Prepared By:

Alfrey J. Corpuz, RN
Health Education
• is any combination of learning
experiences designed to help
individuals and communities improve
their health, by increasing their
knowledge or influencing their
attitudes (WHO).
Education
• is the aquisition of knowledge, skills,
and attitudes that make man do better.
• it is not only a preparation for life but it
is life itself.

A. Formal
B. Informal
Health
• a state of complete physical,
mental, and social wellbeing
rather than the mere absence of
disease (WHO).
• is the state of being free from
illness or injury.
Why should I
care about
Health
Education?
Importance of Health Education
• aims to influence a person’s knowledge,
attitudes and behaviours connected to
health in a positive way.
• enhances the quality of life for all people.
• reduces premature deaths.
• learn skills they will use to make healthy
choices throughout their lifetime.
 Overview of Education in Health
Care
• Education in health care today
• A topic of utmost interest to health professional
• Important aspect of a health professional's role
• Focused on outcomes
• An evidence for uniqueness of Nurses among
other health professions
Historical Foundations for the Teaching Role
of Health Professionals
• Health professionals must understand the forces, both
historical and present day
• “Patient Education” in Pre-Historic Era(Barlet, 1986)
• Mid-18th Century through 20th Century (Barlett, 1986)
a. Formative Period
- Several Key factors influenced and impact the
growth of health education
- Surplus of physicians
- Technological Developments
Historical Foundations for the Teaching Role
of Health Professionals
• Mid-18th Century through 20th Century (Barlett, 1986)
a. Formative Period
- Patient-caregiver relationship
- Spread of Tuberculosis
→ Patients were acquired to take
medications for a long period
→ Resulted to the establishment of the 1st
Society for the Prevention of Tuberculosis (SPTB)
Historical Foundations for the Teaching Role
of Health Professionals
• Mid-18th Century through 20th Century (Barlett, 1986)
a. Formative Period
- Growing interest on the welfare of mother and
children
→ Resulted to the establishment of the
Division of Child Hygiene (DCH) in New York in
1908
→ Publich Health Nurses (PHNs) educated
mothers on how to keep infants healthy
 Historical Foundations for the Teaching Role of
Health Professionals
• Mid-18th Century through 20th Century (Barlett, 1986)
b. Florence Nightingale
- especially during the Crimean War (October 1853-Febuary 1856)
►a resolute advocate of the health educational responsibilities
►advocated the environmental factors affecting health
● pure/fresh air
● pure/clean water
● effective drainage
● cleanliness
● light (especially direct sunlight)
 Historical Foundations for the Teaching Role of
Health Professionals
• Mid-18th Century through 20th Century (Barlett, 1986)
b. Florence Nightingale
- authored “Health Teaching in Towns and Villages” (as cited by
Monterio, 1985)
►advocate school of nursing on health rules
►advocate home nursing
→ health teaching at home
 Historical Foundations for the Teaching Role of
Health Professionals
• Mid-18th Century through 20th Century (Barlett, 1986)
c. Urbanization and Technological changes
►resulted in swelling/increase in number of physicians
→ however; fewer physicians were needed
►population shift and technological advancement (automobile
and telephone)
→ inventions (stethoscope, laryngoscope,
opthalmoscope)
→ changed the dynamics of physician-patient
relationship
● lessened the amount of therapeutic touching

-thus, encouraging a more detached

relationship
 Historical Foundations for the Teaching Role of
Health Professionals
• 1930-1960
►time of “relative quiet” for patient education
→ rising technological orientation of medicine overshadowed health
education in actual clinical encounters

