1.3 Standards Related to Health Teaching and Health Promotion

Standards regarding health teaching and health promotion are set by federal and state regulations and the American Nursing Association.

The Joint Commission

Health teaching is inextricably intertwined with client safety. Clients who have received appropriate health teaching are less likely to experience harm and unnecessary readmissions to the hospital. Clients who have not received adequate health teaching experience poorer health outcomes and are less likely to follow their provider’s advice. For this reason, one of the National Client Safety Goals established by The Joint Commission (TJC) states, “Improving health care equity is a quality and client safety priority. For example, health care disparities in the client population are identified, and a written plan describes ways to improve health care equity.”^[1]

To achieve quality outcomes for all populations, clients must be actively engaged in decisions about their health care and have access to information and support. Additionally, a client-centered approach must be adopted where client safety guides all decision-making and clients and families are partners at every level of care.^[2]

Several standards from TJC address client rights and provide an excellent starting point for understanding the requirements for providing health teaching. These standards require that organizations do the following^[3]:

• Respect, protect, and promote client rights
• Respect the client’s right to receive information in a manner they understand
• Respect the client’s right to participate in decisions about their care, treatment, and services
• Inform the client about their responsibilities related to their care, treatment, and services

American Nurses Association’s Standards of Practice

The American Nurses Association (ANA) is a national organization that fosters high standards of professional nursing practice with a focus on improving quality health care for all. In their Nursing: Scope and Standards of Practice publication, the Standards of Professional Nursing Practice are defined as “authoritative statements of the actions and behaviors that all registered nurses, regardless of role, population, specialty, and setting, are expected to perform competently.”^[4] These standards define a competent level of nursing practice based on the critical thinking model known as the nursing process. The nursing process includes the steps of assessment, diagnosis, outcomes identification, planning, implementation, and evaluation. The “implementation” step includes a secondary standard called “Health Teaching and Promotion.” This Health Teaching and Promotion standard is defined as the nurse “employs strategies to teach and promote health and wellness.”^[5] The competencies for this standard are outlined in the following box.

Definitions Related to ANA Standards

Definitions related to ANA’s standards discussed above are described in this section and will be used throughout this chapter.

• Health care consumers are clients, persons, families, groups, communities, or populations who are the focus of the nurse’s attention. This global term is intended to reflect a proactive focus on health and wellness care, rather than a reaction to disease and illness.^[7] The NCLEX Test Plan uses the term client, which refers to an individual, family, or group, including significant others and populations.^[8]
• Health literacy is a type of health promotion and is defined as, “the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.^[9],[10]
• Disease prevention includes primary, secondary, and tertiary prevention.
• Self-management is the “day-to-day management of chronic conditions by individuals over the course of an illness as active participants in their own care, including problem-solving, decision-making, resource utilization, partnerships with health care providers, and taking action.”^[11]
• Self-care is the ability to care for oneself through awareness, self-control, and self-reliance to achieve, maintain, or promote optimal health and well-being.^[12] For example, nurses provide health teaching to clients diagnosed with diabetes on how to perform blood glucose monitoring, inject insulin, and problem solve when their blood glucose levels are out of range.
• Healthy lifestyles refers to lifestyle choices to reduce risk of disease and lower mortality.^[13] For example, nurses provide health teaching related to avoiding obesity, consuming alcohol in moderation, smoking cessation, eating a healthy diet, and engaging in physical activity to reduce the risk of cardiovascular disease.
• Coping refers to cognitive and behavioral efforts made to master, tolerate, or reduce external and internal demands and conflicts. Coping strategies are actions or thought processes used to adapt to a stressful or unpleasant situation and/or modify one’s reaction to such a situation.^[14] Resiliency refers to the ability to effectively cope with adversity. For example, nurses provide health teaching to clients about healthy coping strategies for dealing with stress.
• When providing health teaching and health promotion, the ANA standard states that the nurse collaborates with the client’s “values, beliefs, health practices, developmental level, learning needs, readiness and ability to learn, language preference, spirituality, culture, and socioeconomic status.” Cultural humility refers to the humble and respectful attitude toward all individuals and requires a commitment by the nurse to provide dignity, respect, and grace to people regardless of origin, race, sexual preference, background, or socioeconomic status. When providing health teaching, it is essential for nurses to model the profession’s commitment to cultural humility, social justice, and health to address the social determinants of health and promote well-being in all settings.^[15]

Scope of Practice and Health Teaching

In addition to the standards and guidelines set by The Joint Commission and the American Nurses Association, registered nurses (RNs) and licensed practical/vocational nurses (LPN/VNs) must also follow the scope of practice for providing health teaching as defined in the Nurse Practice Act in the state in which they are employed. The Nurse Practice Act (NPA) establishes regulations for nursing practice and defines the scope of nursing practice in that state.

RNs perform learner assessments and plan health teaching based on clients’ goals, readiness to learn, and potential barriers for learning. In many settings, RNs plan and perform the initial client teaching, and then LPN/VNs provide ongoing teaching and reinforcement of information.

LPNs/VNs reinforce health teaching outlined in teaching plans that were created by an RN. LPNs may also teach from established, written teaching material and/or guidelines. After completing the teaching, LPN/VNs report back to the RN if the client does not seem to understand the concepts taught or if there are other barriers to learning so that the teaching plan can be modified accordingly.^[16] See an example of the teaching roles of an RN and LPN/VN in the following box.