NCM 102: Health Education Prelims 3.

Health educate to create a friendly

environment
Overview of Education on Health Care
Dimensions of the HE Process by Heidgerken
Health education
(1971)
 act of providing info and learning
1. Substantive or Aurricular Dimension –
experience for purposes of behavior change
refers to what is taught and learned
for health betterment of client
2. Procedure or Methodological Dimension
 acquisition of knowledge thru exchange of
– teaching method and learner acts. used
information from the teacher and learner
3. Environmental or Social Dimension –
that facilitates better understanding of the
physical and social factors in the body
need for change
learning situation; intrinsic factor that
 totality of experience which favorably
captures the interest of learning
influence habits, attitudes, and knowledge
Physical: actual setting where learning takes
R/T individuals, communities and racial
place, ex. Classroom equipped with AV
health
presentations lab, commu, health agencies,
Purposes hosps, clinic
4. Human Resources Dimension – includes
1. Means of propagating health promotion persons involved in the nursing care
and disease prevention practice that influence the effectiveness of
 determines role of individual the teaching and learning process
regarding self-reliant behavior ex. Students or learners – recipient of
for improvement of health knowledge, teachers or CIs – source of
2. May be used to modify/continue health knowledge, administrators – resource
behaviors if necessary allocator
3. Provides health info and services
4. Emphasizes on good health habits and Importance
practices which is an integral aspect of
1. enhance knowledge awareness for guidance
culture, media and technology
2. promotes health, safety, and security of
5. A means to commu. the vital info to the
people
public
3. develop and improve commu. resources
6. A form of advocacy
4. increase productivity and strength of
Types of Health Education character
5. disease prevention
1. Health educ and the body and how to take 6. minimize cost
care of it: 7. promotes self-reliant behavior
 human biology and hygiene
 human body and how to take Concepts of Teaching and Learning
care of it
Education – interactive process of importing
2. Health educ and services and the sensible
knowledge, thru sharing, explaining, clarifying, and
use of health care resources
synthesizing the substantive content of the learning

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process, for the learner to arrive at positive Historical Foundations of the Nurse Educator
judgment and well-developed wisdom and Role
behavior
 teaching function will always be an integral
Health – condition that permits optimal part of the duties of a professional nurse
functioning of the individual  dates back to the time when nursing was
given recognition as a discipline in the
Learning – acquisition of knowledge of all kinds,
1800s and health educ became a unique
activities, habits, attitudes, value and skills to create
and independent function of the nurse
change in an individual; gradual continuous process
 regarded as the “period of educated
throughout lfe
nursing”
Patient teaching – basic function of nursing,
Florence Nightingale
independent, integral function of nursing; dynamic
interactions between the nurse as the teacher and  mother of modern nursing
the patient as the learner  epitome of the true nurse educator as she
advocated the important function of
Teaching – process of providing learning materials,
teaching to promote health & recovery thru
activities, situations, and experience to enable
a clear, pleasant, and inhabitable
clients or learners to acquire knowledge, attitudes,
environment
values, and skills to facilitate self-reliant behavior
 founded the FN school of nsg at St. Thomas
Education process – a systematic, sequential, Hosp in London in June 15, 1860
logical, scientifically based, planned course of  taught the importance of manipulating the
action consisting of teaching and learning; a cycle environment so nature can act on the
that involves the teacher and learners patient on his recovery
 2 books: Notes on Nursing, Notes on
Nursing Process Education Process
Hospital
Identify physical Assessment Identify learning
and psychosocial needs, styles, and
needs. readiness to learn RA 9173 Nsg Act of 2002
Develop care plan Planning Develop teaching
thru mutual goal plan based on  Article 6, Section 28
setting to meet mutually  Scope of Nsg Practice
ind. needs predetermined
behavioral  Patient teaching to Individual nsg function
outcomes to meet
individual need DOPE TO POPE
Carry out nsg Intervention Perform the act of
interventions uing teaching based on  disease-oriented patient educ to
std. procedures instructional
prevention-oriented PE
methods and tools
Determine the Evaluation Determine
effectiveness of behavior changes Train the Trainer
nsg interventions (outcomes) in
knowledge, skills  continuing education
and attitudes  in-service programs
 key to success – nurses teaching other
nurses