• 1960s-1970s
►patient education began to be seen as a specific entity
→ emphasis on individual approach on patient education rather than
providing general public health education
►activities affecting health education
→civil rights movement
→women's movement
→consumer and selp-help movement
 Historical Foundations for the Teaching Role of
Health Professionals
• 1930-1960
►activities affecting health education
→voluntary agencies and other Public Health Services (PHS)
- funded various health education services for patients,inclusive
of families
1. CHF
2. Stroke
3. CA
4. Renal Disease
- hospitals became more involved and engaged
 Historical Foundations for the Teaching Role of
Health Professionals
• 1964
►the American Medical Association (AMA) held the 1st National Conference
on Health Education Goals
• 1968
►the American Public Health Association (APHA) formed the
multidisciplinary Committee in Educational Tasks in Chronic Illness (CEDCI)
→recommended formal approach to patient needs and to be included on
patient education
- teaching is based on individual patient needs and to be
included on patient record
≈thus, first documentations of health education
→individualized patient education
-based on individual needs
 Historical Foundations for the Teaching Role of
Health Professionals
• 1971
►US Department of Health, Education and Welfare (US-DOHEW)
→published “The Need for Patient Education”
●provided information about disease and treatment and how to stay
healthy
►use of “Health Education “ and “Patient Education”
→responsibility of hospitals and healthcare institutions
→focused on health programs
→encompasses patient education
●individual health education
 Historical Foundations for the Teaching Role of
Health Professionals
• 1972
►American Hospital Association(AHA) affirmed Prient's Bill of Rights (12
rights)
→formulated in the interest of delivering effective patient health care
►copy of the Bill of Rights published on February 6, 1973 by AHA and
revised in 1992
• 1970s
►involvement of insurance companies
→they looked into the impact of health education on the cost of health
care
►patient education was included as a part of the medical care
►active involvement of other health professions in health education
●pharmacist, dieticians,physical therapist
 Historical Foundations for the Teaching Role of
Health Professionals
• 1980s
►re-trending of the US national programs
►focused on the disease prevention and health promotion
→prioritized establishment of educational and community-based
programs
→directed towards two goals:
●increasing the quality and years of healthy life

●eliminating health disparities

→specific objectives of the health educating programs:

●assist individuals to recognize and change risk behaviors

●adopt or maintain healthy practices

●make appropriate use of available services for health

 Historical Foundations for the Teaching Role of
Health Professionals
• 1993
►establishment of the Nursing Standards by the US Joint Commision (JC)
→also known as “mandates”
→describe the type and level of care, treatment and services
→emphasizes that Nurses must achieve positive outcomes of patient
care
≈through patient education that are patient-centered and family-
oriented
→added interdisciplinary approach in the provision of patient
education
→require evidences of patient and family participation in care and
decision-making
 Historical Foundations for the Teaching Role of
Health Professionals
• 1998
►reform in health professions to address skills needed to function in modern
healthcare
→encompasses new set of competencies for the 21st century relevant to
the following roles of health professionals
a. embrace a personal ethic of social responsibility and service
b. provide evidence-based, clinical competent care
c. incorporating the multiple determinants of health in clinical
care
d. rigorously practice preventive health care
e. improve accessto health care for those with unmet health
needs
f. practice relationship-centered care with individuals and
families
 Historical Foundations for the Teaching Role of
Health Professionals
• 1998
►reform in health professions to address skills needed to function in modern
healthcare
→initiated by Pew Health Professions Commisions (PHPC)
→encompasses new set of competencies for the 21st century relevant to
the following roles of health professionals
g. provide culturally-sensitive care to a diverse society
h. use communication and information technology effectively
and appropriately
i. continue to learn and help others learn
Issues and Trends in Health Education

A. General Issues and Trends

• Politicians and healthcare administrators alike recognize the
importance of health education to accomplish the economic goal
of reducing the high costs of health services.
• Healthcare professionals are increasingly concerned about
malpractice claims and disciplinary action for incompetence.
• Consumers are demanding inceased knowledge and skills about
how to care for themselves and how to prevent disease.
• The aging of the population are requiring and emphasis to be
placed on self-reliance and maintenance of a healthy status over
an expanded lifespan.
Issues and Trends in Health Education

A. General Issues and Trends

• Major cause of morbidity and mortality are those disease that are
lifestyle related and preventable through educational intervention.
• The increase in chronic and incurable conditions requires
individuals and families become informed participants to manage
their own illnesses.
• Client education improves compliance.
• The increase number of self-help groups exist to support clients in
meeting their physical and psychosocial needs.
Issues and Trends in Health Education

A. Specific Issues and Trends

1. Current Mandates for Nurses as Educators
• To increase the quality and years of healthy life
• To eliminate health disparities among different segments of the
population
• To use theory and evidence based startegies to promote desirable
health behavior
Issues and Trends in Health Education

A. Specific Issues and Trends

1. Trends affecting Health care
• Growth of managed care
• Increased attention to health and well-being of everyone in society
• Cost containment measures to control healthcare expenses
• Concern for continuing education as vehicle to prevent
malpractice and incompetence
• Expanding scope and depth of nurses' responsibilities
Issues and Trends in Health Education

A. Specific Issues and Trends

1. Trends affecting Health care
• Social, economic, and political forces that affect nurse's role in
teaching:
– consumers demanding more knowledge and skills for self-care
– demographic trends influencing type and amount of health care needed
– recognition of life style related diseases which are largely preventable
– health literacy increasingly required
– consumers demanding more knowledge and skills for self-care
– demographic trends influence type and amount of health care needed
– Advocacy for self-help groups
Remember This: “Nurses, Yes You! Are the Key
Position to Carry Out Health Education!”

