HEALTH EDUCATION

Perspective on Health Education,

Teaching and Learning
Course Description

This course deals with concepts, principles

and theories and learning. It also focuses
on the appropriate strategies of health
education as they apply in various health
care scenarios. The learners are expected
to develop beginning skills in designing
and implementing a teaching plan using
the nursing process as a framework.
(
(OVERVIEW) Historical Foundations for the
Teaching Role of Nurses

Florence Nightingale, the founder of

modern nursing, was the ultimate
educator.
-She also emphasized the importance of
teaching patients of the need for
adequate nutrition, fresh air, exercise,
and personal hygiene to improve their
well-being.
Historical Foundations for the Teaching
Role of Nurses
• By the early 1900's, public health nurses in the
country clearly understood the significance of the
role of the nurse as teacher in preventing disease
and in maintaining the health of society.
Historical Foundations for the Teaching Role
of Nurses
• As early as 1918, the National League of Nursing
Education (NLNE) in the United States (now the
National League for Nursing [NLN]) observed the
importance of health teaching as a function within
the scope of nursing practice.
• Two decades later, this organization recognized
nurses as agents for the promotion of health and
prevention of illness in all settings in which they
practiced (National League of Nursing Education,
1937).
Historical Foundations for the Teaching
Role of Nurses
• By 1950, the NLNE had identified course content in
nursing school curricula to prepare nurses to
assume the role as teaching others.
• In addition, the International Council of Nurses
(ICN) has long endorsed the nurse's role as educator
to be an essential component of nursing care
delivery.
• Today, all state nurse practice acts (NPA's) include
teaching within the scope of nursing practice
responsibilities.
Historical Foundations for the Teaching Role
of Nurses
• as early as 1993 the Joint Commission (JC) formerly
the Joint Commission on Accreditation of
Healthcare 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.
Historical Foundations for the Teaching Role
of Nurses
In addition, the Patient's Bill of Rights,
first developed in the 1970's by the American
Hospital Association, has been adopted by
hospitals nationwide.
Historical Foundations for the Teaching Role
of Nurses

Pew Health Professions Commission

(1995), influenced by the dramatic
changes surrounding health care,
published a broad set of competencies it
believed would mark the success of
health professions in the 21st century.
Historical Foundations for the Teaching
Role of Nurses

In 2006, the Institute for Healthcare

Improvement announced the 5 Million
Lives campaign. The campaign's
objective is to reduce the 15 million
incidents of medical harm that occur in
U.S. hospitals each year.
Historical Foundations for the Teaching
Role of Nurses
Another recent initiative was the formation of
Sullivan Alliance to recruit and educate staff nurses
to deliver culturally competent care to the public
they serve. This organization's goal is to increase the
racial and cultural mix of nursing faculty, students,
and staff, who will be sensitive to the needs of
clients of diverse backgrounds (Sullivan & Bristow,
2007)
Historical Foundations for the Teaching Role
of Nurses
Since the 1980's, the role of the nurse as educator
has undergone a paradigm shift, evolving from what
once was disease-oriented approach to a more
prevention-oriented approach.
-from Disease –Oriented Patient Education
(DOPE) to Prevention-Oriented Patient Education
(POPE)
Historical Foundations for the Teaching Role
of Nurses
The role of today's educator is one of training the
trainer---that is, preparing nursing staff through
continuing education, in-service programs, and staff
development to maintain and improve their clinical
skills and teaching abilities.
- Another important role 0f the nurse as educator is
serving as a clinical instructor for students in the
practice settings
 Concepts of teaching learning, education process
vis-à-vis nursing process for the teaching role of
the nurse

• Education process is a systematic, sequential.

logical, scientifically based, planned course of
action consisting two major interdependent
operations, which are the teaching and
learning.
• Forms a continuous cycle that also involves
two interdependent players, the TEACHER
AND THE STUDENT
• Education process is a framework for a
participatory, shared approach to teaching
and learning.
• Education process has always been compared
to nursing process
Education process parallels nursing process

Nursing Process EDUCATION PROCESS

ASSESSMENT
Appraise physical and ASCERTAIN LERNING NEEDS, Readiness to
psychosocial need to learn and learning styles

PLANNING
Develop care plan based on develop teaching plan
Mutual goal setting
IMPLEMENTA
Carry out nursing care TION perform the act of teaching
interventions

EVALUATION
Determine physical and determine behavior changes
psychosocial outcomes
Role of the nurse as educator
- promote learning and provide for an environment
conducive to learning
- Role of the nurse as teacher should stem from
partnership philosophy
- Nurse act as a facilitator
- The new educational paradigm focuses on the
learner learning that is the teacher becomes the
guide on the side,
- To increase comprehension recall, and
application of information, clients must e
actively involved in the learning experience
- Nurse serves as the coordinator of care
- assist colleagues in gaining knowledge and
skills necessary for the delivery of
professional nursing
LEARNING
THEORIES
Learning Theories

A. Behaviorist Learning Theory

-Focusing mainly on what is directly
observable .behaviorists view learning as the
product of the stimulus conditions (S) and the
responses (R) that follow
- sometimes termed the S-R model of learning
-– behaviors closely observe responses and then
manipulate the environment to bring about the
intended change.
Cont. behaviorist theory

-To modify people’s attitudes and response,

behaviorists either alter the stimulus
conditions in the environment or change
what happens after a response occurs.
Behaviorist Theories

1.John Watson Theory

- he define behavior as muscle movement
- he postulated that behavior is a result of a series of
conditioned reflexes, and all emotion and thoughts is a
result of behavior learned through conditioning
for example:
fear of a hot stove is learned when a child’s curiosity leads
him to touch a stove ( a stimulus followed by a response)
and he feels pain ( another stimulus and response),Because
of that innate fear of pain, the child now conditioned to
avoid touching the stove even when its cold.
2.Reinforcement Theory by Thorndike and Skinner
-proposed that stimulus- response bonds are strengthened
by reinforcements like reward or punishment
example;
same example of a child touching the stove. The child
learns to avoid the stove because the pain was negative
reinforcer for the behavior
- a behavior that is rewarded is more likely to occur
3.Operant Conditioning Model: Contingencies to increase
and decrease the probability of an organism’s response
I- To increase the probability of response
A. Positive reinforcement- application of pleasant stimulus
Reward Conditioning- a pleasant stimulus is applied
following an organism’s response
B. Negative Reinforcement- removal of an aversive or
unpleasant stimulus
Escape conditioning: as an aversive stimulus is anticipated
by the organism, which makes a response to avoid the
unpleasant event
II To decrease or extinguish the probability of a
response:
A. Non reinforcement : an organism’s conditioned
response is not followed by any kind of
reinforcement (positive, negative, or punishment)
B. Punishment: Following a response, an aversive
stimulus that the organism cannot escape or avoid
is applied.
Cognitive Learning Theory

B. Cognitive Learning Theory

-While behaviorists generally ignore the internal
dynamics of learning, cognitive learning theorists
stress the importance of what goes on inside the
learner.
-The key to learning and charging is the
individual’s condition (perception, thought,
memory, and ways of processing and structuring
information).
- Cognitive learning, a highly active process largely
directed by the individual, involves perceiving the
information into new insights or understanding
(Bandura, 2001); Hunt Ellis, & Ellis 2004.
- -maintain that reward is not necessary for learning.
More important are learner’s goals and
expectations, which create disequilibrium,
imbalance, and tension that motivate them to act.
Perspectives of Cognitive Learning
Theories
1.Information Processing Model of Memory
Functioning

