HEALTH EDUCATION 6.

The extent of behavioral changes needed,

both in number and complexity, can
1. Guidelines for teaching clients with impairment.
overwhelm learners and dissuade them
For Memory Impaired:
from attending to and accomplishing
a. Use repetition.
learning objectives and goals.
b. Use a variety of cues (verbal, written,
7. Lack of support and lack of positive
pictures and symbols)
reinforcement from the nurse and S.O.
For Visually Impaired:
serve to block the potential for learning.
c. Provide large print materials
8. Denial of learning needs, resentment of
d. Provide prescription eyeglasses and
authority, and lack of willingness to take
magnifying glass
responsibility are some psychological
e. Provide adequate lighting while reducing
obstacles to accomplishing behavioral
glare
change.
For Hearing Impaired:
9. The inconvenience, complexity,
f. Face the client directly when you speak
inaccessibility, fragmentation and
g. Use short sentences and words that are
dehumanization of the healthcare system
easily understood.
often result in frustration and
h. Use sign language. Reinforce verbal
abandonment of efforts by the learner to
information, point by point, use gesture,
participate in and comply with the goals
demonstrate
and objectives for learning.
For all other clients:
i. Encourage client involvement and
3. Barriers to Teaching
participation.
1. Lack of time to teach.
j. Ask for feedback
- Early discharge from inpatient
k. Provide for frequent feedback.
and outpatient results in fleeting
contact with one another.
2. Obstacles to Learning
- Schedules and responsibilities
1. Lack of time to learn due to rapid pt
of nurses are very demanding.
discharge from care and the amount of
2. Many nurses and healthcare personnel
info a client is expected to learn can
admit that they do not feel competent or
discourage and frustrate the learner,
confident with their teaching skills.
impending the ability and willingness to
3. Personal characteristics of the nurse
learn.
educator play an important role in
2. The stress of acute and chronic illness,
determining the outcome of a teaching-
anxiety and sensory deficits in patients are
learning interaction.
just a few problems that can diminish
- Motivation to teach and skill in
learner motivation and interfere with the
teaching are prime factors in determining
process of learning.
the success of any educational
3. Low literacy and functional health
endeavour.
illiteracy has been found to be a
4. Low priority was often assigned to patient
significant factor in the ability of clients to
and staff education by administration and
make use of the written and verbal
supervisory personnel.
instructions given to them by providers.
5. The environment in the various settings
4. The negative influence of the hospital
where nurses are expected to teach is not
environment itself, resulting in loss of
always conducive in carrying out the
control, lack of privacy, and social
teaching-learning process. Lack of space,
isolation can interfere with the patient’s
lack of privacy, noise and frequent
active role in health decision making and
interferences due to client treatment
involvement in the teaching- learning
schedules and staff work demands are
process.
some of the factors that negatively affect
5. Personal characteristics of the learner
the nurse’s ability to concentrate and to
have major effects on the degree to which
effectively interact with the learners.
behavioral outcomes are achieved.
6. Some nurses and physicians question
Readiness to learn, motivation and
whether patient education is effective as a
compliance, developmental-stage
means to improve health outcomes when
characteristics, and learning styles are
patients do not display interest in changing
some of the prime factors influencing the
behavior, when they demonstrate an
success of educational endeavours.
JJMC
 unwillingness to learn, or when their
ability to learn is in question.
7. Both formal and informal teaching are
often done but not written down because
if insufficient time, inattention to detail,
and inadequate forms on which to record
the extent of teaching activities.
- many of the forms used for
documentation of teaching are designed
to simply check off the areas addressed
rather than allow for elaboration of what
was actually accomplished
4. Compare the education process and the nursing
process
5. Stages in the Process of change
1. Precontemplation Stage. No serious
thought is given to changing the behavior
in the next 6 months
- Interventions in this stage
should focus on:
Increasing awareness
Increasing the perception of seriousness of
the unhealthy behavior
Highlighting the benefits of adopting the
new behaviour
2. Contemplation Stage. People are at least
aware of the need to change their
behavior and are thinking about making a
change in the next 6 months. They are
weighing the pros and cons of the new
behaviour When the 2nd stage last for a
longer period, it is termed Behavioral
Procrastination.
