PARTW

Perspectives On Teaching
And Leaming

43

\
 !Nv(Jsets of 'Wfsdinn.

-Let my Gfe he tlie ca.ndk J:.oratliat slii.tte.sfor YO'U.·

· 'IM J:.fglit of a :Miilum :Murnin(Js-

CHAPTERW

Concept• of Education. In Relation to Health

Care
A. OVERVIEW OF Bl>UCATI01' 01" HRALTR CAR&

E;;i"Health education is a process

concerned with
d r ''"!!fielnlplementha,:a.nd ewluatiq educational propama
that e tamWe1, pouJ141, orpnisatlona a.nd commua!U.•
to play active roles in achievinc, protecthlc aod aaatalDlq
Ila.1th. C)
• Health education is also defined as •au.y combination of
leanwll experie.nc• dealped to facllltate voluntuy
adaptations of behavior conducive to health (Green et al.,
198Qk. 6J
• lts"""purpoaeis to contribute to health and weD-belq by
~o~ llfeaty1ea, co~it.y ac~!!!_ ll!ld_,con__g!t:loaa
that make It possffileto-llvehealthful lives" (The Code of
Ethics for Health Educators, Association for the Advancement
of Health Education).

The recent developments in the field of health care have

9e:rVed to highlight the important role of education ln "helplq
Ute patients and their famlllea aaa11111e reaponalbtllt.y for aelf-
oue m&1U1&ome11t"(Bastable, 2003). Gone were the days when
patients remained in the hospital until they are totally healed or
fully rehabilitated. With the cUffnt thinl·party payor s:J1(te111,
au H an ezpected to be the prime maven in delive~ htp
.-,tty, effective 8.1ld effl.clent a~ care -d patte11t
ecbacatloa whJch w:111 result to aborter hospital coallDeaaeat
mad contfa-tiOD of recoveiy and rehabUltatfon tbroup home
p_-..3~0~ -nl,,1/.<,J~... gi;~Olr- r; 'I
45 i t;ricar- IRlJ/iny
t
.... lr L,~n:1,1 i
~ 1111 t,t<)C)CIO t.'1~ '{ I I ~" 1
oare or commnmty-bued n'lll'lllnf cue.
JtdacatJoD for health begina with peo
Ce. It hopes to
motivate them with whatever interests they may have m
Improving their Uymg C011ditions. Its aim is to develop in them
a Ma&e of respouibWty for health conditions for themselves as
individuals, as members of families, and as commueuties. In
commwucable dieeue control, health education commonly
include• an apprahlal of what I• lmown by a population about
a dl•eae, an aaa-ent of habits and attitudes of the people
aa they relate to spread and fteciuency of the ~a.e, and the
presentation of speclffc nieana to remedy observed
cleftcienclea

B. CO,!ll~r OF TEA=';;;.EARJffl1fG, EDUCATIOlf

The Edu tft,J
Process- fa a aystematlc, aeq11e11tial, planned
coune of'action with teacli.in.g and learning u ita. two ma.jor
interdependent funaions and the teacher and learner as the key
p)aJiers involved (Butable, 2003).

l !) Teaching· is a deliberate intervention involving the

plaantng and bni,leuaentation of uwtructional actlviUea and
qperiea.cea to meet the intended learner outcome• baaed 011
the teachbl~ plan.

• In . tc,/011- is just one ~pect of teachfn g

whJch involvea
commlliaJc:a~ blf'ormatlo11 abo11t a apecUlc akill (cognitive,
affective or psychomotor). It is sometunea used interch1111geabl
with teaching.
Leamiog- Is a chance In behavior (lmowledle, aldlla ud
attttudeaJ that can OCC1IJ' at any tinle or ln any place u a
nsalt of ex.poslll'e to e11virollmental atimwi.
Leana~· is an action by which Jmowledce, aldlla aad
attibadea are couctouaty or 1111consclo'IUllyacquued and
behavtor is altered which can be seen or observed.
htient ed1lcatlou.- a pr-• or usbtlnc people to leam
laealth-related behaviors (knowledge, skills, attitudes, values)
whJ.ohCUl be incorporated into their everyday Uvea.

46
• Staff education· Amidst all these mandates and requirements
that the nurse as a health educator faces is the need to be
knowledgeable about the principles of teachblg and learnlllg.
lllstead oftbe "teacher teach~. the paradipD has ahlf\ed to
focus on the "'learner learning"\ Bence, the nurse needs to
know not only the su~ct matter but also her role in the
t$11Chhlg-leamingprocess and the n~ of the 1-mer.

The three pillars

1. tsacher;
2• leQ.rrulr; and,
3. subject- matter
c
of the wach~(U'tti.ngprocess are the:

1 /'ClI I
/
Ea.ch component has its own contribution to the whore
procestJof teaching and lea.ndng. Studies have aho'IVJl that:
a. the ttttal role of the teaeher ts moffPCZting nudents to
lBarn
b. and inspiring th.em to get out ofthetr comfort z:onea,
to stretch and develop the 98% portion of their' bratn which
is still untapped and unused.

How fm:portant the teacher factor is in detenninlng the

e.ic:tent of learning as influenced by the relationship, support
and rapport between the student and the meatoJ' is now the
subject of researches and studies particularly in the field of
educational psychology.