• Most continuous contact with clients

• Most accessible source of information for the consumer
• Most highly trusted of all health professionals
Theories in Health Education
Pender's Health Promotion Theory
Nola J. Pender, Ph.D,RN, FAAN
- has been a nurse educator for over forty years.
Throughout her career, she taught baccalaureate,
masters, and Ph.D students, she also mentored a
number of pastoral fellows. In the year 1998, she
received the Mae Edna Doyle Teacher of the year
Award from the University of Chicago, School of
Nursing.
Overview
• The health promotion model describes the
multidimensional nature of person as they interact within
their environment to pursue health
• It defines health as a positive dynamic state rather than
simply the absence of disease. Health promotion is
directed at increasing a patient's level of well-being.
• It also assist nurses in understanding the major
determinats of health behaviors as a basis for behavioral
counseling to promote healthy life style.
 Key Concepts in Nursing Defined as a Basis for the
Health Promotion Model

• Person
-is a biopsychosocial organism that is partially
shaped by the environment but also seeks to create
an environment in which inherent and acquired
human potential can be fully expressed. Thus, the
relationship between person and environment is
reciprocal.
 Key Concepts in Nursing Defined as a Basis for the
Health Promotion Model

• Environment
-is the social, cultural and physical context in which
the life course unfolds.
-The environment can be manipulated by the
individual to create a positive context of cues and
facilitators for health-enhancing behaviors.
 Key Concepts in Nursing Defined as a Basis for the
Health Promotion Model

• Nursing
- is collaboration with individuals, families, and
communities to create the most favorable conditions
for the expression of optimal health and high-level
well-being.
 Key Concepts in Nursing Defined as a Basis for the
Health Promotion Model

• Health
- in reference to the individual is defined as the
actualization of inherent and acquired human
potential through goal-directed behavior, competent
self-care, and satisfying relationships with others,
while adjustments are made as needed to maintain
structural integrity and harmony with relevant
environments.
 Key Concepts in Nursing Defined as a Basis for the
Health Promotion Model

• Illnesses
- are discrete events throughout the life span of
either short (acute) or long (chronic) duration that
can hinder or facilitate one’s continuing quest for
health.
 HPM Assumptions

• Individuals seek to actively regulate their own behavior.

• Individuals in all their biopsychosocial complexity interact
with the environment, progressively transforming the
environment and being transformed over time.
• Health professionals constitute a part of the interpersonal
environment, which exerts influence on persons
throughout their lifespan.
• Self-initiated reconfiguration of person-environment
interactive patterns is essential to behavior change.
 HPM Theoretical Propositions

1. Prior behavior and inherited and acquired characteristics

influence beliefs, affect, and enactment of health-promoting
behavior.
2. Persons commit to engaging in behaviors from which
they anticipate deriving personally valued benefits.
3. Perceived barriers can constrain commitment to action, a
mediator of behavior as well as actual behavior.
4. Perceived competence or self-efficacy to execute a given
behavior increases thelikelihood of commitment to action
and actual performance of the behavior.
 HPM Theoretical Propositions

5. Greater perceived self-efficacy results in fewer perceived

barriers to a specific health behavior.
6. Positive affect toward a behavior results in greater
perceived self-efficacy.
7. When positive emotions or affect are associated with a
behavior, the probability of commitment and action is
increased.
 HPM Theoretical Propositions

8. Persons are more likely to commit to and engage in

health-promoting behaviors
when significant others model the behavior, expect the
behavior to occur, and provide assistance and support to
enable the behavior.
9. Families, peers, and health care providers are important
sources of interpersonal
influence that can increase or decrease commitment to and
engagement in healthpromoting
behavior.
 HPM Theoretical Propositions

