NUPC 103

DARIO M. RAGMAC, RN
2nd Semester SY 2020-2021

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MODULE II

Lesson 1 : Evidence Based-

Practiced Related to
Health Education

Lesson 2 : Ethico-Moral and Legal

Foundations of Client
Education

Lesson 3 : Health Education Team

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 INTRODUCTION

This course talks about evidenced-based practice in relation to health

education, the ethico-moral and legal foundations of clients education, and the
different roles of the health education team in relation to client education.

LEARNING OUTCOMES

After studying the module, you should be able to:

 To know and understand the importance of evidenced-based practice

to health education.
 To apply the different ethical principles in the provision of healthcare
and clients education.
 Discuss and explain the roles of the nurse as educator and the roles of
the other members of the health education team as a whole..

 DIRECTIONS/ MODULE ORGANIZER

There are two lessons in the module. Read each lesson carefully then
answer the exercises/activities to find out how much you have benefited
from it. Work on these exercises carefully and submit your output through
my email account dragmac@dmmmsu.edu.ph. Essays will be graded using
the rubrics provided in the preliminaries of this module.

In case you encounter difficulty, we can discuss this during the face-
to-face meeting.

Happy reading!!!

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Lesson 1
Evidence Based-
 Practiced Related to
Health Education
For most of history, professions have based their practices on expertise derived
from experience passed down in the form of tradition. Many of these practices
have not been justified by evidence, which has sometimes enabled quackery and
poor performance. Even when overt quackery is not present, quality and efficiency
of tradition-based practices may not be optimal. As the scientific method has
become increasingly recognized as a sound means to evaluate practices, evidence-
based practices have become increasingly adopted

One of the earliest proponents of EBP was Archie Cochrane, an epidemiologist who
authored the book Effectiveness and Efficiency: Random Reflections on Health
Services in 1972. Cochrane's book argued for the importance of properly testing
health care strategies, and was foundational to the evidence-based practice of
medicine. Cochrane suggested that because resources would always be limited,
they should be used to provide forms of health care which had been shown in
properly designed evaluations to be effective. Cochrane maintained that the most
reliable evidence was that which came from randomised controlled trials

During the 1980s the term “evidenced-based medicine” emerged to describe the
approach that used scientific evidence to determine the best practice. Evidence
based practice movement started in England in the early 1990s. Evidenced based
practice (EBP), is the judicious use of the best current evidence in making decisions
about the care of the individual patient. It represents both an ideology and a
method. The ideology springs from the ethical principle that clients deserve to be
provided with the most effective interventions possible. The method of EBP is the
way we go about finding and then implementing those interventions.

DEFINITION OF TERMS

 Evidence
 Something that furnishes proof or testimonies
 Something legally submitted to ascertain in the truth of matter
 Evidence Based Practice
 It is a systemic inter connecting of scientifically generated evidence
with the tacit knowledge of the expert practitioner to achieve a
change in a particular practice for the benefit of a well-defined
client/patient group.(French 1999).
 Evidence Based Nursing
 A process by which nurses make clinical decisions using the best
available research evidence, their clinical expertise and patient
preferences (Mulhall 1998).
 Evidence Based Medicine or Practice
 Conscientious, explicit, and judicious use of current best evidence in
making decisions about the care of individual patient (Dr. David
Sackett, Rosenberg 1996).
 Evidence Based Practice in Nursing

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 A way of providing nursing care that is guided by the integration of

the best available scientific knowledge with nursing expertise.
 This approach requires nurses to critically assess relevant scientific
data or research evidenced and to implement high quality
interventions for their nursing practice (NLM PubMed).

NEED FOR EVIDENCE BASED PRACTICE

 For making sure that each patient get the best possible services.
 Update knowledge and is essential for lifelong learning.
 Provide clinical judgment.
 Improvement care provided and save lives.

GOAL OF EVIDENCE BASED PRACTICE

 Provide practicing nurse the evidence based data to deliver effective care.
 Resolve problem in clinical setting.
 Achieve excellence in care delivery.
 Reduces the variations in nursing care and assist with efficient and effective
decision making.