C. COMl"ARISOlf OF TBE NURSING PROCESS AND THE

EDUCATION PROCESS Snm;AJUTIES (BASTABLE, 2003):

1. both consist of the basic elements of a1111eaament, planning,

implementation and evaluation; '·
2. they are logical, scientlflcally-baaed frameworld for nursing
processes providing for 'a rational b113is for llUJ'tlbig practice
rather than an intuitive one;
3. both are lllethods for monitoring and Jndgblg the overall
quality of nursing b.terven.tlons based on objective data -d
sclent.tftc criteria,

47
 DDTERB1'CES B&i wm JfDRSDfO PROCESS AllD
BI>UCATI01' PROCESS

1. avama p- focuees on plalllllne aad tmplemellltat.loll

of cue ba11ed Oil aueaameat ead diapoala of the patie1at'•
phywlcal aad ,-ychoeoclal needa while the
:.t. edacetioa proc... ldentUlea h:laUUctionel conteat IUld
methodll beaed Oil aa aeae .. me11t of the cUent'• 1-.natq
needll, read.lllua to leUD and learntna atylea;
3. beffa of outcom.ea:
• nunbl& ptoeeN: when the phyalcel aad ,-ych080Clal
needa of the client ue m.et
• educatfon proceu: when chaqea lD bowJedae,
attltade.t aad ·~ occur.

According to Wagner and Ash (1998), "the role of the

educator is not primarily to teach, but to promote learnlQ& and
to provlde for an envito11ment cond11cJve to leamtnc to mate
SJa• tgehalple momeqt rather tbu lv•t waftfnr (or It to
MRM&,
~ XODBL AS EDUCATIONPROCESS PARADIGM

I G ..
t • \· .,
The ASSURE model ie • pide to ... tet teac:hon ill
ld.q 111,tructloll&I materlala. It ie aa ACROlf'YM whlcla
ataad.a for:
A-..analyse the learner; tde11tlt,, who your learnen an
be.Nd 011:
1. pneral cbaracterietlca lilce age, highest educational
attainment or grade level, socioeconomic factors, ethnicity and
culture;
2. epecillc learner compete1aclea like lmoWleqe, e)d)Ja and
attitude• nprdln& the topic;
(, a. Inlonnattoa-proc ... 1n1 habit. like analytical/ global,
~ focused/non-focused. reflective/ impulsive, narrow/broad
categoruati.on, tolerant/intolerant of incongruities
/ It. lloU-tlonaJ facton: attention span, factors which
\ may interfere with learning like anxiety, depression, etc ..

48
3. leamlng atylea which referto perceptual,,.,....._. U4
atnn,tha likevla1Ull, auditory, tact.De ud lda..a.tle
8--- State the objectt,.. u&ing WART
meuunble, attablable, reallstic aacl dme-k-d)
l••••ffto,
lllleed - ._
course ayllabua
8--alect the lnatnlctlor.ial media and maters.Ja 1ly:
a. aelect:IDC the available materials
b. modlfymc existing materials
e. clealpmc, N'll'l.aiDg or m•Jdn1 new materiala
U--1111e the m•terlala and the inatracdmla1 ••dla
ltr,
a. nvlewlq the materials and meatmJ.ra1 the ... of the
materials
b. practlctn1 the use of the materials and the instructional
media
e, preparlng the clanroom, equlpm.-t -• lulllltlea
d. present1D1 the materlala uatn,1 J01U' _...... uul
teachJns lltylea
R---require learn.er parttclpetloa by pNpariq ut11'1des
that w1ll encoara,e studenbl to Napoad .-d IIOtlwly
perttclpate; the teacher abould pN appropriate IMdllllelr to
the atudents• reaponaes.
£---evaluate and nvlae...to e"1"8t• the efteotfftty of die

~-ti-
preaentatlon, the followJD1 queattom may be vli:9d:
• Wu the visual material able to help m.e mab a olNr,
coherent and lntereatlng pNNlltaUoa?
- Wu It ablo to help me meet tll.e of die
leason?
- Wu it able to help the leanaen/tnf••• a..t die
objeetfvea of the leuon?

Bued oa thia evaluation, J'01I _,. ....._ awvlshu w

modlflcatlop and even rcmloroo or ~- fHet. of die
preaentatlon that contributed to etreotm waalllas aatl
1earnma. ·
For ·nursN to fUUUl the role of edtloator, tJaq a..-
bave a solid foaadatlOII. ill the priaaiplft of teedtfq uul
J.eanwa1 and special tnfnln1 in inatl'1lctloul aldlla.

