Introduction to Health: A Summary

What is health:  Old views on health  Health is that state of moral, mental and physical well-being which enables a man to face any crisis in life with the utmost facility and grace. – (Pericles, AD 400).  A state of complete physical, mental and social well-being and not merely the a...

What is health:  Old views on health  Health is that state of moral, mental and physical well-being which enables a man to face any crisis in life with the utmost facility and grace. – (Pericles, AD 400).  A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. – (WHO, 1946). 1  The extent to which an individual or group is able, on the one hand, to realise aspirations and satisfy needs and, on the other hand, to change or cope with the environment. Health is therefore seen as a resource for everyday life, not the objective of living: it is a positive concept, encompassing social and personal resources as well as physical capabilities – (WHO, 1984) 2 The concept of health promotion Is very prominent internationally. Umbrella term. Overlaps with other concepts Health promotion includes activities that a person undertakes to enjoy life to the fullest. It is associated with wellness behavior rather than with disease prevention. 3  Key Strategies for Promoting Health Reorientating Health Services. Developing Personal Skills. Building a Healthy Public Policy. Strengthening Community Action. Creating Supportive Environments for Health. (WHO, 1986). 4  ?What is Health Education is part of the health promotion process. Health education through:- information giving advice support and skills training 5  Health promotion vs. health education Health promotion includes activities that a person undertakes to enjoy life to the fullest. It is associated with wellness behavior rather than with disease prevention. 6  Patient education has long been considered a major function of standard care given by nurses. The role of the nurse as a teacher to patients began as early as the nursing was first recognized as a unique discipline Florence Nightingale the founder of modern nursing emphasized the importance of teaching patients the need for adequate nutrition, fresh air, exercise and personal hygiene to improve their well-being 7  Health education : A participatory educational approach, often used interchangeably with the term patient education or client education, aimed at preventing disease, promoting positive health, and incorporating the physical, mental, and social aspects of learning needs Patient education: is a process of assisting consumers of health care to learn how to incorporate health related behaviors (knowledge, skills and/or attitude) into every day life with the purpose of achieving the goal of optimal health 8  Education: an umbrella term used to describe the process, including the components of teaching and instruction, of producing observable or measurable behavioral changes (in knowledge, attitudes, and/ or skills) in the learner through planned educational activities. 9  Education process: is a systematic, sequential, logical, planned course of action consisting of two major operations, teaching and learning. This process forms a continuous cycle that also involves two interdependent players, the teacher and the learner. Learning: A conscious or unconscious permanent change in behavior as a result of lifelong, dynamic process by which individuals a quire new knowledge, skills, and/ or attitudes that can be measured and can occur at any time or in any place due to exposure to environmental stimuli 10  Teaching teaching is undertaking certain ethical tasks or activities the intention of which is to induce learning 11  Learning 12 13  Learning is: An experience that occurs inside the learner A consequence of experience The discovery of the personal meaning and relevance of ideas A collaborative and cooperative process A process that is both intellectual and emotional An evolutionary process 14  Learning needs: gaps in knowledge between a desired level of performance and the actual level of performance. It is what the learner needs to know Knowledge deficit: is the NURSING DIAGNOSIS of the learner needs which can include learner needs in the cognitive, affective and psychomotor domains 15  Learning theory: A coherent frame work and set of integrated constructs and principles that describe, explain, or predict how people learn. Literacy: The ability of adults to read, understand, and interpret information written - It is an umbrella term used to describe socially required and expected reading and writing abilities; the relative ability of persons to use printed and written material commonly encountered in daily life 16  Purpose, goals and benefits of Health Education The most important goal of patient education (or health education) is to prepare patients (or clients) and their families for independence. The purpose of patient education is to increase the competence and confidence of clients for self- management. Its purpose also to assist clients in making appropriate health-related decisions. Health related decision that clients make are: 1. Decisions about personal health behavior 2. Decisions about use of available health resources 3. Decisions about societal health issues 17  :Decisions about personal health behavior People make decisions regarding personal behavior that promote health or prevent or cure illness Health education has been perceived as a mean of freeing people from factors that enslave them to unhealthy behavior Unhealthy behavior believed to arise from a need to conform that results from poor self-esteem, guilt, hostility, anger, low assertiveness and inability to communicate effectively. The purpose of HE then is to improve self-esteem, clarify values, and reduce isolation and improve client’s understanding of their own motivations to free them to make appropriate health decisions Fore example ; Decision about smoking 18 2. Decisions about use of available health resources: Health education can help people become aware of the health care resources available to them and help them make decisions regarding what type of resource to use and when to use them. Some People may need answers to questions like: Am I sick enough to go to doctor, should I go to emergency room for care or go to regular health care provider, For example ; decision about mammogram screening for breast cancer 19 3. Decisions about societal health issues:  People need health education to be aware about their role and be effective in decisions concerned the public or the community.  