Nov 22, 2015 - The ethics of health promotion has its roots in the. Ottawa Charter1 of 1986 ... 1 The Ottawa Charter for Health Promotion. 1986. Retrieved 30 ...
Editorial Comment International and national health policies emphasize support for self-management, self-care and empowerment of individuals and populations. In these policies, the values on which these issues are based are not always clearly defined. Emphasis on self-management, self-care and empowerment, however, can be seen to be based on the value of the individual human being who is capable of understanding the meaning of health, cognitively processing information, and acting to promote his or her own health. Health care professionals have an important role in the support of patients’ own cognitive resources: they need to guarantee the availability and evidence-based quality of knowledge, support the processing and structuring of that knowledge, and know how to use it. In the nursing field it is difficult to identify any nursing action for which supervision of patients does not exist. This is especially important in health promotion and patient education. The ethics of health promotion has its roots in the Ottawa Charter1 of 1986 and, in recent years, the need for an ethical agenda for health promotion has attracted some attention. The ethics of patient education has, however, not often been discussed, although interesting openings are appearing.2 In the support of patients’ own cognitive resources and their use of them, at least two ethical dimensions can be identified. The first has to do with the evaluation of existing relevant knowledge. How can nurses know if they can trust this knowledge and educate patients based on that knowledge? The basic assumption is that professionals work only with right and true knowledge. Yet what kind of knowledge is right and true, or wrong and not reliable? A minimum requirement is to understand the multidimensional nature of health-related knowledge and theories of truth, and to select knowledge based on these. Most important is to tell patients of the origin and evaluation criteria of the knowledge, and to supervise them to find, evaluate and select knowledge for themselves. Very often, professionals inform patients without giving them much opportunity to discuss different alternatives, possible risks, or outcomes of solutions. They behave as if there was only one truth that patients need to follow. In many cases, however, there are alternatives. Evaluation of knowledge for patient education has to do with evidence, currently a popular topic in nursing literature. Evidence, however, is also a multidimensional concept and sources of evidence have been described on different levels. In patient education, relying on only one level of evidence can cause problems; even if we seem to have strong research evidence for certain actions, individual patients may not necessarily be committed to carry out these actions. In patient education, the ethical base consists of a strong research foundation and also a robust respect for individual experiences. The second ethical dimension has to do with the support of individual patients in their processing and structuring of the knowledge and their use of it. Nurses need to know different ways of processing; they must have understanding and respect for different cognitive structures and factors influencing these structures (such as cultural Nursing Ethics 2009 16 (3) © 2009 SAGE Publications
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Editorial comment
differences). They do not have a right to change the cognitive structures of other people, but have to support patients to find, construct and use their own resources. This is the core of empowerment in health promotion and patient education.3 Support for processing knowledge and its use has to do with patients’ perspectives. Both underestimation and overestimation of patients’ learning needs and skills are unethical. Today, people’s knowledge level in general, and that of patients in particular, is high; there are many sources of information and patients have the means to look for this. However, many health problems are of a complicated nature and patients need special cognitive support. It is most important for nurses to concentrate on the diagnostic phase in patient education, and also on judgement of learning needs and patients’ expectations. Care in the diagnostic phase is a precondition for effective solutions, while respecting patients’ own resources, cognitive autonomy and dignity. More research should be carried out on the ethics of patient education and health promotion on both strategic and clinical levels. On both these levels, an analysis of underlying values must form the core of the research. There is also a need to analyse how patients’ rights are upheld during educational activities and in supporting patients’ cognitive processing. Helena Leino-Kilpi
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The Ottawa Charter for Health Promotion. 1986. Retrieved 30 December, 2008, from: www.who. int/hpr/NPH/docs/ottawa_charter_hp.pdf Redman BK. When is patient education unethical? Nurs Ethics 2008; 15: 813–20. Rankinen S, Salanterä S, Heikkinen K, Johansson K, Kaljonen A, Leino-Kilpi H. Expectations and received knowledge by surgical patients. Int J Qual Health Care 2007; 19: 113–19.
Nursing Ethics 2009 16 (3)
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