Stimuli: attention, then is the key to learning. Thus,

if a client is not attending to what a nurse educator
is saying, perhaps because the client is weary or
distracted, it would be prudent to try the
explanation at another tine when he is more
receptive and attentive
In the second stage, the information is
processed by the senses. Here it becomes
important to consider the client’s preferred
mode of sensory processing (visual, auditory,
or motor manipulation) and t ascertain
whether there are sensory deficits.
In the third stage, the information is transformed
and incorporated (encoded) briefly into short-term
memory, after which it is either disregarded and
forgotten or stored in long-term memory
-Long-term memory involves the organization of
information by using a preferred strategy for storage
(e.g., imagery, association, rehearsal, or breaking
the information into units).
-The last storage involves the action or
response that the individual makes on the
basis of how information was processed and
stored
-In general, cognitive psychologists note that
memory processing and the retrieval of
information are enhanced by organizing
information and making it meaningful.
Nine events in cognitive processes that active effective learning
by Robert Gagne
:

•Gain the learner’s attention (reception)

•Inform the learner of the objectives and expectations (expectancy)
•Stimulate the learner’s recall of prior learning (retrieval)
•Present information (selective preparation)
•Provide guidance to facilitate the learner’s understanding (semantic
encoding)
•Have the learner demonstrate the information or skill (responding)
•Give feedback to the learner (reinforcement)
•Assess the learner’s performance (retrieval)
•Work to enhance retention and transfer through application and varied
practice (generalization)
C. Social Learning Theory
- proposed by Albert Bandura (1977)
- later renamed to Social Cognitive Theory
- first people learn as they are in constant reaction
with other environment.
Two concepts in Social Learning Theory
1. Role Modeling
2. Vicarious Reinforcement- involves determining
whether role models are perceived as rewarded or
punished for their behavior
Four Step Internal Process outline by Bandura
• -firstly, most learning occurs as a result of
observing other people’s behavior and its
consequences (rolemodeling)
• - second, attentional processes
determine which modelled behaviors will be
learned
- Third. Retention processes refers to the
ability retain modeled behaviors in
permanent memory.
- for retention to occur, must retain a mental
image of the modeled behavior (e.g picturing
skilled being carried out) or a verbal symbol
that is easily recalled (e.g an example is
remembering a numbered list of activities
involved in a skill)
- - rehearsal is seen as a significant way of
committing learned material to memory.
- -Bandura emphasizes that although
observation starts the learning process,
expertise is developed through practice with
external and internal feedback
- Motivation for learning will determine which
modeled behaviors are enacted.
- A person is motivated when he sees the
possibility of valued outcomes as opposed to
unrewarding or punishing outcomes.
- ex. An example of valued outcome as a
motivator is a situation in which a student always
hands assignments in early because each time he
receives praise from the teacher for doing so.
D.A Model of Adult Learning
- proposed by Malcolm Knowles (1984)
- crusaded for a model of education for adults that
was different from the education of children
- He adopted the term Andragogy – teaching of
adult
Pedagogy- teaching of children
Comparison Pedagogy to Andragogy
according to Knowles
PEDAGOGY ANDRAGOGY

NEED TO KNOW Learn what the teacher wants them to Need to know why they need to
learn learn something

Self Concept Perception of being dependent on the Feel responsible for their own
teacher for learning learning

Role of Experience s Adults learn when they need to

know

Readiness to learn Must be ready when the teacher says Ready to learn when they feel the
they must or they will not be promoted need to know

Orientation to learning Subject centered orientation Li-fe centered or task centered

orientation

Motivation Externally motivated Primarily internally motivated, with

some external motivation
•PRINCIPLES OF
TEACHING AND
LEARNING
Hallmarks of effective teaching in nursing

Six major categories in effective teaching

1.Professional Competence
-maintains and expands his knowledge through
reading, research, clinical practice, and continuing
education
2. Interpersonal relationship with students
- an effective teacher is skillful in interpersonal
relationship
3.Personal Characteristics
-qualities such as magnetism, enthusiasm, cheerfulness,
self-control, patience, flexibility, a sense of humour, a good
speaking voice, self- confidence, willingness to admit errors,
and caring attitude
4.Teaching Practices
-is defined as mechanics, methods and skills in
classroom and clinical teaching.
5.Evaluation Practices-
6.Availability to students
Principles of good teaching practice in
undergraduate education
.1Encourage student- faculty contact
2.Encourage cooperation among students
3.Encourage active learning
4. Give prompt feedback
5. Emphasize time on task
6. Communicate high expectation
7. Respect diverse talents and ways of learning
Barriers to education and obstacles to
learning
1.Lack of time to teach- greatest barrier
2.Many nurses and other healthcare personnel admit
that they don’t feel competent with their teaching
skills
3. personal characteristics of the nurse educator play
an important role in determining the outcome of a
teaching-learning interaction.
4.Low priority assigned to patient and staff education
by administration and supervisory personnel
5.Lack of privacy, noise and frequent interferences
due to client treatment schedules and staff work
6.Absence of third- party reimbursements to support
patient education
7. Some nurses and physician questions whether
health education is effective
8.The type of documentation system used by
healthcare agencies has an effect on the quality and
quantity of patient teaching.
Factors impacting ability to learn
1.Lack of time due to rapid patient discharge from care
2.The stress of acute and chronic illness
3.Low literacy and functional health literacy
4.The negative influence of the hospital environment
itself, resulting in loss of control, lack of privacy, and
social isolation
5.Personal characteristics of the learner
6.Lack of support an lack of ongoing positive
reinforcement from the nurse and significant others
7.Denialof learning needs, resentment of authority,
and lack of willingness to take responsibility
8.The inconvenience, complexity, inaccessibility,
fragmentation of healthcare system
Principles of learning
Learning is defined in as relatively permanent
change in mental processing, emotional
functioning, and/or behavior as a result of
experience.
It is a lifelong, dynamic process by which
individuals acquire new knowledge or skills and
alter their thoughts, feelings, attitudes, and actions.
-Learning enables individuals to adapt to demands
and changing circumstances and is crucial in health
care
- Learning theory- is a coherent framework of
integrated constructs and principles that describe ,
explain, or predict how people learn
Patient Education- is a process of assisting people to
learn health related behavior that can be
incorporated into everyday life with the goal of
optimal health and independence in self- care.
Staff Education- is the process of influencing the
behavior of nurses by producing changes in their
knowledge, attitudes, and kills, to help nurses
maintain and improve their competencies for the
delivery of quality care to the consumer.
Types of Learning

Gagne’s Condition of Learning( eight types of

learning)
1.Stimulus -Response Learning- involves a voluntary response to a
specific stimulus or combination of stimuli
example; nursing student learning to monitor an intravenous solution.
2. Signal Learning or the conditioned response- the person develops a
general diffuse reaction to a stimulus
Example; a nursing aide student may feel fear every time the term skill
test is mentioned because he fear whenever taking an actual skill
test. Because of the association, just the term skill test is enough to
evoke fear. The words have become the signal that elicits response
3.Chaining- is the acquisition of a series of related
conditioned responses or stimulus- response
connections.
Ex. The nursing student is told to monitor the IV line
and fit he line is not dripping , first is open the
clamp further. If the action is not successful,
checking the line for a return back flow is in order.
4.Verbal Association- is a type of chaining and is easily recognized in
the process of learning medical terminology.
5. Discrimination Learning
- a great deal can be learned through forming large numbers of
stimulus- response or verbal response chains. However the, the more
new chains that are learned, the easier is to forget previous chains.
To learn and retain large numbers of chains , the person has to be
able to discriminate among them.
6.Concept Learning- is learning how to classify stimuli into
groups represented by a common concept.
7.Rule Learning
- a rule can be considered a chain of concepts or a
relationship between concepts.
- rules generally expressed as “ if … then” relationships.
8. Problem solving-
- to solve a problem the learner must have a clear idea of
the problem or goal being sought and must be able to recall
and apply previously learned rules that relate to situation.
Learning Styles of different age group