Decisional Balance - weighing the pros
(perceived benefits of change) which act
as facilitators of change and the cons
(disadvantages) which act as barriers for
change
3. Preparation or Planning Stage. Once the
decision is made, people during this time,
plan to make the behavioral change in the
immediate future, often, within the next
month. The means by which they will
implement the change has been
identified. ( Nicotine patch)
- Most receptive to health educn
interv that are action oriented.
4. Action Stage. The person is actively
involved in the behavior change or in
adopting the new behavior.
5. Maintenance Stage. It begins after 6
months of adherence to the new behavior.
It is a period of constant attention to the
new behavior to prevent relapse.
Sustaining the new behavior can be
difficult especially when there are cues in
the environment that can trigger the old
behavior.
6. Termination Stage. When the new
behavior has become a habit. Behavior
change has been completed and
maintenance comes to an end when
temptation in problematic situations is no
longer a threat and the ability to resist
relapse has developed.
6. Negative transfer and positive transfer
a. POSITIVE TRANSFER - occurs when
present learning is enhanced by past
learning.
b. NEGATIVE TRANSFER - when past
learning interferes with present learning
7. Laws of Learning
a. The law of exercise or repetition. The
more often a stimulus-induced response is
repeated, the longer will it be retained. (N-
actual DR cases). A nurse develops the
expertise of handling actual delivery cases
if she repeatedly does it.
b. The law of effect. A response is
strengthened if followed by pleasure and
weakened if followed by displeasure.
Self-injection of insulin to patient
with DM will increase the pleasure in
injecting self if he is relieved of
hypergycemia.
c. The law of readiness. States that because
of the structure of the nervous system,
certain conduction units, in a given
situation, are more predisposed to
function than other parts of the body
system. Age and developmental tasks
proceed simultaneously such that reading
and writing skills can only be developed at
6 or 7 years of age.
8. Positive and negative reinforcement
a. Positive reinforcement – reward.
Enhances the likelihood that a response
will be repeated in similar circumstances.
ex. A patient groans and moans as he
attempts to get up and walk for the first
JJMC
 time after an operation, praise and
encouragement (reward) for his efforts at
walking (response) will improve the
chances that he will continue struggling
toward independence.
ex. A student who is praised or rewarded
with high grades after doing very well in
class will perform better than those who
are not praised
b. Negative reinforcement. This involves the
removal of an unpleasant stimulus
through either escape conditioning or
avoidance conditioning.
9. Domains of Learning
a. Cognitive domain (thinking) involves the
intellect, the acquisition of facts and data,
the understanding of information and how
that develops through application on a
scale that increases from basic recall to
complex evaluation and creation.
b. Affective domain (feeling) involves our
emotions toward learning and how that
develops as we progress from a low order
process, such as listening, to a higher order
process, like resolving an issue. Involves
changing attitudes, emotions and beliefs,
interests and appreciation. Used in making
judgments
c. The psychomotor domain (skill) involves
our physicality and how that develops
from basic motor skills to intricate
performance. Psychomotor (skill) domain.
Involves gaining motor skills. Uses physical
application of knowledge.
10. Paradigm shift in the role of the nurse
a. DOPE (Disease-oriented patient
education)
b. POPE (Prevention-oriented pt educ’n)
c. HOPE ( Health-oriented pt educ’n)
11. Historical development of health education
Prior to the coming of the religious orders
to the Phil., ‘arbularyos’ or local doctors had been
tending to the health needs of the community. They
were repositories of K of how to take care of one’s
health. With the coming of the religious orders, the
more informed way of treating the sick had been
institutionalized with the awarding of degrees in
nursing and medicine.
The religious sisters continued to be
nurses until lay individuals were able to secure
nursing degrees in the 1800’s.
FLORENCE NIGHTINGALE- the founder of modern
nursing, and the ultimate educator. She developed
the first school of nursing. She devoted a large
portion of her career to teaching nurses, physicians
and health officials about the importance of proper
conditions hospitals and homes to improve the
health of people.
