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1、Barriers to Patient EducationSome of the barriers to education of patients about a chronic disease may relate to the setting in which the conference between nurse and patient is held, the lack of clear-cut goals for educational work, the failure to extend scarce, professional time by group teaching,

2、 limitations under which the agency must operate, and cultural differences between the patients and the nurse.Conference setting. Since person-to-person teaching and interviewing are an essential part of the nurses professional work,arrangements should be made for a suitable place to talk with patie

3、nts. If teaching takes place in the midst of telephone calls and other distractions, neither patient nor nurse can concentrate on what the other has to say. Distractions can inhibit or even prevent effective communication and teaching.Clear-cut Goals Goals. to define what the nurse hopes to accompli

4、sh in a conference, inte view,or group work are indispensable. The goals will be determined in the part by the questions the patient or his family asks, the interests he expresses,what he and his family already know about the disease, and how the patient is cooperating in his medical treatment. The

5、objectives need to be related to specific ways of helping the group or person to understand the disease and its treatment,to comprehend the necessity for cooperation over a considerable period, and to discover what community services are available to the patient and his family. Unless the nurse take

6、s time to think through the objectives for each educational experience, teaching may be inadequate and vague, including too much material at one time or omitting important aspects altogether;it also may not be keyed to the immediate needs of the patient or to his interests.Group work. Discussion in

7、which the experience of members of the group is elicited may effect changes in attitudes and practices.We have often seen patients and members of their families sitting silently in rows, waiting patiently to see the physician or nurse. Can some of this time be spent more productively in group talks

8、and discussion? Has the nurse tried working with small groups in educational activities? Can group teaching be done in the waiting rooms of outpatient departments and clinics?Is it possible to use educational aids such as slides or filmstrips at this time?And most important ,can the nurse involve th

9、e patients and ex-patients in planning for,and participating in, educational activities?Othe barriers. Patients lack of understanding and acceptance of the educational message may be due to illiteracy,a low educational level, cultural differences,or other reasons.Language differences, particularly a

10、mong some of the elderly，may prevent them from understanding and therefore,from putting into practice, the teaching about the disease. There may be agency barriers, too, relating to shortage of staff, inadequate facilities, or inadequate budget.Changing Health Practices Clear communication and educa

11、tional experiences attuned to meet the personal, family,or group situation can change patients attitudes andpractices.Communication. To the nurse, communication is a two-way process,an interaction in which she is listening, observing, and speaking. While speaking, she transmits both information and

12、feelings; while and observing,listening, she receives both information and feelings. A personsmanner of speaking, expression, voice, gesture, and posture all help or hinder communication; encourage or inhibit a permissive attitude; promote or repress questions or comments. The way a nurse meets a pa

13、tient in the clinic and her way of speaking over the telephone are also part of her communication.When technical expressions are difficult to translate into simple language or when words seem inadequate to explain a procedure, does the nurse supplement verbal communication with a demonstration or a

14、simple visual aid, such as a chart, photograph, or diagram? To make sure that thepatient clearly understands,some nurses say, Wont you show me how you do it? or at the end of a conference or interview, Now lets review what we said.The nurse in the tuberculosis field, for example, usually has intensi

15、ve and close contact with patients and families over a fairly long period. This period provides time for her to gain their confidence; to learn how to speak so that she is understood; and to discover how to make her teaching acceptable and practical for the patient within the family milieu. She has

16、the opportunity to encourage the patient to express his feelings, ideas, and questions.often the first steps in developing rapport.This two-way communication gives the nurse leads as to the patients interests, problems, and needs. She, too, is learning as well as teaching during these contacts and especially during home visits, for in these she can observe the patient in his environment and discover h