HE - Health Education Perspective

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TEACHING STRATEGY IN NURSING

HEALTH EDUCATION PERSPECTIVE

A. Historical development in health education Mid-1800s

Nursing was acknowledged as unique

discipline Teaching as an important role of

nurses as caregivers: promoting thehealth of the well public

Educating other nurses for professional

practice

Florence Nightingale Ultimate educator

Teaching nurses, physicians and health

officialsimportance of proper

conditions in hospitals and homes toimprove the health of people.

Importance of teaching patients of the

need for adequate nutrition, fresh air ,

exercise, and personal hygiene toimprove the well being

Early 1900s ---public health nurses in

this country clearly understood the

significance of the role of the nurse asteacher in preventing disease and in

maintaining the health of society. For decades, then, patient teaching

has been recognized as anindependent nursing function.

nurses has always educated others-

patients, families and colleagues

It is from this roots that nurses haveexpanded their practice to include the

broader concepts of health and illness In 1918, The National League of

Nursing Education in the US (NowNLN National League for Nurses)

observed the importance of healthteaching as a function within the scope

of nursing practice. 2 decades later, this organization

recognized nurses as agents for thepromotion of health and the

prevention of illness in all settings in

which they practiced By 1950,, the NLNE had identified

course content in nursing school

curricula to prepare nurses to assumethe role as teachers of others.

Recently, the NLN developed the first

certified nurse educator (CNE) exam to raisethe visibility and status of the academic

nurse educator role as am advancedprofessional practice discipline with a defined

practice setting

American Nurses Association has for yearsput forth statements on the functions,standards and qualifications for nursing

practice of which, patient teaching is a keyelement.

The ICN (International Council of Nurses)

has long endorsed the nurses role as

educator to be an essential component ofnursing care delivery.

Today, all state nurse practice acts (NPAs)

include teaching within the scope of

nursing practice responsibilities. Nursing career ladders often incorporate

teaching effectiveness as a measure of

excellence in practice. By teaching patients and families as well

as health care personnel, nurses can

achieve the professional goal of providing

cost effective, safe, and high quality care.

As early as 1993 the Joint Commission(JC) formerly the Joint Commission on

Accreditation of Health care Organizations

(JCAHO) established nursing standards forpatient 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 toreceive accreditation

1980s the role of the nurse as educator

has undergone a paradigm shift, evolvingfrom what once was a disease oriented

approach to a more prevention oriented

approach. Education , once done as part of discharge

plans at the end of hospitalization

As described by Grueninger (1995)

this transition toward wellness has entailed aprogression from disease oriented patient

education (DOPE) to prevention oriented

patient education (POPE)

To ultimately become a health orientedpatient education (HOPE)

This new approach has changed the role

of nurse from one of wise healer to expert

advisor/teacher to facilitator of change. The emphasis is now on empowering

patients to use their potentials, abilitiesand resources to the fullest (Glanville

2000)

Role of the nurse as health educators1. Serving as a clinical instructor for students

in the practice setting.

2. Clinical preceptors and mentors to ensurethat nursing students meet their expectedlearning outcomes

The role of the clinical educator

Is a dynamic one that requires the teacher

to actively engage students to become

competent and caring professionals Role training the trainer

That is preparing the nursing staff through

continuing education, in service programs,

and staff development to maintain and

improve their clinical skills and teachingabilities The key to the success of our profession is

for nurses to teach each other nurses The professional teacher

Licensed professional who

possesses dignity and reputation

with high moral values as well astechnical and professional

competence

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Nurses as Teachers

With shorter hospital stays, increase in

community based care, and the growth of

health care consumerism, we can expectthat staff nurse will have to be skilled

teachers.