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Teaching
 providing acts. that faci. nsg
 an art and science
 Instruction – commu of info about a
specific skill in the cognitive (knowledge),
psychomotor (skills), or affective domain
(attitude)
 Learning – tested thru change in behavior
 Education – nsg process vs. educ process
Organizations & Agencies
1. NLNE/NLN (Natl. League for Nsg Educ)
 1st observed health-teaching-important
function
 health teaching: responsibility of the nurse
 declared “nurse was fundamentally
teacher and an agent of health regardless of
the setting” (1938)
 responsible for identifying course content
for curriculum on principles of teaching and
learning
2. American Nurses Association (ANA)
 responsible for establishing stds.
qualifications for practice including patient
teaching
3. International Council of Nurses (ICN)
 endorses health educ as an assertive
component of nsg care delivery
4. State Nsg Practice Act (SNPA)
 universally includes teaching within the
scope of nsg process
 expected to assist clients to maintain health,
prevent diseases, manage illnesses and
render supportive care thru
teachings/education as a news of providing
cost-effective, safe and high quality care
5. Joint Commission on Accreditation of Health
Care Organization (ICAHO)
 accreditation mandates requirement
evidence of Patient ed to impress outcome
 teachings must be patient and family-
oriented
6. American Hosp Assoc (AHA)
 Patient’s Bill of Rights ensures that clients
receive complete and current info
7. Pew Health Profession Commission
 puts forth a set of health profession
competencies for the 21st century
 over ½ of recommendations pertain to
importance of patient and staff educ and
a
the role of the nurse as educator
Roles and Responsibilities of the Nurse as
Health Education and in Patient Teaching
Nurse Educator
 primary source of knowledge of learners in
nursing
and  primary catalyst for the learning process –
causes someone to change or something to
happen
 role model for nsg students
 active facilitator, who demonstrates and
teachers patient care to clients of care
 diligent thru continuing prof. educ engaging
in doing researches, and being actively
involved in various workshops or seminars
Roles and Functions of the Teacher or Nurse
Educator
1. Instructed Roles
health
a) Planning & organizing courses
b) Choosing the sustainable content
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 c) Creating or maintaining desirable group  giving tests
climate
6. Availability to students esp. in the laboratory,
d) Motivating and challenging students to
clinical and other skills application areas
pursue and to sustain learning activities
Qualities of Effective Nurse Educator
2. Faculty Roles - ex. Chairperson, chairman,
coordinator, counselor A. Personal Qualities

3. Individual Roles – ex. mother, wife, members of 1. Respect her students’ maturity and sense
the church, community, citizen of the country responsibility (ex. coming on class on time
and prepared speaking politely and gently)
Hallmarks of Effective Teaching in Nursing
2. Psychologically secure in her own abilities
1. Professional Competence – knowledgeable, 3. Has a sense of humor
through knowledge or masters on the subject 4. Has a well-balanced personality
matter 5. Tolerant and fair to all her students
6. Shows no partiality and is available to listen
2. Interpersonal Relationships with Students
to student’s problems
 skinful interpersonal relationship, personal 7. Approachable, kind, and patient
interest in the welfare of the student 8. Sincere in her efforts of educating the young
 fair and just specially in giving grades and & has the passion for both nursing &
credits to the student learners
 sensitive to the feelings and problems of 9. Has leadership abilities
student 10. Image of an ideal nurse with interest in each
 should convey respect for students student
 allow learner to fully express themselves and
B. Professional Qualities
ask questions
 be accessible, availability for conference or 1. Teaches the lessons that stimulate students
consultation to think & learn
 guided of principle of “Ein Coco Parentis” 2. Gives clear and concise assignments
– parental role, disciplinary resources 3. Encourages students feedback on assigned
lessons & activities done
3. Personal Characteristic – ex. charisma,
4. Prevents a well-organized subject matter for
enthusiasm, cheerfulness, self-control, patient,
student’s easy understanding
flexible
5. Provides her students with relevant clinical
4. Teaching Practices – mechanics/methods or learning experience
strategies/skills being used 6. Possesses masters of the subject matter
7. The teacher can speak clearly, audibly, and
5. Evaluation Practices fluently
8. Professionally well-groomed, properly
 clearly communicating expectations
dressed and poisoned
 providing timely feedback on student
9. She must have broad interests
program
10. Evaluates objectively student’s performance
 correcting the students rightfully

