Differentiating between patient education and health education is helpful. The term patient education is normally used to describe a series of planned teaching–learning activities designed for individuals, families, or groups who have an identified alteration in health. The nurse uses a systematic process to assess patient learning needs that relate to the health problem and then implements the teaching plan to accomplish changes in attitude or behavior (Redman, 1997).

Health education focuses on health promotion and disease prevention. The role of the community/public health nurse includes educating and empowering people to avoid disease, to make lifestyle changes, and to improve health for themselves, their families, the environment, and their community. The difference between patient education and health education is that health education is directed toward individuals or populations who are not experiencing an acute alteration in health. Community assessment identifies individuals, families, groups, and populations who would benefit from additional information on healthy behaviors and healthy lifestyles. The U.S. Department of Health and Human Services monitors the effectiveness of health education as it relates to the population of the United States and publishes this information regularly in the Healthy People reports. Data is collected, reviewed and published at the Healthy People website (U.S. Department of Health and Human Services [USDHHS], 2010a). See the Healthy People 2020 box.

The Quad Council of Public Health Nursing Organizations collaborated to produce Public Health Nursing: Scope and Standards of Practice (American Nurses Association [ANA], 2007), which outlines health education and the provision of teaching–learning opportunities as a distinct intervention by the community/public health nurse. Health education interventions may be conducted with individuals, families, and groups in health care institutions, homes, schools, communities, and the workplace. Health education nursing interventions are often implemented in partnership with community members, community leaders, and other health care providers.

Experiential readiness includes the client’s background, skill, and ability to learn (Redman, 1984). Assessment of the client’s background examines cultural factors, the home environment, and socioeconomic status. This background information is useful in describing current health behaviors and the learner’s ability to use education to change behavior.

Client skills and self-perception of skills are part of experiential readiness. A client who is learning to bathe a newborn needs both coordination and the belief that he or she can learn. It is also useful to assess how clients prefer to learn procedures or skills. Based on experience, do clients prefer to try themselves, correcting their own mistakes, or do they prefer to be led through the process step-by-step several times until they feel confident?

Developmental stages of both the individual and the family present another aspect of experiential readiness. Educational content should be developmentally appropriate. For example, a session on the dangers of teenagers’ drinking and driving would have similar content on the dangers of drinking and tips to prevent or resist alcohol use whether delivered to a group of teens or to a group of their parents. However, the material would be presented differently to the two groups.

Finally, in determining experiential readiness, the client’s ability to learn should be assessed. Very pertinent is determining the client’s educational level. Direct questioning related to years of formal education is useful but does not always provide complete and accurate information. For example, although a client may have completed college, if the client did not study medicine or nursing, he or she may not understand complex medical terminology. In addition, reading ability and learning disabilities should be considered (Box 20-1).

Assessment of the learner also requires assessment of barriers to learning. Barriers may be cultural, language, or physical barriers. One of the foundation health measures in Healthy People 2020 is the elimination of health care disparities such as those that may be inherent in health education programs. Inclusion of culturally appropriate teaching materials and a culturally sensitive approach to individual and family education is required. Culturally appropriate teaching materials for diverse groups are available through several resources including the U.S. Department of Health and Human Services (2011) Healthfinder.gov site (http://www.healthfinder.gov), and the Office of Minority Health (2011) (http://minorityhealth.hhs.gov). The Healthfinder.gov site can be viewed entirely in Spanish and the Office of Minority Health website includes links for numerous population groups including African Americans, American Indians and Alaskan Natives, and Asian Americans. In addition, the community/public health nurse should establish partnerships with leaders of the community. These partners can help the nurse develop understanding of the population(s) and interpret their acceptance (or lack of acceptance) of health recommendations.

Physical barriers are also important in assessing the learner. Some physical barriers are obvious, such as the use of mobility aids, and the nurse will be able to help clients with these difficulties access the learning environment. Less obvious are physical barriers such as vision or hearing problems, brain injury, or learning disabilities. The nurse should make sure that the setting accommodates learners with these problems so that they do not become frustrated with health education. Large-print materials, good lighting, reduction of background noise, and appropriate seating are a few easy modifications that can reduce or eliminate physical barriers to learning.