure of
excellence in practice.

8. Trends Affecting Health Care
Social, economic, and political forces that
affect a nurse’s role in teaching:
• Federal initiatives outlined in Healthy People
2020
• 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

9. 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
• Increased prevalence of chronic conditions

10. Trends (cont’d)
• Impacts of advanced technology
• Health literacy increasingly required
• Research findings that client education
improves compliance
• Advocacy for self-help groups
• Increased use of online technologies
• Screenings occasioned by advances in genetics
and genomics

11. Purpose, Goals, and Benefits of
Client and Staff Education
Purpose: To increase the competence and
confidence of clients to manage their own
self-care and of staff and students to deliver
high-quality care
Benefits of education to clients:
– Increases consumer satisfaction
– Improves quality of life
– Ensures continuity of care

12. Purpose, Goals, and Benefits
(cont’d)
– Decreases client anxiety
– Reduces incidence of illness complications
– Promotes adherence to treatment plans
– Maximizes independence
– Empowers consumers to become involved in
planning their own care

13. Purpose, Goals, and Benefits
(cont’d)
Benefits of education to staff:
– Enhances job satisfaction
– Improves therapeutic relationships
– Increases autonomy in practice
– Provides opportunity to create change that
matters

14. 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

15. The Education Process (cont’d)
Learning: A change in behavior (knowledge,
attitudes, and/or skills) that can be
observed or measured, and that can occur
at any time or in any place as a result of
exposure to environmental stimuli

16. 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

17. ASSURE Model
A useful paradigm to assist nurses to organize
and carry out the education process
Analyze the learner
State the objectives
Select instructional methods and materials
Use instructional methods and materials
Require learner performance
Evaluate/revise the teaching plan

18. Contemporary 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.

19. Role of Nurse As Educator (cont’d)
• The partnership philosophy stresses the
participatory nature of the teaching and
learning process.
• The new educational paradigm focuses on
the learner learning.
– Instead of the teacher teaching
– The nurse becomes the “guide on the side.”

20. Role of Nurse as Educator (cont’d)
• Nursing education transformation
– Gap between nursing education and practice
• Patient engagement
– Nursing Alliance for Quality Care (NAQC) goals:
Consumer-centered health care, performance
measurement and public reporting, advocacy,
and leadership

21. Role of Nurse as Educator (cont’d)
• Quality and safety education in nursing
– Robert Wood Johnson Foundation (RWJF)
Quality and Safety Education in Nursing (QSEN)
competencies:
• Patient-centered care
• Teamwork and collaboration
• Evidence-based practice

22. Role of Nurse as Educator (cont’d)
– RWJF Quality and Safety Education in Nursing
competencies (cont’d):
• Quality improvement
• Informatics
• Safety

23. Role of Nurse as Educator (cont’d)
• Institute of Medicine (IOM)
– The Future of Nursing: Leading Change,
Advancing Health
• Written in response to the Affordable Care Act
• Describes the role of nursing in a transformed
healthcare system

24. Role of Nurse as Educator (cont’d)
• Institute of Medicine (cont’d)
– The Future of Nursing recommendations:
• Remove scope of practice barriers
• Expand opportunities for nurses to lead in
collaborative efforts
• Implement nurse residency programs

25. Role of Nurse as Educator (cont’d)
• Institute of Medicine (cont’d)
– The Future of Nursing recommendations
(cont’d):
• Increase proportion of nurses with baccalaureate
degrees to 80% by 2020
• Double number of nurses with a doctorate by 2020

26. Role of Nurse as Educator (cont’d)
• Institute of Medicine (cont’d)
– The Future of Nursing recommendations
(cont’d):
• Prepare and enable nurses to lead change to advance
health
• Build infrastructure for the collection and analysis of
data
• Ensure that nurses engage in lifelong learning

27. 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

28. Barriers to Teaching (cont’d)
• Environments not conducive to the teaching–
learning process
• Absence of third-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

29. 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
• Low literacy and functional health illiteracy

30. Obstacles (cont’d)
• Loss of control, lack of privacy, and social
isolation of hospital environment
• Situational and personal variations in readiness
to learn, motivation and compliance, and learning
styles
• Extent of behavioral changes (in number and
complexity) required

31. 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, fragmentation, and
dehumanization of the healthcare system

32. Questions to Be Asked about
Teaching and Learning
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?

33. 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 ?

34. 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?

35. 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?

36. State of the Evidence
• 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.

37. State of the Evidence (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