ALLIED HEALTH SCIENCES DEPARTMENT

DIPLOMA IN MIDWIFERY

MID 9: Principles, Methods & Strategies in Teaching Health Education

Prepared by: LEONARDO B. BACLA-AN JR., RM, RN.
Modified (Sept. 11, 2023): INEE E. REGALADO-CAÑETE, RN

UNIT 1: INTRODUCTION TO HEALTH EDUCATION

A. Historical development in health education

• Mid-1800s
– Nursing was acknowledged as unique discipline
– Teaching as an important role of nurses as caregivers: promoting the health of the well public
• Educating other nurses for professional practice

Florence Nightingale
– Ultimate educator
– Teaching nurses, physicians, and health officials—importance of proper conditions in hospitals
and homes to improve the health of people.
– Importance of teaching patients of the need for adequate nutrition, fresh air, exercise, and
personal hygiene to improve the well being
– Early 1900s ---public health nurses in this country clearly understood the significance of the
role of the nurse as teacher in preventing disease and in maintaining the health of society.
– For decades, then, patient teaching has been recognized as an independent nursing function.
– nurses have always educated others-patients, families, and colleagues
– It is from this roots that nurses have expanded their practice to include the broader concepts of
health and illness
– In 1918, The National League of Nursing Education in the US (Now NLN –National League for
Nurses) observed the importance of health teaching as a function within the scope of nursing
practice.
– 2 decades later, this organization recognized nurses as agents for the promotion of health and
the prevention of illness in all settings in which they practiced
– By 1950, the NLNE had identified course content in nursing school curricula to prepare nurses
to assume the role as teachers of others.

Recently, the NLN developed the first certified nurse educator (CNE) exam to raise the “visibility
and status of the academic nurse educator role as am advanced professional practice discipline with a
defined practice setting”
• American Nurses Association has for years put forth statements on the functions, standards and
qualifications for nursing practice of which, patient teaching is a key element.
• The ICN (International Council of Nurses) has long endorsed the nurse’s role as educator to be an
essential component of nursing care delivery.
• Today, all state nurse practice acts (NPAs) include teaching within the scope of nursing practice
responsibilities.
• Nursing career ladders often incorporate teaching effectiveness as a measure of excellence in
practice.
• By teaching patients and families as well as health care personnel, nurses can achieve the
professional goal of providing cost effective, safe, and high-quality care.

As early as 1993 the Joint Commission (JC) formerly the Joint Commission on Accreditation of
Health care Organizations (JCAHO) established nursing standards for patient education.
• These standards, known as mandates, describe the type and level of care, treatment and services
that must be provided by an agency or organization to receive accreditation
• 1980s the role of the nurse as educator has undergone a paradigm shift, evolving from what once
was a disease-oriented approach to a more prevention –oriented approach.
• Education, once done as part of discharge plans at the end of hospitalization

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 As described by Grueninger (1995) this transition toward wellness has entailed a progression
from disease oriented patient education (DOPE) to prevention oriented patient education (POPE)
• To ultimately become a health oriented patient education (HOPE)
• This new approach has changed the role of nurse from one of wise healer to expert advisor/teacher
to facilitator of change.
• The emphasis is now on empowering patients to use their potentials, abilities, and resources to the
fullest (Glanville 2000)

Role of the nurse as health educators

1. Serving as a clinical instructor for students in the practice setting.
2. Clinical preceptors and mentors to ensure that nursing students meet their expected learning
outcomes

The role of the clinical educator

– Is a dynamic one that requires the teacher to actively engage students to become competent and
caring professionals
– Role – training the trainer
– That is preparing the nursing staff through continuing education, in service programs, and staff
development to maintain and improve their clinical skills and teaching abilities
– The key to the success of our profession is for nurses to teach each other nurses
• The professional teacher – Licensed professional who possesses dignity and reputation with
high moral values as well as technical and professional competence

Nurses as Teachers
– With shorter hospital stays, increase in community-based care, and the growth of health care
consumerism, we can expect that staff nurse will have to be skilled teachers.

Health education
– A process concerned with designing, implementing, and evaluating educational programs that
enable families, groups, organizations, and communities to play active roles in achieving,
protecting and sustaining health
Purpose
• Is to contribute to health and wellbeing by promoting lifestyles, community actions and conditions
that make it possible to live healthful lives
• Health education= is also defined as any combination of learning experience designed to facilitate
voluntary adaptations of behavior conducive to health.
• Refers to the act of providing information and learning experience for purposes of behavior change
for health betterment of the client.
• It is a process with intellectual, psychological and social dimensions relating to activities that
increase the abilities of people

Process of health education

1. Physical Health
2. Emotional health
3. Mental health
4. Social health
5. Spiritual health

Key aspects
1. Planned opportunity
2. Specific setting
3. Program series or events
4. Based on what was previously learned
5. Comprehensively emphasizes how various aspects of health interrelate and how health affects the
quality of life
6. Interaction between qualified educator and learner

Purposes why health educators plan and conduct heath teachings

• Be aware of the values of health
• Develop skills
• Acquire and apply concepts and information received
• Develop and discuss opinions
• Formulate accurate and effective decision making

