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Just as computerized information systems are revolutionizing the way hospitals distribute patient information around the healthcare system, interactive video technology now is revolutionizing the way television sets are used in patient rooms. The TV set is becoming a source of hospital and patient information, and helps provide patient education.

This study evaluates the effect of a nurse training program in family planning counseling skills on the quality of service delivery at the clinic level, as well as its impact on client compliance with prearranged appointments. The study used a quasi-experimental design to compare certified nurses who received six weeks of family planning technical training with certified nurses who, in addition to the technical training course, received a three-day course in counseling skills. Data were collected through client exit interviews, expert observation, and inspection of medical record abstracts. Trained nurses performed better than their untrained counterparts in the quality-of-care areas investigated--interpersonal relations, information giving, counseling, and mechanisms for encouraging continuity. The likelihood that clients will attend follow-up visits was also found to improve when they were attended by trained professionals. Short-term counseling training can significantly improve the quality of care provided by family planning workers, as well as client compliance with follow-up appointments.

This paper explores educational concepts in relation to client education, and more specifically the area of prenatal education. In particular, it examines how nurses and women clients can work together to create education programmes aimed at enhancing decision-making processes and developing knowledge which has the potential to emancipate women from the medical domination of the health services. Traditional approaches to teaching and learning are challenged and the role of the nurse as a leader in a critical approach to curricula of client education programmes is considered.

Patient education is an important and necessary tool to facilitate coping with a chronic disease. The existing studies about new approaches to patient education and their effects are reviewed and discussed. The interdisciplinary team of the MRH tried to improve the deficient situation concerning patient education in rheumatology in Germany. They elaborated the "cP-Schule Hannover", a curriculum for patient education in small groups in an outpatient clinic setting. The courses include eight sessions taught by a psychologist and performed by a team of health professionals. Four groups with a total of 31 RA-sufferers have been evaluated in a controlled prospective study over 3 months. The significant effects of this patient education program were an increase of knowledge and satisfaction which were still evident after a follow-up period of 3 months. Negative side-effects like worsening of psychological status were not observed. Based on these positive experiences and results a "patient education" working group was founded in late 1989. This working group is a member of the German Association of Rheumatology. It focuses on the elaboration of a structured, supra-regional standardized patient education program for rheumatoid arthritis consisting of several modules.

Health care demands are rising rapidly as we move towards the year 2000 and effective health education is essential if increasing numbers of patients are to be nursed in the community and the effects of preventable illnesses are to be minimized. It is therefore extremely pertinent to discuss how well nurses are educating their patients at present and what strategies the profession may need to consider in order to meet educational needs of the future. It seems clear that nurses have a responsibility to provide the information that their patients require, although there remains some debate regarding whether they are the most appropriate member of the health care team to do so. Recent studies show that nurses can be effective educators. However, although many recognize the importance of this role, they still often lack the skills, knowledge, motivation and support required to organize and implement an adequate programme of patient education.

Education of patients with arthritis began with an emphasis on conveying knowledge, grew to include behaviour change, compliance, and more general coping and management of disease and then progressed to consider physical and psychosocial health outcomes. Research continues in all these areas. Control, in many forms (locus of control, self perceived efficacy, learned helplessness), is now suggested to be a central mediating variable. Evaluation of programmes is moving away from programme v usual care towards comparison of alternative methods of delivery and matching of method to learner. The first generation of researchers in arthritis education tended to be care givers with little formal education in behavioural sciences and evaluation methodology; the programmes they designed were often empirically based. The current generation, nurtured in large part by funds from the Arthritis Foundation and the National Institutes of Health, is better trained in designing programmes grounded in behavioural sciences and educational theory. In the long run, collaborations with care givers and patients will considerably strengthen the effectiveness of education programmes for patients. A variety of educational strategies have been shown to change the knowledge, behaviour, and health of patients with arthritis for the better. Many methods seem to work, so long as the programme is planned, has a goal, and is accountable. There is much work still to be done to teach care givers to be better teachers, and patients to be better managers of their diseases, in concert with their doctors, and to focus on high risk groups. Although most work has been done with patients with rheumatoid arthritis and osteoarthritis, many of these findings can and should be safely generalised to less studied rheumatic diseases. Finally, we need to consider the patient first as a person, and to provide education through all avenues, not just the medical care system.

New programs for the prevention of blindness caused by diabetic retinopathy have been elaborated in different countries. The author analyses the results of a survey conducted in Switzerland in 5 University Ophthalmology clinics and in 9 regional centres, reviewing the ocular examinations and treatments applied to diabetic patients. A common attitude towards this disease is suggested.

The many changes expected in the future will create challenges and opportunities in the field of patient education. The aging population, increased numbers of cancer survivors, minorities and disadvantaged patients, more illiteracy, and the changing health care system are a few of these trends. They will require broad changes in patient education and the way information is provided.