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Principles of Good Teaching Practice
1. Encourage student-faculty interaction
2. Promote cooperation among students
3. Promote active learning
4. Give prompt feedback
5. Emphasize use of time in each task
6. Commu. high expectations
7. Respect diverse talents & ways of learning
Paradigm shift: from teacher teaching to learner
learning
Barriers and Obstacles to Education
 Barriers to teaching are factors impeding
the nurse’s ability to optimally deliver
educational services
 Obstacles to learning are those factors that
negatively impact on the learner’s ability
and process info
 Ex. Inadequate facilities
Barriers in Teaching
1. Lack of time to teach
2. Lack if educational prep. to teach
3. Personal characteristics of the educator
4. Low priority assigned to patient & staff educ
5. Lack of space & privacy
6. Absence of reimbursement
7. Skepticism
8. Inadequate coordination in the HC team
9. Teachings are often not written down
Obstacles to Learning
 stress, anxiety, sensory deficits, low literacy
 negative influence of hospital environment
 lack of time to learn
 personal characteristics of learner
 extent of behavioral changes needed
 lack of support & ongoing posi
reinforcement
 denial of learning needs, resentment of
authority, and lack of willingness to take
responsibility
 inconvenience, complexity, inaccessibility,
fragmentation, and dehumanization of HC
system
Applying Learning Theories
Major Types of Learning
1. Ideational Learning – pursued in the cognitive
domain
a. Cognition – refers to process thru a which an
individual obtains knowledge about anything by
perceiving, remembering, discriminating,
integrating, abstracting, generalizing, evaluating,
imagining, thinking, problem-solving and creating
b. Perception
 source of all concepts w/c initiates mental
activity
 begins from “sensation” of all the stimulus
surrounding the learner & the learning envi
 mental process thru w/c various stimuli are
interpreted
c. Concept – an idea or a mental image w/c makes
reflective thinking possible
d. Principle – a form of generalization that implies
action; a statement that explains a large number of
related phenomena w/c may serve as a guide to
action
2. Skill or Psychomotor Learning
 is pursued & developed in the cognitive and
psychomotor domain
 not a mere action or a thing but a united
organic, whole movement or total act of the
learner
 implies a learned response to a situation
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3. Emotional Learning – refers to a mental states  always consider the comfort and the
which is characterized by certain feelings and convenience of the learner
emotions
4. Learning Readiness
 Emotion and Will – ability to accept and
 assess the extent to w/c the learner is ready
cope with reflection & still continue
to learn
performing tasks to achieve a specific set of
 readiness to learn is affected by factors like
goals
emotional states
 Attitudes – disposition, readiness,
inclination, or tendency to act toward a 5. Relevance of info
specific goal in a particular way
 Values in emotional learning  determine the relevance of information
 learned thru observation, stimulations, and  anything that is perceived by the learner to
significant & reliable info necessary for be important or useful will be easier to learn
adaption and retain
 differentiated from other skins & knowledge
6 Repeat the Info
since it is concerned about the appreciation
of learning that is made to exist in a given  continuous repetition of info over a period
situation/experience of time enhances learning
 applying the info to a diff. situation and
Principles of Learning
asking the learner to apply the info to
1. Use Several Senses another situation/rewarding it & giving
practiced applications
 10% - what they read
 20% - what they hear 7. Generalize info - cite applications of the info to
 30% - see/watch a # of applications; give examples
 50% - see & hear
8. Make learning a pleasant experience - give
 70% - say
frequent encouragement, recognize
 90% - say and do
accomplishment, and give positive feedback
2. Active Learner Involvement
9. Be systematic – begin with what is known, to
 actively involve the patients/clients/learners what is unknown
in the learning process
10. Be steady – present info at an appropriate rate
 use more interactive methods involving the
participation of the learners like role- Learning Theories – coherent framework and set
playing, buzz sessions, Q&A, format, case of integrated constructs and principles that
studies, small group discussions, describe, explain or predict how people learn, how
demonstration, and return demonstration learning occurs and what motivates people to learn
and change
3. Conducive Learning Environment