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Purposes of health education
1. Propagating health promotion and disease prevention
2. Maybe used to modify or continue health behaviors if necessary
3. Provides health information and services
4. Emphasis on good health habits and practices
5. Means for communication
6. Advocacy

Types of health education

1. Information
2. Health services
3. A friendly environment

Purposes, Goals, and Benefits of Client and Staff Education

Purpose:
– To increase the competence and confidence of clients for self-management
Goal:
– To increase the responsibility and independence of clients for self-care
Benefits of Client Education:
– Increase consumer satisfaction
– Improve quality of life
– Ensure continuity of care
– Decrease client anxiety
– Effectively reduce the complications of illness and incidence of disease
– Promote adherence to treatment plans
– Maximize independence in the performance of ADL
– Energize and empower consumers to become actively involved in the planning of their care

Discipline – A branch of knowledge or instruction

Profession – is an occupation that properly involves a liberal, scientific, or artistic education

Characteristics of a profession by Upton

1. Provide a unique and essential social services
2. Require of its members an extensive period of preparation (BSN, MAN)
3. Have a theoretical base underlying its practice
4. Have a system of internal controls that tends to regulate the behavior of its members
5. Have a culture peculiar to the profession
6. Be sanctioned by the community
7. Have an association that is representative of all and can speak on behalf of all the members of the
occupation

PRINCIPLES OF HEALTH EDUCATION

1. Good health practices
2. Use of preventive services like immunization, screening, antenatal and child health clinics
3. The correct use of medications and the pursuit of rehabilitation regimen
4. The recognition of early symptoms of disease and promoting early referral
5. Community support for primary health care and government control measures.

Issues and trends in health education

• In the USA, patients are being discharge “quicker and earlier” due to:
– New “health care economics
– Advances in medical technology
Nurse’s greater involvement
1. Client teaching in self-care management
2. Discharge planning
3. Providing for continuing care

Practice in particular and the health care system in general

• Lifestyle related and preventable thru educational intervention
• Increase in chronic and incurable conditions requires the individual and families become informed
participants to manage their own illnesses
• Advance technology
• Increasingly aware that client health literacy is an essential skill if health outcomes are to be
improved .
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 • Client education improves
• Increasing number of self-help groups
The call for developing global health strategies with the integration of health education and action is
now a clamor that can no longer be ignored.

B. Perspective on teaching and learning

1. Overview of education on health care

• Teaching function will always be an integral part of the duties of a professional nurse. This dates to
the time when Nursing was given recognition as a discipline in the 1800s and health education
became a unique and independent function of the nurse. This was regarded as the period of
educated Nursing.
• Florence Nightingale, who has earned the title of “Mother of Modern Nursing”, was the epitome of
the true nurse educator as she advocated the important function of teaching to promote health and
recovery through a clean, pleasant, and inhabitable environment
• 1918- The NLNE recognized the importance of health teaching as a responsibility of the nurse for
the promotion of health and prevention of illness in different settings.
• 1950- NLNE specified the course content dealing with teaching skills, developmental and
educational Psychology and Principles of teaching and learning as part of the nursing curriculum of
all nursing schools
• THE ICN has endorsed health education as an essential requisite for the delivery of nursing care.
• Today, NPAs in USA “universally include teaching within the scope of nursing practice
responsibilities. They are expected to assist clients to maintain health, prevent disease, manage
illness and render supportive care to family members through health teachings/education as a
means to providing cost-effectiveness, safe and high-quality care.
• 1993- JCAHO delineated nursing standards or mandates for patient education which ARE BASED on
positive outcomes of patient care. the teachings must be patient and family oriented.
• 1998- The Pew Health Professionals Commission released a follow up on health professional
practice and more than half of the recommendations were on the importance of patient and staff
education and the role of the nurse as educator.

Concepts of teaching, learning, education process vis-a-vis nursing process, historical

foundation s for the teaching role of the nurse
Education Process – is a systematic, sequential planned course, planned course of action
with teaching and learning as its two major interdependent functions.
Key players:
1. Teaching – is a deliberate intervention involving the planning and implementation of
instructional activities and experiences.
• Instruction – involves communicating of information about a specific skill: cognitive,
affective, psychomotor.
2. Learning – a change in behavior (knowledge, skill, attitudes)
- Acquisition of knowledge of all kinds such as: Abilities, Habits, Attitudes, Values, Skills

Patient education – a process of assisting people to learn health related behaviors (knowledge, skill,
attitudes, values)

Education – is an interactive process of imparting knowledge through sharing, explaining, clarifying, and
synthesizing the substantive content of the learning process to arrive at a positive judgment and well-
developed wisdom and behavior

Patient teaching – is the process of influencing patient behavior and producing changes in knowledge,
attitudes, and skills necessary in maintaining or improving health.
Purposes of patient teaching:
• 1. Increase client’s awareness
• 2. Increase client’s satisfaction
• 3. Improve quality of life
• 4. Ensure continuity of care
• 5. Decrease patient anxiety
• 6. Increase self-reliant behavior
• 7. Effectively reduce the incidence of complications of illness
• 8. Promote adherence to health care treatments
• 9. Maximize independence in the performance of ADLs to become actively involved in the planning
of their care

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Health – is the sense of being physically fit, mentally stable, and socially comfortable. It encompasses
more than the state of being free from diseases.