10. Situational influences in the external environment can

increase or decrease commitment to or participation in
health-promoting behavior.
11. The greater the commitment to a specific plan of action,
the more likely health promoting behaviors are to be
maintained over time.
12. Commitment to a plan of action is less likely to result in
the desired behavior when competing demands over which
persons have little control require immediate attention.
 HPM Theoretical Propositions

13. Commitment to a plan of action is less likely to result in

the desired behavior when other actions are more attractive
and thus preferred over the target behavior.
14. Persons can modify cognitions, affect, interpersonal
influences, and situational influences to create incentives
for health promoting behavior.
Bandura's Self Eficacy Theory
Bandura's Self Eficacy Theory
Bandura's Self Eficacy Theory
Bandura's Self Eficacy Theory
Bandura's Self Eficacy Theory
Bandura's Self Eficacy Theory
Bandura's Self Eficacy Theory
Bandura's Self Eficacy Theory
 Health Belief Model
A. Health Locus of Control Model
Locus of Control (LOC)
-is a concept from social learning theory that nurses can use to determine
whether clients are likely to take action regarding health, that is, whether clients
believe that their health status is under own or others' control.
1.Internal
-people who believe that they have a major influence on their own health status
- that health is largely self-determine.
Example: People who exercise, Adhere to prescribed health care regimens,
maintaining diets, Giving up smoking
2. External
-peopel who believe their health is largely controlled by outside forces
 Health Belief Model
B. Rosenstock's And Becker's Health Beleif Models
Rosenstock
-proposed a health belief model intended to predict which individuals would or
would not use preventive measures such as screening for early detection of
cancer.
Becker
-modified the health belief model to include these components: individual
perceptios, modifying factors, and variables likely to affect initiating action
Health Belief Model
Dorothea Orem's Self-Care Deficit Theory
• Based on the premise that all clients want to take care of
themselves
• Believes that clients has a natural ability to self-care and taht
nursing should focus on the affecting/influencing that ability
• Involves three theoretical constructs:
- self-care
- self-care deficit
→ a client is incapable of continuos self-care
- nursing systems
→ supportive (through health education, use of nursing
process)
Imogene King's Goal Attainment Theory

• Focuses on influencing clients to be more independednt

→ involvement of clients starting from the planning
phase( implies significance of nurse-client
interaction and collaboration)
Lawrence Green' Precede-Proceed Model
Perspective on Teaching and Learning
A.Overview of Education in Health Care
1. Purpose
- To increase the competence and confidence of patients to
manage their own self-care and of staff and students to
deliver high-quality care
2. Benefits of Eduaction to Patients
a. increase consumer satisfaction
b. improves quality of life
c. ensures continuity of care
d. reduces incidence of illness and complications
Perspective on Teaching and Learning
2. Benefits of Eduaction to Patients
e. increase compliance with treatment
f. decrease anxiety
g. maximizes independence

3. Benefits of Education to Staff

a. enhance job satisfaction
b. improves therapeuitic relationship
c. increases autonomy in practice
d. improves knowledge and skills
Perspective on Teaching and Learning
4. Benefits of Preceptor Education for Nursing Students
a. prepared clinical preceptors
b. continuity of teaching/learning from classroom curriculum
c. evaluation and improvement of students clinical skills

GOAL: To increase self-care responsibility of clients and to

improve quality of care delivered by nurses
Perspective on Teaching and Learning
B. Concepts of Teaching, Learning , Education vis-ᾲ-vis
Nursing Process, Historical Foundations for the Teaching
Role of the Nurse

The Education Process Defimitions of Terms:

Education Process
-a systematic, sequencial, planned course of action on the
part of both the teacher and learner to achive the outcomes
of teaching and learning
Perspective on Teaching and Learning
The Education Process Defimitions of Terms:
Teaching/Instruction
-a deliberate intervention that involves sharing information
and experiences to meet the intended learning outcomes.