49
 • ,Luker & Caress (1989)- article on "Rethinking Patient
' · Education", suggested that it is unreuonable to expect ever,
nur_se to te&J:h ~ell they have oAly bad bUlc nunbl&
education.
• They suggested that the minimum qualification for nune
educaton should. be a BSl'f depe alld Ideally the
educator's role should 'be delepted to nunes with muter'•
degrees (advanced practice nunes like cllDiw nune
specialists and nune practitioners). The role of educator le
not primarily to teaeh, but to:
• Promote learning
• l"rovide for an envirooment conducive to learnln&-· ~
create a teachable moment rather than tust waiting t'or
it to hil,.l!l!lm (Waper & Aah, 19981,
The difference between:
a. patient teachmg· implies a didaetie information- giving
, .. ,apprpaeh
.b. ,-tient edu~ation- IDlplJee somethbig more coinprehensive,
for which specialist skills are required

D. HIS:OORJCALJi'OUNDATIONS FOR THE TEACHIHO ROLE

It OF l'fURSES

II The teaching fiu1etion will always be an intepal part of tlae

dutie• of a ,pr9fesslonal nurse. This dates back to the time when
Nursing was given recognition as a discipline in the 1800's and
I health educatio.n became a unique and independent function of
the nurse. This was regarded as the period of Educated lfuni:llg.
The hiatorieal evolution of teac:hlni as an e•aentlal role of the
nunie traces its roots to the inid-1800s through the initiative and
efforts of FloTence Ni&httnple, the mother of modem nUl'SiDC
an.d founder of the fil'at sehool of o.uning.
• Nightingale taught nurses, physicians and other health
officials about the importance of clean, we}l-ventilated and
well-lit environment in the hospital and at home in assisting
the patients to get well and improve their sense of well-being.

50
• She also founded the Florence Nightingale School of Nursing at
St. Thomas Hospital in London in June 15, 1860 which trained
and taught nurses, physicians and health officials on the
importance of manipulating the environment so that nature
can act on the patient in his recovery and healing process. Her
ideas were· published in two books which are "Notes on
Nursing" and "Notes on Hospitals".

By the early 1900s, the importance of education in the

promotion of health and. prevention of tllnen was recognaed
-d practiced by the public health niiraea. Today, teaching is
included within the 11eope of nunlng practice responsibilities.

• Giver of inform.ation
• Facilitator of learning
• Coordinator of teaching
• Client advocate
In. the d~slgnfimplementa.tion of strategies and
m,rthods, health educators have an obligation to two
pnn.cip1-
1. the people have a right to make decisions affecting their
lives;
2. ther.e is moral lmpentive to pl'Ovide. people with all
relevant information and reso\ll"CeS'possible to make
their chotce freely and itltelUgentlg (Cottrell, Girvan, &
Mckenzie, 2001).

F. EFFECTIVE TEACHING IN NURSING

Learners can always identify the best teacher who is also

the most effective and the worst who is also the weakest {de
Young, 2003). The effective teacher possesses certain qualities,
characteristics and attitudes which make them one of the most
approachable and respected members of the Faculty.

51
 EFl'BCTIVB T&CIIERS ARE ( FLOWERS, 2000):

, -v 1. committed, that is, they don't watch lhe clock, they go the
extra mile and work long hours; .
2, creative, meaning they stlmµ]ate __ .iatdhKltual lnquf.-
-/1 s!Uveneu, as well as, exploratory and critical tbJ.aldq.
Ultimately, what dtstingu.l8M$ the g,w,.t uacheni .from the
ordinary or average mentors is their u.nsp<1ring g'(ft of Mltf and
their capacity for carlng for their stud4!nts (Rodden, 2000).
This is not pseudo-care via maudlin gestures or gushy words but
can even be manifested by a bracing care, laced with a stern
affection or bolstered by an impersonal rigor or strictness. ht
their aim u always to awaken the students to tltdr
awan!t.lUS of thetr greaur potential.
3. intuitive, meaning the teacher is i;tble to ul,mt(fy the
~ atudent's predormnant style of Intelligence and based oil tht.
knowledge, the t.eacher ts able to butld oil the stuCNftt's
stren~~ .

• In all instances, the c~ of an eJ!ectlw teaclwr

should always be studied and appUed to the edwcator rot.
if we are to ju.1,fUl our profesaional rupoMtlrillty for
prvrildlng hfgh quaUty care and hlgh quality ~--

• In evaluating teacher ejfectioene58, there ts no ~ style.

skill or t,echnique that ta ef(ecttw for cdl le~ and all
tsachinq situations, It wlll Qlways be a ·COfflbmcrtlon or a
composite of Sttyks that will epentuallg dlatinqulsh the
ef(ecti..,._ and cffic!f!mt from the orcffnari,, n,n:.of-U..-ndll
t.nstn,ctor.
~-·~) HALLMARKS OF GOOD OR. EFFECTIVE TEACBllfO
~ _. 'i.. 1J - JN !IURSINO (JACOBS&R)

• Profesa'°Dal competence which is evidenced by:

~~ugh knowledge of the subject matter end proper
demonstration of skills;
b. reading, researching, undertaking Continuing Professional
Education (CPE), and has clinical practice and expertise.

