Nurse-as-Educator-5th-Edition.pdf

Nurse as Educator Principles of Teaching and Learning for Nursing Practice FIFTH EDITION © Helaine Weide/Moment/Getty The Pedagogy Nurse as Educator: Principles of Teaching and Learning for Nursing Practice, Fifth Edition drives comprehension through various strategie...

Nurse as Educator Principles of Teaching and Learning for Nursing Practice FIFTH EDITION © Helaine Weide/Moment/Getty The Pedagogy Nurse as Educator: Principles of Teaching and Learning for Nursing Practice, Fifth Edition drives comprehension through various strategies that meet the learning needs of students, while also gen- erating enthusiasm about the topic. This interactive approach addresses different learning styles, making this the ideal text to ensure mastery of key concepts. The pedagogical aids that appear in most chapters include the following: CHAPTER 1 Overview of Education in Health Care Chapter Highlights Chapter high- lights provide a quick-look over- Susan B. Bastable Kattiria M. Gonzalez view of the content presented in CHAPTER HIGHLIGHTS each chapter. Historical Foundations for Patient Education in Health Care The Evolution of the Teaching Role of Nurses Key Terms Found in a list at the be- Social, Economic, and Political Trends Affecting Health Care Purposes, Goals, and Benefits of Patient and Nursing Staff/Student Education The Education Process Defined ginning of each chapter, these terms will create an ­expanded vocabulary. The Contemporary Role of the Nurse as Educator Nursing Education Transformation Patient Engagement Quality and Safety Education in Nursing The Institute of Medicine Report: The Future of Nursing Barriers to Teaching and Obstacles to Learning Factors Affecting the Ability to Teach Factors Affecting the Ability to Learn Questions to Be Asked About Teaching and Learning State of the Evidence KEY TERMS education process patient education barriers to teaching teaching/instruction staff education obstacles to learning learning © Helaine Weide/Moment/Getty 3  596 Chapter 14 Evaluation in Healthcare Education KEY TERMS Objectives These learning objectives evaluation assessment impact evaluation provide instructors and students with a evidence-based practice process evaluation total program evaluation (EBP) (formative evaluation) evaluation research external evidence content evaluation reflective practice snapshot of the key information they will internal evidence practice-based evidence outcome evaluation (summative evaluation) encounter in each chapter. They serve as a checklist to help guide and focus study. OBJECTIVES After completing this chapter, the reader will be able to 1. Define the term evaluation. 2. Discuss the relationships among evaluation, evidence-based practice, and practice-based evidence. 3. Describe the differences between the terms evaluation and assessment. 4. Identify the purposes of evaluation. 5. Distinguish between five basic types of evaluation: process, content, outcome, impact, and program. 6. Discuss characteristics of various models of evaluation. 7. Explain the similarities and differences between evaluation and research. 8. List the major barriers to evaluation. 9. Examine methods for conducting an evaluation. 10. Explain the variables that must be considered in selecting appropriate evaluation instruments for the collection of different types of data. 11. Identify guidelines for reporting the results of evaluation. 12. Describe the strength of the current evidence base for evaluation of patient and nursing staff education. E valuation is defined as a systematic pro- the learner and for the organization, must be cess that judges the worth or value of some- measurably effective. thing—in this case, teaching and learning. For example, the importance of evaluating Evaluation can provide evidence that what nurses patient education is essential (London, 2009). do as educators makes a value-added difference Patients must be educated about their health Review Questions 627 in the care they provide. needs and how to manage their own care so that Early consideration of evaluation has never patient outcomes are improved and healthcare been more critical than in today’s healthcare en- costs are decreased (Institute for Healthcare Im- results. Process, content, and outcome evalu- The importance of evaluation as internal vironment, which demands that “best” practice provement, 2012; Schaefer, Miller, Goldstein, & ations also are more frequently conducted as evidence has gained even greater momentum be based on evidence. Crucial decisions regard- Simmons, 2009). Preparing patients for safe dis- research projects, however, underscoring the with the movement toward EBP. Perhaps the ing learners rest on the outcomes of learning. charge from hospitals or from home care must importance of evidence as a basis for making most important point to remember is this: Each Can the patient go home? Is the nurse provid- be efficient so that the time patients are under practice decisions. Sinclair, Kable, Levett-Jones, aspect of the evaluation process is important, ing competent care? If education is to be jus- the supervision of nurses is reduced, and it also and Booth (2016) conducted a systematic re- but all these considerations are meaningless if tified as a value-added activity, the process of must be effective in preventing unplanned read- view of randomized clinical trials to determine the results of evaluation are not used to guide education must be measurably efficient and missions (Stevens, 2015). Monitoring the hos- the effectiveness of e-learning programs on future action in planning and carrying out ed- must be measurably linked to education out- pital return rates of patients is not a new idea health professionals’ behavior and patient out- ucational interventions. comes. The outcomes of education, both for as a method to evaluate effectiveness of patient comes. After screening articles initially iden- tified for review, the authors found 12 process and outcome RCTs worthy of further appraisal Review Questions and 7 articles worthy of inclusion in the final 1. How is the term evaluation defined? systematic review. This is just one example of 2. How does the process of evaluation differ the increase in level of rigor in evaluations of from the process of assessment? healthcare education. 3. How is evidence-based practice (EBP) related to evaluation? ▸ Summary 4. How does internal evidence differ from Conducting evaluations in healthcare educa- 5. external evidence? What is the first and most important step Review Questions Review key con- tion involves gathering, summarizing, inter- preting, and using data to determine the extent 6. in planning any evaluation? What are the five basic components cepts from your reading with these to which an educational activity is efficient, included in determining the focus of an effective, and useful for those who participate evaluation? exercises at the end of each chapter. in that activity as learners, teachers, or sponsors. 7. How does formative evaluation differ Five types of evaluation were discussed in this from summative evaluation, and what is chapter: (1) process, (2) content, (3) outcome, another name for each of these two types (4) impact, and (5) program evaluations. Each of of evaluation? these types focuses on a specific purpose, scope, 8. What are the five basic types (levels) of eval- and questions to be asked of an educational uation, in order from simple to complex, activity or program to meet the needs of those as identified in Abruzzese’s RSA evalua- who ask for the evaluation or who can benefit tion model? from its results. Each type of evaluation also re- 9. What is the purpose of each type (level) quires some level of available resources for the of evaluation as described by Abruzzese evaluation to be conducted. in her RSA evaluation model? The number and variety of evaluation 10. Which data collection methods can be models, designs, methods, and instruments are used in conducting an evaluation of growing exponentially as the importance of educational interventions? evaluation becomes widely accepted in today’s 11. What are the three major barriers to healthcare environment. Many guidelines, rules conducting an evaluation? of thumb, suggestions, and examples were in- 12. When and why should a pilot test be cluded in this chapter’s discussion of how a nurse conducted prior to implementing a full educator might go about selecting the most ap- evaluation? propriate model, design, methods, and instru- 13. What are three guidelines to follow in ments for a certain type of evaluation. reporting the results of an evaluation?  