A few months ago, I was invited to speak with a staff nurse about her plan to open a freestanding center that would help discharged patients and their families to manage ongoing health problems. For the sake of argument, I asked her why patients would need this service. Shouldn't the teaching be done before patients leave the hospital, and reinforced during a home care or follow-up visit? She replied, "Nurses no longer have time for patient teaching in the hospital. It's a major reason why they're unsatisfied with their practice." FIGURE
Nurses have long known that preoperative education encourages patients' participation in postoperative care and improves surgical outcomes. More than 30 years ago, nurse researchers began studying patient education and how to go about it. But much more needs to be done.
This issue features original research, conducted by Maude Joseph and Margaret Freda, that documents how primary care nurses at a major medical center realized their potential contributions to the health of families through assessment, case finding, outreach, and patient education. Nurses working in an ambulatory care center in the Bronx knew that their family assessments and outreach efforts could make a difference to the community they served and could enhance the community's access to cost-effective care. They designed a program in which they interviewed patients about their family members' health needs and risk factors, then made appointments for those who needed services. The nurses noted a high rate of kept appointments, suggesting that their efforts met a vital need.
It's abundantly clear that nurses are among the most highly trusted of health professionals. (For the second year in a row, nurses were ranked first in honesty and ethics among 45 occupations in a recent Gallup poll-see News, page 20.) Yet it's not clear if the public views nurses as leaders in health care-and whether nurses see themselves as such. For example, will nurses take charge in the next phase of the development of patient education, in which both the quality of health education and basic literacy are addressed?
One study (published in the December 6, 1999, Journal of the American Medical Association) found that one-third of English-speaking patients at two public hospitals were unable to read materials such as instructions for taking medications, appointment slips, or consent forms; the American Medical Association responded by forming an Ad Hoc Committee on Health Literacy. However, I was disappointed to note that a monograph, Health Literacy, the proceedings (published by Pfizer) of a January 2000 conference, included not one nurse-led presentation. Shouldn't nurses participate in policy discussions on health literacy? Can't we lead efforts to improve patient literacy as well as the quality of patient education in our institutions? Can we afford to wait to be asked to do so?
Patient education has always been an intrinsic component of nursing care. It's included in state practice acts as an independent nursing function. Why then are nurses now accepting the fact that patients receive no teaching or that responsibility has fallen to physicians and health educators? Patient education should be a core component of every provider's role if patients and family members are to participate in health care. But why are we not making more aggressive attempts to ensure that it remains a nursing function? If you argue that patient education is an important aspect of your role and that you're fulfilling it, I ask: How are you addressing the needs of your patients who are illiterate? How do you know if your patients are literate?
I urge you not to accept the purging of patient teaching from the nursing role. Consider the Bronx study as an example of a project that validates nurses as educators and promotes job satisfaction and retention. Although my colleague's idea for a patient education center is interesting, such a facility would not ensure that patients are ready for discharge and able to act as informed participants in their care.