52
 CJoapter 3 Concep of~ la Relatloo to Beuth Care 2011

2. PoueMion of sldllfbl interpersonal relationahlpa with

atuclenta which wu rated aa the most lm,portant. The
teacher:
a. takes personal interest bt the wellate of the student
b. is fair and jMt especially in giving grades and credits to
students;
c. is aenaitive to their feelinga and probleJ11s;
d. conveys r,o.pect for the students;
e, allows teamer to freely express thegiaelwlt and uk
questions; '
f. is accesalble Cor conferences and consultationa;
g. conveys a Hnae or warmth;

Three basic approaches by which the instructor can increua

aell-eateam and reduce amd.ety are through:
a. empathic llatelllng by l.latenlng to tbe learner and seeJng
the world through hla/her o- eyes;
b. acceptlD.g the leamen as they are whether you lib them
or 11ot; avoid imposin1 your OWll prejudlees or standards;
e, eomanulicatina honestly with your students by lettil'.l.g them
know what your expectations are attd what their
reaponalbWtlea aee. The bottom line is that the t<11GChoer ts
c,q,,,ct;ed to rupect the ~-rs, care caboratt u..tr
co-m., and b'JI to und4,rstand thlll world a.s flu, r.-
~ctr ft.
• In the performance of the duties and responsibilities as a
mentor, the teacher is guided by the principle of "ill loco
parent:ia" which gives the teacher the right to uereiae
the parental role in the absence of tho real parents. Thi"
also a.llowa the teacher to Impose appropriate
cSgclpllnary measure• for minor offenses committed by
the student jn his/her presence.

This is the dilemma that new or IM>gjnotnglnatructon

raoe. They have a difficulty in performing these f\mctioll8 -d
at the -e time malntatntna profeMionallam RDd Httiaa
llmltatlona Plld boundaries in their relationship with their
students.

53
 3, Deairahlo penonal characteriatica of the teacher which
mclude chari.sma or penonal mag;netuim, enthuatum,
cheerf'v.lnNa.· self-control, patience, fleldbillt:,, aen11e of
humor, good apeaklll1 voice, aell-conftdence, wtJUnpou to
admit uror or Jack of knowledge and a caring attitude
( Kotzabassaki, 1997 and Fanbrother, 1996);

4. Teachlllg l)ractlcea which include:

• mechanics
• methoda
• akilla in the classroom and clinicnl practice:
• the teacher has thorough lmowledle ol the subject
matter and
• pre11enta the materials hi. clear, lntereatinc, lopcal and
orsanlaed manner;

5. Evaluation pncticea which include:

• claarly communtcatina: e,i:pcctatlona;
• providing timely feedback on student p.roa:reu;
• corNctioe the atudenta blctlully;
• belllc fair in tbe evaluation proceuea; and,
• giving teata that are ,.rt1aent to the subject matter
and ual.gxunenta

6. AvaJlabWty lo atudenta especially In the laboratol'3", cliAlcal

and other aldlla application aieaa which are mostly marked b:,
su.uful and/or critJcal ,ttutlon.a or aceurloa; hl.atractor'•
clile-a is being in two or mow place, at the aame time. This
can be remedied by commu.alcatinc wJu,re he/alle can h
located and elldonilna the atudenta to a knowledgeable member
of the staff during her absence in the area.

OTBB.R IIIPORTAN'f' CIIARACT&RlSTICS or A T.&4CDR:

- ,1, TeacMr clarity deals.with behaviors that teachers 1111•
"I: to make wbat ta to be I.a.med as illt•Wcfl,le,
'Y compreheJU1Jble and 1earnab1e as possible. A clear
( teacher is one who logically orpuiaea bletruction,
eaplaina what la to be learned, llaea atmple term.a in
presenting new materials, conat:aatly UM .. u whether

54
 ~r 3 eo..cepa of Bdncatlon la Relation to Bealtll care 2011

student can understand and follow the teacher's train of thought,

uaea 0111U11ples, whenever possible, and uses repetition and
aam.m.arisation.
• Studies show that teacher c;:Jarity has a positive
correlation with atudent achievement and attitude•
towards claasroom teaming and inatructlon.
•· "Is it cleat, class?" or "what was the muddiest point in-our
lesson"? are usually the questions that the effective teacher
would ask; and, 1
-'3
,.,...-2._ T6Geher style involves tr.t..,p,:1 s,cmal, projenwnat ond
pei'$Oll4l aspect.& of good uachlng ; additionally, it also
includes
'- a. a &1'Jnd of fonn or content which is a combination of
- certain ways of talking, moving, relating and
thlnldne; schol.arllnesa, .b:ttelligenee and ainceritr,
b. the teachlng persona which is the ability to aUmulate
the student's interest and enthwuasm for the
subject;
e, a pkraaant speaking voice;
d, the use of a oarfety o/ t.eachfng strategies, Joke,•,
humor;
e. good timing wherein the teacher knows how to adapt
the apeed of delivery for individual learners or the
whole cl.ass and knowing when they are ready for a
new material, when to stop and wh- to shift gea~.
H. ~ m ~I.ES 0(-1,l)Ol). f>~TfillClflM; IN ~l).IWe
f/l!.K!ATION c~ AMl QIIHESONJ

J. Encourage interaction between tM uacher and tlul

learru!r which refers to effective teacher characterlatica and to
what the teacher does in the learning environment to motivate the
student to actively participate ~d ask questions in the learning
process;
2, BHcU coope~ among tM .students w do collaborative
&rarning through study groups, undertaking group projects and
other group activities. Studies have shown that .sffiti'Mlts l.eam
more coUaborattiielu tho.ta competitiw&li