628 Chapter 14 Evaluation in Healthcare Education Case Studies Case studies encour- age active learning and promote CASE STUDY critical thinking skills in learners. Having recently completed her master’s degree in nursing, Sharon has accepted a new role as clinical Students can read about real-life nurse educator for three adult medicine units in the medical center where she has been employed as a staff nurse for the past 6 years. Eager to put her education to practice in a manner that would benefit scenarios and then analyze the both patients and staff, Sharon meets with the nurse managers of the three units to learn what they view as priority issues on which she should focus. All three managers agree that their primary concern situation they are presented with. is teaching their staff how to better prepare patients with type 2 diabetes to care for themselves after they are discharged home. One manager comments, “Half of my nurses are new graduates. I’m not even certain that they know much about type 2 diabetes—how on earth can they teach the patients?” The other two managers nod, agreeing with the first, and chime in: “The patients aren’t being taught what they need to know, they don’t believe what they’re hearing, or they don’t understand what they’re hearing. As a result, I’m being told by ambulatory service nurses that our discharged patients aren’t taking their medications, aren’t making any changes in diet or lifestyle, and seem unconcerned about their hyperglycemia.” You next meet with Eric, the certified diabetes educator at your hospital, and he reminds you that all nurses are mandated to annually review the patient and family education program for patients with type 2 diabetes and complete the cognitive posttest. 1. Which type of evaluation is being conducted every year when the nurses review the program and complete the cognitive test? 2. Which type(s) of evaluation would be most relevant to the nurse manager’s concerns? 3. Putting yourself into Sharon’s place, describe in detail an evaluation that you would conduct with the patients as a primary audience. 4. If evaluation is so crucial to healthcare education, what are some of the reasons why evaluation seems often an afterthought or is even overlooked entirely by the educator? References Ammerman, A., Smith, T. W., & Calancie, L. (2014). Practice- based evidence in public health: Improving reach, Abruzzese, R. S. (1992). Evaluation in nursing staff relevance, and results. Annual Reviews in Public Health, 35, development. In R. S. Abruzzese (Ed.), Nursing staff 47–63. doi:10.1146/annurev-publhealth-032013-182458 development: Strategies for success (pp. 235–248). St. Bahreini, M., Moattari, M., Shahamat, S., Dobaradaran, S., & Louis, MO: Mosby–Year Book. Ravanipour, M. (2013). Improvement of Iranian Adams, R. J. (2010). Improving health outcomes with better nurses’ competence through professional portfolio: A patient understanding and education. Dovepress, 2010(3), quasi-experimental study, Nursing and Health Sciences, 61–72. Retrieved from http://www.ncbi.nlm.nih.gov 15, 51–57. doi:10.1111/j.1442-2018.2012.00733.x /pubmed/22312219 Balas, M. C., Burke, W. J., Gannon, D., Cohen, M. Z., Colburn, L., Allen, J., Annells, M., Clark, E., Lang, L., Nunn, R., Petrie, E., & Bevil, C.,... Vasilevskis, E. E. (2013). Implementing Robins, A. (2012). Mixed methods evaluation research for the ABCDE bundle into everyday care: Opportuni- a mental health screening and referral clinical pathway. ties, challenges, and lessons learned for implementing Worldviews on Evidence-Based Nursing, 9(3), 172–185. the ICU pain, agitation, and delirium (PAD) guidelines. American Nurses Credentialing Center, Commission on Critical Care Medicine, 41(9 Suppl. 1), S116–S127. doi: Accreditation. (2014, September). The importance of 10.1097/CCM.0b013e3182a17064 evaluating the impact of continuing nursing education Bates, O. L., O’Connor, N., Dunn, D., & Hasenau, S. M. on outcomes: Professional nursing practice and patient (2014). Applying STAAR interventions in incremental care. Retrieved from http://www.nursecredentialing bundles: Improving post-CABG surgical patient.org/Accreditation/ResourcesServices/Evaluating-the care. Worldviews on Evidence-Based Nursing, 11(2), -Impact-CNE-Outcomes.pdf 89–97. Nurse as Educator Principles of Teaching and Learning for Nursing Practice FIFTH EDITION Susan B. Bastable, EdD, RN Nursing Education Consultant Professor Emerita and Founding Chair Department of Nursing Purcell School of Professional Studies Le Moyne College Syracuse, New York World Headquarters Jones & Bartlett Learning 5 Wall Street Burlington, MA 01803 978-443-5000 [email protected] www.jblearning.com Jones & Bartlett Learning books and products are available through most bookstores and online booksellers. To contact Jones & Bartlett Learning directly, call 800-832-0034, fax 978-443-8000, or visit our website, www.jblearning.com. 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Any individuals and scenarios featured in the case studies throughout this product may be real or fictitious, but are used for instructional purposes only. The authors, editor, and publisher have made every effort to provide accurate information. However, they are not responsible for errors, omissions, or for any outcomes related to the use of the contents of this book and take no responsibility for the use of the products and procedures described. Treatments and side effects described in this book may not be applicable to all people; likewise, some people may require a dose or experience a side effect that is not described herein. Drugs and medical devices are discussed that may have limited availability controlled by the Food and Drug Administration (FDA) for use only in a research study or clinical trial. Research, clinical practice, and government regulations often change the accepted standard in this field. When consideration is being given to use of any drug in the clinical setting, the health care provider or reader is responsible for determining FDA status of the drug, reading the package insert, and reviewing prescribing information for the most up-to-date recommendations on dose, precautions, and contraindications, and determining the appropriate usage for the product. This is especially important in the case of drugs that are new or seldom used. 12746-1 Production Credits VP, Product Management: David D. Cella Cover Design: Kristin E. Parker Director of Product Management: Amanda Martin Rights & Media Specialist: Wes DeShano Product Manager: Rebecca Stephenson Media Development Editor: Troy Liston Product Assistant: Anna Maria Forger Cover Image (Title Page, Part Opener, Chapter Opener): Production Editor: Vanessa Richards © Helaine Weide/Moment/Getty Senior Marketing Manager: Jennifer Scherzay Printing and Binding: Edwards Brothers Malloy Product Fulfillment Manager: Wendy Kilborn Cover Printing: Edwards Brothers Malloy Composition: S4Carlisle Publishing Services Library of Congress Cataloging-in-Publication Data Names: Bastable, Susan Bacorn, editor. Title: Nurse as educator : principles of teaching and learning for nursing practice / edited by Susan B. Bastable. Description: Fifth edition. | Burlington, Massachusetts : Jones & Bartlett Learning, | Includes bibliographical references and index. Identifiers: LCCN 2017030094 | ISBN 9781284127201 (pbk.) Subjects: | MESH: Patient Education as Topic--methods | Teaching | Learning | Nurses’ Instruction Classification: LCC RT42 | NLM WY 105 | DDC 610.73--dc23 LC record available at https://lccn.loc.gov/2017030094 6048 Printed in the United States of America 21 20 19 18 17 10 9 8 7 6 5 4 3 2 1  In memory of my dear colleague and friend of 43 years, Dr. M. Louise Fitzpatrick, Dean of the College of Nursing at Villanova University for 4 decades. She was my advisor during my master’s program and chair of my doctoral dissertation committee at Columbia University and a mentor throughout my professional career. Louise wrote the foreword for my first, second, and third editions of this text. She was the ultimate educator and her advice, guidance, support, and friendship will be dearly missed. To nursing students and professional colleagues who over the years have shared their teaching experiences as well as their knowledge, skills, ideas, and reflections on the principles of teaching and learning. © Helaine Weide/Moment/Getty Contents Foreword..................................... xii Chapter 2 Ethical, Legal, and Economic Preface...................................... xiii Foundations of the Educational Acknowledgments............................. xv Process..................... 