SOURCES OF EVIDENCE
Research evidence has assumed priority over other sources of evidence in the
delivery of evidence based health care. It includes:

 FILTERED RESOURCES- Clinical experts and subject specialist pose a

question and then synthesize evidence to state conclusion based o available
research. These sources are helpful because the literature has been
searched and results evaluated to provide an answer to clinical question.

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 UNFILTERED RESOURCES (Primary Literature)- It provides most recent

information. Example is MEDLINE, it provides primary and secondary
literature for medicine.

 CLINICAL EXPERIENCES- Knowledge through professional practice and life

experiences makes up the second part in the evidenced based, person-
centered care.

 KNOWLEDGE FROM PATIENTS- Evidenced delivered from patients

knowledge of themselves, their bodies and social lives.

 KNOWLEDGE FROM LOCAL CONTEXT- These are:

 Audit and performance data
 Patient stories and narratives
 Knowledge about the culture of the organization & individuals
within it.
 Social & professional networks
 Information from feedbacks
 Local & national policy

MODELS OF EVIDENCE BASED PRACTICE

 JOHN HOPKINS NURSING EBP MODEL- Used as a framework to guide the

synthesis and translation of evidence into practice. (Newhouse, Dearholt,
Poe, Pugh, & White, 2007)

There are three phases to the JHNEBP model:

1. The identification of an answerable question.
2. A systematic review and synthesis of both research and non-research
evidence.
3. Translation includes implementation of the practice change as a
pilot study, measurement of outcomes, and dissemination of
findings.

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 IOWA MODEL- This model focuses on organization and collaboration

incorporating conduct and usw of research, along with other types of
evidence. (Titler et al, 2001). It was originated in 1994.

 THE STETLER MODEL- This model examines how to use evidence to create
formal change within organizations, as well how individual practitioners can
use research on an informal basis as part of critical and effective practice.

The Stetler model of evidenced based practice based on the following:

1. Use maybe instrumental, conceptual and/or symbolic/strategic.

2. Other types of evidence and/or non-research related information are likely
to be combined with research findings to facilitate decision making or
problem solving.
3. Internal or external factors can influence an individual’s or group’s review
and use of evidence.
4. Research and evaluation can provide probabilistic information, not
absolutes.
5. Lack of knowledge pertaining to research use and evidence-informed
practice can inhibit appropriate and effective use.

This model consists of five phases. Each phase is designed to:

 Facilitate critical thinking about the practical application of research
findings.
 Result in the use of evidence in the context of daily practice.
 Mitigate some of the human errors made in the decision making.

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BARRIERS IN EVIDENCE BASED PRACTICE

 Lack of value for research in practice

 Difficulty in bringing change
 Lack of administrative support
 Lack of knowledge mentors
 Lack of time for research
 Lack of knowledge about research
 Research reports not easily available
 Complexity of research reports
 Lack of knowledge about evidence based practice

ADVANTAGES OF EVIDENCE BASED PRACTICE

 Provide better information to practitioner

 Enable consistency of care
 Better patient outcome
 Provide client focused care
 Structured process
 Increases confidence in decision-making
 Generalize information
 Contribute to science of nursing

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 Provide guidelines for further research

 Helps nurses to provide high quality patient care

DISADVANTAGES OF EVIDENCE BASED PRACTICE

 Not enough evidence for EBP

 Time consuming
 Reduced client source
 Reduced professional judgment/autonomy
 Suppress creativity
 Influence legal proceedings
 Publication bias

THINK!

Directions: Answer the question briefly (5-10 sentences only). Write/ encode your
answer on a short bond paper then send a digital copy (image/ picture/ softcopy) to
the respective email of your instructor. You will be graded using the rubrics
provided.

Activity #1: Why do you think that Evidenced-Based Practice is important in

Health Education?