55
 11()11

3. Student. should engage in ac:tiYe leambl« where they can

pro-actively manipulate the c,ontent of what they are 1eamlAc
by talldn1 about the material, wdttn1 aboa.t it, m.aldn1 an
outline about it, applyiq it, aaldng qu.. tiODa about it, •ctbla It
out or juat reflecting upon it;
4. Ol.11Ulll p,ompt/eedback-rela~ to class recitations, qui=s,
major 'exams or other written works and projects serves as a
re~ or poaiti'N reinforcement for a job -11 done an.d for
any commendable behavior or attitude ezh!blted by the
learner.
S. :Smpluuuln11 tunA/1 on task where the teacher makes sure
that the student knows how much time they should spend
learning a particular material and by uln& time effl.ctently
(knowing how to study, do library research, or work on their
projects). This refers to pl'Ope.r, effective, and blteW,ent time
mana,;ement.
6. Communicating hlt,hl!r e.q,eceaticme which refers to the
cb•llenp that the teacher pvea to the student and tb:e
student'• ireapoRM to me up to that challenge with the
taache~aencoura,ementandaupport.
7. R~~I\II tlue dew,- tal.ents and u,ap of 1-mf~ since
learners have cllfl'erent tu.mine atylea which the teacher must
be able to identify so that !<he could me cWrerent teachinl
atn.tepea, approaehea &Dd methoda.

I. BARRIERS TO EDUCATION A1'D OBSTACLES TO

LEARIUl(G

l'A~TO~ ~TO~
(factors hindering or preventing (factors that negative!I affect
the nurse's ability to the abilitt of the learner to
deliver educational attend to and.procesa
services to the patient/family information)
members -;... ~, \\
fM<JfS, fMO,S.
, 1. lack of time to teaela (,reateet 1. the stress of acute 8' elu'omo
burl•rt ._... to: "'-eN, amdety, N..-Y
8.. short period of confinement deflatt8II low liten.q anaoas
b. very demanding schedules of .. tie.ts can result to
nurses diminished learner motivation &
c. very demanding reaponStDilities leam.ing
ofnW'8CS
Cliapt« s c-im atlMn ,..,_ ta a : th n to Bealtla cue
I :a. lilck of pnpantlon of n-
..
tolNdl
lacJc of knowledge on
principles of teaching and
learning
b. nurses don't feel competent
or confident regarding their
teaching skills due ro their
inadequate preparation for their
roleQas nurse educators
3. Pencmal ohuacterlstice of
the mane asa teacher
influence the outcome of the
teaching-learning process
4. low priority &i•en to patJeut
astd staff education by
admbmtfttion a. npervtso:y
penom,.el
&. lack of apace and priY&OY in
the various environmental
settings is not alwaya con4uclve
to canyiAc 01l\ tbe t-elung -
1eanwlC proceu
6. Absence of tJw,l party
nlmlnanem.ent to aupport
patient •4-tloct programs
relegates teachiu& a. J.euninC
to leas than :bJ.Ch priority
atat:Ps. Patiant education In
Jlome,cue la not teim.JIW L!.d
nnleu apecU1callyoNlered by
the •h-lclaa
7. Some wand physlclllns
question tJae effecttrity
patient education u a ·mean•
to Imp"""" bMlth OllUO-
-;
aon
I 2. the aoptift mfbae,noe of I
the ~ CllVU'OIUIUIDt
tt.dl re$Ulting to lossof
control, lack of privacy and
social isolation
3. laokoftmaetoieuudue
ro rapid patient discharge can
discourage and frustrate the
learner, impeding the ability
and willinzness to learn.
4. Pel'M>IUl.l chancterilltics of
the leuDer lib readineas to
leant, motivation astd
com-pllance, denlopmeat:al
.
s. -1e·
stage cJ>uuter!fflcs and
the extent of bebavionl
cha.aeea needed
can ...,..,_helm the leuuer a.
diacounge him from attending
to & accomplishing learning
obiectives& zoals
6. Lack of 1111.pport a. poaittn
reinforcement &om the 11:tune
a. atpm.,..ut others
-~~
'T. J'.)enf•I of leanllD( -ck.
.of reaeDtment of
&lltllorit)'. aud lack of
wtlHDCDCN to tab reapoa-
~ (Jocu of conuol) are
some ~ologtoal ONtadM
to ac o c m plJsblajJ klaa-..tonl
57
CJu,pter 3 eo-,ts of 141 .._ la Pelatlml to ...W. can

a. Content needs to be 8. Tbe '-11..ea.lence,

atandard!sed, teachill& compla.ity, laaccettfltllity,
~•pomdl,Uitlea need to be fn.gJ!nentat!on and dela11m•nJ.
made clear, and Uuea ~ aaUon of the laealtbeare system
co-anfcatioo mJUt be !ruatntn the i-er Oo
•uengthened amo,q the dbc01ll'&&•• hbn &om
bea ltbcare providers.
9. Jned.equete tune to
reconl/document paUent
I putidpat!Dc bl a. complJill&
with the coala a. objectm• for
learmD&·
teachl.Jlg; E:ic noiM, ftequent
••· Inadequate forms on llltenen>-. aeatment
which. to ;rec.en teaclab>& acbedules whieb aegattve!y
ac:tbrl.ties. affect concentration and
ef!"fl>Uve lnteractlot

Banien and Oblltaeles to Teaching and Leaming

Communication bl Bunin&
We know that COllln1unic:atlo11 Is the transfer of
tnlormatlon between m amoq people. The practice of
nuntng utilize• COD&tant comanutlcatioa between the nune
and the patient, the patient's family, the 1n1ne•a co-worken,
supemson, and many others. Communication in nuniDg can
be a complleated process, and the po9sibility of ae11ding or
receiving incorrect menages frequently emts. It ls eaaent!al
that we know the by components of the commwdcatlon
proceaa, how to improve our skUla, and the potential problems
that exlat with erron in comanmlcatfon.