35 Contributors................................. xvi M. Janice Nelson and Kattiria M. Gonzalez About the Author............................. xviii A Differentiated View of Ethics, Morality, and the Law................................... 38 Evolution of Ethical and Legal Principles in Health Care.................................. 40 PART 1 Perspectives on Teaching Application of Ethical Principles to Patient and Learning 1 Education...................................... 42 The Ethics of Education in Classroom Chapter 1 Overview of Education and Practice Settings........................... 49 in Health Care................ 3 Legality of Patient Education and Information.................................... 52 Susan B. Bastable and Kattiria M. Gonzalez Legal and Financial Implications Historical Foundations for Patient Education in of Documentation............................. 53 Health Care..................................... 5 Economic Factors in Healthcare Education: The Evolution of the Teaching Role Justice and Duty Revisited..................... 57 of Nurses....................................... 9 Financial Terminology............................ 58 Social, Economic, and Political Trends Affecting Health Care................................... 10 Program Planning and Implementation........... 60 Purposes, Goals, and Benefits of Patient Cost-Benefit Analysis and Cost-Effectiveness and Nursing Staff/Student Education........... 12 Analysis........................................ 61 The Education Process Defined................... 13 State of the Evidence............................. 62 The Contemporary Role of the Nurse as Summary......................................... 63 Educator....................................... 15 References....................................... 64 Barriers to Teaching and Obstacles to Learning.................................... 21 Questions to Be Asked About Teaching Chapter 3 Applying Learning Theories to and Learning.................................. 26 Healthcare Practice.......... 69 State of the Evidence............................. 26 Margaret M. Braungart, Richard G. Braungart, and Summary......................................... 28 Pamela R. Gramet References....................................... 29 Psychological Learning Theories.................. 72 viii  Contents ix Neuropsychology and Learning.................. 93 Chapter 6 Compliance, Motivation, Comparison of Learning Theories................. 95 and Health Behaviors of Motor Learning................................... 98 the Learner............... 219 Common Principles of Learning................. 106 Mary Ann Wafer State of the Evidence........................... 108 Compliance and Adherence.................... 221 Summary....................................... 109 Motivation..................................... 225 References..................................... 111 Selected Models and Theories.................. 235 Models for Health Education.................... 244 The Role of Nurse as Educator in Health PART 2 Characteristics of the Promotion................................... 247 Learner 117 State of the Evidence........................... 248 Summary....................................... 248 Chapter 4 Determinants of Learning... 119 References..................................... 250 Sharon Kitchie The Educator’s Role in Learning................. 121 Chapter 7 Literacy in the Adult Client Assessment of the Learner...................... 121 Population................. 257 Assessing Learning Needs...................... 122 Susan B. Bastable, Gina M. Myers, and Leigh Bastable Methods to Assess Learning Needs............. 127 Poitevent Readiness to Learn............................. 131 Definition of Terms............................. 262 Learning Styles................................. 139 Scope and Incidence of the Problem............ 266 Learning Style Models and Instruments......... 140 Trends Associated with Literacy Problems....... 269 Interpretation of the Use of Learning Those at Risk................................... 270 Style Models and Instruments................ 159 Myths, Stereotypes, and Assumptions........... 272 State of the Evidence........................... 161 Assessment: Clues to Look For.................. 274 Summary....................................... 162 Impact of Illiteracy on Motivation References..................................... 163 and Compliance............................. 275 Ethical, Financial, and Legal Concerns........... 277 Chapter 5 D evelopmental Stages Readability of Printed Education Materials...... 279 of the Learner............. 169 Measurement Tools to Test Literacy Levels...... 281 Susan B. Bastable and Gina M. Myers Formulas to Measure Readability of Printed Education Materials.......................... 282 Developmental Characteristics.................. 171 Tests to Measure Comprehension of Printed The Developmental Stages of Childhood....... 172 Education Materials............................ 284 The Developmental Stages of Adulthood....... 192 Tests to Measure General Reading Skills The Role of the Family in Patient and Health Literacy Skills of Clients........... 286 Education.................................... 210 Simplifying the Readability of Printed State of the Evidence........................... 212 Education Materials......................... 289 Summary....................................... 213 Teaching Strategies to Promote Health References..................................... 215 Literacy...................................... 297 x Contents State of the Evidence........................... 301 Assistive Technologies.......................... 409 Summary....................................... 304 State of the Evidence........................... 411 References..................................... 306 Summary....................................... 412 References..................................... 413 Chapter 8 Gender, Socioeconomic, and Cultural Attributes Techniques and Strategies PART 3  of the Learner.............. 315 for Teaching and Susan B. Bastable and Deborah L. Sopczyk Gender Characteristics.......................... 317 Learning 421 Socioeconomic Characteristics................. 327 Chapter 10 Behavioral Objectives Cultural Characteristics......................... 330 and Teaching Plans......... 423 Assessment Models for the Delivery of Culturally Sensitive Care...................... 330 Susan B. Bastable and Loretta G. Quigley The Four Major Subcultural Ethnic Groups...... 337 Types of Objectives............................. 426 Preparing Nurses for Diversity Care.............. 353 Characteristics of Goals and Objectives......... 426 Stereotyping: Identifying the Meaning, The Importance of Using Behavioral the Risks, and the Solutions.................. 354 Objectives......................................... 427 State of the Evidence........................... 356 Writing Behavioral Objectives and Goals........ 428 Summary....................................... 357 Common Mistakes When Writing Objectives...... 431 References..................................... 359 Taxonomy of Objectives According to Learning Domains......................... 432 Chapter 9 Educating Learners with Development of Teaching Plans................ 444 Disabilities and Chronic Use of Learning Contracts...................... 448 Illnesses................... 369 The Concept of Learning Curve................. 449 Deborah L. Sopczyk State of the Evidence........................... 453 Scope of the Problem........................... 371 Summary....................................... 454 Models and Definitions......................... 372 References..................................... 455 The Language of Disabilities.................... 374 Chapter 11 Teaching Methods The Roles and Responsibilities of Nurse Educators.................................... 375 and Settings.............. 459 Types of Disabilities............................. 376 Kathleen Fitzgerald and Kara Keyes Sensory Disabilities............................. 377 Teaching Methods.............................. 461 Learning Disabilities............................ 387 Selection of Teaching Methods................. 486 Developmental Disabilities..................... 393 Evaluation of Teaching Methods................ 488 Mental Illness................................... 399 Increasing Effectiveness of Teaching............ 489 Physical Disabilities............................. 401 Settings for Teaching........................... 496 Communication Disorders...................... 403 State of the Evidence........................... 498 Chronic Illness.................................. 407 Summary....................................... 499 The Family’s Role in Chronic Illness or Disability.... 408 References..................................... 500  Contents xi Chapter 12 Instructional Materials..... 505 Summary....................................... 