Health Care and Nursing and Autonomy As A Goals of Patient Education
What Are Goals Of Patient Education,Autonomy as a Goal for Patient and Health Education In Nursing
What Are Goals Of Patient Education
The overriding goal of patient education should be to support the
patient’s autonomous decision making, not (as it has been conceptualized) to
get patients to follow doctor’s orders. This represents a dramatic shift of
goals and requires that health professionals who teach patients are free from a
requirement to merely support the physician’s orders.
Autonomy as a Goal for Patient and Health Education In Nursing
Truly patient centered
education may be critical of physician and institutional performance,
limitations in medical knowledge, and rationing disguised as clinical
judgments. Even more important, true patient autonomy requires creating new
options to meet patient needs, not just as is now frequently the case, having
the right to refuse a treatment option.
As much as possible, patients must have
a range of significant options from which to choose. It is important to note
that developing and supporting patient autonomy goes well beyond informed
consent and infuses every interaction with the patient. An autonomous person
makes decisions with a sense of control, creating and evaluating options and
reflecting on how values, preferences, attitudes, and beliefs function in the
final decision.
Perhaps the view of autonomy most compatible with patient
education is Diana Meyers’s (1989) theory of autonomy competency a cluster of
different skills and capacities of self-discovery, self direction, and
self definition. The range of skills may be more or less developed, exercised,
and coordinated.
Certain kinds of socialization encourage the development of some
skills that make up autonomy competence at the expense of others. For example,
traditional gender socialization compromises women’s capacity to achieve full
autonomy in several areas of life and so can interfere with women’s ability to
trust themselves to choose and act in ways that are consistent with their goals
and values.
An example of an oppressive social norm is that women alone are
responsible for what happens during pregnancy (Mackenzie & Stoljar, 2000;
McLeod, 2002). If patient education accepts and assumes that norm, it can add
to oppression and diminish patient autonomy. Another example of an oppressive
norm is denial of patients’ bodily knowledge as legitimate clinical evidence.
Such can be the pattern for all groups that are not socially dominant.
Ignorance is a primary obstacle to autonomy, and doctors and health
care systems that allow ignorance crucial to patient self care and decisions
have contributed to oppression. If patients leave interactions with doctors not
feeling capable of making decisions on their own, their options are decreased.
Their only remaining option is to defer to the doctors’ authority. Patients
from lower socioeconomic classes get their primary medical identity from their
disease; those from higher classes get to retain their identities. When a group
is oppressed, society at large operates as if that group is less worthy and
less competent than others and devalues its members, who in turn internalize
these attitudes and accept society’s devaluation of their ability to make appropriate
choices.
It takes energy to oppose oppression and is easier to “go along” or to
experience the benefits of conforming to dominant stereotypes or interests
(McLeod & Sherwin, 2000). This is an old, accepted pattern in health care.
The traditional framework of thought and interaction in health care
is a setup for seriously limiting patient autonomy. The emphasis on disclosure
and understanding of physician recommended treatment limits what patients can
believe about their health care options.
Thus, the indirectly paternalistic
practice of tailoring information is provided, in order to ensure selection of
what the health care expert considers to be the best choice for the patient
(McLeod & Sherwin, 2000). The options are further diminished by lack of
research on health problems of non dominant groups.