Learning
-a change in behavior(knowledge,skills,attitudes) that can
be observed and measured, and can occur at any time or in
any place as a result of exposure to environmental stimuli
Perspective on Teaching and Learning
The Education Process Defimitions of Terms:
Patient Education
-the process of helping clients learn health-related
behaviors to achieve the goal of optimal health and
independence of self-care

Staff Education
-the process of helping nurses acquire knowledge,
attitudes, skills to improve the delivery of quality care to the
consumer
Perspective on Teaching and Learning

ASSURE Model
- is an ISD (Instructional
System Design)
-useful paradigm to assist
nurses to organize and carry
out the education process
Perspective on Teaching and Learning

Historical Foundations of the Nurse Educator Role

• Health education has long been considered a standard
care-giving role of the nurse
• Patient teaching is recognize as an independent nursing
function
• Bursing practice has expanded to include education in the
broad concepts of health and illness
Perspective on Teaching and Learning
Organizations and Agencies Promulgating Standards and
Mandates:
1. NLN (National League for Nursing)
-first observed health teaching as an important function
within the scope of nursing practice
-responsible for identifying course content for curriculum on
pronciples of teaching and learning

2. ANA (American Nurses Association)

-responsible for establishing standards and qualifications for
practice, including patient teaching
Perspective on Teaching and Learning
Organizations and Agencies Promulgating Standards and
Mandates:
3. ICN (International Council of Nurses)
-endorses health education as an essential component of
nursing care delivery

4. State Nurse Practice Act

-universally includes teaching within the scope of nursing
practice
Perspective on Teaching and Learning
Organizations and Agencies Promulgating Standards and
Mandates:
5. JCAHO (Joint Commission on Accreditation of
Healthcare Organization)
-accreditation mandates require evidence of patient
education to improve outcomes

6. AHA (American Hospital Association)

-Patient's Bill of Rights ensures that client receives
complete and current information
Perspective on Teaching and Learning
Organizations and Agencies Promulgating Standards and
Mandates:
7. Pew Health Professions Commission
-puts forth a set of health profession competencies for the
21st Century; over one-half of recommendations pertain to
importance of patient and staff eduaction
Role of Nurse as Health Educator
• With atleast 3 years hospital stays, organizations expect
that staff will have to be skilled teacher
• They will need to learn basic principles of teaching and
how to apply them
• Nurses who spend the majority of their time in the
education role such as staff development instructors or
educators in collegiate settings have more formal
preparations for the educator role
Role of Nurse as Health Educator
• Provide a holistic approach to care delivery
• Act as facilitators
• Clarify confusing information
• Serve as coordinator of care
• Assist colleagues in gaining knowledge and skills
necessary for the delivery of professional nursinf care.
Hallmark of Effective Teaching in Nursing

I. Professional Competence
a. Through knowledge and subject matter
b. Polishes her skills throout her career
c. Maintains and expands her knowledge in reading,
research, clinical practice and continuing education
d. Portrays excellent clinical skills and judgement become a
positive role model for learner
Hallmark of Effective Teaching in Nursing

II. Interpersonal Relationship with Students

a. Taking personal interest in learners
b. Being sensitive to their feelings and problems, conveying
respect for them.
c. Alleviating their anxieties
d. Being accessible for conferences
e. Being fair, permitting learners to express different points
of view
Hallmark of Effective Teaching in Nursing

III. Teaching Practices

• Defined the mechanics, methods, skills in classroom and
clinical teaching

IV. Personal Characteristics

• Qualities such as authenticity, personal magnetism,
enthusiasm, cheerfullness, self-control, patience,
flexibility, a sense of humor, a good speaking voice,
self-confidence, willingness to admit errors, and a
caring attitude are all desirablle characteristic teachers
Hallmark of Effective Teaching in Nursing

V. Evaluation Practices
• Valued by students include clearly communicating
expectations, providing timely feedback on student
progress, correcting students tactfully, being fair in the
evaluation process, and giving test that are pertinent to
the subject matter.
Hallmark of Effective Teaching in Nursing

V. Availability to students
• Presence during and even after classes or clinical
experience
→ physically assists students in providing care
→ provision of appropriate amount of supervision
→ answers inquiries of learners
→ a resource person during clinical experiences
 Seven Principles for Good Practice in Undergraduate Education
Arthur W. Chickering and Zelda F. Gamson (1987)