Health education Is a process concerned with designing,

implementing, and evaluating educationalprograms that enable families, groups,

organizations and communities to playactive roles in achieving, protecting and

sustaining health.Purpose Is to contribute to health and well being

by promoting lifestyles, community

actions and conditions that make itpossible to live healthful lives

Health education= is also defined as any

combination of learning experiencedesigned to facilitate voluntary

adaptations of behavior conducive to

health. Refers to the act of providing information

and learning experience for purposes ofbehavior change for health betterment of

the client. It is a process with intellectual ,

psychological and social dimensionsrelating to activities that increase the

abilities of peopleProcess of health education

1. Physical Health

2. Emotional health3. Mental health

4. Social health

5. Spiritual healthKey aspects

1. Planned opportunity2. Specific setting

3. Program series or events4. Based on what was previously learned

5. Comprehensively emphasizes how variousaspects of health interrelate and how

health affects the quality of life6. Interaction between qualified educator

and learner

Purposes why health educators plan andconduct heath teachings

Be aware of the values of health

Develop skills

Acquire and apply concepts andinformation received

Develop and discuss opinions

Formulate accurate and effective decision

making

Purposes of health education1. Propagating health promotion and disease

prevention2. Maybe used to modify or continue health

behaviors if necessary3. Provides health information and services

4. Emphasis on good health habits andpractices

5. Means for communication6. Advocacy

Types of health education1. Information

2. Health services3. A friendly environment

Purposes, Goals, and Benefits of Client and

Staff EducationPurpose:

To increase the competence and

confidence of clients for self managementGoal:

To increase the responsibility and

independence of clients for self-careBenefits of Client Education:

Increase consumer satisfaction Improve quality of life

Ensure continuity of care

Decrease client anxiety

Effectively reduce the complications of

illness and incidence of disease Promote adherence to treatment plans Maximize independence in the

performance of ADL Energize and empower consumers to

become actively involved in the planningof their care

Discipline A branch of knowledge or

instruction

Profession is an occupation that properlyinvolves a liberal, scientific or artistic education

Characteristics of a profession by Upton

1. Provide a unique and essential social

services2. Require of its members an extensive

period of preparation ( BSN, MAN)

3. Have a theoretical base underlying its

practice4. Have a system of internal controls that

tends to regulate the behavior of itsmembers

5. Have a culture peculiar to the profession6. Be sanctioned by the community

7. Have an association that is representativeof all and can speak on behalf of all the

members of the occupation

PRINCIPLES OF HEALTH EDUCATION1. Good health practices

2. Use of preventive services likeimmunization, screening, antenatal and

child health clinics3. The correct use of medications and the

pursuit of rehabilitation regimen4. The recognition of early symptoms of

disease and promoting early referral5. Community support for primary health

care and government control measures.

2. Issues and trends in health education In the USA , patients are being discharge

quicker and earlier due to: New health care economics

Advances in medical technology

Nurses greater involvement

1. Client teaching in self care management2. Discharge planning

3. Providing for continuing care

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Practice in particular and the health care

system in general Lifestyle related and preventable thru

educational intervention Increase in chronic and incurable

conditions requires the individual and

families become informed participants to

manage their own illnesses

Advance technology Increasingly aware that client health

literacy is an essential skill if health

outcomes are to be improved . Client education improves

Increasing number of self help groups

The call for developing global health

strategies with the integration of healtheducation and action is now a clamor that can no

longer be ignored.

3. Theories in health education1. Banduras Self Efficacy Theory

2. Penders Health Promotion Theory3. Health Belief Model

4. Greens Precede-Proceed Model

B. Perspective on teaching and learning

1. Overview of education on health care Teaching function will always be an

integral part of the duties of a professionalnurse. This dates back to the time when

Nursing was given recognition as adiscipline in the 1800s and health

education became a unique andindependent function of the nurse.. This

was regarded as the period of educatedNursing.

Florence Nightingale, who has earned the

title of Mother of Modern Nursing, wasthe epitome of the true nurse educator as

she advocated the important function ofteaching to promote health and recovery

through a clean, pleasant and inhabitableenvironment

1918- The NLNE recognized the

importance of health teaching as a

responsibility of the nurse for thepromotion of health and prevention of

illness in different settings. 1950- NLNE specified the course content

dealing with teaching skills,developmental and educational

Psychology and Principles of teaching andlearning as part of the nursing curriculum

of all nursing schools THE ICN has endorsed health education as

an essential requisite for the delivery ofnursing care.

