Health education

Health education

• Helping patients and families make informed decisions about their health care as well as the health of their community

• As you might guess, nurses play a very large role in health education

• Patient education is very important in today’s health care:– Patients are being discharged earlier, after shorter

hospital stays– Chronic illnesses are on the rise, especially

diabetes and all of its related complications

• Patient education is key for helping prevent disease, manage existing illnesses, restore health, and help patients cope with impaired function

Teaching and learning

• Teaching: when the RN provides information to the patient in the hopes that it will be retained and acted upon

• Learning: absorption of the material by the patient, with the possibility of lifestyle changes– It is best when nurses match their teaching to the

needs of the patient– For example- it would not be appropriate to teach

thermal physics in this course- there’s no reason to cover it, and students would not learn it because there was no need for that information

– Similarly, patients will often choose to learn what they need to know and tune out the rest as “fluff”

Key components of health education

• Health education involves the use of teaching-learning strategies to help ensure effective learning

• Learners decide whether or not to make changes in their lifestyles that impact their health– Nurses can teach and encourage, but the decision

to change ultimately rests with the patient or family, not the nurse

– “You can lead a horse to water, but you can’t make him drink”

• Health education focuses on changing behaviors that have been shown to improve health status of patients, families, and communities

Goals of health education

• To help patients, families, and communities achieve optimal states of health through their own initiative– This means that patients and families take actions

to improve their health, based on the teachings of the nurse

• Individuals, families and communities are empowered to make competent, informed decisions about their health and health care– Nurses inspire patients and families with the

confidence and provide information but ultimately allow them to make their own decisions

Ethical considerations

• RNs have an ethical responsibility to teach their patients– This does not mean that the patient will necessarily

learn everything that is taught, but the RN has to try to offer appropriate teaching

• The RN must be an effective teacher to increase the chance of learning and compliance by the patient– This more than simply rattling off facts to the

patient– The RN must find out what the patient needs to

know and how the patient learns best– It would not be appropriate to give printed

pamphlets to a blind patient, or a lengthy lecture to a toddler- the RN does an assessment to determine the best ways to teach the particular patient

Interpersonal communication

• Patients must feel comfortable with the RN to admit that they cannot read or do not understand the material

• The RN can assess non-verbal cues to determine whether or not the patient understands the material being presented

• Patients can tell when the RN is not interested in teaching the material, and will automatically discount any information as being unimportant

Patient teaching

• All health care providers are always teaching, whether they realize it or not

• For example: – If the RNs enter the patient’s room and start

procedures without washing their hands first, the patient may come to believe that hand washing is unimportant

– However- if the RNs use careful, sterile technique when doing wound care, the patient will come to believe that it should always be done that way

– Patients observe and imitate just like toddlers watch their parents, both good and bad practices

Learning assumptions

• Nurses have to consider the developmental stage, cognitive level, and interests of the learner– Obviously, the nurse will use different teaching

approaches with young children than with mature adults

• Nurses have to consider what kind of material is to be taught, as well as the skills and abilities of the learner– Nurses may have to adapt their teaching style for

patients with disabilities, who are illiterate, or who don’t speak English

• Children deserve special planning for health teaching

How to facilitate learning

• Use methods that stimulate a variety of senses– If the learner can touch and manipulate equipment

that he will have to learn to use, it will be more effective than simply having him watch a video

• Actively involve the learner in the learning process– Find out what the learner wants and needs to know

– Let the learner set the pace for teaching sessions

– Let the learner participate in the teaching sessions, by joining in discussions, handling equipment, and performing return demonstrations.

How to facilitate learning

• Establish a comfortable, appropriate learning environment– Teaching is not effective when the patient is in pain,

nauseated, preoccupied with upcoming tests or upset about a new or terminal diagnosis

– Teaching is not effective when there are multiple distractions that draw attention away from the material being presented (busy ERs, loud, interrupting roommates)

• Assess the readiness of the learner, which may be affected by physical or emotional factors– See if the learner is ready to participate in the

teaching session- if not, it is best to delay the teaching until a later time

How to facilitate learning

• Make the information relevant by connecting with the existing needs and interests of the learner– Focus on what the learner wants and needs to

know, not irrelevant material that will probably be quickly forgotten

– Relate the material to the learner’s life and condition so that it has meaning for the learner- it will then be more likely adopted as a lifestyle change