3 Pillars of the Teaching-Learning Process

1. Teacher
2. Learner
3. Subject matter

Contributions of teaching and learning:

1. The vital role of the teacher is motivating students to learn
2. Inspiring them to go out of their comfort zones, to stretch and develop the 98% portion of their
brain which is still untapped and unused.

Education Process vs. Nursing Process

• Assessment
− Nursing process: Appraise physical and psychosocial needs
− Education process: Ascertain learning needs, readiness to learn, and learning styles
• Planning
− Nursing process: Develop care plan based on mutual goal setting to meet individual needs
− Education process: Develop teaching plan based on mutually predetermined behavioral
outcomes to meet individual needs
• Implementation
− Nursing process: Carry out nursing care interventions using standard procedures
− Education process: Perform the act of teaching using specific instructional methods and
tools
• Evaluation
− Nursing process: Determine physical and psychosocial outcomes
− Education process: Determine behavior changes in knowledge, attitudes, and skills

Nurse Educator
1. The primary source of knowledge of learners in nursing
2. The primary catalyst for the learning process
3. A role model for nursing students
4. An active facilitator, who demonstrates and teaches patient care to nursing students in the
classroom and clinical settings
5. A source of health care information and patient care to clients of care
6. Is diligent; keeps abreast of developments in his or her field through continuing education, reading
of nursing journals and active participation in workshops and seminars

Role of the Nurse as a Health Educator

1. Provide clinically competent and coordinated care to the public
2. Involve patients and their families in the decision-making process regarding health interventions
3. Provide clients with education and counselling on ethical issues
4. Expand public access to effective care
5. Ensure cost effective and appropriate care for the consumer
6. Provide for prevention of illness and promotion of healthy lifestyle for all Americans
• Effective health education programs are envisioned to cut health care costs and prevent the
premature onset of disease and disability
• The battle cry is to” attain and maintain healthy lifestyle through health education” since the
leading cause s of morbidity and mortality is lifestyle –related diseases.

Health Educator
• Is a practitioner professionally prepared in the field of health education, who demonstrate
competence in both theory and practice and accepts responsibility in advancing the aims of the
health education process.

A health educator performs the following:

1. Collaborates with health specialists and civic groups in assessing community health needs and
availability of resources and services and in developing goals for meeting health needs of clients
2. Designs and conducts evaluation and diagnostic studies to assess the quality and performance
of health education programs.
3. Develops and implements health education and promotion programs such as training
workshops, conferences and school or community projects
4. Develops operational plans and policies necessary to achieve heath education objectives and
services

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Barriers to education
Factors impeding the nurse’s ability to deliver educational services:
1. Lack of time to teach
2. Many nurses admit that they do not feel competent or confident regarding their teaching skills
3. Personal characteristics of the nurse educator
4. Low priority
5. The lack of space and privacy in the various environmental settings
6. An absence of third-party reimbursement
7. Some nurses and physicians question whether patient education is effective to improve health
outcomes.
8. There seems to be a “malfunction” of the healthcare team
9. Both formal and informal teaching

Obstacles to Learning
Factors that negatively affect the ability of the learner to attend to and process information:
1. The stress of acute and chronic illness, anxiety, sensory deficits, and low literacy in patients.
2. The negative influence of the hospital environment itself, resulting in loss of control, lack of
privacy, and social isolation, can interfere with a client’s active role in health decision making and
involvement in the teaching-learning process.
3. Lack of time to learn due to rapid patient discharge from care can discourage and frustrate the
learner, impeding the ability and willingness to learn.
4. Personal characteristics of the learner have major effects on the degree to which predetermined
behavioral outcomes are achieved.
A. Readiness to learn
B. Motivation to learn
C. Compliance
D. Developmental stage characteristics
E. Learning styles
F. The extent of behavioral changes needed can overwhelm learners and dissuade them from
attending to and accomplishing learning objectives and goals.
• Lack of support and ongoing positive reinforcement from the nurse and significant others
serves to block the potential for learning.
• Psychological obstacles to accomplishing behavioral change:
• Denial of learning needs
• Resentment of authority
• Lack of willingness to take responsibility
- The inconvenience, complexity, inaccessibility, fragmentation, and dehumanization of the healthcare
system often result in frustration and abandonment of efforts by the learner to participate in and
comply with the goals and objectives for learning.

Principles of Learning
1. Satisfying stimulus
2. Reinforcement
3. Over learning
4. Verbal and non-verbal associations
5. Cognitive –perceptual readiness and internal motivation
6. The ordering principles
7. Stimulus response associations and discrimination abilities
8. Cognitive construct
9. Multiple discrimination and generalization responses
10. Previous knowledge
11. Critical thinking skills
12. Flexibility and adaptation
13. Feedback
14. Balanced growth and development patterns

Changes:
– Growth – which is quantitative involving increase in the size of the parts of the body
– Development – which is qualitative involving gradual changes in character

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