5 2 Patient Education And Self Care

I Definition and history of patient education and self-care


Patient education can be defined as the process of influencing patient behavior and producing the changes in knowledge, attitudes and skills necessary to maintain or improve health. The Latin origin of the word doctor,“docere,” means “to teach,” and the education of patients and their families, as well as communities, is the responsibility of all physicians.

Self-care is the practice of individuals looking after their own health using the knowledge and information available to them. It is a decision-making process that empowers individuals to look after their own health efficiently and conveniently, in collaboration with health and social care professionals as needed.
The field of therapeutic education has evolved extensively over decades owing to interdisciplinary research.

B)Historical context

Patient education has been part of health care since always. Although the term patient education was not specifically used, considerable efforts by the earliest healers to inform, encourage and caution patients to follow appropriate hygienic and therapeutic measures occurred even in prehistoric times. From the mid 1800s through the turn of the 20th century, is described as the reformative period, since several key factors influenced the growth of patient education. First of because of the big progress in medecine but also because of the emerge of certain health professions such as nursing. This transition toward wellness entails a progression from a disease-oriented patient education to prevention-oriented education to ultimately become health-oriented patient education.

Through most of human history self-care focused on doing what was necessary for survival. Only members of the aristocracy and other wealthy individuals could afford the luxury of devoting time and resources to doing things purely for enjoyment and for their physical and mental betterment. For general population, self care as we think of it today would have been a foreign concept.Nonetheless, people have always done small to make their lives tolerables, such as adding décorative touches to their possessions, singing songs and so forth. Many instituted a Saturday half-day holiday, and vacations began to be regularly offered (though usually unpaid). With more leisure time available, a wider variety of entertainment activities became available including vaudeville shows, circuses, Wild West shows, and county fairs. Parks, playgrounds and sports fields were dedicated. Museums and libraries opened in many communities. On a more commercial front, amusement parks, resorts and hotels began to crop up across the country. People began to form clubs related to hobbies or common interests, as well as sports teams and leagues. The term self-care was originally used in the medical field by doctors who wanted patients to be active participants in their own care by eating healthy, exercising, and maintaining healthy habits in general. Over time professionals in high-risk and emotionally daunting professions such as EMTs and ER staff were encouraged to practice self-care by attending to their own physical, mental, and emotional welfare. Professionals in fields such as counseling, social work, and nursing are now routinely taught that self-care is necessary for the prevention of compassion fatigue and burnout.

II Patient education (nowadays)

A)In which ways is it possible

Health professionals have the responsibility to fully explore the patient’s situation and tailor interventions based on personal needs, anticipate patients’ difficulties in following recommendations and communicate in a way that is effective. Learning, gathering knowledge and skills, is not automatic and has to be enhanced by teaching and methodological choices. Favorable learning situations involve several learning processes. Learning processes do not occur in isolation but in combination.
While there are some commonalities between all learners, there are significant differences between adults and children as learners and both have characteristics which set them apart from each other.
Children depend upon adults for material support, psychological support and management of day to day life, perceive one of their major roles in life to be that of a learner, have limited life experience, generally learn very quickly, they are open to new ideas and information and will adjust their view more readily, and have few expectations in terms of formal learning.

In adults

Adults depend upon themselves for material support and management of day to day life, are predominately self directed but must still meet many psychological needs through others, learn best when they understand why it is important to learn, have more life experience and use this to relate to new learning, may learn more slowly but can learn just as effectively, readiness to learn is linked to need, concerned with the immediate applicability of the learning, they are internally motivated, and can have well formed expectations of formal learning, generally negative because they are based on past unpleasant learning experiences

Educating adult patients, carers and family members
When providing adult patients and carers with education, it is important to consider and incorporate the principles of adult learning.
Malcolm Knowles, a pioneer in the field of adult education, was the first to theorise how adults learn (called andragogy), describing adult learning as a process of self-directed inquiry.

Knowles identifies six principles of adult learning:

-Adults are internally motivated and self-directed. They want to know why they need to learn something and want to understand the value of learning it. Adults want their learning experiences to meet their needs, be relevant, and be helpful to achieve their goals.
-Adults bring life experiences and knowledge to learning experiences. Adult learners are a valuable resource because they have diverse knowledge and life experience which can be applied to new learning experiences.
-Adults are goal oriented. They seek meaningful learning experiences and need clear learning goals. Adults are ready to learn when they identify something they want to know or when they experience something that connects with their life situations. They become ready to learn things in order to cope effectively with real-life situations.
-Adults are relevancy oriented, they want to know the relevance of what they are learning to what they want to achieve.
-Adults are practical, they want to learn what will help them perform tasks or deal with problems they see in their lives now. They want to be involved in planning their learning and will focus on the aspects that are most useful to them.
-Adult learners like to be respected and to be seen as capable learners. Where possible, they should be offered choice and be encouraged to set their own learning goals.