627 References..................................... 628 Diane Hainsworth and Kara Keyes General Principles.............................. 507 Choosing Instructional Materials................ 507 Appendix A Tests to Measure Readability, The Three Major Components of Comprehension, and Health Instructional Materials........................ 508 Literacy and Tools to Assess Types of Instructional Materials................. 510 Instructional Materials..... 633 Evaluating Instructional Materials............... 537 How to Use the Flesch–Kincaid Scale........... 633 State of the Evidence........................... 539 How to Use the Fog Formula................... 634 Summary....................................... 541 How to Use the Fry Readability Graph........... 634 References..................................... 544 How to Use the SMOG Formula................. 635 Chapter 13 Technology in Education.... 549 The Cloze Test.................................. 637 Guidelines for Writing and Evaluating Printed Deborah L. Sopczyk Education Materials.......................... 642 Health Education in a Technology-Based World... 551 Newest Vital Sign............................... 643 The Impact of Technology on the Teacher and References..................................... 649 the Learner.................................. 554 Strategies for Using Technology in Healthcare Appendix B Resources and Organizations Education.................................... 557 for People with The Internet.................................... 572 Disabilities............... 651 Issues Related to the Use of Technology......... 581 Technology for Professional Development in Assistive Technology............................ 651 Nursing...................................... 584 Augmentations and Alternative State of the Evidence........................... 587 Communication............................. 651 Summary....................................... 588 Blindness....................................... 651 References..................................... 589 Deafness....................................... 652 Developmental Disabilities..................... 652 Chapter 14 Evaluation in Healthcare Disability Services.............................. 652 Education................. 595 Head Injury..................................... 653 Priscilla Sandford Worral Healthcare-Related Federal Agencies........... 653 Evaluation, Evidence-Based Practice, and Learning Disabilities............................ 653 Practice-Based Evidence..................... 597 Mental Health.................................. 653 Evaluation Versus Assessment.................. 598 Neuromuscular Disorders....................... 654 Evaluation Models.............................. 600 Stroke........................................... 654 Designing the Evaluation....................... 611 Conducting the Evaluation..................... 622 Glossary.................................... 655 Analyzing and Interpreting Data Collected...... 623 Index...................................... 675 Reporting Evaluation Results.................... 625 State of the Evidence........................... 626 © Helaine Weide/Moment/Getty Foreword H ealth care in the United States is being social and cultural requirements. Nurses also delivered during a time of great uncer- play a vital role in teaching other members of tainty, transformation, and consumer- the ­healthcare team and in educating the next ism. Patients and communities are demanding generation of nurses. greater control and input into their healthcare The author and her chapter contribu- decisions and how care should be provided. The tors have anticipated and explored all the di- positive impact of healthcare reform is improv- mensions of teaching and learning in this very ing access to care, but the need continues for a important text. Although it includes the funda- more integrated and equitable health system, mentals of learning theories, teaching methods, driven by highly competent and compassionate and instructional materials, Nurse as Educator caregivers who fully understand and embrace also focuses on critical issues such as readiness the needs of their patients and who collaborate to learn, learning styles, motivation and com- with all members of the healthcare team. In ad- pliance, and teaching people with disabilities, dition, the future will require a relentless focus all based on the latest research and theoretical on quality, care coordination, innovation, and underpinnings. efficiency in an environment of ever scarcer re- Nurses will greatly benefit from the content sources and disruptive forces. and format of this comprehensive and well-or- Nurse as Educator recognizes these sea ganized book that prepares them to fully em- changes and builds on the author’s four suc- brace the new challenges of an ever-changing cessful editions of the book, which have given healthcare environment. The knowledge, skills, nurses invaluable strategies for partnering with and commitment of nurses in educating patients patients and serving the community. Nurses and families to manage their care independently are the most trusted members of the health- and in teaching colleagues and students to prac- care team and Nurse as Educator gives them all tice competently for the delivery of high-­quality, of the practical tools they need to provide ef- compassionate, and efficient care will drive the fective and efficient patient/family education as necessary improvements in the health system well as to educate nursing colleagues and nurs- and will demonstrate their leadership in trans- ing students. forming health care. This book could not be more timely as nurses strive to enhance their patients’ abil- Nancy Schlichting ity to manage their own care, educate fam- Retired President and CEO ily members to support the overwhelming Henry Ford Health System complexity of clinical protocols, and under- Former Chair, Commission on Care stand the needs of learners who have highly Director, Walgreens Boots Alliance and variable levels of health literacy and diverse Hill-Rom Holdings, Inc. xii © Helaine Weide/Moment/Getty Preface T his text has been written for staff nurses However, nurses are not born with the in- as caregivers and as staff educators for nate ability to teach or to understand the ways whom the role of teacher is a significant in which people learn. The art and science of practice component of their daily activities, for teaching takes special expertise about how to undergraduate and graduate nursing students best communicate information and about how learning the knowledge and skills to become that information is most successfully acquired the professional nurses of tomorrow, as well as by the learner. Teaching patients, staff, and stu- for faculty teaching in academic nursing pro- dents is critical to the provision of high-qual- grams to prepare future nurses at all levels of ity nursing care, and nurses must capture this education. No matter their role or status, it is a domain as an important and unique aspect of legal, ethical, and moral responsibility of nurses their holistic approach to professional practice. practicing in any setting to teach others, whether This text is a timely resource that provides their audience consists of patients and families, approaches essential to addressing many of to- fellow colleagues, or prospective members of day’s pressing issues in the healthcare environ- the profession. Mandates included in the nurse ment. The growing demand for nurses to deliver practice acts of all states and territories, expec- the highest quality of care possible, the criti- tations by the national and regional standards cal shortage of faculty in nursing schools na- of nursing organizations and accrediting bodies, tionwide, the significant problem of consumer and the policies and procedures adopted by lo- health literacy, the ongoing movement to guar- cal healthcare institutions and agencies require antee access to care for all, the technological ad- that nurses function in the role of educators. vances increasing the complexity of health care, Teaching patients and their significant oth- the changing demographics of the population, ers has been the obligation of nurses since the the increasing emphasis on health promotion profession began during the era of Florence and disease prevention, and the rise in chronic Nightingale. Since then, the scope of nurs- illnesses are just a few of the many important ing practice has significantly evolved and has trends. Not only is it recognized that patient ed- grown to include nurses teaching members of ucation by nurses can significantly improve cli- their own discipline to render safe, high-qual- ent health outcomes, but consumers today must