With their unique perspectives in the identification, design, promotion, and evaluation of cancer patient education programs and services, the National Cancer Institute and the American Cancer Society have the abilities to meet a wide variety of cancer patient education needs. With federal support and connections to national organizations and the comprehensive and clinical cancer center networks, the National Cancer Institute has access to nationwide experts in medical care and the resources to develop, design, and promote quality, state-of-the-art education programs. The American Cancer Society, with its strong volunteer community base, can pull together local expertise and collaborate with local organizations to meet the special needs of local population groups. In addition, the American Cancer Society volunteer committees have the flexibility to individualize programming and resources to answer specific patient/family education problems. As the number of people affected by cancer continues to raise, and as organizations realize the need to maximize their resources with collaborative efforts, the National Cancer Institute and the American Cancer Society are challenged to focus their energies on the patient education initiatives that build upon and combine their unique strengths.

The health care system in Canada is gradually shifting towards greater emphasis on patient involvement, health promotion and management of chronic illness. Nurses can play a key role in shaping these changes. This article provides an overview of several facets of the nurse's role in patient education: national policy guidelines, standards of care, research and exemplary patient education programs.

We reviewed the routines for providing information on drugs, and for training in the use of drugs and aids to medication in hospital and nursing homes by interviewing 11 ward supervisors. We found that little attention was given to systematic training in the use of drugs, training and aids to medication as part of the patient rehabilitation. All wards informed the patients about the type and dosage of drugs to be taken after discharge. However, printed information from the Norwegian Medicines Control Authority was not used to any significant extent. Lack of time was stated as the major reason for not providing more systematic information and training on drug usage as part of the rehabilitation programme for elderly inpatients.

While patient education has been an integral part of health care for centuries, the management of this process is a relatively new concept for US hospitals. Beginning in the late 1960s, documentation of patient education coordinator positions, policies, committee mandates, and other management structures began to appear. National surveys and projects documented the growth of these structures and provided some evidence that their existence positively impacted the number of programs and their effectiveness. Financial pressures on hospitals including the advent of the prospective pricing system, other actions by government and business to control health care costs, and changes in technology have resulted in budget cuts, staff reductions, and reorganizations that have posed new challenges for the development of patient education management. This paper discusses these developments and their impact on management of patient education programs in hospitals.

In this article a description is given of the development of the function of patient education coordinator in the Netherlands. In general, these developments have been successful. The differences in emphasis between the work of Dutch coordinators and those in the United States are discussed, set against the background of the Dutch health care system and its prevailing attitudes. Besides sketching the common elements which have proven to be successful ways of inducing organizational change, a description is given of a particularly successful project involving feedback from patients to medical specialists. This project succeeded in combining aspects of organizational change and the education of members of the medical staff in communication with patients; it might be useful for emulation by others. The article concludes by sketching changes in general political and cultural ideology and the way these changes affect the developments in patient education.

Patient education by nurses makes a substantial contribution to patients' health and wellness. Nursing studies document patient benefits resulting from patient education. Studies indicate that some patients have fewer symptoms from their illnesses after patient education, whereas other chronically ill patients experience fewer hospitalizations. To date, most benefits have been empirically observed rather than scientifically documented. To determine the extent to which patient education contributes to health improvement, studies need to focus on measurable long-term benefits that can be translated into cost-effectiveness. Nurses are encouraged to demonstrate the value of patient education with documentation of its effects on patient health.

Compliance remains a subject in the focus of international attention, which is, undoubtedly, due both to the predominance of chronic diseases within the morbidity spectrum and the rising cost in all national health systems. The research during the last decade can be summarized under two aspects: Greater emphasis is laid on the compliance on the part of the physician and its effect on the patient's collaborative behaviour; on the other hand, only a few papers are published nowadays in which the "disobedient" patient is looked for by means of a sociological inventory. Rather, the relationship between physician and patient and its constituent elements have been recognized to be the most important bundle of causes. Many efforts have been made to differentiate further.

Although most pediatricians agree on the importance of teaching parents and children about health care, they may not succeed in patient education because of a lack of the requisite communication skills, inadequate printed materials to augment personal involvement, a tendency to substitute such materials for personal involvement, and inadequate compensation. Physician recognition of an obligation to teach is a requisite for effective education. Adjustment of current practices is essential: use of educational materials must be systematically incorporated; educational efforts must make effective use of time and be cost-effective. Information should be readily understood, parents given an opportunity to ask questions, and effectiveness of the education evaluated. Pediatricians must have a constant source of supplementary material to use in patient education. Videotapes and interactive computer programs should be considered for more effective communication. Residency programs must teach future pediatricians how to educate parents and children.