Learning styles refers to the ways in which,

and conditions under which, learners most
efficiently and most effectively perceive,
process, store, and recall what they are
attempting to learn (James & Gardner, 1995)
and how they prefer to approach different
learning tasks .
Keefe (1979) defines learning styles as the
way the learners learn, taking into account
cognitive, affective, and physiological factors
that affect how learners perceive, interact
with, and respond to the learning
environment.
Six Learning Style Principles
1.Both the style by which the educator prefers to teach and the style by
which the learner prefers to learn can be identified.
2.Educators need to guard against relying on teaching methods and tools
that match their own preferred learning styles.
3.Educators are most helpful when they assist learners in identifying and
learning through their own style preferences.
4.Learners should have the opportunity to learn through their preferred
style.
5.Learners should be encouraged to diversify their style preferences.
6.Educators can develop specific learning activities that reinforce each
modality or style.
• 
 Learning Style Models
1. Right-Brain/Left-Brain and Whole-Brain Thinking
-The left hemisphere of the brain was found to be
the coal and analytical side, which is used for
verbalization and for reality-based and logical
thinking.
-The right hemisphere was found to be the
emotional, visual-spatial, and nonverbal side, with
thinking processes that are intuitive, subjective,
relational, holistic, and time free.
2. Field-Independent/Field-Dependent Perception
-An extensive series of studies by Witkin, Olman,
Raskin, and Karp (1971b) identified two styles of
learning in the cognitive domain, which are based
on the bipolar distribution of characteristic of how
learners process and structure information in their
environment
CHARACTERISTICS OF FIELD-INDEPENDENT AND FIELD-DEPENDENT
LEARNERS
A. Field-Independent Learners
• Are not affected by criticism
• Will not conform to peer pressure
• Are less influenced by external feedback
• Learn best by organizing their own material
• Have an impersonal orientation to the world
• Place emphasis on applying principles
• Are interested in new ideas or concepts for own sake
• Provide self-directed goals, objectives, and reinforcement
• Prefer lecture method
B. Field-Dependent Learners
• Are easily affected by criticism
• Will conform to peer pressure
• Are influenced by feedback (grades and evaluations)
• Learn best when material is organized
• Have a social orientation to the world
• Place emphasis on facts
• Prefer learning to be relevant to own experience
• Need external goals, objectives, and reinforcements
• Prefer discussion method
C. Dunn and Dunn Learning Styles( Rita and Kenneth
Dunn )
- assist educators in identifying those
characteristics that allow individuals to learn in
different ways
-The model includes motivational factors, social
interaction, and physiological and environmental
elements
Dunn and Dunn five basic stimuli that affect a person’s ability to
learn;
1. Environmental elements (such as sound, light, temperature, and
design), which are biological in nature.
2.Emotional elements (such as motivation, persistence, responsibility,
and structure), which are developmental and emerge over time as an
outgrowth of experiences that have happened at home, school, play,
or work.
3.Sociological patterns (such as the desire to work alone or in groups
or a combination of these two approaches), which are thought to be
socio culturally based.
4.Physical elements (such as perceptual
strength, intake, time of day, and mobility),
which are also biological in nature and relate
to the way learners function physically.
5.Psychological elements (such as the way
learners process and react to information),
which are also biological in nature.
Terms used in Dunn and Dunn model and its meaning
1.Sound
Individuals react to sound in different ways some need complete
silence, others are able to block out sounds around them, and still
others require sound in their environment for learning.
2. Light some learners work best under bright lights, whereas others
need dim or low lighting.
3. Temperature some learners have difficulty thinking or concentrating
if a room is too hot or, conversely, if it is too cold.
4.Design
- when learners are seated on wooden, steel, or plastic chairs, 75% of
the total body weight is supported on only four square inches of
bone.
This results in fatigue, discomfort, and the need for frequent body
position changes
-some learners are more relaxed and can learn better in an informal
environment by being able to position themselves in a lounge chair,
on the floor, on pillows, or on carpeting. Others cannot learn in an
informal environment because it makes them drowsy.
THE EMOTIONAL ELEMENTS
1.Motivation
-or the desire to achieve, increases when learning success increases.
Unmotivated learners need short learning assignments that enhance
their strengths.
2. Persistence
Learners differ in their preference to complete tasks in one sitting or
to take periodic breaks and return to the task at a later time.
3. Responsibility
-involves the desire to do what the learner thinks is
expected. It is related to the concept of conformity or
following through on what an educator asks or tells
the leaner to do.
4. Structure
-refers to either the preference for specific
directions, guidance, or rules prior to carrying out an
assignment or the preference for doing an assignment
without structure in the learner’s own way.
 THE SOCIOLOGICAL ELEMENTS
1.Learning Alone
-Some learners prefer to study by themselves, whereas others refer
to learn with a friend or colleague.
2.Presence of an Authority Figure
- Some learners feel more comfortable when someone with
authority or recognized expertise is present during learning.
3.Variety of Ways
-Some learners are flexible and can learn as well alone as they can
with authority figures and peer groups.
• THE PHYSICAL ELEMENTS
1.Perceptual Strengths
Four types of learners are distinguished in this category:
a. Those with auditory preferences.
b. Those with visual preferences
c. Those with tactile preferences
d. Those with kinesthetic preferences
 INTAKE
Time of Day
 a. Early-morning learners
b. Late-morning learners
c. Afternoon learners
d. Evening learners
 Mobility
Mobility refers to how still the learner
can sit and for how long a period of
time.
 
 THE PSYCHOLOGICAL ELEMENTS
1.Global Versus Analytic
- some learners are global in their thinking and learn best
by obtaining meaning from a broad, overall concept
before focusing on the details in the surrounding
environment.
2. Hemispheric Preference
-Learners who possess right-brain
preference tend to learn best in
environments that have low illumination,
background music, casual seating, and
tactile instructional resources.
3. Impulsivity Versus Reflectivity
-Impulsive learners prefer opportunities to
participate verbally in groups and tend to answer
questions spontaneously and without consciously
processing their thinking.
-Reflective learners seldom volunteer information
unless they are asked to do so, prefer to
contemplate information, and tend to be
uncomfortable participating in group discussions.
The Educator’s Role in Learning

The educator plays a crucial role in the learning process by:

• Assessing problems or deficits.
• Providing important information and presenting it in unique and
appropriate ways.
• Identifying progress being made.
• Giving feedback and follow-up.
• Reinforcing learning in the acquisition of new knowledge, skills, and
attitudes.
• Evaluating learners’ abilities.
Determinants of Learning