ity care. Nevertheless, most nurses acknowledge be taught how to independently manage their that they have not had the formal preparation own care. In turn, nurses must be adequately to successfully and securely carry out their ed- prepared as lifelong learners to participate in ucator role. Every nurse must have the knowl- the constantly transformative and challenging edge and skills to competently and confidently system of health care. teach learners with various needs in a variety of The content of this text reflects a balance be- settings. Also, they must be able to do so with tween theories and models associated with teach- efficiency and effectiveness based on a solid mas- ing and learning and their application to the real tery of the principles of teaching and learning. world of patient, staff, and student education. xiii xiv Preface This latest edition fully acknowledges the im- In essence, this text provides answers to ques- portant role of the professional nurse as well as tions that pertain to the teaching process—who, the changing role of the consumer of health care what, where, when, how, and why. with respect to accountability and responsibil- Thus, the focus of this text is on the con- ity for teaching and learning. No longer should temporary role of the nurse as educator. Teach- the nurse be the giver of information only but ing patients, well or ill, to maintain optimal must function as the guide on the side and as health and to prevent disease and disability as- the facilitator in partnership with the consumer, sists them to become as independent as possi- who must assume a much greater role in learn- ble in self-care activities. Properly educating ing. The philosophy of the interdependence be- consumers has the potential to accomplish the tween the teacher and learner in the education economic goal of reducing the high costs of process is emphasized throughout the chapters. healthcare services. Teaching staff and students All chapters have been revised to include to competently, confidently, effectively, and ef- new content, such as information on nursing ficiently practice in an interdisciplinary man- education transformation, patient engagement, ner in any setting with individuals and groups quality and safety education in nursing, interpro- from diverse backgrounds will ensure the de- fessional education, patient portals, new findings livery of high-quality care. in neuroscience on gender differences in learn- I sincerely hope that this text serves as an ing, and third-party reimbursement for nurses invaluable resource to its readers who are striv- doing patient teaching. Also, the most updated ing to become adept at delivering patient, staff, references have been added to every chapter, and/or student education based on the princi- but classic works relevant to the field of educa- ples of how the nurse can best teach and how tion have been retained. Current statistics reflect consumers can best learn. As nurses, we must changes in population trends, and new tables never forget our solemn duty to make a pos- and figures have been added to visually sum- itive difference in the lives of those we serve, marize the information presented. In addition, and teaching is a major factor that influences the most recent websites are provided through- the health, development, and well-being of our out the text as sources of further information audience of learners. on particular topics. And, by popular demand, case study scenarios have been retained at the Susan B. Bastable, EdD, RN end of each chapter for application of teach- Nursing Education Consultant ing and learning principles to nursing practice. Professor Emerita and Founding Chair This text is comprehensive in scope, taking Department of Nursing into consideration the basic foundations of the Purcell School of Professional Studies education process, the needs and characteristics Le Moyne College of learners, the appropriate techniques and strat- egies for instruction, and the methods to eval- uate the achievement of educational outcomes. © Helaine Weide/Moment/Getty Acknowledgments A special appreciation is extended to the publication. The incredible copyediting skills original authors of the 14 chapters whose of Sandra Kerka must be acknowledged, too. valuable work provided the founda- All of them together are a very talented team tion for adding new material to this most re- of professionals! cent fifth edition. I am grateful for the loyalty In addition, Cathleen Scott, science librar- of seven contributors who agreed to once again ian at Le Moyne College, worked diligently be- edit their own work and for a group of new col- hind the scenes in locating relevant and current leagues who joined the team to contribute their references used to update the content of many professional knowledge, practice expertise, and of the chapters. She made herself available at all fresh perspectives in revising the content of the times and responded promptly to my many re- remaining chapters. Every one of them dedi- quests for books and full-text journal articles. cated their efforts to significantly updating the The in-depth investigation of resources for this information and references contained in ev- book could not have been possible without her. ery chapter for the benefit of the intended au- Thanks, too, to Nancy Schlichting who has dience of readers. written the foreword in this text. She has been a Also, I extend my sincerest thanks to the national leader in health care for decades and is entire publishing staff of the nursing division of recognized for her keen mind, person-centered Jones & Bartlett Learning for making this new- leadership, incredible compassion toward oth- est edition possible. In particular, I would like to ers, and innovative spirit in transforming health- acknowledge Amanda Martin, director of prod- care delivery and advocating for the health of uct management; Rebecca Stephenson, product the public. She has been a close friend and col- manager; Vanessa Richards, production editor; league for many years. Wes DeShano, rights and media specialist; and And last, but certainly not least, my hus- Jennifer Scherzay, senior marketing manager. band, Jeffrey, deserves the deepest gratitude from They have provided expert technical advice me for his steadfast support during the count- and guidance, organizational skills, and con- less hours and endless months that I devoted to stant support, understanding, and encourage- research, writing, and editing, which was key to ment throughout the process of launching this making this fifth edition a reality. xv © Helaine Weide/Moment/Getty Contributors Susan B. Bastable, EdD, RN Diane Hainsworth, MS, RN-C, ANP Nursing Education Consultant Clinical Case Manager—Oncology (retired) Professor Emerita and Founding Chair University Hospital Department of Nursing State University of New York Purcell School of Professional Studies Upstate Medical University Le Moyne College Syracuse, New York Syracuse, New York Kara Keyes, MS, RN-BC, Doctoral Candidate Margaret M. Braungart, PhD Professor of Practice Professor Emerita of Psychology Department of Nursing Center for Bioethics and Humanities Purcell School of Professional Studies State University of New York Le Moyne College Upstate Medical University Syracuse, New York Syracuse, New York Sharon Kitchie, PhD, RN Richard G. Braungart, PhD Adjunct Instructor Professor Emeritus of Sociology and Keuka College International Relations Keuka Park, New York Maxwell School of Citizenship and Public Affairs Director of Patient Education and Interpreter Syracuse University Services (retired) Syracuse, New York University Hospital SUNY Upstate Medical University Kathleen Fitzgerald, MS, RN, CDE Syracuse, New York Patient Educator (retired) St. Joseph’s Hospital Health Center Gina M. Myers, PhD, RN Syracuse, New York Adjunct Faculty Department of Nursing Kattiria M. Gonzalez, MS, RN, Doctoral Candidate Purcell School of Professional Studies Clinical Coordinator—Instructor Le Moyne College Department of Nursing Syracuse, New York Purcell School of Professional Studies Associate/Research Consultant Le Moyne College St. Joseph’s Hospital Health Center Syracuse, New York Syracuse, New York Pamela R. Gramet, PhD, PT M. Janice Nelson, EdD, RN Associate Professor and Chair (retired) Professor and Dean Emerita Department of Physical Therapy College of Nursing State University of New York State University of New York Upstate Medical University Upstate Medical University Syracuse, New York Syracuse, New York xvi  Contributors xvii Leigh Bastable Poitevent, FNP, RN Mary Ann Wafer, PhD, RN, BC, CPHQ, CPHRM Former Critical Care Nurse, United States Former Associate, Quality Resources Navy Nurse Corps Associate for