Nurses, on a day-to-day basis, and the profession as a whole, will continue to be challenged by the economic climate and nursing shortage. Nursing must march forward, demonstrating the ability to delivery cost-effective patient education based on research. Issues in patient education must be addressed by the profession as a whole. Benefits of education, resulting from nursing care, for patients, families, and communities, as outlined in this overview, must be brought to the public's attention. In this way the opportunities for the twenty-first century will be achieved and the challenges met.

Informed consent is not a new principle in the patient--physician relationship. It emphasizes the basic principle of the patient's autonomy and the respect which is due to him/her. In oncology it covers clinical examination, complementary investigations, different treatments and follow-up. Obtaining the necessary information may be complicated by difficulties concerning the patient, the cancers and the physicians. The problematical aspects can be alleviated if the patient's autonomy is acknowledged and respected and if the physician succeeds in establishing a sound personal relationship with the patient.

The current status of education, behavioral change, and use of technology identifies a need for professionals who can develop interactive educational programs and apply existing techniques in a cost-effective manner. The general public, including patients with cardiac disease, are sophisticated consumers of information technology and demand quality production. The challenge is to train specialists to produce educational programs, to instruct health professionals in use of these programs, to deliver appropriate messages, to teach needed skills to patients with cardiac disease, and to evaluate the outcomes. Unless incentives to restore cardiac patients to an optimal functional status with few recurrences and complications are as tangible as are incentives for treating acute cardiac illnesses, the appropriate use of technology to educate patients with heart disease is unlikely to develop. However, the trend to increased ambulatory care under prospective payment systems makes it likely that technology will be applied to improve the efficiency in maintaining health and preventing acute illness. The potential benefits to the nation are substantial.

Asthma self-management education has the potential to improve the health and quality of life for children and to reduce use of acute care services. The preparation of parents and children to prevent asthma attacks and to ameliorate acute episodes when they do occur can best be accomplished with the support of medical care providers. This analysis addresses policy issues relevant to that acceptance: the degree of integration into medical practice that is desirable; the most hospitable clinical settings; and the incentives for providers, consumers, and payers that would result in appropriate supply and use of ASME:. The analysis commences with a discussion of the costs and benefits of making ASME a part of medical care. It then turns to a description of the trends that led to the current array of institutions, services, and incentives within the health care sector. Future changes in family context, financing, and other determinants of the use of medical services by children and youth are forecast. The framework for the analysis of incentives is diffusion of innovation. ASME is analyzed according to the attributes that generally facilitate the acceptance of a new procedure. In its current form and with current incentives, ASME is fairly complex and difficult to communicate, has little relative advantage, and is not necessarily compatible with the usual provider goals. The motivating factors for three interrelated groups-providers, consumers, and third-party payers-and leverage points for the application of incentives are identified. The latter include reimbursement, standards of practice, information generation and flow, insurance regulation, institutional development, and research funding. Important information to potential adopters includes the definition of the service, its optimal intensity and mix of providers, and its effects on net costs and quality of life.

The development of patient education in hospitals received its first impetus in the U.S. For this reason, countries like the Netherlands where these developments tend to lag behind a bit, look to U.S. hospitals and literature for guidance on how to proceed in this matter. Although patient education in the U.S. has been steadily (and sometimes stealthily) creeping forward there are still many dilemmas and snags to be overcome. Some of these have gradually become clear, enabling patient educators in other countries to profit from American experience and using it whenever possible in their own situation. Given this context, the differences in social, political, and organizational climate between The Netherlands and the U.S., provide unique opportunities for clarifying some of the issues that characterize the development of patient education. In turn, such clarification may prove profitable for patient educators in the U.S. In view of the above, I propose in this paper to discuss some issues in patient education which may at first glance seem outdated, but are none the less unresolved. What are the general goals of patient education, and what means do educators have at their disposal to reach these goals? Is the practical day-to-day state of the art as expressed by these means in accordance with, or at least not contrary to, the lofty ideals that somehow seem to lie behind our efforts at implementation? Out of these general considerations emerges the dilemma which I will be dealing with in this article. After that I will outline a specific educational theory which might usefully be brought to bear on this dilemma: the theory of Paolo Freire. Having discussed its implications for patient education, I will draw some conclusions for the political issues involved as well as for the practical work of patient educators.

Using participant observation data on worker-client exchanges from Bangladesh, this article examines the interface between a government family planning program and the rural women it serves. Case material focuses first on the program function typically identified in the literature: meeting unmet demand for contraception by providing convenient supply. Functions that have been less recognized are then illustrated: (1) the worker's role in reducing fear of contraceptive technology; (2) her effort to address religious barriers, child mortality risks, and high fertility preferences; and (3) her role in mobilizing male support. The range of functions performed by the female family planning worker in the cases discussed here demonstrates that her role transcends the boundaries of what is conventionally implied by the concept of supply. She acts as an agent of change whose presence helps to shift reproductive decision-making away from passivity, exposing women long secluded by the tradition of purdah to the modern notion of deliberate choice.