• Use repetition and review to reinforce concepts several times– Use a variety of methods to prevent boredom– Repeat demonstrations are effective, as they allow

the learner to practice techniques as many times as needed until proficiency is reached

How to facilitate learning

• Make the learning encounter positive– If the learner does not respect and appreciate the

teacher as a professional, the information is less likely to be learned effectively

– Structure the teaching session to include frequent, positive feedback for the learner

– Use an upbeat, positive attitude

• Start with what is known by the learner and proceed to what is unknown– Move from the simple to the complex– Give the learner credit for what is already known

and understood– Allow the learner to proceed at his own pace

How to facilitate learning

• Apply the concepts to real settings to facilitate understanding and application into the learner’s lifestyle and practices– Use language that is easily understood by the

learner– Make the information real and let the learner know

how what you are teaching can impact his health and daily activities

• Pace the teaching session to the needs of the learner, not the nurse– Just because the nurse is done teaching, it

doesn’t mean that the learner understands the material!

Family health education

• Families must often learn specific tasks to care for an ill family member

– Patients are now going home with tube feedings, IV infusions, tracheostomies, urinary catheters, surgical drains, and other care needs that family members will be responsible for

– Teaching by nurses allows patients to stay at home with their families instead of being sent to nursing homes and extended care facilities

• Healthy behaviors are learned (or not) within the family structure

Assessment

To assess a person’s perceived state of health or threat of disease,

the nurse examines the following:• Individual perceptions or readiness for

change– If the learner isn’t interested, the change probably

won’t happen, despite all the teaching in the world

• The values of health to the individual as compared to other aspects of living– Value of avoiding lung cancer vs. enjoyment of

smoking– Value of avoiding heart disease vs. enjoyment of

fast food and watching TV instead of exercising

Assessment

• Perceived susceptibility to a disease and its potential complications– “I won’t get lung cancer because I smoke less than

a pack a day”– “I don’t drink enough to cause liver damage”

• Perceived seriousness of the disease threatening the achievement of certain goals or aims– “If I have a heart attack, I won’t be able to travel all

over the world after I retire- I better start exercising and watching what I eat!”

– “I don’t want to bother with a rectal exam any more- prostate cancer is no big deal at my age”

Assessment

• Belief in the diagnosis and therapy plan– If the patient does not believe in the diagnosis or

therapy plan, teaching will probably not be effective– For example:– “What’s the point of doing all these exercises? My

left side is permanently paralyzed after my stroke”

– “I’m not really sure if I should have a lumpectomy or have a total mastectomy to make sure that the cancer doesn’t come back”

– “I did some reading about chemotherapy and I found out that this drug offers the best chance of remission for my cancer”

– “I don’t really think that there is anything wrong with my heart- it was just a little heartburn and I feel fine now”

Assessment

• People who value the perceived benefits will attempt to make lifestyle and health changes when:– Their current lifestyles pose a threat to a personally

valued outcome, such as health or appearance• “I better stop sunbathing so much or my face will look

like a prune in a few years”

– Particular behavioral changes will reduce the threat to their valued outcome

• “I better start exercising if I want to be able to keep up with my grandkids”

– They are personally capable of adopting the new behaviors

• “I can start grilling my chicken instead of frying it, and eating frozen yogurt instead of Ben & Jerry’s Chunky Monkey ice cream.”

When people just don’t learn…

• They are often labeled as “noncompliant” by health care staff– This term implies that the individual has not

followed the instructions of the health care professionals

– Enlisting the learner’s partnership or cooperation is crucial the learner has to embrace the lifestyle change as their own, not simply agree to follow orders

– Often there are other reasons for noncompliance• Patients are often unable to read the educational

information that is given to them

• Patients often cannot afford to pay for medications or treatment supplies

• The treatment plan goes against religious or cultural beliefs

When people just don’t learn…

• Effective health education requires an understanding of the influential factors affecting decision-making– Values, beliefs, attitudes, or religion

• “I just don’t believe in prolonging life when it’s someone’s time to pass”

• “I can’t follow my diet this month- I need to fast for Ramadan”

– Current life stressors• “I haven’t got time to check my blood sugar before

every meal- I’m just too busy working two jobs trying to make ends meet”

– Previous experiences with the health care system • “The visiting nurse was useless last time, so there’s

no point in having one come out again.”

– Life goals• “I can’t follow my diet very well when I am traveling

for work- which is all the time!”