Alumni and Development for Family Nurse Practitioner the College of Nursing CVS Caremark Minute Clinic St. Joseph’s Hospital Health Center Cambridge, Massachusetts Syracuse, New York Loretta G. Quigley, EdD, RN, CNE Priscilla Sandford Worral, PhD, RN, FNAP Academic Dean Nurse Research Scientist St. Joseph’s College of Nursing University Hospital Syracuse, New York State University of New York Upstate Medical University Deborah L. Sopczyk, PhD, RN Syracuse, New York Provost and Chief Academic Officer Excelsior College Albany, New York © Helaine Weide/Moment/Getty About the Author Susan Bacorn Bastable earned her MEd in com- munity health nursing and her EdD in curric- ulum and instruction in nursing at Teachers ­C ollege, Columbia University, in 1976 and 1979, respectively. She received her diploma in nursing from Hahnemann Hospital School of Nursing (now known as Drexel Univer- sity of the Health Sciences) in Philadelphia in 1969 and her bachelor’s degree in nursing from ­Syracuse University in 1972. Dr. Bastable was professor and found- ing chair of the Department of Nursing at Le Moyne College in Syracuse, New York for 11 years. She retired in May 2015 and was hon- ored with the title of professor emerita. She began her academic career in 1979 as assis- tant professor at Hunter College, Bellevue School of Nursing in New York City, where she remained on the faculty for 2 years. From 1987 to 1989, she was assistant professor in program; a master of science program and the College of Nursing at the University of three post-MS certificate programs with tracks Rhode Island. In 1990, she joined the faculty in nursing education, nursing administration, of the College of Nursing at the State Univer- and informatics; and most recently a family sity of New York (SUNY) at Upstate Medical nurse practitioner (FNP) program as well as ­University in Syracuse, where she was associ- a post-MS FNP option. ate professor and chair of the undergraduate Dr. Bastable has taught undergraduate program for 14 years. In 2004, she assumed courses in nursing research, community health, her leadership position at Le Moyne College and the role of the nurse as educator, and and successfully established an RN-BS com- courses at the master’s and postmaster’s level pletion program; an innovative 4-year under- in the a­ cademic faculty role, curriculum and graduate dual-degree partnership in nursing program development, and educational assess- (DDPN) supported by a Robert Wood ­Johnson ment and evaluation. For 31 years she served Foundation grant in conjunction with the as- as consultant and external faculty member for sociate’s degree program at St. Joseph’s ­C ollege Excelsior College (formerly known as Regents of Nursing in Syracuse; a BS-MS bridge pro- College of the University of the State of New gram; a postbaccalaureate RN-MS certificate York). Her clinical practice includes experiences xviii  About the Author xix in community health, oncology, rehabilitation In addition to authoring five editions of Nurse and neurology, occupational health, and med- as ­Educator, she is the author of Essentials of ical/surgical nursing. ­Patient Education and is the main editor of Dr. Bastable received the President’s Award the textbook Health Professional as Educator. for Excellence in Teaching at Upstate Medical Currently, she actively serves in the role of University and the SUNY Chancellor’s Award a nursing education consultant for national and for Excellence in Teaching. Also, she was rec- regional program accreditations and to assist ognized for the Women in Leadership award colleges of nursing across New York and other from the Greater Syracuse Chamber of Com- states in replicating the unique 1+2+1 dual d­ egree merce and was honored with the Distinguished partnership model mentioned herein, the first Achievement Award in Nursing Education of its kind in the country. from Teacher’s College, Columbia University. PART ONE Perspectives on Teaching and Learning CHAPTER 1 Overview of Education in Health Care CHAPTER 2 Ethical, Legal, and Economic Foundations of the Educational Process CHAPTER 3 Applying Learning Theories to Healthcare Practice © Helaine Weide/Moment/Getty 1 CHAPTER 1 Overview of Education in Health Care Susan B. Bastable Kattiria M. Gonzalez CHAPTER HIGHLIGHTS Historical Foundations for Patient Education in Health Care The Evolution of the Teaching Role of Nurses Social, Economic, and Political Trends Affecting Health Care Purposes, Goals, and Benefits of Patient and Nursing Staff/Student Education The Education Process Defined The Contemporary Role of the Nurse as Educator Nursing Education Transformation Patient Engagement Quality and Safety Education in Nursing The Institute of Medicine Report: The Future of Nursing Barriers to Teaching and Obstacles to Learning Factors Affecting the Ability to Teach Factors Affecting the Ability to Learn Questions to Be Asked About Teaching and Learning State of the Evidence KEY TERMS education process patient education barriers to teaching teaching/instruction staff education obstacles to learning learning © Helaine Weide/Moment/Getty 3 4 Chapter 1 Overview of Education in Health Care OBJECTIVES After completing this chapter, the reader will be able to 1. Discuss the evolution of patient education in health care and the teaching role of nurses. 2. Recognize trends affecting the healthcare system in general and nursing practice in particular. 3. Identify the purposes, goals, and benefits of patient and nursing staff/student education. 4. Compare the education process to the nursing process. 5. Define the terms education process, teaching, and learning. 6. Identify why patient and staff/student education is an important duty for nurses. 7. Discuss the barriers to teaching and the obstacles to learning. 8. Formulate questions that nurses in the role of educator should ask about the teaching–learning process. E ducation in health care today—both pa- the healthcare environment. Because so many tient education and nursing staff/student changes are occurring in the healthcare system, education—is a topic of utmost interest to nurses are increasingly finding themselves in nurses in every setting in which they practice. challenging, constantly changing, and highly Teaching is an important aspect of the nurse’s complex positions (Gillespie & McFetridge, professional role (Andersson, Svanström, Ek, 2006). Nurses in the role of educators must un- Rosén, & Berglund, 2015; Friberg, Granum, & derstand the forces, both historical and present Bergh, 2012), whether it be educating patients day, that have influenced and continue to influ- and their family members, colleagues, or nursing ence their responsibilities in practice. students. The current trends in health care are One purpose of this chapter is to shed light making it essential that patients be prepared to on the historical evolution of patient education assume responsibility for self-care management in health care and the nurse’s role as teacher. An- and that nurses in the workplace be accountable other purpose is to offer a perspective on the cur- for the delivery of safe, high-quality care (Hines & rent trends in health care that make the teaching Barndt-Maglio, 2011; Lockhart, 2016; Shi & of clients a highly visible and required function Singh, 2015; U. S. Department of Health and of nursing care delivery. Also, this chapter ad- Human Services [USDHHS], 2015). The fo- dresses the continuing education efforts neces- cus of modern health care is on outcomes that sary to ensure ongoing practice competencies demonstrate the extent to which patients and their of nursing personnel. significant others have learned essential knowl- In addition, this chapter clarifies the broad edge and skills for independent care or to which purposes, goals, and benefits of the teaching– staff nurses and nursing students have acquired learning process; focuses on the philosophy of the up-to-date knowledge and skills needed to the nurse–client partnership in teaching and competently and confidently render care to the learning; compares the education process to the consumer in a variety of settings (Adams, 2010; nursing process; identifies barriers to teaching Committee on Quality of Health Care in Amer- and obstacles to learning; and highlights the sta- ica & Institute of Medicine [IOM], 2001; Doyle, tus of research in the field of patient education Lennox, & Bell, 2013). as well as in the education of nursing staff and According to Friberg and colleagues (2012), students. The focus is on the overall role of the patient education is an issue in nursing practice nurse in teaching and learning, no matter who and will continue to be a significant focus in the audience of learners might be. Nurses must  Historical