SV.ccesaflll C1)JJ1JJ1wdca~ has major

components, namely: /

a)sender,
b) receiver, and
~'· 01
e] meswaae

· 111 nunf.n&, we trequez,.tly have a great deal of

hlfonnatton to send to others in a abort period of time. To do
thla effecttvely, we need to know Ui.t there are £acton wbieh
could IDJluenc:. how our m-ae ia reeeiftd aad laterpretecl.
58
 :!011

We 1Dust consider the setting fn which the co-um.cation

occun, the past experiences and penona1 perceptions of both
the sender and receiver, the ttmtn1 of the m-~e, etc.

BreakdoWJl in co-untcatl<>n can C811118 negative

outcomes. We all lmow how importallt lt is to give a thoroufb
patient report to the oncollliag nurse at shift change. Ill
eltuatlons where this does not occur and Important
1nro~tlon is aot conveyed. treatmeats, medicatlon.s,
ete. may be m!Pcd. For .-inple, tu one llitu.ation an.
oncomin.f nune was aot informed that a patient had tallen on
the previous shift. The nurse therefore did not mow to
aseesa the patieat for iDJurles or other complication.a from the
ran. or to in.itiate ran precautiona. The patient fell once again
and was Injured. Thia possibly coald have been prevented had
the communication between the n'1de8 been complete.

We mow that the trust or our patients and their

fam.llles ls an lmportallt part or provldiDI effective nunfag
care. If they don't trust us, any eommv.nicatloa that we
attempt to send to them may be dlsre,prded. We can tab
steps to ensure that we have their trust. They may seem
aiJDple and self-evident; howe,,er, in our J,usy practice they
a.re not al-ya followed.
STEPS TOWARDS EFFECTIVE COIOIUIUCATION \
(Lhynnelli,http://nursingcno.comiwp-cootentluploads'tberapeitic-~ -"
relationsbip2l.jpg \ • 1,1.
The first step towards effectivecommunication i hone. .
Don't tell a patient that you are going to do something u ss ou
mean it, and if you can't follow through, explain why. Prcnnlllea,
It made, mu.t be kept. r. ~ ~
~
Other important: factors are availa1rillty aad
res_J!9Dlli'!l.eJ!,ea&.Patients and tamflfes beeosne illlpatient aad
sosnet:im.esangry when they feel that they are being I.pored.
Sometimes these feelings are not reasonable, but sometimes they
are justifiable. If we encounter this type of complaint, we need to
take a look at the corornunication process, timing, etc- between

59
 Cbaptu 3 Concopta ot JW.11cat1oa Ill Rela&a to a.Ith care 2011

the nurse and the patient. If It appean Inadequate, take

correctiveaction.

It has been said AAtat as much as eighty percent of our

communication la ~latb~. We need to pajr attention to our
body language, eye contac!t, and tone of voice when
addnaalng patients and families. Thia is aieo true when
addnaaiDJ co-worken, nunlng aupervl.aon, and virtually
everyone else. Conflict among co-workers can impact patients,
and sometimes can be prevented or corrected if we are aware of
how our attitude may be interpreted.

Also, cultural •-rene,, can be an Important part of the

knowledge base that we need to have as nurses when ..
communicating. For example, we may want to pat the arm or hold
the hand of a patient or family member, but we need to make
,ure that thJa behavior I• acceptable and not seen u
b1approprlate.

Most importantly, we must appear to be empathetic with

thoee in our care. We are the face of nursing and the face of the
facility to our patients and their visitors. We will encounter many
people in our professional lives. They may not remember our
names, but they will remember how we treated them during a
difficu It time in their lives.

Communication Techoiques (Source: http: //nursingcrib.com)

Communication as an interaction take• illto account
the proceea of m11t1Ull influence in communication. This
process is cyclic, where i.nfonnatlon Is tran.mitted to a
receiver, b11t in which the reaction of the receiver
contlnao11Sly alten or changes the sender's oext signal. In this
olrcular proces• the p~oipan""-take turns at being the
commwucator and the eel~ \ {j - 11,,
Seven key eleme~ '1ontrfbu;\o the eucces, or failure
of iAdtviduaJcommwu ~on. Th/1.e componentll are the
medium, me....-, spealrer;---U..tenn.feedback. lnte,fereace,
and conteJEt. ·

60
 Cba~t 3 Concept,, otlldwtloa la Peletlo" to a.WI C- 211)11

1. The medium Is auoclated with the curler of the

measage, which may be personal communication through face-to
face interaction, telephone call, or a letter.
2. The message In personal communication is most critical
because it is influenced by culture and directness.
Communication to be successful usually must be direct.
3. The •peaker muat be clear, eft'ecttve, and Clllturally
lleJl&itive to the indlvidnal'a needs. An adequate vocabulary and
clear expression are priorities for success.
4. The U.tener mu.et devote fall attention to the •peaker.
5. It is Imperative to provide the speaker with feedback; a
reaction to the conversation as an lndlcatJon of attentiveness
Includes clarification of mieundentood statements.
6. Interference occurs wheb a U.tener fails to hear the
me-ge because of ~ernal (noise) or internal (somethiq
else on mlnd) interference.
7. The context ie related to the time, place, and situation
ln which the conversation oecun. Tbe effectlveneaa of a
communication may be ~lated to the ~ceptlvenesa of and
lack of ln.terference for the participant.