In children, adolescent and young adults patients

When providing pediatric patients and their families with education, it is important to recognise that a different approach is needed. The ability of children to understand a diagnosis and its treatment can be dependent on their developmental level.
Family education most often includes adults (parents, guardians, family members) as well as the young patient. The parent or guardian is always included; however, the child must also be included in the education, which must be directed to the child in an age appropriate manner.

During infancy education is directly solely towards the parent or caregiver.

During this stage of development education is also solely directed towards the parent or caregiver however, as the child gains autonomy and independence, it is important the toddler is included in aspects of care as they are capable of some degree of understanding, especially with regards to procedures. Education should be provided using age appropriate teaching strategies. Although children of this age are able to comprehend more words, they may take things literally therefore caution is needed.

Early childhood
During this stage of development, education should include both the parents and child with the aim of facilitating communication between the parent and child about all aspects of their treatment and ongoing care.

Middle and late childhood
During this stage of development, education should include both the parents and child however, health professionals are able to establish a one on one relationship and can provide education directly to the child, without the parent present if requested.

During this stage of development, education should include both the parents and adolescent however, if requested, can be delivered separately. Health professionals are able to establish a one on one relationship and it is important to understand the characteristic of the developmental stage in order for education to be effective.

B)Why is patient education important

Patient education is more important than ever in today’s value-based care system, which focuses on patient outcomes beyond the four walls of your healthcare organization. For a growing number of hospitals and practices, the key to educating patients and ensuring they have a good understanding of their care recommendations is simple—effective patient and family communication.
We hear often in the self-help world how important patient self-care education is.
Patient self-care education is surely important because the patient is the only person who is present 24/7. Patient has to have a good idea of how to care for self. An educated patient will be able to cooperate responsibly with physicians, knowing what info must be given, ready to provide it, saving the physician's time. With self-care education, a patient may be more responsible to act wisely in terms of diet, exercise and other factors that facilitate regaining health.
The self-care education is very important because it represents one of the best ways to reduce danger: educating a patient means to teach him the drug related dangers, how to recognize them and how to behave, it teaches him to optimize his treatment for better efficiency.
All this will contribute in reducing medication errors, reduce the readmissions and of course reduce the cost of care and avoid unnecessary constraints.

The benefits of education for patients with a cancer diagnosis include:
-improved understanding of their diagnosis and disease and any associated disability
-increased ability to cope with and manage their health in the context of their disease and its treatment
-better understanding of treatment options, side effects and toxicities
-improved self-advocacy and greater empowerment to make decisions related to their care
-increased compliance with treatment regimens
-decreased treatment related complications
-promotion of recovery and improved function during and following completion of treatment
-increased confidence in self management strategies
-reduced psychological distress and stress

When patients, carers and family members are provided with effective education, long term outcomes include:
-increased use of self management strategies
-improved health related quality of life
-improved patient outcomes
-increased satisfaction with care
To provide timely and effective patient education requires health professionals to be prepared and knowledgeable about the patient education process and associated resources.