E.g. HE can help people vote for or against decisions like mandatory screening for breast cancer, or for AIDS, banning of smoking in public places (e.g. Hospitals, schools).  Health education can create an informed public prepared to make important decisions on major health issues. 20  Nurses role: The role of the nurse in teaching is to support patients (clients) through the transition from being invalids to being independent in care, from being dependent recipients to being involved participants in the care process through: 1. Assessing problems or deficits 2. Providing meaningful information and presenting the information in unique way 3. Identify progress 4. Giving feed back 5. Reinforce learning and add new knowledge 6. Evaluate the client’s abilities 21  Effective health education  To teach effectively and maximize learning, nurses need understanding of:  Domains or types of learning  Theories of learning (how people learn)  Factors that impact on learning and teaching  How to plan a teaching session  How to select and effectively use the appropriate teaching methods, strategies, and aids  Methods of evaluation and assessing the teaching and learning process 22 The education process The education process forms a continuous cycle that also involves the teacher and the learner. the education process has always been compared to the nursing process, that is the step of each process run parallel to one another. It is like the nursing process consist of the basic elements of assessment, planning, implementation, and evaluation. The two are different in that: -Nursing process focuses on the planning and implementation of care based on the assessment of the physical and psychosocial needs of the patient, while the education process , on the other hand focuses on the planning and implementation of teaching based on assessment of the client’s learning needs, readiness to learn, and learning style. 23  The outcomes of nursing process are achieved when the physical and psychosocial needs of the clients are met. The outcomes of education process are achieved when changes in knowledge, attitudes, and skills occur. Both processes are ongoing with assessment and evaluation redirecting the planning and implementation phases of the processes. 24  Education Process parallel Nursing Process nursing process Education Process appraise physical assessment Ascertain learning need, readiness and psychosocial needs to learn, & learning styles develop care plan based on mutual goal setting planning develop teaching plan based on to meet individual needs mutually predetermined behavioral outcomes to meet individual needs carry out nug care perform the act of teaching using implementation intervention using standard specific instructional methods & procedure tools determine physical & determine behavior changes(outcomes) evaluation in know ledge, attitudes, & skills psychosocial outcome 25 Challenges in patient education 1. Nurses’ self preparation To be a capable patient or client teacher, nurses must assess their own learning needs as well as their client’s needs and find resources to meet them. To fulfill the role of teacher of patients and family members, nurses must have a solid foundation in the principles of teaching and learning. It is not just a giver of information, but to promote learning and provide an environment conducive to learning to teachable moment rather than just waiting for it to happen Nurse should actively involve learners in the education process E.g. a CHN receives a referral of a new client who was discharged from a nearby medical center with a rare or unfamiliar diagnosis. The nurse need to read about the case to be able to teach the client and his family 26 2. Nurse as Role Model How important is it for nurses to practice what they teach to be positive role model for clients It is unacceptable for a nurse give advice she don’t follow. E.g. smoke while she/he teaching about smoking cessation or overweight who being more and more obese while giving sessions about weight loss 27 3. Promoting team work understanding the contribution that other health care professionals can make to client teaching increases the effectiveness of client education and improves attempts to develop collegiality and collaboration of the health care team. Criteria for successful team work: - communication: verbal and written communication, facilitated by planning meetings, care conferences, telephone consultation and good documentation - Mutual respect among disciplines: including recognizing respective areas of expertise, knowing one’s limits and teaching each others - Desire to work as a team and recognition of a common goal 28 4. Case management Case management involves leadership from nurses to oversee the process of providing care, with the goal of improving efficiency, increasing effectiveness of interventions, and containing costs 29 5. Staff development and continuing education: staff development and continuing education targeted to helping health care professionals increase skills in patient education. Staff development can help to bridge the gaps between