1. encourages contact between students and faculty

2. develops reciprocity and cooperation among
students
3. encourages active learning
4. gives prompt feedback
5. emphasizes time on task
6. communicates high expectations
7. respects diverse talents and ways of learning
1.Encourages Contact Between Students and Faculty
• Frequent student-faculty contact in and out of classes is
the most important factor in student motivation and
involvement.
• Faculty concern helps students get through rough times
and keep on working.
• Knowing few faculty members well enhances students'
intellectual commitment and encourages them to think
about their own values and future plans.
2. Develops Reciprocity and Cooperation Among
Students
• Learning is enhanced when it is more like a team effort than a
solo race.
• Good learning, like good work, is collaborative and social, not
competitive and isolated.
• Working with others often increases involvement in learning.
• Sharing one's own ideas and responding to others' reactions
sharpens thinking and deepens understanding.
3. Encourages Active Learning
• Students do not learn much just by sitting in classes
listening to teachers, memorizing pre-packaged
assignments, and spitting out answers.
• STUDENTS must talk about what they are learning, write
about it, relate it to past experiences and apply it to their
daily lives.
• must make what they learn part of themselves.
4. Gives Prompt Feedback
• Knowing what you know and don't know focuses learning.
• Students need appropriate feedback on performance to
benefit from courses.
• When getting started, students need help in assessing
existing knowledge and competence.
• In classes, students need frequent opportunities to perform
and receive suggestions for improvement.
• At various points during college, and at the end, students
need chances to reflect on what they have learned, what
they still need to know, and how to assess themselves
5. Emphasizes Time on Task
• Time plus energy equals learning.
• There is no substitute for time on task.
• Learning to use one's time well is critical for students and
professionals alike.
• Students need help in learning effective time management.
• Allocating realistic amounts of time means effective
learning for students and effective teaching for faculty.
• How an institution defines time expectations for students,
faculty, administrators, and other professional staff can
establish the basis of high performance for all.
6. Communicates High Expectations
• Expect more and you will get more.
• High expectations are important for everyone -- for the
poorly prepared, for those unwilling to exert themselves,
and for the bright and well motivated.
• Expecting students to perform well becomes a self-fulfilling
prophecy when teachers and institutions hold high
expectations for themselves and make extra efforts.
7. Respects Diverse Talents and Ways of
Learning
• People bring different talents and styles of
learning to college.
• Brilliant students in the seminar room may
be all thumbs in the lab or art studio.
• Students rich in hands-on experience may
not do so well with theory.
• Students need the opportunity to show their
talents and learn in ways that work for them.
Then they can be pushed to learn in new
ways that do not come so easily.
 SIX POWERFUL FORCES IN EDUCATION:

• activity
• expectations
• cooperation
• interaction
• diversity
• responsibility
QUALITIES OF ENVIRONMENT

• A strong sense of shared purposes.

