Patient Education

and
Health Promotion
in Medical Care
RST-04-11
FK-UWK sem IVB

Patient Educ-FK-UWK-sem IVB-RST-11 1

 Introduction
• Klien: dapat Warga masyarakat, Karyawan
rumah sakit prof, Kesehatan.
• Peserta: klien dalam pelayanan pendidikan
formal
• Pasien: pulih dari, mengelola pada penyakit
atau mempersiapkan prosedur medis.
• Penyedia: istilah umum untuk segala Care Giver
• Instruktur: penyedia formal, educ direncanakan.
jasa

Patient Educ-FK-UWK-sem IVB-RST-11 2

 I. Yayasan Pendidikan Pasien & HP

II. Langkah-langkah dalam Perencanaan

dan Pelaksana Layanan Pendidikan

III. Keterampilan dan Metode Intervensi

Patient Educ-FK-UWK-sem IVB-RST-11 3

 Yayasan Pendidikan Pasien &
HP

• Sebuah Model untuk Pendidikan

Pasien dan Pemrograman Promosi
Kesehatan
• Mengembangkan Filsafat dan
sebuah Pemikiran

Patient Educ-FK-UWK-sem IVB-RST-11 4

 A Model for Patient Education and HP-
Programming
Organizing Concepts.

Tiga Tingkat
Empat Tahapan Layanan:
Program
LEMBAGA-WIDE ...
Development:
PENILAIAN rumah sakit
PERENCANAAN Program ...
PELAKSANAAN populasi tertentu
EVALUASI KLIEN individu ..

Patient Educ-FK-UWK-sem IVB-RST-11 5

A Model for HE Program devt at 3. Org.levels

LEVEL OF ORGANIZATION
Program Institutional Programmatic Client:
Development. individual /group
Stage
I.Assessment
A. Objectives To determine To generate specific To determine KAP
need for policy client group & of patient &
disease profiles. family

B. Outcome Facility profile Priority needs for Learning needs

(educational program
needs & development
programs)
C. Topics for  Policy  What are disease  Course of
baseline statement for characteristics? disease, stage,
questions PE in the Prevalence? impact on
facility? Incidence? indiv. Patients
Patient Educ-FK-UWK-sem IVB-RST-11
Clusters? 6
A Model for HE Program devt at 3. Org.levels
LEVEL OF ORGANIZATION Client: individual
/group
Program Institutional Programmatic Client: individual
Developt. /group
Stage

I.Assess
 Support for PE  Who are the  Individual client
ment  Perceptions of clients?(demogra, & fam. Psychosoc
C.Topics for utility & psychosocial, & cultural
baseline effectiveness of physician levels, background?
questions PE fam.configuration  Readiness of
 What org. units  Climate for client for
are involved in change? (Staff learning?
PE? Coordination readiness &  Client’s level of
mechanism? Adm capability) functioning –
Focus for Educ?  Are staff physical. mental,?
Support for knowledge,  Level of client –
Creating one? Attitudes, Skills provider
Patient Educ-FK-UWK-sem IVB-RST-11 sufficient? interaction? 7
 A Model for HE Program devt at 3. Org.levels
LEVEL OF ORGANIZATION
Program Institutional Programmatic Client: individual
Devt. /group
Stage
I.Assess
 Existing  What are the  Are resource and
ment expenditures, organization’s educational
C.Topics resources, characteristics? (No. materials
for baseline administrative of clients, average available,
questions capacity, staff, funds, length of stay, total adequate, used?
etc. Management of hours, no. of contacts,
resources? Potential space, records
for coordinating system)
consolidations?
 Present status of
quality of care:
morbidity, Mortality,
disability, etc?
Patient Educ-FK-UWK-sem IVB-RST-11 8
 A Model for HE Program devt at 3. Org.levels
LEVEL OF ORGANIZATION
Program Devt. Institutional Programmatic Client: individual
Stage /group

I.Assessm
 Multidisciplinary  Health team members  Client
ent task force  Representatives of  Family
D. Participants community agencies  Provider or team
 Representative clients
& family members.