Foundations for Patient Education in Health Care 5 have a basic prerequisite understanding of the development of organized health care. In sup- principles and processes of teaching and learn- port of maternal and child health in the United ing to carry out their professional practice re- States, the Division of Child Hygiene was estab- sponsibilities with efficiency and effectiveness. lished in New York City in 1908 (Bartlett, 1986). Under the auspices of this organization, public health nurses provided instruction to mothers ▸▸ Historical Foundations of newborns in the Lower East Side on how to keep their infants healthy. Diagnostic tools, sci- for Patient Education entific discoveries, new vaccines and antibiotic medications, and effective surgery and treatment in Health Care practices led to education programs in sanita- tion, immunization, prevention and treatment “Patient education has been a part of health care of infectious diseases, and a growth in the U.S. since the first healer gave the first patient advice public health system. The National League of about treating his (or her) ailments” (May, 1999, Nursing Education (NLNE) recognized that pub- p. 3). Although the term patient education was lic health nurses were essential to the well-being not specifically used, considerable efforts by the of communities and the teaching they provided earliest healers to inform, encourage, and cau- to individuals, families, and groups was consid- tion patients to follow appropriate hygienic and ered “a precursor to modern patient and health therapeutic measures occurred even in prehis- education” (Dreeben, 2010, p.11). toric times (Bartlett, 1986). Because these early The third phase in the development of orga- healers—physicians, herbalists, midwives, and nized health care began after World War II. It was shamans—did not have a lot of effective diag- a time of significant scientific accomplishments nostic and treatment interventions, it is likely and a profound change in the delivery system of that education was, in fact, one of the most com- health care (Dreeben, 2010). From the late 1940s mon interventions (Bartlett, 1986). through the 1950s is described as a time when From the mid-1800s through the turn of patient education continued to occur as part of the 20th century, described as the formative clinical encounters, but often it was overshad- period by Bartlett (1986) and as the first phase owed by the increasingly more technological ori- in the development of organized health care by entation of health care ­(Bartlett, 1986). The first ­Dreeben (2010), several key factors influenced references in the literature to patient education the growth of patient education. The emergence began to appear in the early 1950s (Falvo, 2004). of nursing and other health professions, tech- In 1953, Veterans Administration (VA) hospi- nological ­developments, the emphasis on the tals issued a technical bulletin titled Patient Ed- patient–­caregiver relationship, the spread of tu- ucation and the Hospital Program. This bulletin berculosis and other communicable diseases, and identified the nature and scope of patient edu- the growing interest in the welfare of mothers cation and provided guidance to all hospital ser- and children all had an impact on patient educa- vices involved in patient education ­(Veterans tion (­ Bartlett, 1986; Dreeben, 2010). In nursing, Administration, 1953). Florence Nightingale emerged as a resolute advo- In the 1960s and 1970s, patient education cate of the educational responsibilities of district began to be seen as a specific task where empha- public health nurses and authored Health Teach- sis was placed on educating individual patients ing in Towns and Villages, which advocated for rather than providing general public health ed- school teaching of health rules as well as health ucation. Developments during this time, such as teaching in the home (Monterio, 1985). the civil rights movement, the women’s move- Dreeben (2010) describes the first 4 decades ment, and the consumer and self-help move- of the 20th century as the second phase in the ment, all affected patient education (Bartlett, 6 Chapter 1 Overview of Education in Health Care 1986; Nyswander, 1980; Rosen, 1977). In the using the term health education (Falvo, 2004). 1960s, voluntary agencies and the U.S. Pub- Nixon later appointed the President’s Commit- lic Health Service funded several patient and tee on Health Education, which recommended family education projects dealing with conges- that hospitals offer health education to families tive heart failure, stroke, cancer, and renal dial- of patients (Bartlett, 1986; Weingarten, 1974). ysis, and hospitals in a variety of states became Although the terms health education and pa- involved in various education programs and tient education were used interchangeably, this projects (Public Health Service, 1971). By the recommendation had a great impact on the fu- mid-1960s, patients were recognized as health- ture of patient education because a health edu- care consumers and society adopted the new cation focal point was established in what was perspective that health care was a right and not then the U.S. Department of Health, Education, a privilege for all Americans. In 1965, the U.S. and Welfare (Falvo, 2004). Congress passed Titles XVIII and XIX of the Resulting from this committee’s recom- Social Security Act that created respectively the mendations, the American Hospital Associa- Medicare and Medicaid plans to provide health tion (AHA) appointed a special committee on care to indigent persons, older adults, and peo- health education (Falvo, 2004). The AHA com- ple with medical disabilities (Dreeben, 2010). mittee suggested that it was a responsibility of Concerned that patient education was be- hospitals as well as other healthcare institutions ing provided only occasionally and that patients to provide educational programs for patients were not routinely being given information that and that all health professionals were to be in- would allow them to participate in their own cluded in patient education (AHA, 1976). Also, health care, the American Public Health Asso- the healthcare system began to pay more atten- ciation formed a multidisciplinary Committee tion to patient rights and protections involving on Educational Tasks in Chronic Illness in 1968 informed consent (Roter, Stashefsky-Margalit, & that recommended a more formal approach to Rudd, 2001). patient education (Public Health Service, 1971). Also in the early 1970s, patient education One of the committee’s seven basic premises was a significant part of the AHA’s Statement on was an educational prescription that would base a Patient’s Bill of Rights, affirmed in 1972 and teaching on individual patient needs and be in- then formally published in 1973 (AHA, 1973). cluded as part of the patient’s record. This rec- This document outlines patients’ rights to re- ommendation represented one of the earliest ceive current information about their diagno- mentions of the documentation of patient edu- sis, treatment, and prognosis in understandable cation (Falvo, 2004). The committee ultimately terms as well as information that enables them developed a model that defined the educational to make informed decisions about their health processes necessary for patient and family ed- care. The Patient’s Bill of Rights also guarantees ucation that could be used with any illness by a patient’s right to respectful and considerate any member of the healthcare team (Health Ser- care. The adoption of this bill of rights promoted vices and Mental Health Administration, 1972). additional growth in the concept of patient ed- In 1971, two significant events occurred: ucation, which reinforced the concept as a “pa- (1) A publication from the U.S. Department of tient right” as well as it being seen an obligation Health, Education, and Welfare, titled The Need and legal responsibility of health professionals. for Patient Education, emphasized a concept of In addition, patient education was recognized patient education that provided information as a condition of high-quality care and as a fac- about disease and treatment as well as teaching tor that could affect the efficiency of the health- patients how to stay healthy, and (2) President care system (Falvo, 2004). Furthermore, during Richard Nixon issued a message to Congress the 1970s, insurance companies began to deal  Historical Foundations for Patient Education in Health Care 7 with issues surrounding patient education, be- agencies or organizations must provide to re- cause they saw how patient education could ceive accreditation. Required accreditation stan- positively influence the costs of health care dards have provided the impetus