Chapter 1 Overview of Education in Health Care

1. Chapter 1Overview of Education in Health Care

2. Historical Foundations of the Nurse Educator Role • Health education has long been considered a standard care-giving role of the nurse. • Patient teaching is recognized as an independent nursing function. • Nursing practice has expanded to include education in the broad concepts of health and illness.

3. Historical Foundations (cont’d) Organizations and Agencies Promulgating Standards and Mandates: 1. NLNE (NLN) • first observed health teaching as an important function within the scope of nursing practice • responsible for identifying course content for curriculum on principles of teaching and learning

4. Historical Foundations (cont’d) 2. ANA - responsible for establishing standards and qualifications for practice, including patient teaching 3. ICN - endorses health education as an essential component of nursing care delivery

5. Historical Foundations (cont’d) 4. State Nurse Practice Acts - universally includes teaching within the scope of nursing practice 5. JCAHO - accreditation mandates require evidence of patient education to improve outcomes 6. AHA - Patient’s Bill of Rights ensures that clients receive complete and current information

6. Historical Foundations (cont’d) 7. Pew Health Professions Commission - puts forth a set of health profession competencies for the 21st century - over one-half of recommendations pertain to importance of patient and staff education

7. Current Mandates for Nurse as Educator Institute of Medicine 2001 CROSSING THE QUALITY CHASM: A NEW HEALTH SYSTEM FOR THE 21ST CENTURY • focuses more broadly on how the health system can be reinvented to foster innovation and improve the delivery of care. • Six Aims for Improvement • Ten Rules for Redesign

8. Joint Commission:Patient and Family Education • The organization provides education that supports patient and family participation in care decisions and care processes. • Education and training help meet patients’ ongoing health needs. • Education methods consider the patient’s and family’s values and preferences and allow sufficient interaction among the patient, family, and staff for learning to occur.

9. Current Mandates for Nurse as Educator Healthy People 2020 (USDHHS) Federal initiatives outlined: To increase the quality & years of healthy life To eliminate health disparities among different segments of the population *Requires the nurse as educator to use theory and evidenced based strategies to promote desirable health behavior.

10. Trends Affecting Health Care Social, economic, and political forces that affect a nurse’s role in teaching: • growth of managed care • increased attention to health and well-being of everyone in society • cost containment measures to control healthcare expenses • concern for continuing education as vehicle to prevent malpractice and incompetence

11. Trends (cont’d) • expanding scope and depth of nurses’ practice responsibilities • consumers demanding more knowledge and skills for self-care • demographic trends influencing type and amount of health care needed • recognition of lifestyle related diseases which are largely preventable • health literacy increasingly required • advocacy for self-help groups

12. Purpose, Benefits, and Goals of Patient, Staff and Student Education Purpose: to increase the competence and confidence of patients to manage their own self-care and of staff and students to deliver high-quality care Benefits of education to patients: - increases consumer satisfaction - improves quality of life - ensures continuity of care

13. Purpose, Benefits and Goals (cont’d) - reduces incidence of illness complications - increases compliance with treatment - decreases anxiety - maximizes independence Benefits of education to staff: - enhances job satisfaction - improves therapeutic relationships - increases autonomy in practice - improves knowledge and skills

14. Purpose, Benefits and Goals (cont’d) Benefits of preceptor education for nursing students • prepared clinical preceptors • continuity of teaching/learning from classroom curriculum • evaluation and improvement of student clinical skills

15. Purpose, Benefits, and Goals (cont’d) Goal: to increase self-care responsibility of clients and to improve the quality of care delivered by nurses

16. The Education Process Definition of Terms Education Process: a systematic, sequential, planned course of action on the part of both the teacher and learner to achieve the outcomes of teaching and learning Teaching/Instruction: a deliberate intervention that involves sharing information and experiences to meet the intended learner outcomes

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

18. The Education Process (cont’d) Patient Education: the process of helping clients learn health-related behaviors to achieve the goal of optimal health and independence in self-care Staff Education: the process of helping nurses acquire knowledge, attitudes, and skills to improve the delivery of quality care to the consumer

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

20. Role of the Nurse As Educator • Nurses act in the role of educator for a diverse audience of learners—patients and their family members, nursing students, nursing staff, and other agency personnel. • Despite the varied levels of basic nursing school preparation, legal and accreditation mandates have made the educator role integral to all nurses.

21. Role of Nurse As Educator (cont’d) • Nurses function in the role of educator as: - the giver of information - the assessor of needs - the evaluator of learning - the reviser of appropriate methodology • The partnership philosophy stresses the participatory nature of the teaching and learning process.

22. Barriers to Teaching Barriers to teaching are those factors impeding the nurse’s ability to optimally deliver educational services. Major barriers include: • lack of time to teach • inadequate preparation of nurses to assume the role of educator with confidence and competence • personal characteristics • low-priority status given to teaching

23. Barriers to Education (cont’d) • environments not conducive to the reaching-learning process • absence of 3rd party reimbursement • doubt that patient education effectively changes outcomes • inadequate documentation system to allow for efficiency and ease of recording the quality and quantity of teaching efforts

24. Obstacles to Learning Obstacles to learning are those factors that negatively impact on the learner’s ability to attend to and process information. Major obstacles include: • limited time due to rapid discharge from care • stress of acute and chronic illness, anxiety, sensory deficits, and low literacy • functional health illiteracy

25. Obstacles (cont’d) • lack of privacy or social isolation of health-care environment • situational and personal variations in readiness to learn, motivation and compliance, and learning styles • extent of behavioral changes (in number and complexity) required

26. Obstacles (cont’d) • lack of support and positive reinforcement from providers and/or significant others • denial of learning needs, resentment of authority and locus of control issues • complexity, inaccessibility, and fragmentation, of the healthcare system

27. Questions (cont’d) • What are the common mistakes made in the teaching of others? • How can teaching and learning best be evaluated? What other questions might you ask?