• Concrete support from administrators and faculty leaders
for those purposes.
• Adequate funding appropriate for the purposes.
• Policies and procedures consistent with the purposes.
• Continuing examination of how well the purposes are
being achieved.
BARRIERS TO EDUCATION
1. Lack of time to teach
• greatest barrier to being able to carry out their educator role
effectively.
• Very ill patients are hospitalized for only short periods of
time.
• Early discharge from inpatient settings and the movement
toward community-based care often result in nurses and
patients having fleeting contact with one another in
emergency, outpatient, and other ambulatory care settings.
• nurses’ schedules and responsibilities are very
demanding.
• Finding time to allocate to teaching is very challenging in
light of the competition from other work demands and
expectations.
• The textbook approach to teaching has been the ideal but
is no longer realistic.
• Nurses must know how to adopt an abbreviated, efficient,
and expeditious approach to patient and staff education by
first adequately assessing the learner and then by using
appropriate instructional methods and tools at their
disposal.
• Discharge planning will play an ever more important role in
ensuring continuity of care across settings.
2. ill prepared to teach
• principles of teaching and the concepts of learning are
unclear to a large number of practicing nurses.
• Many nurses admit that they do not feel competent or
confident with regard to their teaching skills.
• Nursing education has for years failed to adequately
prepare nurses for the role as educator, either during
basic training or afterward.
• Although nurses are expected to teach, content in
teaching and learning principles in nursing school
curricula has been neglected
• The concepts of patient education are usually integrated
throughout nursing curricula rather than being offered as
a specific course of study.
• Kruger (1991)
• surveyed 1230 nurses in staff, administrative,
and education positions regarding their
perceptions of the extent of nurses’
responsibility for and level of achievement of
patient education.
• three groups strongly believed that patient
education is a primary responsibility of nurses
• majority rated their ability to perform patient
education activities as not being satisfactory.
• findings indicate that the role of the nurse as
patient educator needs to be strengthened.
3. Personal characteristics of the nurse
• Motivation to teach is a prime factor in determining the success of any educational endeavor
• Teaching by nurses sometimes is relegated to a low-priority status because of the physical,
task-oriented nature of nursing care, the relatively minor importance assigned to teaching, and
the lack of confidence on the part of practitioners in performing the teaching role.
4. Low priority
•low priority was often assigned to patient and staff
education by administration and supervisory
personnel.
•budget allocations for educational programs remain
tight and can interfere with the adoption of
innovative and time-saving teaching strategies and
techniques.
5. lack of space and privacy in the various
environmental settings
• not always conducive to carrying out the teaching–learning
process.
• Noise, frequent interferences, treatment schedules, and
the like serve to negatively affect concentration and
effective interaction.
6. absence of third-party reimbursement to support
patient education programs
• Nursing services within healthcare facilities are subsumed
under hospital room costs and, therefore, are not
specifically reimbursed
• patient education in some settings, such as home care,
often cannot be incorporated as a legitimate aspect of
routine nursing care delivery unless specifically ordered by
a physician.
7. nurses and physicians question
whether patient education is
effective as a means to improve
health outcomes
• view patients as impediments to
teaching when patients do not
display an interest in changing
behavior, when they demonstrate
an unwillingness to learn, or when
their ability to learn is in question.
8. malfunction of the healthcare team
• inadequate coordination and delegation of responsibility so
that health teaching can proceed in a timely, smooth,
organized, and thorough fashion.
9. documentation system
• Both formal and informal teaching are often done but not
written down because of a lack of time as well as
inattention to documentation and inadequate forms on
which to record teaching activities.
• most nurses do not recognize the scope and depth of
teaching that they perform on a daily basis.
OBSTACLES TO LEARNING
1. The stress of acute and chronic illness, anxiety,
sensory deficits, and low literacy in patients
2. 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
→ not ready to learn
→ lack of motivation and compliance
→ developmental stage characteristics
→ preferred learning styles
5. extent of behavioral changes needed, both in number
and in complexity, can overwhelm learners and
dissuade them from attending to and accomplishing
learning objectives and goals.
6. Lack of support and ongoing positive reinforcement
from the nurse and significant others
7. Denial of learning needs, resentment of authority,
and lack of willingness to take responsibility are some
psychological obstacles to accomplishing behavioral
change.
8. 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.
APPLYING LEARNING THEORIES
TO HEALTH CARE PRACTICE
PRINCIPLES OF LEARNING
Learning
• is a relatively permanent change in mental processing,
emotional functioning, and/or behavior as a result of
experience.
• It is the lifelong, dynamic process by which individuals
acquire new knowledge or skills and alter their thoughts,
feelings, attitudes, and actions.
How Does Learning Occur?

• Learning takes place as individuals interact with their

environment and incorporate new information or
experiences with what they already know or have learned.
What Kinds of Experiences
Facilitate or
Hinder the Learning Process?

• educator’s selection of learning

theories and structuring of the
learning experience
• educators must have knowledge,
and they must be competent
• lack of clarity and meaningfulness in what is to be learned
• neglect or harsh punishment
• Fear
• negative or ineffective role models, and rewards for
unhealthy behavior
• confusing reinforcement
• inappropriate materials for the individual’s ability
• readiness to learn
• stage of life-cycle development
• detrimental socialization experiences
• deprived of stimulating environments
• without goals and realistic expectations for themselves
What Helps Ensure That Learning
Becomes Relatively Permanent?
• make it meaningful and pleasurable
• Pace the presentation in keeping with the learner’s ability
to process information
• Practice (mentally and physically) new knowledge or skills
under varied conditions
• Reinforcement serves as a signal to the individual that
learning has occurred (Hill, 1990).
• Assessment and evaluation soon after the learning
experience
learning theory
• is a coherent framework and set of integrated constructs
and principles that describe, explain, or predict how
people learn
LEARNING THEORIES
→ Behaviorist
→ Cognitive
→ Social Learning/Cognitive
TYPES OF LEARNING

How do you learn?