1.Assessment of the Learner

Nursing assessment of learners’
needs, readiness, and styles of learning
is the first and most important step in
instructional design – but it is also the
step most likely to be neglected.
Three determinants in the assessment
of the learner
1. learning needs – what the learner
needs and wants to learn.
2.Readiness to learn – when the learner
is receptive to learning.
3.Learning style – how the learner best
learns.
2. Assessing Learning Needs
Learning needs are defined as gaps in knowledge
that exist between a desired level of performance
and the actual level of performance
A learning need is the gap between what someone
knows and what someone needs or wants to know
- Such gaps exist because of a lack of knowledge,
attitude, or skill.
3.LEARNER’S CHARACTERISTCS
Important steps in the assessment of learning needs:
1.Identify the learner. Who is the audience?
2.Choose the right setting. Establishing a trusting environment
will help learners feel a sense of security in confiding
information, believe their concerns are taken seriously and
considered important, and feel respected.
3.Collect data about the learner. Once the learner is
identified, the educator can determine characteristic needs
of the population by exploring typical health problems or
issues of interest to the population.
4. Collect data from the learner.
Learners are usually the most important source
of needs assessment data about themselves. Allow
the patient and/or family members to identify what
is important to them, what they perceive their
needs to be, what types of social support systems
are available, and what assistance these supports
can provide.
5. Involve members of the healthcare team.
Other healthcare professionals will likely
have insight into patient of family needs or
the educational needs of the nursing staff or
students as a result of their frequent contacts
with consumers as well as caregivers.
6. Prioritize needs.
A list of identified needs can become
endless and seemingly impossible to
accomplish. Maslow’s (1970) hierarchy of
human needs may help the educator with
prioritizing so that the learner’s basic needs
are attended to first and foremost before
higher needs can be met.
7. Determine availability of educational
resources.
A need may be identified, but it may be
useless to proceed with interventions if the
proper educational resources are not
available, are unrealistic to obtain, or do not
match the learner’s needs.
8.Assess demands of the organization.
This assessment will yield information
that reflects the climate of the
organization.
9.Take time-management issues into
account.
Learner’s Characteristics that influence a
client’s ability, motivation, and desire to
learn:
1.Culture
2.Literacy
3. Age
4.Education Level and Health status
5.Socioeconomic level
 CRITERIA FOR PRIOPITIZING LEARNING
NEEDS
1.Mandatory:
Needs that must be learned for survival or
situations in which the learner’s life of safety is
threatened. Learning needs in this category must
be met immediately. For example, a patient who
has experienced a recent heart attack needs to
know the signs and symptoms and when to get
immediate help.
2. Desirable
Needs that are not life dependent but are
related to well-being or the overall ability to provide
quality care in situations involving changes in
institutional procedure.
For examples:
It is important for patients who have
cardiovascular disease to understand the effects of
a high-fat diet on their condition.
3. Possible:
Needs for information that are nice
to know but not essential or required or
situations in which the learning need is
not directly related to daily activities.
•
 
 Methods to Access Learning Needs
1.Informal Conversations
• Often learning needs will be discovered
during impromptu conversations that take
place with other healthcare team members
involved in the cared of the client, and
between the nurse and the patient or his or
her family
2. Structured Interviews
• The structured interview is perhaps the most
common form of needs assessment to solicit
the learner’s point of view. The nurse asks
the learner direct and often predetermined
questions to gather information about
learning needs.
3. Focus Groups
Focus groups involve getting together a small
number (4 to 12) of potential learners to
determine areas of educational need by using
group discussion to identify points of view or
knowledge about a certain topic.
4. Self-Administered Questionnaires
• The learner’s written responses to questions
about learning needs can be obtained by
survey instruments. Checklists are one of the
most common forms of questionnaires.
5.  Test
Giving written pretests before teaching is
planned can help identify the knowledge
levels of potential learners regarding a
particular subject and assist in identifying
their specific learning needs.
6. Observations
•Observing health behaviors in several
different time periods can help to
determine conclusions about
established patterns of behavior that
cannot and should not be drawn from a
single observation
7. Patient Charts
•Physicians’ progress notes, nursing care
plans, nurses’ notes, and discharge
planning forms can provide information
on the learning needs of clients.
Readiness to Learn
Once learning needs have been identified, the next step is to
determine the learner’s readiness to receive information.
Readiness to learn- can be defined as the time when the learner
demonstrates an interest in learning the information necessary to
maintain optimal health or to become more skillful in a job.
-Observations, conducting interviews,
gathering information from the learner as
well as other healthcare team members, and
reviewing written data in charts.
Timing—that is, the point at which teaching
should take place—is very important.
Learning Styles of different age group

Learning styles refers to the ways in which,

and conditions under which, learners most
efficiently and most effectively perceive,
process, store, and recall what they are
attempting to learn (James & Gardner, 1995)
and how they prefer to approach different
learning tasks .
 Learning Styles of Different age groups
Introduction
• When planning, designing, and implementing an
educational programme, the nurse educator must
consider the learners’ developmental stage in life.
• An individual’s developmental stage significantly
influences the ability to learn.
• At each developmental period throughout the life,
the educator must take into account the three
major stage-range factors associated with the
learner’s readiness – physical, cognitive, and
psychosocial maturation.
100
• When planning, designing, and implementing an
educational programme, the nurse educator must
consider the learners’ developmental stage in life.
• An individual’s developmental stage significantly
influences the ability to learn.
• At each developmental period throughout the life, the
educator must take into account the three major stage-
range factors associated with the learner’s readiness –
physical, cognitive, and psychosocial maturation.

101
• Identify the physical, cognitive, and psychosocial
characteristics of learners that influence learning at
various stages of growth and development
• Recognise the role of the nurse as educator in
assessing stage-specific learner needs according to
maturational level
 The Developmental Stages of Childhood

Within childhood, there are four stages.:

• infancy- toddlerhood (0-3 years),
• preschooling (approx. 3-6 years),
• school-aged childhood (approx. 6-12),
• and adolescence (approx. 12-18).

• Pedagogy is the art and science of helping children

to learn.

• Throughout childhood, learning is subject-centred.

.
103
 Teaching Strategies During Infancy and Toddlerhood
• Patient education need not be illness-related. Less time
should be devoted to teaching parents about illness
care. More attention should be given to teaching
parents about normal development, safety, health
promotion, and disease prevention.
• If the child is ill, assessment of the child’s and parents’
anxiety levels and helping them cope with their stress
represent the first priority for teaching intervention.
This is because anxiety negatively impacts on readiness
to learn.
• Health teaching should take place at home or day-care
centre. During hospitalisation, teaching should take
place in safe and secure environment.
104
• The following teaching strategies are suggested for
short-term learning:
• Read simple stories from books with lots of pictures
• Use dolls to act out feelings and behaviours
• Use simple audiotapes with music and videotapes
with cartoon characters
• Role-play to bring the child’s imagination closer to
reality
• Perform procedures on a doll to help the child
understand what an experience would be like
• Keep teaching sessions brief (5 minutes) and close
together

105
Adolescent (ages 12-19)

• Marks the transition from childhood to adulthood.