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Lesson 2
Ethico-Moral and Legal
 Foundations of Client
Education
Approximately 45 years ago, the field of modern Western bioethics arose in
response to the increasing complexity of medical care and decision making. The
field of bioethics provides systematic theoretical and practical approaches for
handling such complex issues and the dilemmas that ensue from them. As a
result, programs of study for health professionals, including nursing, now provide
formal ethics education—some by mandate. Healthcare providers who commit
ethical infractions while in training or practice may be referred for ethics
remediation by their programs or specialty licensing boards or may risk professional
sanctions.

The issues of human rights are fundamental to the delivery of high-quality

healthcare services. They are equally fundamental to the education process,
in that the intent of the educator should be to empower the client to identify
and articulate his or her values and preferences; acknowledge his or her role in
a family, community, or other relationship; and make well-informed choices,
reasonably aware of the alternatives and consequences of those choices (Butts
& Rich, 2016; Mason, Gardner, Outlaw, & O’Grady, 2016; Parker, 2007). Thus, an
interpretation of the role of the nurse in the teaching–learning process must
include the ethical and legal foundations of that process. Teaching and
learning principles, with their inherent legal and ethical dimensions, apply to any
situation in which the education process occurs.

The purpose of this lesson is to provide the ethical, legal, and economic
foundations that are essential to carrying out patient education initiatives, on the
one hand, and the rights and responsibilities of the healthcare provider, on the
other hand. It also describes the differences between and among ethical, moral,
and legal concepts. It explores the foundations of human rights based on ethics and
the law, and it reviews the ethical and legal dimensions of health care.

A Differentiated View of Ethics, Morality, and the Law

Although ethics as a branch of classical philosophy has been studied throughout

the centuries, by and large these studies were left to the domains of philosophical
and religious thinkers. More recently, because of the complexities of contemporary
life and the heightened awareness of an educated public, ethical issues related to
health care have surfaced as a major concern of both consumers and healthcare
providers. It is now a widely held belief that the patient has the right to know his
or her medical diagnosis, the treatments available, and the expected outcomes.
This information is necessary so that patients can make informed choices about
their health and their care options with advice offered by health professionals.
Ethical principles that pertain to human rights are based on natural laws, which, in
the absence of any other guidelines, are binding on human society. Inherent in
these natural laws are, for example, the principles of respect for others, truth
telling, honesty, and respect for life. Ethics as a discipline interprets these basic
principles of behavior in broad terms that direct moral decision making in all
realms of human activity (Tong, 2007; World Health Organization [WHO], 2017).

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Although multiple perspectives on the rightness or wrongness of human acts exist,

among the most commonly referenced are the writings of

 Immanuel Kant (18th Century German Philosopher)- Kant proposed that

individual rights prevail and openly proclaimed the deontological notion of
the “Golden Rule.” Deontology (from the Greek word deon, which means
“duty” and logos, which means “science” or “study”) is the ethical belief
system that stresses the importance of doing one’s duty and following the
rules (Stanford Encyclopedia of Philosophy, 2016a). Thus, according to Kant,
respect for individual rights is key, and one person should never be treated
merely for the benefit or well-being of another person or group (Tong,
2007).

 John Stuart Mill (19th Century English Philosopher)- Mill, in contrast,

proposed the teleological notion or utilitarian approach to ethical decision
making that allows for the sacrifice of one or more individuals so that a
group of people can benefit in some important way. He believed that given
the alternatives, choices should be made that result in the greatest good for
the greatest number of people (Stanford Encyclopedia of Philosophy,
2016b).

Likewise, the legal system and its laws are based on ethical and moral
principles that, through experience and over time, society has accepted as
behavioral norms (Hall, 1996; Lesnik & Anderson, 1962). In fact, the terms
ethical, moral, and legal are often used in synchrony. It should be made clear,
however, that although these terms are certainly interrelated, they are not
necessarily synonymous.

