Abstract and Introduction

Abstract

Nurses and nurse midwives have historically considered patient education one of their most important responsibilities. Increasingly, however, appropriate and comprehensive patient education has become more difficult to accomplish. There are many reasons for this, including the huge influx of clients of varying cultures into virtually all health care systems across the United States, the lack of time available for patient education in tightly scheduled managed care visits, the dearth of educational materials written at appropriate readability levels and/or in languages other than English, and the lack of reimbursement for time spent on patient education. In addition, many providers might not have specific training in the provision of patient education or in the development of appropriate health educational materials for the population they serve. This article discusses these issues, suggesting also that there are ethical dilemmas inherent in the provision of some aspects of patient education.

Introduction

Health education has always been a vital component of nursing and midwifery care.[1] Even though “productivity” has become the bottom line in most health care systems today, providers still work hard at finding the time to teach, no matter how overscheduled their days. But patient education is becoming more difficult to accomplish due to many factors outside our control. The influx of clients of varying cultures (speaking countless languages) into the health care system, the lack of time for patient education in managed care visits, the dearth of educational materials in languages other than English, and the lack of reimbursement for time spent on patient education all make the provision of this vital service more difficult to accomplish. In addition, providers might not have been afforded specific training in the provision of patient education and, therefore, might lack skills needed to perform this activity successfully. The literature also provides strong evidence that health education materials are rarely written at appropriate literacy levels, yet they continue to be produced in this manner.

There are also issues to consider for the clients we serve. Paramount among these issues are the culture from which they come, and their ability to understand verbal or written instructions, whether or not they speak English, for lack of understanding of written patient education materials can occur in English-speaking clients as well as in clients who speak other languages. Clients are routinely asked to read informed consent forms and then sign them, thus agreeing to undergo tests or procedures they may or may not fully understand. A lack of “health literacy,” a concept that denotes not only the clients’ ability to read but also to comprehend and act on medical instructions, can influence health outcomes. Diminished health literacy is common among ethnic minorities, as has been shown by Schillinger et al.,[2] who found that reduced health literacy was correlated with negative health outcomes, such as poor glycemic control and more retinopathy of diabetes. This article describes some current issues in patient education practice, linking some of them to ethical dilemmas.

Related Posts