• Are known to be among the nations' most at risk
populations (American Association of Colleges of
Nursing,1994)
Physical, Cognitive & Psychosocial
Development
• Adolescents vary greatly in their
biological ,psychosocial, social, and cognitive
development.
• They must adapt to rapid, dramatic, and significant
bodily changes , which can temporarily results in
clumsiness and poorly uncoordinated movements.
• Alterations in physical size, shape and function of
other bodies , along with the appearance and
development of secondary characteristics.
• Bring about a significant preoccupation with their
appearance and a strong desire to express sexual
urges. (Santrock,2006; Vander Zanden et al., 2007)
• Piaget (1951,1952,1976) termed this stage of
cognitive development as a period of formal
operations.
• Adolescents are able to hypothesize and apply the
principles of logic to situation never encountered
before.
 EGOCENTRISM

• With this capacity ,teenagers can become

obsessed with what they think as well as
what others are thinking, a characteristic
known as adolescent egocentrism.
 IMAGINARY AUDIENCE

• ELKIND (1984) labeled this belief as the

imaginary audience, a type of social thinking
that has considerable influence over an
adolescents behavior.
• Adolescents are able to understand the concept of
health illness , the multiple causes of disease ,the
influence of variables on health status ,and the
ideas associated with health promotion and health
prevention.
• They can also identify health behaviors but may
reject practicing them or begin to engage in risk-
taking behaviors because of the social pressures
they receive from peers as well as their feelings of
invincibility.
 PERSONAL FABLE

The personal fable leads adolescents to

believe that they are vulnerable—other
people grow old and die , but not them;
other people may not realize their personal
ambitions ,but they will.
• Erikson (1968) has identified the psychosocial
dilemma adolescents face as one of identity versus
role confusion.
• Teenagers have a strong need for belonging to a
group ,friendship peer acceptance and peer
support.
 TEACHING STRATEGIES

• An estimated number of 20% of the united

states teenagers have at least 1 serious
health problem such as asthma, learning
disabilities, eating disorder ( e.g., obesity,
anorexia, or bulimia) diabetes, a range of
disabilities as a result of injury ,or
psychological problems as a result of
depression or physical and/ or emotional
maltreatment.
• Accident- 50% are results from motor
vehicles.
• Homicide
• Suicide
 T-TERM LEARNING

• Use one on one instruction to ensure confidentiality

of sensitive information.
• Choose peer group discussion sessions as an
effective approach to deal with health topics as
smoking, alcohol and drug use, safety measures,
teenage sexuality.
• Use face to face or computer group discussion, role-
playing, and gaming as methods to clarify values
and problem solve, which feed into the teenager’s
need to belong and to be actively involved.
• Employ adjunct instructional tools, such as complex models,
diagrams, and specific, detailed written materials, which can
be used competently, by many adolescents.
• Clarify any scientific terminology and medical jargon used.
• Share decisions making whenever possible because control
is an important issue for adolescent.
• Include them in formulating teaching plans related to
teaching strategies, expected outcomes, and determining
what to be learned and how it can best be achieve d to meet
their needs for autonomy.
• Suggest options so that they feel they have a choice
about courses of action.
• Give rationale for all that it is said and done to help
adolescents feel a sense of control.
• Approach them with respect, tact, openness, and
flexibility to elicit their attention and encourage
their responsiveness to teaching-learning situation.
• Expect negative responses, which are common
when their self-image and self integrity are
threatened.
• Avoid confrontation and acting like an
authority figure.
 LONG-TERM LEARNING

• Accept adolescents personal fable and imaginary

audience as valid, rather than challenging their
feelings of uniqueness and invincibility.
• Acknowledge that their feelings are very real
because denying them their opinions simply will not
work.
• Allow them the opportunity to test their own
convictions.
ADULT

• Young adult stage

(20-40 Years of Age)
• Middle-aged adult stage
(40-64 Years of age)
• Older adult stage
(65 Years of Age and above)

Andragogy – is the art and science of

teaching adults.
Adult learn best when:
• Learning is related to an immediate need,
problem, or deficit.
• Learning is voluntary and self-initiated.
• Learning is person centered and problem
centered.
• Learning is self-controlled and self-
directed.
• The role of the teacher is one of
facilitator.
• Information and assignments are pertinent.
• New materials draws on past experiences and
is related to something the learner already
knows.
• The threat to self is reduced to a minimum
in the educational situation.
• The learner is able to participate actively
in the learning process.
• The learner is able to learn in a group.
• The nature of the learning activity changes
frequently.
• Learning is reinforced by application and
prompt feedback.
Young Adulthood(20-40 Years of Age)
Physical, Cognitive, and Psychosocial Development
Physical – During this this period, physical
abilities for most young adults are at their peak,
and the body is at its optimal functioning
capacity.
Cognitive – the cognitive capacity of young adults
is fully developed, but with maturation, they
continue to accumulate new knowledge and skills
from expanding reservoir of formal and informal
experiences.
Psychosocial – Erikson describes the young adult’s
stage of psychosocial development as the period of
intimacy versus isolation.
Teaching Strategies
The nurse as educator must find a way of
reaching and communicating with this
audience about health promotion and disease
prevention measures.
It is important for the nurse as educator
to allow them the opportunity for mutual
collaboration in health education decision
making.
They should be encouraged to select what
to learn, how they want material to be
presented and which indicators will be used
to determine the achievement of learning
goals.
It is important to draw on their
experiences to make learning
relevant, useful, and motivating.
Making them aware of health issues
and learning opportunities can
occur in a variety of settings,
such as physicians’ offices,
community clinics, outpatient
departments, or hospitals.
Group discussion is an attractive method
for teaching and learning because it
provides young adults with the opportunity
to interact with others with similar age
and situation.
 Middle-Aged
Adults ( 41-64 yrs.
old)
 Middle-Aged Adults
It is the years of stability and consolidation
It is the time when children have grown and moved
away from home.
They have time to share their talents, serves as
mentors for others and pursue new interests.
It is the time wherein they are mature enough to
assume responsibility in a realistic manner and make
decisions for themselves.
Physical development

During this stage of maturation, a number of

physiological changes begin and others affect
middle-aged adults self-image, ability to
learn, and motivation for learning about
health promotion, disease prevention and
maintenance of health.
The menopausal period
Menopause
 refers to the so-called change of life in
women

Andropause (climacteric)
 denote the change in sexual response in
men
Psychosocial development

Generativity versus Stagnation

(Erikson, 1963)
Developing all the factors that may cause
them to become aware of their own mortality.
The later years are the phase in which
productivity and contributions to society are
valued.
It is also the years of retirement
Cognitive development

Formal operations
Piaget maintained that cognitive development stopped with this
stage that was achieved during adolescence.

Postformal operations
the adult thought processes go beyond logical problem solving.
Dialectical thinking
It is the ability to search for complex and
changing understanding to find a variety of
solutions to any given situation or problem.
Teaching Strategies for Middle-
Aged Adults
Midlife crisis issues :

Menopause
Physical changes in their bodies
Own parents declining health status
How finite their life really is
 OLDER ADULTHHOOD
(65 Years of Age and Oder)
PHYSICAL, COGNITIVE, AND PSYCHOSOCIAL
DEVELOPMENT
Physiological Changes

• The senses of sight, hearing, touch, taste and smell are

usually the first areas of decreased functioning noticed
by adults.

• The perceptive abilities that relate most closely to

learning capacity are visual and auditory changes.