 Ethics- refers to the guiding principles of behavior

 Ethical- refers to norms or standards of behavior accepted by the
society to which a person belongs.
 Moral values-refer to an internal belief system (what one believes to be
right). This value system, defined as morality, is expressed externally
through a person’s behaviors.
 Ethical dilemmas-are a “specific type of moral conflict in which two or
more ethical principles apply but support mutually inconsistent
courses of action” (Dwarswaard & van de Bovenkamp, 2015, pp. 1131–
1132).

 Legal rights and duties-refer to rules governing behavior or conduct 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
profession’s scope of practice, and provide guidelines for state professional
boards of nursing regarding standards for practice, entry into a profession
via licensure, and disciplinary actions that can be taken when necessary
(Russell, 2012).

Code of Ethics for Filipino Nurses

The professional code of ethics for Filipino nurses strongly emphasizes the four-fold
responsibility of the nurse, the universality of nursing practice, the scope of their

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responsibilities to the people they serve, to their co-workers, to society and

environment, and to their profession.

The Code of Ethics used by Filipino nurses prior to 1984, was the code promulgated
by the International Council for Nurses. In 1982, the PNA Special Committee
developed a Code of Ethics for Filipino Nurses, but was not implemented.

In 1984, the Board of Nursing adopted the Code of Ethics of the ICN, adding
“promotion of spiritual environment” as the fifth-fold responsibility of the nurse.

In 1989, the Code of Ethics promulgated by the PNA was approved by the
Professional Regulation Commission and was recommended for use. This was
approved In October 25, 1990 by the general assembly of the PNA .

In July 14, 2004, a new Code of Ethics for Filipino Nurse was adopted under R.A.
9173 and was promulgated by the BON.

The Code of Ethics for Filipino Nurses embodies ethical principles and guidelines to
be observed, stipulated under seven (7) articles. The ethical principles are stated
below.

Article I – Preamble
1. Health is a fundamental right. The Filipino RN, believing in the worth
and dignity of each human being, recognizes the primary responsibility
to preserve health at all cost. This responsibility encompasses promotion
of health, prevention of illness, alleviation of suffering, and restoration
of health. However, when the foregoing are not possible, assistance
towards a peaceful death shall be his/her obligation.
2. To assume this responsibility, RNs have to gain knowledge and
understanding of man’s cultural, social, spiritual, psychological, and
ecological aspects of illness, utilizing the therapeutic process. Cultural
diversity and political and socio-economic status are inherent factors to
effective nursing care.
3. The desire for the respect and confidence of clientele, colleagues, co-
workers, and the members of the community provides the incentive to
attain and maintain the highest possible degree of ethical conduct.

Article II – Registered Nurses and People

1. Values, customs, and spiritual beliefs held by individual shall be
represented.
2. Individual freedom to make rational and unconstrained decisions shall
be respected.
3. Personal information acquired in the process of giving nursing care
shall be held in strict confidence.

Article III – Registered Nurses and Practice

1. Human life is inviolable.
2. Quality and excellence in the care of patients are the goals of
nursing practice.
3. Accurate documentation of actions and outcomes of delivered care
is the hallmark of nursing accountability.
4. Registered nurses are the advocates of the patients: they shall
take appropriate steps to safeguard their rights and privileges.

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5. Registered Nurses are aware that their actions have professional

ethical, moral and legal dimensions. They strive to perform their
work in the best interest of all concerned.

Article IV – Registered Nurses and Co-workers

1. The RN is in solidarity with other members of the health care team in
working for the patient’s best interest.
2. The RN maintains collegial and collaborative working relationship with
colleagues and other health care providers.

Article V – Registered Nurses, Society, and Environment

1. The preservation of life, respect for human rights, and promotion of
healthy environment shall be a commitment of a RN.
2. The establishment of linkages with the public in promoting local,
national, and international efforts to meet health and social needs of
the people as a contributing member of society is a noble concern of a
RN.

Article VI – Registered Nurses and the Profession

1. Maintenance of loyalty to the nursing profession and preservation of its
integrity are ideal.
2. Compliance with the by-laws of the accredited professional organization
(PNA) and other professional organizations of which the RN is a member
is a lofty duty.
3. Commitment to continual learning and active participation in the
development and growth of the profession are commendable
obligations.
4. Contribution to the improvement of the socio-economic conditions and
general welfare of nurses through appropriate legislation is a practice
and visionary mission.