Some techniques one can use for comm.unlcatlo,mclude:

1. efl'ectlveapeaJdng f
2. eft'ectlve llatening ·
3, giving f'-eedback /
4. being alert to nonverbal signals
5. asaertlveneaa '--
6. handling co~ct

Quick Checklist for Effective Communlcatlo \ '-· /

(1) Ask open -ended questions /'
(2) Focus on feelings
(3) State behaviors observed \
(4) Reflect, restate, rephrase verbalization of p~ent /
(5) Give neutral responses ""---- /

Effective communieatfob..is
,::::::::,., \
(1) Appropriate "'i?l'C4J Concise .
(2) Su;nple 1 1 '2 ?, .,- (5) Credible
(3) Adaptive __ /

61
----

2011

Tbenpeutlc Tec~quea in Com.m1u:licatton

1. OfferiDg Self· making self-available and showing interest and
concern.
"I will walk with you"
2. Active J.tatenJng. paying-close attention to what the patient is
eaying by observing both verbal and non-verbal cues.
· Maintaining eye contact and making verbal remarks to
clarify and encourage further communication-
3. Exploring
"Tell me more about your son".
4. Giving broad openinp
"•What do you want to talk about today?"
S. Silence· planned absence of verbal remarks or momentary
silence to allow patient and nurse to think over what is being
discussed and encourage the patient to l;ay more.
6. stating the observed· verbalizing what is observed in the
patient for validation and to encourage discussion.
"You sound angry".
7. Ellcouraglni compari•ons·· asking to describe similarities and
differences among feelings, behaviors, and events.
"Can you tell me what makes you more comfortable:
working by yourself or working as a member of a team?"
8. Ide-ntifying themes -asking to identify recurring thoughts,
feelings, and behaviors.
"When do you always feel the need to check the locks and
doors?"
9. SUm.marizing -reviewing the main points of discussions and
making appropriate conclusions.
"During this meeting, we discussed about what you will do
when you feel the urge to liurt yourself again and this include ...•
10. Placing the event in · tJme or sequence -asking for
relationship among events.
"When do you begin to experience this ticks? Befor.eor after
you entered grade school?"
11. Voicing doubt . voicing uncertainty about the reality of
patient's statements, perceptions and amclusions.
"I find it hard to believe... •

62
C)la,m" 8 Concopta ot Sdncatlou ill ltelado.a iio Health can ::IOll

12. hcoura,ing descriptions of perceptions - asking the

patients to describe feelings, perceptions and views of their
situations.
"What are these voices telling you to do?"
13. Presenting :reallty or confrontfng - stating what is real and
what is not without arguing with the patient.
"I !mow you hear these voices but I do not hear them".
"I am Lhynnelli, your ,nurse, and this is a hospital, not a
beach resort.
14. Seelltng clarlftcation - asking patient lo restate, elaborate, or
give examples of ideas or feelings to seek clarification of what is
unclear.
•1 am not familiar with your work, can you describe it
further for me".
"I don't think I understand what you are saying".
US. Verballslng the implied · rephrasing patient's words to
highlight an underlying message to clarify statements.
Patient: I won't be bothering you anymore soon.
Nurse: Are you thinking of killing yourself?
16. Reneetill& · throwing back the patient's statement in a form
of question helps the patient identify feelings.
Patient: I think I should leave now.
Nurse: Do yo·u think you should leave now?
17. ReatatlD& · repeating the exact words of patients to remind
them of what they said and to let them know they arc heard.
Patient: 1 can't sleep. I stay awake all night.
Nurse: You can't sleep at night?
18. General leada . using neutral expressions to encourage
patients to continue talking.
-'Goon ... 1'
"You were saying ... • .
19. Mkin& question - using open-ended questions to achieve
relevance and depth in discussion.
"How did you feet when the doctor told you that you are
ready for discharge soon?"
20. Empathy . recognizing and acknowledging patient's feelings.
"It's hard to begin to live alone when you have been married
for more than thirty years".
21. Focusing - pursuing a topic until its meaning or importance
is clear.
"Let us talk more about your best friend in college"
"You were saying ... "
63
~ 3 CODcepta "'* ,1e.1a --, ,.,. co a.1t1a c:u. aou
22, ln.terpretfn1· providing a view of the meaning or importance
of something.
Patient: Ialways take this towel wherever I go.
Nurse: That towel must alweys be with you.
23. Encoma,mi evaluation - asking for patient's views of the
meaning or importance of something.
"What do you trunk led the court to commit you here?"
"Can you tell me the reasons you don't want to be
discharged?
~. 8ugeatl.Dg collaboration - offering to help patients solve
problems.
"Perbape you can discuss this with your children so they
will know how you feel and what you want".
26. EncourqjD.1 goal ••ttiu& · asking patient to decide on the
type of change needed.
"What do you trunk about the thin,gs you have to change in
yourself?" .
26. Encouragtu 1 formulatlon of a plan of action - probing for
step by step actions that will be needed.
"If you decide to leave home when your husband beat you
again what will you do next?"
:27. Ellco~ c decbion.a - asking patients to make a choice
among options.
"Given all these choices, what would you prefer to do.
28. ltncounpn1 con.aldention of optlou · asking patients to
consider the pros and cons of possible options.
"Have you thought of the possible effects of your decision to
you and your family?"
29. Oivuae 1Dformat1oa - providing information that will help
patients make better choices.
"Nobody deserves. to be beaten and there ere people who
can help and places to go when you do not feel safe at home
anymore".
30. Limit Mttl.Dg - discouraging nonproductive feelings and
behaviors, and encouraging productive ones.
"Please stop now. If you don't, I will ask you to leave the
group and go to your room.
31. Supportive co11&o11tation • acknowledging the difficulty in
changing. but pushing for action.
"1 understand. You feel rejected when your children sent
you here but if you look at it this way... •