E. Decision  Administration  Chiefs of services, or  Client

makers  Board of trustees section chiefs  Family
 Chiefs of services  Medical advisory  Provider or team
committee, or
equivalent

Patient Educ-FK-UWK-sem IVB-RST-11 9

 A Model for HE Program devt at 3. Org.levels
LEVEL OF ORGANIZATION
Program Institutional Programmatic Client: individual
Develpoment. /group
Stage

II.Plan
To develop facility- To develop program To identify
ning wide plan for PE & plans for priority needs individual client
A. Objectives HP learning objectives
or contract
B. Outcomes  Formulation of  Standard protocols  Individual
policy statement  Staff training teaching plan for
 Development of  Educational methods clients and
goals & strategies & materials family
 Development of  Records &  Plan for follow-
org. structure evaluation systems up and referral
 Identification and  Communication  Documentation
establishment of channels method.
internal& external
Patient Educ-FK-UWK-sem IVB-RST-11 10
 A Model for HE Program devt at 3. Org.levels
LEVEL OF ORGANIZATION
Program Institutional Programmatic Client:
Devt. individual /group
Stage

II.Plan
 Identification and
ning establishment of
B.Outcomes internal& external
linkage systems
 Establishment of
data and
communication
systems
C.Participants  Multidisciplinary  Health team members  Client
task force  Representatives of  Family
community agencies  Provider or
 Representatives of team
clients & fam.members
Patient Educ-FK-UWK-sem IVB-RST-11 11
A Model for HE Program devt at 3. Org.levels
LEVEL OF ORGANIZATION
Program Institutional Programmatic Client: individual
Developmt. /group
Stage

II.Plan
 Administration  Chiefs of services, or  Client
ning  Board of trustees section chiefs  Family
D. Decision  Chiefs of services  Medical advisory  Provider or team
makers committee, or
equivalent
III.Impl  To carry out plan  Same  Same
ementati  To test, revise
 To use
on information
A.Objective gained through
s implementation to
refine and
improve program
Patient Educ-FK-UWK-sem IVB-RST-11 12
 A Model for HE Program devt at 3. Org.levels
LEVEL OF ORGANIZATION
Program Institutional Programmatic Client: individual
Development /group
Stage

B.  Testing goals & Monitoring program Monitoring clients

strategies & delivery in terms of learning in terms of
Processes adapting as utility & acceptance of utility, acceptance of
necessary procedures, training, methods and
 Monitoring: data & materials, methods, materials, client-
communications communication provider interaction,
systems, policies & patterns, record referral mechanisms,
procedures. systems. documentation
systems, staff
communications.
C. Communi Progress reports, staff Documentation in Medical record
cation meetings, etc. medical records, team notes, team
mechanisms conferences, etc. conferences, etc

Patient Educ-FK-UWK-sem IVB-RST-11 13

 A Model for HE Program devt at 3. Org.levels
LEVEL OF ORGANIZATION
Program Institutional Programmatic Client:
Development. individual
Stage /group

C. Time frame Annual Monthly Daily or

weekly
D. Participants Multidisciplinary  Health team members  Client
task force  Representatives of.  Family
Community members  Provider or
 Representatives of team
clients & fam. Members

E.Decision Makers  Administration  Chief of services or  Client

 Board of Trustee section chiefs  Family
 Chief of services  Medical advisory  Provider or
committee or equivalent team

Patient Educ-FK-UWK-sem IVB-RST-11 14

 Developing a philosophy and a
rationale
• PARADOXES IN HEALTH EDUCATION,
• National goals for HP & disease
prevention:
o Improve infant health
o Improve child health
o Improve adult health
o Improve Health & quality of life for
older adults.

Patient Educ-FK-UWK-sem IVB-RST-11 15

 Developing a philosophy and a
rationale
• PARADOXES IN HEALTH EDUCATION,
• The Role of Consumers
o Individual citizens :
• need to take responsibility
• Participate in making policy
• Caring for themselves
• Affecting the environment

The paradox is the more we convey the

message of individual responsibility, the
greater we run the risk of blaming the victim.

