Patient Education – What does the future hold?

In the past century, there have been some significant improvements in patient teaching. Nursing theories-including those developed by Orem, Neuman, Benner, and Watson-have helped nurses focus on self-care and the patient’s experience of the illness. There have been advancements in cognitive and social learning theory-models that help nurses and other health care professionals know more about why and how people decide to change their health-related behaviors. Research looking at patient teaching methods has found almost without exception that patient teaching is an effective and cost-effective means of helping patients manage health care needs and adopting healthy behaviors. Organizations such as the American Hospital Association, the JCAHO, and specialty organizations such as the American Diabetes Association, the Oncology Nurses Association, and the Association of Rehabilitation Nurses have described the need for patient teaching. The American Association of Diabetic Educators developed certification for diabetes educators. The North American Nursing Diagnosis Association (NANDA) developed the diagnosis of „knowledge deficit“ to express patient learning needs. Work has begun on instruction for patients with low literacy skills and on appropriate content and techniques for patients from many different cultural groups. In addition, the potential now exists for a great increase in the use of computer-assisted instruction.

There are many important questions about patient education that remain to be answered. In an atmosphere of cost-containment, there is increasing pressure to demonstrate the effectiveness of patient teaching. Can patient teaching improve health status, decrease the incidence of disease, and prevent costly complications? Does patient teaching reduce the chance of litigation for health care organizations and individual practitioners? How will staff shortages affect the ability to deliver effective patient teaching? Are some strategies for patient teaching more effective than others? How can patient teaching be adapted to best meet the needs of a variety of patients, such as older adults, those from diverse cultural backgrounds, and individuals who have little education and few literacy skills? How should patient education be reimbursed? The answer to these questions depends upon a solid research base, much of which can be done by nurses.

There is no question that nurses will be called on to provide even more patient teaching in this new millennium. However, some basic developments must occur for patient teaching to be as effective as we need it to be. Answers need to be found for how patients learn over the course of chronic disease and what teaching interventions are most effective in specific situations. There is a need to use existing technology in more creative ways. For example, two-way videos could be used in home care to allow health care team members to observe patients and provide support and motivation, and show patients how to provide self-care in the home. Educational materials on treatment options and on self-management of chronic diseases may be widely available soon in video stores. A very positive development is the inclusion of a patient guide with each of the clinical practice guidelines developed by the United States Agency for Health Research and Quality. AHRQ patient guides and similar materials are examples of the growing recognition that patients need to be educated consumers when it comes to health care management.

There is a tremendous need for nursing to look at how well patient teaching principles are taught and integrated into practice. One study looked at nursing texts in relation to how much patient education content they contained. The study investigator found that only 45 percent of nursing texts had substantial content in teaching. Maternity nursing as a specialty seems to be in the forefront of fully realizing the potential of nurses as patient teachers. Maternity texts, in comparison with those in other specialties, had a well-developed curriculum that covered a wide range of issues. In addition, maternity nursing as a specialty used nursing diagnoses broadly to describe patient learning needs rather than limiting education-related problems to the diagnosis of „knowledge deficit“ and „non-compliance.“

This will be a challenging century for patient teaching. It is clear that the need for effective patient teaching will continue to grow rapidly. At the same time, nursing must continue to look at ways to fully integrate teaching theories, principles, and practices into our daily work with the patients and families who look to us for education and support. Nurses are in a key position to further their role as health teachers. Nurses have unlimited opportunities to help patients manage their health. Nurses work in settings where they have contact with large numbers of people of varied ages and ethnic, cultural, and social backgrounds. Nurses spend more time with patients than other team members; this contact provides the opportunity to develop trust, to assess individual learning needs, and to provide continuity throughout the learning process.