Today, NPAs in USA universally includeteaching within the scope of nursing

practice responsibilities. They areexpected to assist clients to maintain

health, prevent disease, manage illnessand render supportive care to family

members through healthteachings/education as a means to

providing cost-effectiveness, safe and highquality care.

1993- JCAHO delineated nursing

standards or mandates for patient

education which ARE BASED on positiveoutcomes of patient care. the teachings

must be patient and family oriented.

1998- The Pew Health Professionals

Commission released a follow up on healthprofessional practice and more than half

of the recommendations were on the

importance of patient and staff educationand the role of the nurse as educator.

Concepts of teaching, learning, education

process vis-a-vis nursing process, historicalfoundation s for the teaching role of the

nurseEducation Process is a systematic, sequential

planned course, planned course of actionwith teaching and learning as its two major

interdependent functions.Key players:

1.Teaching is a deliberate interventioninvolving the planning andimplementation of instructional

activities and experiences.

Instruction involves

communicating of information

about a specific skill: cognitive,affective, psychomotor.

2. Learning a change in behavior

(knowledge, skill, attitudes)

- Acquisition of knowledge of all

kinds such as: Abilities, Habits,

Attitudes, Values, Skills

Patient education a process of assistingpeople to learn health related behaviours

(knowledge, skill, attitudes, values)

Education is an interactive process ofimparting knowledge through sharing, explaining,

clarifying and synthesizing the substantive

content of the learning process in order to arriveat a positive judgment and well developed

wisdom and behavior

Patient teaching is the process of influencingpatient behavior and producing changes inknowledge, attitudes and skills necessary in

maintaining or improving health.Purposes of patient teaching: 1. Increase clients awareness 2. Increase clients satisfaction

3. Improve quality of life

4. Ensure contuinity of care

5. Decrease patient anxiety 6. Increase self reliant behavior

7. Reduce effectively the incidence of

complications of illness

8. promote adherence to health crea

treatments

9. Maximize indpendence in the

performance of ADL S to become actively involved in the

planning of their care

Health is the sense of being physically fit,

mentally stable and socially comfortable. It

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encompasses more than the state of being freefrom diseases.

3 Pillars of the Teaching-Learning Process

1. Teacher2. Learner

3. Subject matterContributions of teaching and learning:

1. The vital role of the teacher is motivating

students to learn2. Inspiring them to go out of their comfort

zones, to stretch and develop the 98%portion of their brain which is still

untapped and unused.

Education Process vs. Nursing Process Assessment

Nursing process: Appraise physical

and psychosocial needs

Education process: Ascertainlearning needs, readiness to learn,

and learning styles Planning

Nursing process; Develop care plan

based on mutual goal setting tomeet individual needs

Education process: Develop

teaching plan based on mutuallypredetermined behavioral

outcomes to meet individual needs Implementation

Nursing process: Carry out nursing

care interventions using standardprocedures

Education process: Perform the actof teaching using specificinstructional methods and tools

Evaluation

Nursing process: Determinephysical and psychosocial

outcomes

Education process: Determinebehavior changes in knowledge,

attitudes and skills

Nurse Educator

1.The primary source of knowledge oflearners in nursing

2. The primary catalyst for the learningprocess

3. A role model for nursing students4. An active facilitator, who demonstrates

and teaches patient care to nursingstudents in the classroom and clinical

settings5. A source of health care information and

patient care to clients of care6. Is diligent; keeps abreast of developments

in his or her field through continuing

education, reading of nursing journals andactive participation in workshops andseminars

Role of the Nurse as a Health Educator

1. Provide clinically competent andcoordinated care to the public

2. Involve patients and their families in thedecision making process regarding health

interventions

3. Provide clients with education andcounselling on ethical issues

4. Expand public access to effective care5. Ensure cost effective and appropriate care

for the consumer6. Provide for prevention of illness and

promotion of healthy lifestyle for allAmericans

Effective health education programs

are envisioned to cut health care costsand prevent the premature onset ofdisease and disability

The battle cry is to attain and

maintain healthy lifestyle through

health education since the leadingcause s of morbidity and, mortality are

lifestyle related diseases.