for nursing (Bartlett, 1986). service managers to emphasize unit-based clin- Further support for and validation of pa- ical staff education activities for the improve- tient education as a right and expectation of ment of nursing care interventions to achieve high-quality health care came in the 1976 edi- expected client outcomes (JCAHO, 2001). These tion of the Accreditation Manual for Hospitals standards required nurses to achieve positive published by the Joint Commission on Accredi- outcomes of patient care through teaching ac- tation of Healthcare Organizations, now known as tivities that must be patient centered and family The Joint Commission (Falvo, 2004). This man- oriented. More recently, TJC expanded its ex- ual broadened the scope of patient education to pectations to include an interdisciplinary team include both outpatient and inpatient services approach in the provision of patient education and specified that criteria for patient education as well as evidence that patients and their sig- should be established. Patients had to receive in- nificant others participate in care and deci- formation about their medical problem, prognosis, sion making and understand what they have and treatment, and evidence had to be provided been taught. This requirement means that all indicating that patients understood the informa- healthcare providers must consider the liter- tion they were given (Joint Commission on Ac- acy level, educational background, language creditation of Healthcare Organizations, 1976). skills, and culture of every client during the ed- In the 1980s and 1990s, national health ucation process (Cipriano, 2007; Davidhizar & education programs once again became pop- Brownson, 1999; JCAHO, 2001). ular as healthcare trends focused on disease In the mid-1990s, the Pew Health Profes- prevention and health promotion. This evolu- sions Commission (1995), influenced by the dra- tion represented a logical response to the cost-­ matic changes surrounding health care, published containment efforts occurring in health care at a broad set of competencies it believed would that time (Dreeben, 2010). The U.S. Department mark the success of the health professions in the of Health and Human Services’ Healthy People 21st century. Shortly thereafter, the commission 2000: National Health Promotion and Disease released a fourth report as a follow-up on health Prevention ­Objectives, issued in 1990 and build- professional practice in the new millennium (Pew ing on the U.S. Surgeon General’s Healthy Peo- Health Professions Commission, 1998). This ple report of 1979, established important goals report offered recommendations pertinent to for national health promotion and disease pre- the scope and training of all health professional vention in 22 areas (USDHHS, Office of Dis- groups, as well as a new set of competencies for ease Prevention and Health Promotion, 2000). the 21st century. Many of the competencies deal Establishing educational and community-based with the teaching role of health professionals, in- programs was one of the priority areas identi- cluding nurses. These competencies for the prac- fied in this document. tice of health care include the need for all health Also, in recognition of the importance of professionals to do the following: patient education by nurses, The Joint Com- mission (TJC), formerly the Joint Commission Embrace a personal ethic of social respon- on Accreditation of Healthcare Organizations sibility and service (JCAHO), established nursing standards for Provide evidence-based, clinically ­competent patient education as early as 1993. These stan- care dards, known as mandates, describe the type Incorporate the multiple determinants of and level of care, treatment, and services that health in clinical care 8 Chapter 1 Overview of Education in Health Care Rigorously practice preventive health care Healthy People initiative, Healthy People 2020 is Improve access to health care for those with the product of an extensive evaluation process unmet health needs by stakeholders. Its 40 topic areas support four Practice relationship-centered care with overarching goals: attaining high-quality and individuals and families longer lives; achieving health equity and elim- Provide culturally sensitive care to a diverse inating disparities; creating social and physi- society cal environments that promote good health for Use communication and information tech- all; and promoting quality of life, healthy de- nology effectively and appropriately velopment, and behaviors across the entire life Continue to learn and help others learn span (USDHHS, 2010). Patient education is a fundamental component of these far-reaching For the 21st century, the Institute for Health- national initiatives. Presently, the Secretary of care Improvement announced the 5 Million Health and Human Services is in the process of Lives campaign in 2006. This campaign’s ob- establishing an advisory committee, informed jective was to reduce the 15 million incidents by the latest scientific evidence, for the devel- of medical harm that occur in U.S. hospitals opment and implementation of recommenda- each year. Such an ambitious campaign has ma- tions on national health promotion and disease jor implications for teaching patients and their prevention objectives for Health People 2030 families as well as teaching staff and students (USDHHS, 2017). the ways they can improve care to reduce in- Thus, since the 1980s the role of the nurse as juries, save lives, and decrease costs of health educator has undergone a paradigm shift, evolv- care (Berwick, 2006). ing from what once was a disease-oriented ap- Another initiative was the formation of proach to a more prevention-oriented approach. the Sullivan Alliance to recruit and educate In other words, the focus is on teaching for the health professionals, including nurses, to de- promotion and maintenance of health (Roter liver culturally competent care to the public et al., 2001). Education, which was once done they serve. Effective health care and health as part of discharge planning at the end of hos- education of patients and their families de- pitalization, has expanded to become part of a pend on a sound scientific base and cultural comprehensive plan of care that occurs across awareness in an increasingly diverse society. the continuum of the healthcare delivery pro- This organization’s goal is to increase the ra- cess (Davidhizar & Brownson, 1999). cial and cultural mix of health professional As described by Grueninger (1995), this faculty, students, and staff, who are sensitive transition toward wellness entails a progres- to the needs of clients of diverse backgrounds sion “from disease-oriented patient education (Sullivan & Bristow, 2007). (DOPE) to prevention-oriented patient edu- Also, following on the heels of Healthy Peo- cation (POPE) to ultimately become health- ple 2000, Healthy People 2010 built on the pre- oriented patient education (HOPE)” (p. 53). In- vious two initiatives and provided an expanded stead of the traditional aim of simply imparting framework for health prevention for the nation information, the emphasis is now on empow- (USDHHS, 2000). Specific goals and objectives ering patients to use their potentials, abilities, included the development of effective health ed- and resources to the fullest (Glanville, 2000; ucation programs to assist individuals to rec- Kelliher, 2013). Along with supporting patient ognize and change risk behaviors, to adopt or empowerment, nurses must be mindful to con- maintain healthy practices, and to make appro- tinue to ensure the protection of “patient voice” priate use of available services for health care and the therapeutic relationship in patient edu- (USDHHS, 2010). As the latest iteration of the cation against the backdrop of ever-increasing  The Evolution of the Teaching Role of Nurses 9 productivity expectations and time constraints health teaching as a function within the scope (Liu, Yu, & Yuan, 2016; Roter et al., 2001). of nursing practice. Two decades later, this or- ganization recognized nurses as agents for the promotion of health and the prevention of ill- ▸▸ The Evolution of the ness in all settings in which they practiced (NLNE, 1937). By 1950, the NLNE had identi- Teaching Role of fied course content in nursing school curricula to prepare nurses to assume the role. Most re- Nurses cently, the NLN (2006) developed the first Cer- tified Nurse Educator (CNE) exam to raise “the Nursing is unique among the health professions visibility and status of the academic nurse ed- in that patient education has long been consid- ucator role as an advanced professional prac- ered a major component of standard care given tice discipline with a defined practic