• Physiological changes affect organ functioning and result

in decreased cardiac output, lung performance and
metabolic rate.
Cognitive changes
Two kinds of intellectual ability
- Crystallized intelligence
- Fluid intelligence

Psychosocial Changes

• Erikson (1963) labeled the major psychosocial

developmental task at this stage in life as ego
integrity versus despair.
Teaching strategies :
Physical Needs

1. To compensate for visual changes, teaching should

be done in an environment that is brightly lit but
without glare.
• Visual aids should include large print, well-spaced
letters, and the use of primary colors.
• Use white or off-white, flat matte paper and black
print for posters, diagrams, and other written
materials.
• Because of older persons’ difficulty in
discriminating certain shades of color, avoid blue,
blue-green and violet hues.
• Additional accommodations should be made to
meet physical needs, such as arranging seats so
that the learner is reasonably close to the
instructor and to any visual aids that may be used.
• For patients who wear glasses, be sure they are
readily accessible, lenses are clean, and frames are
properly fitted.
2. To compensate for hearing losses, eliminate extra
noise, avoid covering your mouth when speaking,
directly face the learner and speak slowly.
• Female instructors should wear bright lipstick, and
male teachers can wear lip gloss.
• Low –pitched voices are heard best, but do not drop
your voice at the end of your words or phrases.
• When addressing a group, microphones are useful
aids.
• Ask for feedback from the learner to determine
whether you are speaking too softly, too fast or not
distinctly enough.
3. to compensate for musculoskeletal problems,
decreased efficiency of the cardiovascular systems,
and reduced kidney functions.
• Keep sessions short, schedule frequent breaks to
allow for use of bathroom facilities.
• Allow time for stretching to relieve painful, stiff
joints and to stimulate circulation.
• Also provide comfort seating.
Cognitive needs

• 1. to compensate for a decrease in fluid

intelligence, provide older persons with more
opportunity to process and react to information
and to see relationships between concepts.
• Wait for a response before introducing a new
concept or word definition.
• For decrease short-term memory, coaching and
repetition are very useful strategies that assist with
recall.
2. be aware of the effects of medications and
energy levels on concentration, alertness and
coordination.
3. be certain to ask what an individual already
knows about a healthcare issue or technique
before explaining it.
4. Find out about older persons’ health habits
and beliefs before trying to change their ways
or teach something new.
Psychosocial needs

1. assess the family relationships to determine how

dependent the older person is on other members for
financial and emotional support.
• With permission to the patient, include the family members in
teaching sessions enlist their support.
2. determine availability of resources.
3. encourage active involvement of older adults to improve
their self-esteem and to stimulate them both mentally and
socially.
Developing a Course Outline or syllabus

A course outline or syllabus is considered a contract between the

teacher and the learner.
- Follow what’s in the outline
- To protect you legally, you may include in the statement at the end of
the outline that state changes in course material or evaluation may b
necessary at times. But the learners will be notified in writing of
changes
General guidelines in formulating course outline
Course outline should include the :
1.Course
2.Name of the Instructor
3.A one- paragraph course description
4.And a list of objectives
5.Topical outline
6.Teaching methods to be used
7.textbook or other readings
8. Methods of evaluation
9.Classroom policy if necessary
Developing of Teaching Plans

Teaching plan –it is a blueprint to achieve the

goal and the objectives that have been
developed.
Developing a teaching plan:
1.Elements
2. Objectives
3.Strategies and Methodologies
4.Resources
5.Evaluation
The following example of consistency among the
first three elements of teaching plan:
Purpose: To provide mothers of male newborns with
the information necessary to perform post
circumcision care .
Goal : The mother will independently manage post
circumcision care for her baby boy.
Objective : Following a 20 minutes teaching session,
the mother will be able to demonstrate the
procedure for post circumcision
Taxonomy of Objectives by Bloom (1984)
1.Cognitive (knowing)
- you can measure knowledge, comprehension,, application,
analysis, synthesis, and evaluation by written or oral test
2.Psychomotor (doing)
- you can observe what the learners are actually doing when they
perform a skill
- learners can demonstrate what they’ve learned and you can rate
their performance
3.Affective ( feeling,valuing)- not easy to measure
Eight Basic Elements of Teaching Plan:
1. Purpose (the why of the educational session)
2. Statement of the overall goal
3. List of Objectives
4. An outline of the content to be covered in the teaching session
5. Instructional Method (s) used for teaching related content
6. Time allotted for the teaching of each objective
7. Instructional resources (materials, tools and
equipment)needed
8. Method (s) used to evaluate learning
Formulating Objectives
Write objective that the meaning is not just for you
but also for the learners
Objectives should reflect what the learner is
supposed to do with what is taught
The value of objectives
1.You need to guide you in your selection and handling of course
materials
2.Need objectives to help you determine whether people in the class
have learned what you have tried to teach
3.Objectives are essential from the learners perspective.
Wording of the objective
- Should contain the following
1.Intended learner
2.The behavior to be performed
3. The conditions under which it is performed
4. And the expected degree of attainment of specific standards

Ex. The nurse will list and explain, with 95 percent accuracy, the
parameters by which effective hemodialysis is measured
Behavioral Verbs Useful for Writing Objectives
Cognitive domain
Knowledge: define, delineate, describe, identify, list, name, state
Comprehension; Classify, discuss, estimate, explain, rephrase,
summarize
Application; Adjust, apply, compute, demonstrate, generate, prove
Analysis: Analyze, compare, contrast, critique, defend, differentiate
Synthesis; create, develop, propose, suggest, write,
Evaluation: assess, choose, conclude, defend, evaluate, judge

Psychomotor domain: Arrange, assemble, calibrate, copy, correct,

create, demonstrate, execute, show, sole, position

Affective ; Accept, agree, choose, comply, defend, explain, influence

integrate, recommend, resolve, volunteer
Selecting content
- The general guidelines for course content are usually prescribed by
the curriculum of the school, health agency or proprietary agency
- -it is generally left to instructors discretion to determine exactly what
to include on Particular topic and what can safely be skipped
Guidelines in selecting content
1.How much information you should include and into how much detail
you should go
- how much time you can devote to the topic
- kind of background the students have
2.Plan the it out and then rehearse it orally
Selecting teaching Methods

- Selection of teaching methods is one of

the most complex parts of teaching yet
it receives the least attention in
instructional planning
Factors affecting Choice of Method
1.Selection of methods depends on the objectives and type of learning
you are trying to achieve
2.Course content also dictates methodology to some extent
3.Choice of teaching strategy depends on the abilities and interests of
the teacher
4.Compatibility between teachers and teaching methods is important
5.Number of people in the class
6.Educators instructional options are limited to resources of the
institution
Teaching Strategies and Methodologies

1.Traditional Teaching Strategies

A. lecturing
a. traditional oral essay
b. participatory lecture
c. lecture with uncompleted handouts
d. the feedback lecture
e. mediated lecture
B. Discussion – formal or informal
C. Questioning
D. Using Audiovisuals- handouts, chalkboards/whiteboards, overhead
transparencies, slides, videotapes,
E. Interactive Lecture- combination of above strategies
2.Activity –Based Learning Strategies
a. cooperative learning-.learners work together and are
responsible for not only their own learning but also for the learning of
other group members.
b. Simulations - controlled representations of reality. They are
exercises that learners engage n to learn the real world without the
risks of the real world.
b.1 Simulation Exercises- : A controlled presentation of a
piece of reality that learners can manipulate to better understand the
corresponding real situation
 b. 2 Simulation Game: A game that represents real-life situations
in which learners compete according to set of rules in order to win or
achieve an object.
b.3 Case study- An analysis of an incident or situation in which
characters and relationships are described , factual, or hypothetical
events transpire, and problems need to b resolved or solved.
b.4 role playing- it is a form of drama in which learners
spontaneously act out roles in an interaction involving problems or
challenges in human relations
b.5 Demonstration and Return Demonstration – Demonstration by
educator ,return demonstration by the learner
C. Team Based Learning- -offers educators a structured, student
centered learning environment.it meant to enrich the student’s
learning experience through active learning strategies.
D. Seminars
E. One –to-one- Instruction- (formal or non formal) involves face to
face delivery of information specifically designed to meet the needs of
an individual learner.
3.Self –Learning Modules or Self Directed learning Modules, Self –
paced learning modules – a self contained
Choosing A textbook
-texts should provide a stable and uniform source of information for
students to use in their individual study
When choosing a textbook evaluate the content scope and quality,
credibility of authorship, format, and issues like cost, permanency,
quality of print, and the like
- Examine book’s appearance
- Consider in which the book will be used.
- Consider the use of the textbooks
Conducting the class