Health Educator Is a practitioner professionally prepared in

the field of health education, whodemonstrate competence in both theory

and practice and accepts responsibility inadvancing the aims of the health

education process.A health educator performs the following:

1. Collaborates with health specialistsand civic groups in assessing

community health needs andavailability of resources and services

and in developing goals for meetinghealth needs of clients

2. Designs and conducts evaluation anddiagnostic studies to assess the quality

and performance of health educationprograms.

3. Develops and implements health

education and promotion programssuch as training workshops ,

conferences and school or communityprojects

4. Develops operational plans andpolicies necessary to achieve heath

education objectives and services

Hallmarks of a Good TeachingWhat constitutes good teaching?

1. Following: behaviors of both nursing

students and faculty generally agreecontribute to effective teaching in nursing,

especially clinical teaching

2. Effective teaching in more general terms

Hallmarks of Effective Teaching in NursingIn 1966, Jacobson

6 major categories: Professional Competence

Interpersonal Relationship Teaching Practices

Personal Characteristics Evaluation Practices

Availability to students

1. Professional competence

A. Thorough knowledge of subject matterB. Proper demonstration of skills

C. Expands knowledge through reading,

research, clinical practice and continuingeducation

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2. Interpersonal relationships with students most important

A. Takes personal interest in the welfare ofthe student;

B. Sensitive to their feelings and problems;C. Conveys respect for them;

D. Alleviates their anxieties;

E. Accessible for conferences;

F. Fair

G. Permits learners to express differingpoints of view

H. Creates an atmosphere in which they feelfree to ask questions

I. Conveys a sense of warmth3 basic therapeutic approaches for the

educators can help learners maintain self esteemand minimize anxieties

1. Empathetic Listening teachers listen to

learners and try to see the world throughtheir eyes.

2. Acceptance accept learners as they are;

whether or not you like them. Affirmingthe fact that learners are worthwhile

people, even though different fromyourself, enhances their self esteem and

convince s them that you have faith intheir desire and ability to learn.

3. Honest communication need to know

something about the teachers thoughts

regarding the topic and regarding the

learners abilities and performance.Openness between the educator and

students creates a relaxed atmosphere

3. Desirable personal characteristicsA. Charisma (personal magnetism)

B. EnthusiasmC. Cheerfulness

D. Self-controlE. Patience

F. Flexibility

G. A sense of humorH. A good speaking voice

I. Self-confidenceJ. Willingness to admit errors

K. Caring attitude

4. Teaching practicesA. Mechanics

B. MethodsC. Skills in the classroom and clinical practice

5. Evaluation practicesA. Clearly communicating expectations

B. Providing timely feedback on studentprogress

C. Correcting the students tactfully

D. Being fair in the evaluation processes

E. Giving tests that are pertinent to thesubject matter and assignments

6. Availability to students Nursing students, especially those taking

courses, expect the instructor to beavailable to them when needed.

This may take the form of being there in

stressful clinical situations, physicallyhelping students to give nursing care,

giving appropriate amounts ofsupervision, freely answering questions

and acting as a resource person duringclinical learning experiences

One of the great stressors for teachers in

nursing is trying to be available to

students or patients who needinstructions, at the precise time they need

it.

The reality is that teachers usually havemany other students or patients they areworking with and they cannot be in six

places at once.

Other important characteristics of a teacherinclude

1. Teacher clarity

Deals with behaviors that teachers use to

make what is to be learned as intelligible,

comprehensible and learnable as possible. A clear teacher is one who:

Logically organizes instruction

Explains what is to be learned

Uses simple terms in presenting new

materials Constantly assesses whether student can

understand and follow the teachers train

of thought Uses examples, whenever possible

Uses repetitions and summarizations

Commonalities (common characteristics

1. Viewing a learner as collaborators , which

lead to the teachers being respectful andsupportive of the learners

2. Admitting weaknesses. They madethemselves somewhat vulnerable whenthey admitted to students that they did

not know an answer or had no experiencein a certain field of knowledge

3. They recognized when their students were

having difficulty and were able to figureout what to do help.