By the early 1900’s, public health nurses
clearly understood the significance of the role of
the nurse as teacher in preventing disease and in
maintaining the health of society.
As early as 1918, the National League of
Nursing Education (in the US), now , the National
League for Nursing observed the importance of
health teaching as a function within the scope of
nursing practice
By 1950, the NLN had identified course
content in nursing school curricula to prepare
nurses to assume the role as teachers of others.
Most recently, the NLN developed the first certified
nurse educator (CNE) exam to raise “the visibility
and status of the academic nurse educator role as
an advanced professional practice discipline with a
defined practice setting” (2006)
Today, all Nurse Practice Acts (NPAs)
include teaching within the scope of nursing
practice responsibilities. Nurses, by legal mandate
of the NPAs , are expected to provide instruction to
consumers to assist them to maintain optimal levels
of wellness and manage illness.
In recognition of the importance of patient
education, by nurses, the Joint Commission (JC)
formerly the JCAHO, established nursing standards
for patient education as early as 1993. 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.
More recently, the JC has expanded its
expectations to include an interdisciplinary team
approach in the provision of patient education as
well as evidence that patients and their significant
others participate in care and decision making and
understand what they have been taught.
The Patient’s Bill of Rights, first developed
in the 1970’s by the American Hospital Association,
established the guidelines to ensure that patients
receive complete and current information
concerning their diagnosis, treatment and
prognosis in terms they can understand
The Pew Health Professions Commission
(1995) published a broad set of competencies it
believed would mark the success of the health
profession in the 21st century. More than half of
them pertain to the importance of patient and staff
education and to the role of the nurse as educator.
12. Health education
Refers to the act of providing information and
learning experiences for purposes of behavior
change for health betterment of the client. It is the
JJMC
 totality of experiences which favorably influence  Emphasize immediate benefit of learning
habits, attitudes, and knowledge relating to information
individual, community and racial health. Factors 15. Teaching strategies utilized in teaching older
that make learners vary adults.
• Assess for reading skills
13. Factors that make learners vary
• Frequent repetition
 Communication - the means by which culture is
• Demonstration
transmitted and preserved through the
• Discussion
generations. Cultural patterns consisting of
• Assess learning style and match with
verbal and nonverbal expression of each cultural
corresponding materials
group affect the way the group expresses ideas
• May need large print materials
and feelings, the way they make decisions, and
• Often a strong desire for independence;
the way they communicate. Educators must be
offer choices
cautious about assuming that a certain
• Chronic illness (arthritis) may impair
communication pattern can be generalized to all
mobility and dexterity
persons in a designated cultural group.
• Aging does not lead to an overall
 Space - an individual’s level of comfort is related
decreased intelligence
to personal space or distance, and discomfort is
experienced when one’s personal space is
invaded. A distance of 3 feet is usually acceptable
with individuals in the US, whereas a distance of
1-2 feet may be accepted in other cultures.
 Social Organization. How one acts in a certain
situation, is socially acquired or learned. Patterns
of cultural behavior are important to the teacher
because they provide explanations for people’s
behavior.
 Time. Refers to how time is viewed. Assisting
students to focus on beginning tasks on time and
sticking to a deadline to achieve a goal may be an
important cultural adjustment for someone
within a future time orientation.
 Environmental Control. Refers to a person’s
ability to plan activities that control nature. It also
refers to the person’s perception of his or her
ability to direct factors in the environment.
 Biological Variations. Educators should know that
learners from different background have genetic
biological differences that may affect their
classroom performance.

14. Teaching strategies utilized in teaching adolescents

 Printed mat’l at appropriate literacy level
 Understand the use of symbols
 Often seek approval by doing the “right”
thing
 Assess child’s reading ability
 Learning needs: safety, hygiene, nutrition,
socialization with peers
 Peer approval is important; group
sessions may be useful unless mat’l to be
taught is too threatening
 Role play
 Demonstration
 Maintain privacy
 Assess for and correct any misinformation
 A sense of invulnerability leads to an “it
can’t happen to me” attitude
JJMC