Noncompliance

• Rather than being a failure of the patient, it may be a failure of the treatment and teaching plan

• It is up to the nurse to assess the situation:– A more effective teaching plan may need to

be developed

– The treatment plan may need to be adjusted or changed completely

– The patient may need assistance dealing with stressors or obstacles that are preventing compliance

Assessing learning needs• What are the characteristics and learning

capabilities of this individual (or family)?

• What are the individual’s (or family’s) needs for health promotion, risk reduction or heath problems?

• What does the individual (or family) know already, and what skills can already be performed that are relevant to health needs?

• Is the individual (or family) motivated to change unhealthy behaviors?

• What are the barriers to and stimuli for heath behavior change?

Domains of learning- #1

• Cognitive– The acquisition of knowledge about facts

or concepts, building on or applying knowledge to new situations

– It is important for patients to not only gain new knowledge, but to be able to apply it in real-life situations

– For example: It is not enough for patients simply to know the signs and symptoms of hypoglycemia- they need to be able to recognize the signs and symptoms when they occur!

Domains of learning - #2

• Psychomotor– Developing physical skills from simple to

complex actions

– Both mental and physical abilities are required to perform procedures and skills

– For example, teaching patients to:• Give themselves injections• Care for colostomies• Wound care and dressing changes• Suctioning

Domains of learning- #3

• Affective– Recognition of values, religious and

spiritual beliefs– Family interaction patterns and

relationships– Personal attitudes that affect decisions and

problem-solving processes– For example:

• Helping patients deal with the emotional impact of having a new colostomy- looking at it, fear of others seeing it or knowing about it

• Teaching patients about the emotional impact of a disability or having a disabled child

The ADULT model for teaching

A Establish rapport by eliciting the patient’s ACTIVE INVOLVEMENT

D Assess needs by listening carefully as the patient DISCUSSES CONCERNS

U Develop a plan by promoting an UNDERSTANDING OF THE ISSUES

L Implement the plan by offering patients opportunities to LEARN NEW

BEHAVIORS

T Evaluate the plan by identifying strategies for TRACKING PATIENT PROGRESS

McCann, D. & Blossom, J. (1990). The physician as patient educator. The Western Journal of Medicine, 153 (1), 44-49.

A: Elicit active involvement!

• It is important to build a rapport with the patient when starting to teach patients:

• Patients who find their health care providers to be courteous, friendly, and approachable tend to absorb the information better and make the suggested lifestyle changes than patients who find their health care providers to be inattentive or indifferent.

• Interest, empathy, and thoughtfulness by the nurse are associated with increased attentiveness by patients to educational information

D: Discuss concerns

• Establish what the patient’s priorities are by allowing the patient to verbalize their health care needs and concerns

• If a diabetic patient just wants to learn about insulin pumps and the nurse wants to teach about exercise, the teaching session probably will not be very effective

• The nurse and patient may “negotiate” topics to be covered. Perhaps the insulin pumps could be covered in the first session, and exercise could be covered later.

U: Understand the issues

• Patients are often disappointed in teaching sessions when the nurse did not provide the information that the patient needed or wanted.

• The nurse should work with the patient to develop the agenda for the teaching session to make sure that the patient receives meaningful information

• Adherence and recall of information is improved when both the patient and nurse agree on the topics and importance of the material

• Encouraging patients to become involved in the planning process has a positive impact on patient learning!

L: Learn new behaviors

• Instructions should be unambiguous, and important issues should be emphasized

• The nurse’s approach should be friendly and instructive, but not dictatorial

• But remember- nurses don’t have to do it all!

• Associated health care providers can provide a good deal of information to patients as well!

– Dieticians can offer suggestions for meal preparation and diets

– Physical and occupational therapists can suggest exercises and tips for activities of daily living

T: Track patient progress

• When health care providers make an attempt to identify why patients do not make the suggested lifestyle changes, patients often relate their difficulties so that further teaching can occur

• This can then lead to the desired lifestyle change by the patient!

• Nurses need to monitor the patient’s behavior closely after the teaching, and document their observations in the medical record!

Bottom line:

• Teach when the patient is ready!

• Get your patients involved in your teaching!

• Make the teaching an enjoyable experience for the patient!

• Focus on what they want and need to know!

• Don’t forget that other health care professionals may be able to give you a hand!

• Make sure to follow up afterward!