 provide an envi. conducive to learning

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Major Learning Theories that are widely used in
patient education and health care practice are the:
Behaviorist, Cognitive, and Social Learning
Behavioral Theories of Learning
 John Watson – proponent of behaviorist
theory which emphasizes the importance of
observable behavior in the study of human
beings
 Behaviorism originated in the field of
psychology.
 Defined behavior as muscle movement and
it came to be assoc with the Stimulus-
response psychology.
 He postulated that behavior results from a
series of conditioned reflexes and that all
emotions and thoughts are a product of
behavior learned thru conditioning.
 Behavior learning is based on respondent
conditioning & operant conditioning
procedures.
Respondent Conditioning
1. Classical/Pavlovian Conditioning
 a process w/c influences the acquisition of
new responses to environmental stimuli
 Pavlov’s most renowned experiment
included meat, a dog, and a bell
 A neutral stimulus (NS) elicits
unconditioned responses (UCR)
repeated pairings with an unconditioned
stimulus (UCS). A NS is a stimulus that has
no particular values, significance or meaning
to the learner.
 When the NS is repeatedly paired with the
UCS and UCR, there comes a time when the
NS, even w/o the UCS, elicits the same UCR.
Pavlov’s Experiment
Before conditioning, ringing the bell (NS) caused
no response from the dog. Placing the food (UCS)
in front of the dog initiated salivation (UCR).
During conditioning, the bell was rung a few
seconds before the dog was presented with food.
After conditioning, the ringing of the bell (CS) alone
produced salivation (CR).
2. Systematic desensitization
 Based on respondent conditioning w/c is
widely used in psychology & in med to
reduce fear and anxiety.
 Done by forming a hierarchy of fear,
involving the conditioned stimulus which is
ranked from least to most fearful. The
patient works their way up starting at the
least unpleasant & practicing their
relaxation technique as they go. When
they feel comfortable, they move to the next
stage in the hieararchy.
3. Stimulus Generalization
 tendency to apply to other stimuli what was
initially learned
 ex. child has been conditioned to fear a
stuffed white rabbit, child will exhibit the
same to similar objects
4. Spontaneous recovery
an
thru  a phenomenon of learning and memory
that was first seen in classical (Pavlovian)
conditioning and refers to re-emergence of
a previously extinguished CR after a delay
 while the response might disappear, this
does not mean that it has been
forgotten/eliminated
Edward Morndike’s Correctionism Theory
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  focused on the effects of reward &  one of the most powerful tool or procedure
punishment, success or failure, and used on teaching and is a major
satisfaction/annoyance on learner conditioned for most learning to take place
 stated that learning has taken place when a
Classification of Educational Reinforcers
strong connection/bond between stimulus
& response if romed 1. Recognition
2. Tangible rewards
3 Primary Laws
3. Learning activities
1. The Law of Exercise/Repetition – the more 4. School responsibility
often a stimulus-induced response is repeated, the 5. Status indicators
longer will it be retained (ex. nurse develops 6. Incentive feedback
expertise if repeatedly done) 7. Personal activities

2. Law of Effect – states the pleasure-pain Positive Reinforcement/Reinforcer

principle; a response is strengthened if followed by
pleasure & weakened if followed by displeasure (ex.
Self-injection of insulin to patients w/ diabetes m.
will increase pleasure in injecting self if he/she is
relieved of hyperglycemia)
 any consequence of behavior that leads to
an increase in the prob. of its occurrence
 any stimulus given or added to increase the
response

3. Law of Readiness Negative Reinforcement/Reinforcr

 the more readiness the learner has to  any stimulus resulting in the increased
respond to the stimulus, the stronger will be frequency of a response when it is
the bond bet. them withdrawn or removed
 when person is ready to respond to a  not a punishment, a reward
stimulus and is not made to respond, it
becomes annoying to the person Punishment
 likewise, if the person is not ready at all to
 a consequence intended to result in
respond to a stimuli & is asked to respond,
reduced responses
that becomes annoying
 weakens a particular behavior through the
Operant Conditioning consequence of experiencing a negative
condition
 developed by B.F. Skinner
 focuses on the behavior of the organism & Extinction/Non-reinforcement
the reinforcement that follows after the
response  weakens a particular behavior thru the
consequence of not experiencing either a
Reinforcements posi or nega condition
 responses that are reinforced are not likely
 events that strengthen responses
to be repeated