-Introduce yourself
- Tell the class about yourself
- Establish a pleasant environment by welcoming the class, reading
names and getting correct pronunciation
- Make sure that everyone gets the handout and commiserating about
the early or late hour, the weather the parking
- A little humor is helpful
The first session is the best time to communicate your expectations for
the course
- Review the course syllabus or the course content and take time to
answer questions about content, methods, and assignments
- - give the class general idea of workload and your expectations in
terms of preparation for class and in terms of learning outcomes
- -cover general classroom rules
- - communicate your enthusiasm for the subject by the end of the first
class
Subsequent classes
- Begin by controlling the attention of the learners before you start to
teach (whistle or a look)
- Walk around the periphery of the room instead of standing behind
the desk or lectern
- Assess the learners to determine backgrounds and how much they
already know about the content course
-
Techniques to enhance the effectiveness of verbal
presentations:
1.Present Information enthusiastically
2.Include Humor
3. Exhibit Risk-Taking Behavior
4.Serve as a Role Model
5.Use Anecdotes and Examples
6. Use technology
General Principles for Teaching Across Methodologies:
• 1.Give positive reinforcement
• 2. Project an attitude of acceptance and sensitivity
• 3.Be organized and give direction
• 4.Elicit and give feedback
• 5.Use Questions
• 6.Use the teach –back or tell-back strategy
• 7.Know the audience
• 8.Use repetition and pacing- pacing refers to the speed at which
information is presented
• 9.Summarize important points
4.Resources or instructional materials- the
tools used in educational lessons, which
includes active learning and assessment.
Basically, any resource a teacher uses to help
him teach his students is an instructional
material.
Three major variables in selecting instructional
materials (LMAT)
1.Charactersitics of the learner
2.Characteristics of the medium
3.Characteristics of the task
Types of Instructional Materials
1.Written Materials- handouts such as leaflets,
books, pamphlets, and instruction sheets
2.Commercially Prepared Materials-
br0chures,posters, pamphlets,
3.Self-Composed Materials -
Evaluation
- summative
- formative

Documentation
Ethico-Moral and Legal Foundations of
Client Education
Definition of Terms

Ethics- refers to the guiding principles of behavior

- it is the area of philosophic study that examines
values, actions and choices to determine right and
wrong.
- It is defined as a system or valued behaviors and
beliefs that governed conduct appropriate for all
members of a group to ensure the rights of an individual.
Ethical – refers to norms or standards of behaviours
accepted by the society to which a person belongs
• Moral Values- refer to internal belief system
• Ethical dilemmas – specific type of moral
conflict in which two or more ethical
principles apply but mutually inconsistent
course of action
Legal Rights and Duties – refer to rules governing behaviors or conduct
that are that are enforceable by law under threat of punishment or
penalty, such as a fine, imprisonment or both.
Practice Acts- are documents that define a profession, describe that a
profession’s scope of practice, described that profession’s scope of
practice and provide guidelines for state professional boards of nursing
regrading standards for practice, entry into a profession via licensure,
and disciplinary actions that can be taken when necessary.
Code of Ethics for Nurses
1.Honorthe human dignity of all patients and
coworkers
2.Establish appropriate nurse- patient boundaries,
and focus on interdisciplinary collaboration
3. The nurse-patient relationship is grounded in
privacy and confidentiality
4. The nurse is accountable for the personal actions
and the behaviors of those persons to whom the
nurse has delegated responsibilities
5.The nurse is responsible of maintaining competence ,preserving
integrity and safety, and continuing personal growth
6. The nurse has a responsibility to deliver high quality care to patients
7.The nurse contributes to the advancement of the profession
8.The nurse participates in global efforts for both health promotion
and disease prevention
9.Involvement in professional nursing organizations supports the
development of social policy.
In order to provide universality on the
practice of code of ethics, the Internal
Council of Nurses made a code of ethics
that served as the basis of standard of
practice of nurses worldwide. This was
first adopted in 1953 and recently
revised in 2006.
•The Code of Ethics for Filipino
Nurses was made after a
consultation on October 23, 2013 at
Iloilo City after accredited
professional organizations decided
to adopt a new Code of Ethics under
the RA 9173.
Application of Ethical Principles to Patient
Education
Six major Ethical Principles:
1. Autonomy – refers to right of self determination
-it the personAL choice control that an individual has
as he goes through life (even death)
- greek word auto “self”
- nomos “law
Laws:
1.Patient Self- Determination Act (PSDA) which was passed by
Congress in 1991- this law require that, either at the time of the
hospital admission or prior to the initiation of care or treatment in
a community health setting
 in PSDA LAW ,every individual receiving health care be informed
in writing of the right under state law to make decisions about his or
her health care, including the right to refuse medical and surgical and
the right to initiate advance directives.
Key components of autonomy
include;
1. An intention to choose actions
2. Understanding of the choices
3. Action without interference or control