Patient Educ-FK-UWK-sem IVB-RST-11 16

 Developing a philosophy and a
rationale
• PARADOXES IN HEALTH EDUCATION,
• H.Educators focus on behavior itself, not
deal with the social relations &
structures, that may underlie &
contribute the behavior pattern
• Who is to benefit?
o Corporate: absenteism + productivity
health cost

Patient Educ-FK-UWK-sem IVB-RST-11 17

 TERMS
1. Health Ed.(HE): is the use of education
process to assist individuals to voluntarily
adopt or alter behaviors that will improve
or maintain their health.
2. Patient Ed (PE): HE directed to patients, their
families & friends, who are either awaiting
or undergoing medical treatment.
3. Planned PE: includes needs assessment,
setting objectives, developing action plan &
implementation, documentation &
evaluation,
Patient Educ-FK-UWK-sem IVB-RST-11 18
 TERMS
4.PE services: planned PE designed to inform
patients about how to use various health care
services, to prepare patients for medical
procedures, to assist patients to manage their
diseases or to use a medical device after
discharge, and to modify their behavior in order
to promote better health & prevent diseases.

Incorporate in one/combination of one-to-one

instruction, group sessions, a series of classes,
and support groups.

Patient Educ-FK-UWK-sem IVB-RST-11 19

 Rationale
benefits PE services to:
• Patients:
o Reduce anxiety, increase ability to
make health decisions, reduce
readmissions for chronic dis.

• MAY REDUCE COST CONTAIMENT

• SHORTENED RECOVERY TIME
• IMPROVE PATIENT MORALE

Patient Educ-FK-UWK-sem IVB-RST-11 20

 Rationale
benefits planned PE services to:
• ,Hospital:
o Enhance efficient use of hospital
services, promote efficient use of
education resources, increase
physician support, increase staff
satisfaction & increase community
support
o Reduce unnecessary utilization of
trained health professional & health
facilities..
Patient Educ-FK-UWK-sem IVB-RST-11 continued 21
PE goals & activities should be planned at
three levels: 1, entire hospital
2. specific patient population: DM
3. individual patient & families

• E.g. Fostering awareness, influencing

attitudes, identifies alternatives so that
individuals can make informed
choices & modify their behavior….
Personal responsibility to protect her
own health!
Patient Educ-FK-UWK-sem IVB-RST-11 22
 planned PE program
should be based on:
1. Identified Objectives
2. sound educational methods
3. Approved content that is
scientifically accurate
4. Be adaptable to the individual
needs of patients.
Patient Educ-FK-UWK-sem IVB-RST-11 23
 e.g. PE activities
Education services:
• Proper nutrition
• Physical Exercise
• Sleep habit
Counseling services:
• To reduce physiological and mental
illness

Patient Educ-FK-UWK-sem IVB-RST-11 24

 Steps in Planning & Implementing
Education Services

• Setting up a Program
• Developing Protocols &
Teaching Plans
• Selecting Educational Methods
• Evaluating Educational Services
Patient Educ-FK-UWK-sem IVB-RST-11 25
 Developing Protocols & Teaching Plans

• PRECEDE is acronym for Predisposing ,

Reinforcing, and Enabling Causes in
Educational Diagnosis and Evaluation. (Green
et al.,1980).
• Epidemiological and Social Diagnosis (Stage 1)
• Behavioral Diagnosis (Stage 2) e.g.
o Smoking, overeating, too little / too much exercise,
uncontrolled hypertension, inability to cope with
stress., Important scale & changeability scale.(Likert)
• Educational Diagnosis
• Administrative diagnosis
Patient Educ-FK-UWK-sem IVB-RST-11 26
 PRECEDE Framework of HE-planning

Phase 4 Phase 3 Phase 2

Phase 1
PREDISPOSING
HEALTH factors
PROMOTION

Health
EDUCATION
REINFORCING BEHAVIOR
factors &
Lifestyle
Quality
HEALTH Of
LIFE
POLICY
Regulation ENABLING
ENVIRONMENT
group factors

Phase 6
Nonhealth PRECEDE, Stage 1
factors

Health
factors Quality of
life
Vital Indicators
-Morbidity Subjectivity of
-Mortality defined problems
-Fertility of indiv.iduals or
-Disability: community
Dimensions Social indicators:
-Incidence
-Prevalence -Illegitimacy - Population
-Distribution -Welfare - Unemployment
-Intensity -Absenteeism - Alienation
-Duration -Hostility - Discrimination
:
Patient Educ-FK-UWK-sem IVB-RST-11 28
 PRECEDE Stage 2 Behavioral Diagnosis