How do you learn?
LEARNING STYLES OF
DIFFERENT AGE GROUPS
DETERMINANTS OF
LEARNING
ASSESSMENT OF THE LEARNER

• helps validate the need for learning and the approach to be used
in designing learning experiences
• done by the educator so that the needs of the learner are
appropriately addressed
• Educator must ensure that optimal learning will occur with
the least amount of stress and anxiety for the learner
THREE DETERMINANTS (Haggard, 1989):
1. Learning needs (what the learner needs to learn)
2. Readiness to learn (when the learner is receptive to
learning)
3. Learning style (how the learner best learns)
1. ASSESSING LEARNING NEEDS

• gaps in knowledge that exist between a desired level of

performance and the actual level of performance
(Healthcare Education Association, 1985)
• the gap between what someone knows and what
someone needs to know
• 90% to 95% of learners can master a subject with a high
degree of success if given sufficient time and appropriate
types of help (Bloom, 1968; Carroll, 1963; Bruner, 1966;
Skinner, 1954)
STEPS IN THE ASSESSMENT OF LEARNING NEEDS:
1. Identify the learner
– Who is the audience?
– Individual- is there a single need or do many needs have to be
fulfilled?
– more than one learner- are their needs congruent or diverse?
2. Choose the right setting
• Establish a trusting environment to help learners feel a
sense of security in confiding information, believe their
concerns are taken seriously and considered important,
and feel respected.
• Assuring privacy and confidentiality is essential to
establishing a trusting relationship (Rankin & Stallings,
2001).
3. Collect data on the learner
• Determine characteristic needs of the population by
exploring typical health problems or issues of interest to
that population.
4. Include the learner as a source of information.
• Allow the patient and/or family members to identify what is
important to them, what types of social support systems are
available or perceived to be available, and how their social
support system can help.
• Actively engaging learners in defining their own problems
and needs allows them to learn in the process and also
motivates them to learn because they have an investment in
planning for a program specifically tailored to their unique
circumstances.
5. Involve members of the healthcare team.
• Nurses are not the sole teachers
• collaborate with other members of the healthcare team for
a richer assessment of learning needs.
• organizations within the healthcare field are also excellent
sources of information.
6. Prioritize needs
• Learning of other needs will be delayed if basic needs are
not attended to first and foremost.
Maslow’s (1970) hierarchy of human needs
Criteria for prioritizing learning needs
7. Determine availability of educational resources.
• 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.
• be familiar with standards of performance required in
various employee categories, along with job descriptions
and hospital, professional, and agency regulations
9. Take time-management issues into Account
• time constraints are a major impediment to the
assessment process,
METHODS TO ASSESS
LEARNING NEEDS

Informal Conversations
• Do active listening
• use open ended
Structured Interviews
• nurse asks the learner direct and often predetermined
questions to gather information about learning needs
• establish a trusting environment
• use open-ended questions
• choose a setting that is free of distractions and allow the
learner to state what is believed to be the learning needs
• remain nonjudgmental
• Notes should be taken with the learner’s permission
Focus Groups
• 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
Self-Administered Questionnaires
• Checklists provide more privacy than interviews
• checklists usually reflect what the nurse educator
perceives as needs
• there should also be a space for the learner to add any
other items of interest or concern.
Tests
• Written pretests- to identify the knowledge level of the
potential learner
• prevents the educator from repeating already known
material in the teaching plan.
• Useful to the educator after the completion of teaching to
determine whether learning has taken place by comparing
pretest scores to post-test scores.
Observations
• conclusions cannot be drawn from a single observation
• watching the learner perform a skill more than once is an
excellent way of assessing a psychomotor need
Patient Charts
• Physicians’ progress notes, nursing care plans, nurses’
notes, and discharge planning forms can also provide
information on learning needs.
2. READINESS TO LEARN

• the time when the learner demonstrates an interest in

learning the type or degree of information necessary to
maintain optimal health or to become more skillful in a job
• when a patient or staff member asks a question, the time
is prime for learning
• occurs when the learner is receptive to learning and is
willing and able to participate in the learning process
 FOUR
TYPES
OF
READI-
NESS
TO
LEARN
3. LEARNING STYLES

• refers to the ways individuals process information

• Each learner is unique and complex, with a distinct
learning style preference that distinguishes one learner
from another
Six Learning Style Principles

1. Both the style by which the

teacher prefers to teach and the
style by which the student
prefers to learn can be identified.
2. Teachers need to guard against overteaching by their
own preferred learning styles.
3. Teachers are most helpful when they assist students in
identifying and learning through their own style preferences.
4. Students should have the opportunity to learn through
their preferred style.
5. Students should be encouraged to diversify their style
preferences.
6. Teachers can develop specific learning activities that
reinforce each modality or style.