64
32. Role playbl.g - practicing behaviors for specific situations,
both the nurse and patient play particular role.
"I'll play your mother, tell me exactly what would you say
.-hen we meet on Sunday".
33. Reheusln& - asking .the patient for a verbal description of
what will be said or done in a particular situation.
"Supposing you meet these people ag~, how would you
respond to them when they ask you to join them. for a drink?".
34. Feedback - pointing out specific behaviors and giving
impressions of reactions.
•1 see you combed your hair todsy".
35. Encounging eva1-tio11-asking patients to evaluate their
actions and their outcomes.
•What did you feel after participating in the group
therapy?".
36. :Reinforcement - giving feedback on positive behaviors.
"Everyone was able to give their options when we talked one
by one and each of waited patiently for our tum to speak".

Jon-therapeutic Techniques
1. Overloading- talking rapidly, changing-subjects too often, and
asking for more information than cannot be absorbed at one time.·
"What's your name? I see you like sports. Where do you
live?"
2. Value Judgments- giving one's own opinion, evaluating,
moralizing or implying one's values by using words such as "nice",
"bad", "right", "wrong", "should" and •ought".
"You shouldli 't do that, it's wrong".
3. Inccmpue11ce-sending verbal and non-verbal messages that
contradict one another. The nurse tells the patient "I'd like to
spend time with you" and then walks away.
4. UD.derloadmg - remaining silent and unresponsive, not pickiiig
up cues, and failing to give feedback. The patient asks the nurse,
simply walks away. -
5. False reaAllr&Dce'/ agnemeat - Using cliche to reassure
client.
"It's going to be alright".
6. Jnvalidatfon - Ignoring/denying another's presence, thoughts
or feelings.
Client: How are you?
Nurse responds: I can't talk now. I'm too busy.

65
 ~

T. Fo~
3 CoD-,ts

OD
of-- la P I H • to 8aJtla C....
2011

Mlf·responding in a way that focuses attention to

the nurse instead of the client
"This sunshine is good for my roses. I have beautiful rose
garden".
8. Changin& the subject - introducing new topic inappropriately,
a pattern that may indicate anxiety.
"The client is crying, when the nurse asks "How many
children do you have?"
9._ Giving advice • telling the client what to do, giving opinions or
making decisions for the client, implies client cannot handle his or
her own life decisions and that the nurse is accepting
responsibility.
"If I were you ... Orit would be better if you do it this way... •
1-0. 111.temal validation- making an assumption about the
meaning of someone else's behavior that is not validated by the
other person ijumping into conclusion).

The nurse sees a suicidal client smiling and tells another

nurse the patient is in good mood.

11 Other meffectlve behaviors and respoR8t:$:

1. Defending -.Your doctor is very good.

2. Requesting an explanation - Why did you do that?
3. Reflecting - You are not suppose to talk like that!
4. Literal responses - If you feel empty then you should eat
more.
5. Looking too busy.
6. Appearing uncomfortable in silence.
7. Being opinionated.
8. Avoidingsensitive topics
9. Arguing and telling the client is wrong
10. Having a closed posture-crcesing arms on chest
11. Making false promises - I'll make sure to call you when you
getllome.
12. Ignoring the patient - 1 can't talk to you right now
13. Making sarcastic remarks
14. Laughing nervously
15. Showing disapproval - You should not do those things.
 O star a CODI ,1 otM tl1&laM .... t,o-Can, :ZOU

summary
The role or health education ht the promotioa of health
ad bealthy Ufeetyles u -u u the pzevention of illneaa 18 a
reapcm11lbilitythat largely faDa oa the shoulders of the nurses
llelq the lugeat P"OUP of health prcmdera. lta lepl bula la
:foand ID It.A 9173. Health echlcatioD should be viewed aa a
moral Ull.dertaJdDC and reapou!blllty not only by the nuae
1nrt by othei health ea.re p!Oriders u well. To do thta
.&edvely· oae affda to am- role or the nurse in health
education aad the hellmvb of dfective teaellmg. The nurse,
to be efflcleilt &11d effective should also know ad utiliz& to the
Aalleet the theiapeutlc commumcation teclmlquea.

..............................
•Food for Thought"

"In resolving conflia; how you say it

is as important as whn.t you say~.

-Purpose -driven Life-

"The greatest gift you can give

someone is your time.•

-Purpose -driven Life-

67