28. Chapter 3Applying Learning Theories toHealthcare Practice

29. LEARNING • Learning: a relatively permanent change in mental processing, emotional functioning, and behavior as a result of experience • Learning Theory: a coherent framework of integrated constructs and principles that describe, explain, or predict how people learn

30. CONTRIBUTION OF LEARNING THEORIES • Provides information and techniques to guide teaching and learning • Can be employed individually or in combination • Can be applied in a variety of settings as well as for personal growth and interpersonal relations

31. Application Questions to Keep in Mind • How does learning occur? • What kinds of experiences facilitate or hinder the process? • What held ensure that learning becomes permanent?

32. BEHAVIORIST THEORY • Concepts: stimulus conditions, reinforcement, response, drive • To change behavior, change the stimulus conditions in the environment and the reinforcement after a response

33. Behaviorist Dynamics • Motivation: drives to be reduced, incentives • Educator: active role; manipulates environmental stimuli and reinforcements to direct change • Transfer: practice and provide similarity in stimulus conditions and responses with a new situation

34. Respondent Conditioning • Learning occurs as the organism responds to stimulus conditions and forms associations • A neutral stimulus is paired with an unconditioned stimulus–unconditioned response connection until the neutral stimulus becomes a conditioned stimulus that elicits the conditioned response

35. Operant Conditioning • Learning occurs as the organism responds to stimuli in the environment and is reinforced for making a particular response. • A reinforcer is applied after a response strengthens the probability that the response will be performed again under similar conditions.

36. Changing Behavior Using Operant Conditioning • To increase behavior • positive reinforcement • negative reinforcement (escape or avoidance conditioning) • To decrease behavior • nonreinforcement • punishment

37. Advantages of Behaviorism • Highly structured situations • Skills training in which steps and sequences can be clearly delineated

38. Disadvantages of Behaviorism • Instruction is mechanistic • Minimizes student involvement in learning • Inappropriate for complex mental processes, problem-solving, and critical thinking

39. COGNITIVE THEORY • Concepts: cognition, gestalt, perception, developmental stage, information-processing, memory, social constructivism, social cognition, attributions • To change behavior, work with the developmental stage and change cognitions, goals, expectations, equilibrium, and ways of processing information

40. Cognitive Dynamics • Motivation: goals, expectations, disequilibrium, cultural and group values • Educator: organize experiences and make them meaningful; encourage insight and reorganization within learner • Transfer: focus on internal processes and provide common patterns with a new situation

41. Gestalt Perspective • Perception and the patterning of stimuli (gestalt) are the keys to learning, with each learner perceiving, interpreting, and reorganizing experiences in her/his own way • Learning occurs through the reorganization of elements to form new insights and understanding

42. Information-Processing Perspective • The way individuals perceive, process, store, and retrieve information from experiences determines how learning occurs and what is learned. • Organizing information and making it meaningful aids the attention and storage process; learning occurs through guidance, feedback, and assessing and correcting errors. • Focus on describing the way information is tracked, the sequence of mental operations, and the results of operations.

43. Cognitive Development Perspective • Learning depends on the stage of cognitive functioning, with qualitative, sequential changes in perception, language, and thought occurring as children and adults interact with the environment. • Recognize the developmental stage and provide appropriate experiences to encourage discovery.

44. Social Constructivist Perspective • A person’s knowledge may not necessarily reflect reality, but through collaboration and negotiation, new understanding is acquired. • Learning is development • Assimilation, accommodation, & construction are part of learning

45. Social Constructivist Perspective ( cont) • Learning is heavily influenced by the culture and occurs as a social process in interaction with others. • A learner constructs new knowledge by building on internal representations of existing knowledge thru personal interpretation of experience.

46. Social Cognition Perspective • An individual’s perceptions, beliefs, and social judgments are affected strongly by social interaction, communication, groups, and the social situation. • Individuals formulate causal explanations to account for behavior that have significant consequences for their attitudes and actions (attribution theory).

47. SOCIAL LEARNING THEORY • Concepts: role modeling, vicarious reinforcement, self-system, self-regulation • To change behavior, utilize effective role models who are perceived to be rewarded, and work with the social situation and the learner’s internal self-regulating mechanisms

48. Social Learning Dynamics • Motivation: compelling role models perceived to be rewarded, self-system regulating behavior, self-efficacy • Educator: model behavior and demonstrate benefits; encourage active learner to regulate and reproduce behavior • Transfer: similarity of setting, feedback, self-efficacy, social influences

49. COGNITIVE THEORY-Advantages • Use of intellectual development gives teacher ↑ professional & personal satisfaction • ↑ satisfaction in relationship with learner • ↑ Increased use of a variety of instructional strategies → teacher creativity • ↑ learner satisfaction as move into improved cognitive ability & look forward to more challenging/ stimulating life • ↑ Critical thinking in learner

50. COGNITIVE THEORY-Disadvantages ↑ time & energy by teacher to become knowledgeable about different viewpoints Students stressed if looking for certainty or absolute answers