To be a good teacher, you have to

really have the desire to be goodbecause it takes a lot of work to

succeed in every aspect of teaching.

Is also a form of parenting-caringabout students , knowing when to setboundaries and knowing a students

potential

A good teacher is concerned with

more than just what students know,

he or she should also be concerned witstudents beliefs, values, and

relationship. In short a good teachercares.

Are committed And creative. They

are committed in that they dont want

the clock, often working long hours.

Creative in the attempts to

stimulate intellectual inquisitiveness in

their students and to help studentsexplore their world.

2. Teacher style involves interpersonal,

professional and personal aspects of goodteaching which includes:

A blend of form or content which is a

combination of certain ways of talking,

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moving, relating and thinking;scholarliness, intelligence and sincerity;

The teaching persona which is the ability

to stimulate the students interest and

enthusiasm for the subject; A pleasant speaking voice

The use of a variety of teaching

strategies, jokes, humor

Good timing wherein the teacher knows

how to adapt the speed of delivery forindividual learners or the whole class andknowing when they are ready for a new

material, when to stop and when to shiftgears.

Effective means to change the style Discuss your teaching with a

knowledgeable peer or consultant Reading books on teacher style

Seven Principles of Good Practice Teaching in

Undergraduate Education1. Encourage student-faculty contact.

2. Encourage cooperation among students.3. Encourage active learning.

4. Give prompt feedback.5. Emphasize time on task.

6. Communicate high expectations.7. Respect diverse talents and ways of

learning.

Barriers to educationFactors impeding the nurses ability to deliver

educational services:

1. Lack of time to teach

2. Many nurses admit that they do not feelcompetent or confident with regard to

their teaching skills3. Personal characteristics of the nurse

educator4. Low priority

5. The lack of space and privacy in thevarious environmental settings

6. An absence of third-party reimbursement7. Some nurses and physicians question

whether patient education is effective as ameans to improve health outcomes.

8. There seems to be a malfunction of the

healthcare team9. Both formal and informal teaching

Obstacles to LearningFactors that negatively affect the ability of the

learner to attend to and process information:1. The stress of acute and chronic illness,

anxiety, sensory deficits, and low literacyin patients.

2. The negative influence of the hospitalenvironment itself, resulting in loss of

control, lack of privacy, and social

isolation, can interfere with a clientsactive 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 andfrustrate the learner, impeding the ability

and willingness to learn.4. Personal characteristics of the learner

have major effects on the degree to which

predetermined behavioral outcomes areachieved.

A. Readiness to learnB. Motivation to learn

C. ComplianceD. Developmental stage characteristics

E. Learning styles

F. The extent of behavioral changes

needed can overwhelm learners and

dissuade them from attending to andaccomplishing learning objectives and

goals. Lack of support and ongoing

positive reinforcement from thenurse and significant others serves

to block the potential for learning. Psychological obstacles to

accomplishing behavioral change: Denial of learning needs

Resentment of authority

Lack of willingness to take

responsibility- The inconvenience, complexity,

inaccessibility, fragmentation, anddehumanization of the healthcare system

often result in frustration and abandonmentof efforts by the learner to participate in

and comply with the goals and objectivesfor learning.

Principles of Learning

1. Satisfying stimulus2. Reinforcement

3. Over learning

4. Verbal and non-verbal associations5. Cognitive perceptual readiness and

internal motivation

6. The ordering principles7. Stimulus response associations and

discrimination abilities8. Cognitive construct

9. Multiple discrimination and generalization

responses10.Previous knowledge

11.Critical thinking skills

12.Flexibility and adaptation13.Feedback

14.Balanced growth and developmentpatterns

Changes :

Growth which is quantitative

involving increase in the size of the parts

of the body

Development which is

qualitative involving gradual changes incharacter

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HE - Health Education Perspective

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