Nonbehavioral factors
Health
problem
behavioral factors

Behavioral Indicators:
- - Prevention action - Self-care
- - Consumption pattern - Compliance
- - Utilization

Dimension:
- - Earliness - Frequency
- - Quality - Range
- - Persistence
Patient Educ-FK-UWK-sem IVB-RST-11 29
 PRECEDE Stage 3 Educational Diagnosis

PREDISPOSING FACTORS:
- Knowledge - Attitudes BE
- Values - Perceptions HA
VI
ENABLING FACTORS: OR
- Availability of resources - Skills AL
- Accessibility - Referrals
Pro
REINFORCING FACTORS: ble
- Attitudes & behavior of health and ms
other personnel, peers, parents,
employers,, etc.
Patient Educ-FK-UWK-sem IVB-RST-11 30
 PRECEDE Stage 4 Administrative Diagnosis
Direct Communication
with public or patients Pre

HE components TRAINING
Enbl
of Health
Program Community
Organization

Indirect Communication: Rein

Staff development, training,
supervision, consultation,
feedback.
Patient Educ-FK-UWK-sem IVB-RST-11 31
 Sample of behaviors identified as important in
making n educational diagnosis (cardiac patients)

1. Predisposing Factor: Client’s perceptions of

appropriate limits of physical exertion

2. Enabling Factor: Client’s referral by

practitioner to exercise program

3. Reinforcing Factor: Client’s having someone

at home who enjoys exercise and who will
encourage client to exercise

Patient Educ-FK-UWK-sem IVB-RST-11 32

 Sample educational strategies for a
post-heart attack exercise program
FACTORS STRATEGIES

1.Predisposing - Lecture-discussion of
Perceptions of parameters following
cardiac stress test
exercise limits
- Film demonstrating
levels of activity

2. Enabling --One-to-one discussion of

Nurse referral benefits of program.
- Pamphlet describing
exercise program

Patient Educ-FK-UWK-sem IVB-RST-11 33

 Sample educational strategies for a
post-heart attack exercise program
FACTORS STRATEGIES
2. Enabling
Nurse referral - Discussion of costs of
program in relation to
benefits derived

3. Reinforcing - Home visit

Family member - Group discussion
encouragement - One-to-one discussion
with family member

Patient Educ-FK-UWK-sem IVB-RST-11 34

 Selecting Educational Methods
HE planning steps
Obtain
Recognise and Conduct
administrative
define health behavioral &
commitment to
problem educational
the educational
diagnosing
program

Develop Select Educati Write learning

teaching plan onal Methods objectives

Patient Educ-FK-UWK-sem IVB-RST-11 35

 Educational Methods
Factors
Predisp. Enabl Reinfor
Methods c

. Group facilitation
-Peer group discussion
-Mutual aid & support + +
-Problem solving + +
+ +
Role playing + + +
Modeling + +
Behavior +
modification
Patient Educ-FK-UWK-sem IVB-RST-11 36
 Educational Methods
Factors

Predi Enabl Reinf

Methods sp. orc
. Skill practice +
Simulation & + +
games
Community +
Organizing
Mass media + +
Patient Educ-FK-UWK-sem IVB-RST-11 37
 Educational Methods
Factors
Predisp. Enabl Reinfor
Methods c

Audiovisual + +
Lecture +
Individual + +
Instruction
Programmed +
Learning

Patient Educ-FK-UWK-sem IVB-RST-11 38

 Educational Methods
Factors
Predisp. Enabl Reinfor
Methods c

Audiovisuals + +
Computer- +
assisted
learning
Interviewing +

Patient Educ-FK-UWK-sem IVB-RST-11 39

 Intervention Skills and Methods
• Educational Assessment as Intervention
• Risk Assessment & Health Improvement
• Techniques for Making Decisions &
Commitments
• The Role of Self-Care in Medical Care
• Maintaining Changes over Time

Patient Educ-FK-UWK-sem IVB-RST-11 40

Daftar Pustaka
• Squyres, Wendy D.1985. Patient Education &
Health Promotion in Medical Care, 1st ed.
Mayfield Publishing Company, Palo Alto and
London.

Patient Educ-FK-UWK-sem IVB-RST-11 41