Issues in Patient Education

Margaret Comerford Freda, RN, EdD, CHES

Disclosures

J Midwifery Womens Health. 2004;49(3) 

In This Article

Principles of Patient Education

The not-so-subtle changes in the health care system in the United States over the past several decades have resulted in the old primarily patriarchal system (in which the client was considered the object of care) evolving into the current system in which the client is ideally considered a partner in care. As partners, clients are now expected to learn enough about their own health to be able to participate in health care decisions. Thus, the goal of patient education has changed from telling the client the best actions to take, to now assisting clients in learning about their health care to improve their own health. This newer view of health education is not an easy concept for many clients in our care to grasp and requires more intense communication between clients and providers. Post et al.[13] studied how to teach clients to communicate more effectively with their health care providers, finding that racial and ethnic differences play a large part in the communication process. Cooper et al.[14] found that, even as the health care system forces clients to gain greater autonomy, not all providers want to work as "partners" with their clients.

The acquisition of enough knowledge about pregnancy, birth, postpartum care, and women's health care to make informed decisions is difficult for some clients to achieve. Some of the clients we serve do not wish to learn as much as we want to teach; some don't have the background education to absorb teaching about complex body systems and physiology. It falls to the individual midwife, then, to assess what her client knows already, what she needs to know, and how best to achieve the goal of helping the client learn enough to make informed decisions about her own health. This requires careful education of each client.

Two important principles for providing patient education are simplicity and reinforcement ( Table 1 ). "Simplicity" means that educational messages must be delivered so the client can readily understand them. Health education can include extremely intricate information (e.g., triple screening, amniocentesis, and Rh incompatibility). Topics such as these can be daunting to teach and difficult for an inexperienced client to learn. The concept of simplicity, then, tells us to start by assessing what the client knows before the teaching session. Never assume that the client needs to be taught everything about a topic, for it is possible that someone close to her has experienced this in the past and she knows a great deal already. In addition, overteaching must be avoided. Although it is tempting to teach the client everything we know about a given topic, in the name of simplicity we need to avoid doing that. Realistically, it is far better to choose three or four essential concepts about a topic and teach those. Using the principle of simplicity to guide a teaching session, then, the midwife should use reinforcement in every patient education encounter. When a concept is heard multiple times during a teaching session, it is more likely that the information will be retained.

Several decades ago, Knowles[15] formulated what he called the "Adult Learning Principles" ( Table 2 ). They remain today essential knowledge for people who teach adults in health settings. These adult learning principles can help us to plan effective health education programs.

  1. Adults learn best when there is a perceived need. If an adult does not understand why she needs to be taught about a subject, little learning will occur. Therefore, we must be sure that our clients understand the underlying health problem we are trying to prevent or the illness we are trying to cure before we begin teaching.

  2. Teaching of adults should progress from the known to the unknown. Always assess what the clients know about a topic before beginning a teaching session. Don't reteach the things they already understand, but use that extra time to teach more about the topic.

  3. Teaching of adults should progress from the simpler concepts to more complex topics. When teaching about triple screening, for instance, start by asking if the client knows about Down syndrome or about spina bifida. Explain what those entities are before going on to a discussion of how to screen for those health problems and what the triple screen might show and what choices the client would be asked to make on receiving the results of the screening test.

  4. Adults learn best using active participation. Classroom-type didactic lecturing is not usually interactive and should be avoided when teaching clients. Teaching sessions about a topic in which the client is frequently asked to restate what has been discussed will inspire far more learning than a passive lecture in which the client is expected to learn simply because someone spoke to them.

  5. Adults require opportunities to practice new skills. Anytime a new manual skill is required (e.g., learning how to draw up and inject insulin or learning how to detect uterine contractions), it is essential that time be spent watching the client practice these skills, giving return demonstrations of manual abilities.

  6. Adults need the behavior reinforced. Teaching about health topics needs reinforcement continually. If syringe skills have been taught, be sure to ask the client to show you their technique on subsequent visits.

  7. Immediate feedback and correction of misconceptions increases learning. Always ask the client to restate what you have taught. Also ask them what they have heard about this topic from their friends or relatives. It could be that the "old wives tales" they have heard from family and friends will be retained as "true," whereas our formal teaching is extinguished within several days.

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