In the past 25 years the theory and research base for patient education has become considerably richer. Definition of a core of educative functions has now been accomplished for most major disease entities or health problems, and standards of practice developed for a few. In the United States, there is very inadequate information about the degree to which patient education is delivered, and institutional supports for it seem to have varied with fiscal conditions. The reimbursement system for health care has not explicitly supported patient education or the outcomes it could achieve. While there has been growth in instructional approaches, it would be charitable to say that there is a broad and well-informed view of potential approaches or an organized research and development function to get these approaches on line. If predictions of patient focus for business and ethical reasons are realized, a major shift in environment could occur, supportive of patient education. Clearly, there is little evidence that patient education represents a mature technology or that it is delivered at acceptable standards to all those who need it. Patient education content in key nursing textbooks published between 1988 and 1992 is analysed to examine the degree and character of conceptual penetration.