The principle of autonomy is demonstrated by the

use of informed consent
Certain situations may limit
autonomy:
1. When the rights of one person
interfere with the rights of another
2. When there’s a high probability
that a person may injure himself or
others.
2. Veracity or truth telling – is
closely linked to informed decision
making and informed consent.
- role of the nurse is expert
witness
- the nurse must always tell
the truth and the patient is always
entitled to the truth.
Four elements of Informed Consent
1.Competence- which refers to the capacity of
the patient to make a reasonable action
2. Disclosure of Information, which requires that
sufficient information regarding risks and
alternative treatments- including no treatment
at all- be provided to the patient to be enable
him or her to make a rational decision
3. Comprehension, which speaks to
the individual’s ability to understand
or grasp intellectually the information
being provided.
4. Voluntariness, which indicates that
the patient can make a decision
without coercion or force from others.
3. Confidentiality- refers to personal information that is entrusted and
protected as privileged information via a social contract, healthcare
standard or code or legal covenant.
- health providers may not disclose any information of
the patient without consent of the patient
- exceptions, when a patient has been the victim or
subject of a crime to which the nurse or doctor is a witness, when
nurses or other health professionals suspect or are aware of child or
elder abuse, narcotic use, legally reported communicable diseases,
gunshot or knife wounds or the threat of violence towards someone.
4.Non Maleficence- is defined as “do no harm”
- this refers to the obligation to inflict
no harm to others, it involves intention or
unintentional
- this refers to the ethics of legal
determinations involving negligence and/or
malpractice
Negligence is defined as conduct which falls
below the standard established by law for the
protection of others against unreasonable risk of
harm.
- it involves the conduct of professionals that
For a negligence to exist there must be;
1. A duty between the injured party and the
person whose actions (or nonactions)
cause the injury
2. A BREACH OF THAT DUTY must have
occurred, it must have been t he
immediate cause of the injury,
3. The injured party must have experienced
damaged from the injury
 Malpractice – refers to a limited class
of negligent activities committed within
the scope of performance by those
pursuing a particular profession involving
highly skilled and technical services.
Most common causes of malpractice;
1. Failure to follow standards of care
2. Failure to use equipment in a responsible manner
3. Failure to communicate
4. Failure to document
5. Failure to assess and monitor
6. Failure to act as patient advocate
7. Failure to delegate tasks properly
5. Beneficence – is defined as “doing good” for the benefit of others
- It is a concept that is legalized through properly
carrying out critical tasks and duties contained in a job description; in
policies, procedures, and protocols set forth by the healthcare
facilities; and in standards and codes of ethical behaviors established
by professional nursing organizations.
6.. Justice – speaks to fairness and the
equitable distribution of goods and services.
- fairness or the obligation to be fair
to all people.
- THE LAW IS THE JUSTICE SYSTEM
- the focus of the law is the protection
of the society
- the focus of health law is the
protection of the consumer
Criteria in Decision making for the fair distribution of resources:
1.To each, an equal share
2.To each, according to need
3.To each, according to effort
4.To each according to contribution
5.To each, according to merit
6.To each, according to the ability to pay
Laws ;
REPUBLIC ACT NO. 8344,
OTHERWISE KNOWN AS "AN ACT PENALIZING THE REFUSAL OF
HOSPITALS AND MEDICAL CLINICS TO ADMINISTER APPROPRIATE
INITIAL MEDICAL TREATMENT AND SUPPORT IN EMERGENCY OR
SERIOUS CASES, AMENDING FOR THE PURPOSE BATAS PAMBANSA
BILANG 702, OTHERWISE KNOWN AS AN ACT PROHIBITING THE
DEMAND OF DEPOSITS OR ADVANCE PAYMENTS FOR THE
CONFINEMENT OR TREATMENT OF PATIENTS IN HOSPITALS AND
MEDICAL CLINICS IN CERTAIN CASES"
The Patient's Bill of Rights
- was first adopted by the American Hospital
Association (AHA) in 1973 and revised in October 1992
-were developed with the expectation that hospitals
and health care institutions would support these rights in
the interest of delivering effective patient care
-AHA encourages institutions to translate and/or
simplify the bill of rights to meet the needs of their
specific patient populations and to make patient rights
and responsibilities understandable to patients and their
families.
 - a patient's rights can be exercised on this or
her behalf by a designated surrogate or proxy
decision-maker if the patient lacks decision-
making capacity, is legally incompetent, or is a
minor.
Bill of Rights
1.The patient has the right to considerate
and respectful care.
2.The patient has the right and is
encouraged to obtain from physicians and
other direct caregivers relevant, current,
and understandable information about his
or her diagnosis, treatment, and prognosis.
3.Except in emergencies when the patient lacks the
ability to make decisions and the need for treatment
is urgent, the patient is entitled to a chance to
discuss and request information related to the
specific procedures and/or treatments available, the
risks involved, the possible length of recovery, and
the medically reasonable alternatives to existing
treatments along with their accompanying risks and
benefits.
4.The patient has the right to know the
identity of physicians, nurses, and others
involved in his or her care, as well as when
those involved are students, residents, or
other trainees. The patient also has the right
to know the immediate and long-term
financial significance of treatment choices
insofar as they are known.
5. The patient has the right to make decisions about
the plan of care before and during the course of
treatment and to refuse a recommended treatment
or plan of care if it is permitted by law and hospital
policy. The patient also has the right to be informed
of the medical consequences of this action. In case of
such refusal, the patient is still entitled to
appropriate care and services that the hospital
provides or to be transferred to another hospital. The
hospital should notify patients of any policy at the
other hospital that might affect patient choice
6. The patient has the right to have an
advance directive (such as a living will, health
care proxy, or durable power of attorney for
health care) concerning treatment or
designating a surrogate decision-maker and to
expect that the hospital will honor that
directive as permitted by law and hospital
policy.
7. Health care institutions must advise the
patient of his or her rights under state law and
hospital policy to make informed medical
choices, must ask if the patient has an
advance directive, and must include that
information in patient records. The patient has
the right to know about any hospital policy
that may keep it from carrying out a legally
valid advance directive.
8. The patient has the right to privacy. Case discussion, consultation,
examination, and treatment should be conducted to protect each
patient's privacy.
9.The patient has the right to expect that all communications and
records pertaining to his/her care will be treated confidentially by the
hospital, except in cases such as suspected abuse and public health
hazards when reporting is permitted or required by law. The patient
has the right to expect that the hospital will emphasize confidentiality
of this information when it releases it to any other parties entitled to
review information in these records.
10.The patient has the right to review his or her medical records and to
have the information explained or interpreted as necessary, except when
restricted by law.
11.The patient has the right to expect that, within its capacity and
policies, a hospital will make reasonable response to the request of a
patient for appropriate and medically indicated care and services. The
hospital must provide evaluation, service, and/or referral as indicated by
the urgency of the case. When medically appropriate and legally
permissible, or when a patient has so requested, a patient may be
transferred to another facility. The institution to which the patient is to
be transferred must first have accepted the patient for transfer. The
patient also must have the benefit of complete information and
explanation concerning the need for, risks, benefits, and alternatives to
such a transfer.
12.The patient has the right to ask and be
told of the existence of any business
relationship among the hospital,
educational institutions, other health care
providers, and/or payers that may
influence the patient's treatment and
care.
13.The patient has the right to consent to or
decline to participate in proposed research
studies or human experimentation or to have
those studies fully explained before they
consent. A patient who declines to participate
in research or experimentation is still entitled
to the most effective care that the hospital can
otherwise provide.
14.The patient has the right to expect
reasonable continuity of care and to be
informed by physicians and other
caregivers of available and realistic patient
care options when hospital care is no
longer appropriate.
15.The patient has the right to be informed of
hospital policies and practices that relate to patient
care treatment, and responsibilities. The patient has
the right to be informed of available resources for
resolving disputes, grievances, and conflicts, such as
ethics committees, patient representatives, or other
mechanisms available in the institution. The patient
has the right to be informed of the hospital's charges
for services and available payment methods.
The effectiveness of care and patient satisfaction with the course of
treatment depends, in part, on the patient's fulfilling certain
responsibilities;
1. Patients are responsible for providing information about past
illnesses, hospitalizations, medications, and other health-related
matters. .
2.Patients must take responsibility for requesting additional
information or clarification about their health status or treatment
when they do not fully understand the current information or
instructions.
4.Patients are responsible for making
sure that the health care institution has a
copy of their written advance directive if
they have one.
5.Patients are responsible for informing
their physicians and other caregivers if
they anticipate problems in following
prescribed treatment.
6.Patients also should be aware that the hospital has
to be reasonably efficient and equitable in providing
care to other patients and the community. The
hospital's rules and regulations are designed to help
the hospital meet this obligation.
7.Patients and their families are responsible for being
considerate of and making reasonable
accommodations to the needs of the hospital, other
patients, medical staff, and hospital employees.
8.Patients are responsible for providing
necessary information for insurance claims
and for working with the hospital as needed to
make payment arrangements.
9.A patient's health depends on much more
than health care services. Patients are
responsible for recognizing the impact of their
lifestyles on their personal health.
•
Role of the Nurse as Health Educator

1.Giver of information
2.Facilitator of learning
3.Coordinator of teaching
4.Advocate for the client
Role of the other members of the health team
Role of the Family in Health Education

• - is considered one of the key variables influencing

positive patient care outcomes
• - primary motives in patient education for involving
family members in the care delivery and decision
making process are to decease the stress of
hospitalization, reduce costs of care, increase
satisfaction with care, reduce hospital re admissions
and effectively prepare the patient for self care
management outside the healthcare setting
- Family role enhancement and increased knowledge
on the part of the family have positive benefits for
the learners as well as the teachers,
- - patients derive increased satisfaction and greater
independence in self- care, and nurses experience
increased job satisfaction and personal gratification
in helping patients to reach their potential and
achieve successful outcomes
 - the family is the educator’s greatest ally in
preparing the patient for discharge and in helping the
patient for discharge and in helping the patient to
become independent in self- care.