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Cardinal rule – “Punish the behavior, not the  individual’s ability to recognize relationships
person.” & patterns between concepts & things, to
think logically, to calculate numbers, and to
Cognitive Theories of Learning solve problems scientifically &
systematically
What is intelligence?
 “number/reasoning smart”
 ability to solve problems or create products
3. Visual-Spatial Intelligence
that are valued within one or more cultural
settings  capability to think in images and orient
 a biopsychological potential to process info oneself spatially; able to graphically
that can be activated in a cultural setting to represent their ideas
solve problems or create products that are  “picture smart”
of value in the culture
4. Musical Intelligence
Theory of Multiple Intelligence (Howard
Gardner)  refers to the capacity to appreciate a variety
of musical forms as well as being able to use
 States that there are various types of talent music as a vehicle of expression; perceptive
or forms of intelligence which may all be to elements of rhythm, melody, and pitch
fully developed in a gifted person/child.  “music smart”
 About 3-4 types may be possessed or
developed by an individual. 5. Bodily-Kinesthetic Intelligence

Multiple Intelligences  capacity of using one’s body skillfully as

means of expression or to work with one’s
1. Logical/Mathematical body to create or manipulate objects
2. Visual/Spatial  “body smart”
3. Bodily/Kinesthetic
4. Musical/Rhythmic 6. Interpersonal (Social) Intelligence
5. Naturalist
6. Interpersonal  capacity to approp. & effectively commu.
7. Intrapersonal with and respond to other people; ability to
8. Verbal/Linguistic work cooperatively with others &
understand their feelings
1. Verbal or Linguistic Intelligence  “people smart”

 individual/s capacity to use language 7. Intrapersonal Intelligence

effectively as a means of expression and
communication thru the written or spoken  capacity to accurately know one’s self,
word including knowledge of one’s own
 “word smart” strengths, motivations, goals, and feelings;
to be capable of self-reflection and to be
2. Logical-Mathematical Intelligence introverted & contemplative are also traits

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 held by persons w/ intrapersonal  children in this zone can almost perform the
intelligence task independently, but not quite there yet
 “self-smart”  with an approp amount of assistance these
children can accomplish the task
8. Naturalistic Intelligence successfully

 ability to identify & classify the component
that make up our envi.
 has to do with nature nurturing and relating
info to one’s natural surrounding
 “nature smart”
Level 1 – Present Level of Dvpt (LOD)
 Describes what the child could potentially
be capable of doing w/o assistance.
L2 – Potential LOD

9. Existentialist Intelligence  Child could potentially be capable of doing

w/ help from other people or “teachers”.
 capability to raise & reflect on philosophical
questions about life, death, and ultimate More Knowledgeable Other
realities
 Children are entrenched in a ociocultural
backdrop in w/o social interaction w/ sig.
Piaget’s Stages of Cognitive Development adults, a crucial factor that affects their
learning.
1. Sensorimotor stage (0-2y/o) – infant builds an
 Adults need to direct & organize the
understanding & reality thru interactions
learning experiences to ensure that the
2. Preop stage (2-4y/o) – child is not yet able to children can master & internalize learning.
conceptualize abstractly & needs concrete physical
Scaffolding
situations
 temporary support given to a child by MKO,
3. Concrete operational (7-11y/o) – childe begins
that enable them to perform a task until
to think abstractly & conceptualize creating logical
such time that the child can perform it
situations
independently
4. Formal operations (11+ y/o) – person is capable  entails changing the quali & quantity of
of deductives & hypothetical reasoning support provided to a child in the course of
a teaching session
Sociocultural Theory of Cognitive Development
 MKO adjusts the level of guidance needed
(20th Century)
to fit the students current level of
 by Lev Sevenovich Vygotsky – Russian performance
psych who lived during the Russian
Social Learning Theory
revolution developed a theory of
development  by Albert Bandura
 People can learn from other people’s
Zone of Proximal Development (ZPD) – learning
experiences.
of children
 Mental states are important in learning.

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  Learning does not necessarily lead to a
change in behavior.

Role Modeling

 central concept of SLT

 emphasizes: to faci. learning, role models
need to be enthusiastic, prof. org., caring,
and self-confident, also knowledgeable,
skilled, and good communicators

Modeling

 learning can occur thru observation

 social learning – learning thru obs,
imitation, and modeling

Vicarious Learning

 learning by seeing the consequence of

another’s behavior
 expectation of reinforcement – affects
performance of what has been learned

Self-efficacy – believing oneself is capable of

performing and reaching goals

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