III Self-care

A)What affects self-care

Self-care has been defined as the process of establishing behaviors to ensure holistic well-being of oneself, to promote health, and to actively management of illness when it occurs. Individuals engage in some form of self-care daily with food choices, exercise, sleep, and dental care. The concept of self care has received increased attention in recent years but it has ancient origins. Socrates has been credited with founding the self-care movement in ancient Greece, and care are of oneself and loved ones has been shown to exist since human beings appeared on earth. It has also been connected to the Black Feminist movement through civil rights activist and poet Audre Lorde and it was used to preserve black feminist's identities, energize their activism, and preserve their minds during the civil rights movement.
Therefore, self-care remains a primary form of personal and community healthcare worldwide; self-care practices vary greatly around the world.
Routine self-care is important when someone is not experiencing any symptoms of illness, but it becomes essential when illness occurs. General benefits of routine self-care include prevention of illness, improved mental health, and comparatively better quality of life.
Self-care practices can greatly vary from individual to individual as it is a very personal act. Self-care is seen as a partial solution to the global rise in health care costs that is placed on governments worldwide.
There are numerous factors that affect self-care. These factors can be grouped as personal factors, external factors, and processes.
Personal factors:
-Lack of motivation: when one doesn’t have enough energy. This can be caused by stress, anxiety, or other mental health illnesses.
- Cultural beliefs: this includes traditional gender roles, family relationships, collectivism. This can also affect self care behaviors
-Self-efficacy or confidence: one’s confidence can positively or negatively affect their mental state.
-Functional and cognitive abilities: by not being perfect humans, one tends to focus on their weakness.
-Support from others: such as from family or friends can be crucial to have a healthy and positive mindset to do self-care.
-Access to care: depending on the self-care some require specific resources or objects in order to carry out.
External factors:
-Living situation: can greatly affect an individual’s self-care.
-Surrounding environment: must be safe and promote self-care for all residents. Proximity of health care facilities: are important to have at a close radius from one’s household. As well as office/clinic opening hours and affordability must be taken into consideration.

B)In which way is it possible (empowerment,monitoring)

Self-care monitoring is the process of surveillance that involves measurement and perception of bodily changes, or "body listening"It can be helpful to understand the concept of bodymind when monitoring self-care. Effective monitoring also requires the ability to label and interpret changes in the body as normal or abnormal.. Recognizing bodily signs and symptoms, understanding disease progression, and their respective treatments allow competency in knowing when to seek further medical help.
(Self-care monitoring consists of both the perception and measurement of symptoms. Symptom perception is the process of monitoring one's body for signs of changing health. This includes body awareness or body listening, and the recognition of symptoms relevant to health.)
Changes in health status or body function can be monitored with various tools and technologies. The range and complexity of medical devices used in both hospital and home care settings are increasing. Certain devices are specific to a common need of a disease process such as glucose monitors for tracking blood sugar levels in diabetic patients. Other devices can provide a more general set of information, such as a weight scale, blood pressure cuff, pulse oximeter, etc. Less technological tools include organizers, charts, and diagrams to trend or keep track of progress such as the number of calories, mood, vital sign measurements.
Because self-care monitoring is conducted primarily by patients, with input from caregivers, it is necessary to work with patients closely on this topic. Providers should assess the current self-care monitoring regimen and build off this to create an individualized plan of care. Knowledge and education specifically designed for the patient's level of understanding has been said to be central to self-care monitoring. When patients understand the symptoms that correspond with their disease, they can learn to recognize these symptoms early on. Then they can self-manage their disease and prevent complications.

Additional research to improve self-care monitoring is underway in the following fields:
-Mindfulness: Mindfulness and meditation, when incorporated into a one-day education program for diabetic patients, have been shown to improve diabetic control in a 3-month follow-up in comparison to those who received the education without a focus on mindfulness.
-Decision-making: How a patient's decision making capacity can be encouraged/improved with the support of their provider, leading to better self-care monitoring and outcomes.
-Self-efficacy: Self-efficacy has been shown to be more closely linked to a patient's ability to perform self-care than health literacy or knowledge.
-Wearable technology: How self-care monitoring is evolving with technology like wearable activity monitors.

C)Why self- care is important

-Self-care is a crucial part of looking after yourself, as well as others. When you practice self-care you produce positive feelings, which boosts motivation and self-esteem leaving you with increased energy to support yourself as well as your loved ones.
-Self-care can help you manage stress
While small amounts of stress is a healthy way to motivate you to get a task done, constant stress and anxiety can have an adverse effect on your mental wellbeing and physical health. Self-care habits such as connecting with a loved one or practicing meditation cuts down the negative effects of stress by improving your mood and boosting your energy and confidence levels.
-Self-care can help your relationship with your partner
Maintaining interests of your own helps to strengthen your relationship with your partner. Relying solely on your partner to provide all your supports and to meet your every need could potentially put a huge strain on your relationship. It’s better to maintain interests outside of your relationship to create a sense of independence and help you harbour confidence. All of which lead to improved mental health.
-Self-care can help your physical health
-Self-care starts with looking after your basic needs. It is not just about your mental health. It’s also about caring for your physical self, by eating healthy, prioritizing sleep and exercising regularly.



Dazzi Maria Giulia
Eleonora Calia
Silvia Di Franco

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