education and practice through:  Formal, ongoing training related to work responsibilities  Socialization into work setting to increase competence and excellence  Improving group performance  Raising awareness of the need for new, innovative approaches to patient education  Identifying barriers that nurses and other providers perceive in the delivery of patient education 30 Barriers to teaching & learning Barriers to teaching 1. Lack of time to teach is cited by nurses as the greatest barrier to being able to carry out their teaching role effectively. - Early discharge from inpatient and outpatient settings often results in nurses and patients having fleeting contact with one another. - In addition ,the schedules and responsibilities of nurses are very demanding. Finding time to allocate to teaching is very challenging in light of other work demands and expectations. 31 2. Many nurses admit that they do not feel competent or confident with their teaching skills. Although nurses are expected to teach, few have ever taken specific course on the principles of teaching and learning. Although most of nurses believed that patient education is a primary responsibility of nurses ,they also rated their ability to perform patient education activities as unsatisfactory. 32 3. Low priority is often assigned to patient education by administrators and physicians.they tend to recognize the time spent by nurses in doing direct physical care tasks as more important than time spent devoted to patient teaching. More over budget allocations for educational resources are often not enough to support new and time –saving teaching approaches to enhance the effectiveness of teaching and learning. 33 4. The environment in the various settings where nurses are expected to teach and learners are expected to learn is not always conducive to carrying out patient education.Lack of space , lack of privacy , noise, and frequent interruptions due to treatment schedules are just some of the factors that interfere with the ability of nurses and patients to concentrate and to interact with one another for patient education to be effective. 34 5. An absence of third –party reimbursement to support patient education relegates teaching and learning to less than high- priority status. Nursing services within healthcare facilities are part of hospital room costs and, therefore, are not specifically reimbursed by insurance payers. In fact, patient education in some settings, such as home care, often cannot be incorporated as legitimate aspect of routine nursing care delivery unless specifically ordered by a physician. 35 6. Disbelief in the effectiveness of patient education. Some nurses and physicians question whether patient education is effective as a mean to improve health outcomes 7. Lack of effective communication and documentation. Some formal or informal teaching are often done but not written because insufficient time, inattention to details, and inadequate forms to record the teaching activities. - In addition most nurses do not recognize the scope and depth of teaching that they perform on a daily basis 36 8. Lack of knowledge of the importance of patient education. This is due to two reasons: - lack of research and access to related evidence which support the effectiveness of client education in controlling health problems - Traditionally health policy and decision-making in health are doctor-centered. Doctors’ preparation and training is mainly hospital-based and focused on diagnosing and managing disease. Such preparation does not allow doctors to develop an understanding of the psychosocial contribution (health education) to the development of chronic illness (e.g. diabetes) and its long term management 37  Barriers to learning 1. Lack of time in side of the learner 2. Lack of motivation due to many problems  Stress e.g. due to chronic diseases  Anxiety  Sensory deficit, pain, fever  Low literacy 3. Negative influence of the setting environment can interfere with client’s active role in health decision making and involvement in the teaching-learning process  lack of privacy  social isolation  Noise, distraction 38 4. Personal characteristics of the learner  Readiness to learn  Motivation and compliance  Developmental stage characteristics of the learner  Learning style  language 5. The extent of behavioral changes needed, both in number and in complexity 6. Lack in support and lack of ingoing reinforcement from the nurse and significant others 7. Denial of learning needs, resentment of authority, lack of willingness to take responsibility 39 Ethical and legal principles in patient education Ethics applied for routine health care are applicable in health education process: 1. Autonomy: an individual’s right to make his or own decisions regarding medical treatment and health care services. This means that patient must be fully informed about his or her condition and be fully aware of what to expect as a result of medical treatment 2. Nonmalfeasance: “do no harm” this principle is at the heart of legal decisions concerning “malpractice or negligence”  negligence: doing or non-doing an act and the acting or the non acting is the cause of injury. It is a wrongful behavior done by anyone  Malpractice: a limited class of negligent activities committed within the scope of performance by those pursuing a particular profession involving highly skilled and technical services. Wrong behavior done by professionals with special education or training 40 3. Confidentiality: protection of privileged information. This meant that the nurse may not reveal personal information gained in a professional capacity from a patient without the consent of the patient unless there is a legal cases in which nurse is a witness 4. Beneficence: means “do good”: sufficient information and up-to-date patient education 41