Article VII – Administrative Penalties, Repealing Clause and Effectivity

The certificate of registration of the RN shall either be revoked or
suspended for violation of any provisions of this Code pursuant to Sec. 23 (f), Art.IV
of R.A. No. 9173 and Sec. 23 (f), rule III of Board Res. No. 425, Series of 2003, the
IRR.

* *Art. IV of R.A. 9173 – Examination and Registration

Sec. 23. Revocation and Suspension of Certificate of Registration/Professional
License and Cancellation of Special/Temporary Permit. – The Board shall have the
power to revoke or suspend the certificate of registration/professional license or
cancel the special/temporary permit of a nurse upon any of the following grounds:
(a) For any of the causes mentioned in the preceding section;
(b) For unprofessional and unethical conduct;
(c) For gross incompetence or serious ignorance;
(d) For malpractice or negligence in the practice of nursing;
(e) For the use of fraud, deceit, or false statements in obtaining a
certificate of
registration/professional license or a temporary/special permit;
(f) For violation of this Act, then rules and regulations, Code of Ethics for
nurses and
technical standards for nursing practice, policies of the Board and the
Commission,

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or the conditions and limitations for the issuance of the

temporary/special permit; or
(g) For practicing his/her profession during his/her suspension from such
practice;

Provided, however, That the suspension of the certificate of

registration/professional license shall be for a period not to exceed four (4) years.

**Rule III of Board Res. No. 425, Series of 2003, the IRR (Implementing Rules and
Regulations
o Same as rule III of Board Res. No. 425, Series of 2003, the IRR except: (f)
For violation of RA No. 9173 and this IRR, Code of Ethics for nurses and
Code of Technical Standards for nursing practice, policies of the Board
and the Commission, or the conditions and limitations for the issuance of
the special/temporary permit; or

For this purpose, the suspension of the Certificate of Registration/Professional

License shall be for a period not to exceed four (4) years.

Application of Ethical Principles to Client Education

Various theories and traditions frame a health professional’s understanding of the
ethical dimensions in the healthcare setting (Butts & Rich, 2016). In considering the
ethical and legal responsibilities inherent in the process of patient education,
nurses and nursing students can turn to a framework of six major ethical
principles.

1. Autonomy
The term autonomy is derived from the Greek words auto (“self ”) and
nomos(“law”) and refers to the right of self-determination (Butts & Rich,
2016; Tong, 2007). Laws have been enacted to protect the patient’s right to
make choices independently. The concept of autonomy can be seen during
decision-making of undergoing such procedures whether invasive or not. An
informed consent is one example of how a nurse can practice the concept of
autonomy. Nurses must be able to accept the fact that an individual may have
different cultural and religious background that could influence his or her
submission to medical procedures. Using a written consent during such cases can
protect the patient and the hospital in particular against legal violations of
invading the privacy of an individual. 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 care and the right
to initiate advance directives. (Mezey, Evans, Golob, Murphy, & White, 1994, p.
30)

2. Veracity
Veracity, or truth telling, is closely linked with informed decision makingand
informed con sent. The landmark Cardozo decision in 1994(Schloendorff v. Society
of New York Hospitals) specified an individual’s fundamental right to make
decisions about his or her own body. This ruling provided a basis in law for patient
education or instruction regarding invasive medical procedures, including the truth
regarding risks or benefits involved in these procedures (Boyd et al., 1998; Rankin
&Stallings, 2001). Nurses are often confronted with issues of truth telling, as was
exemplified in the Tuma case (Rankin & Stallings, 1990). In the interest of full
disclosure of information, the nurse (Tuma) had advised a cancer patient of

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alternative treatments without consultation with the client’s physician. She was
sued by the physician for interfering with the medical regimen that he had
prescribed for care of this particular patient.“A nursing regimen shall be consistent
with and shall not vary from any existing medical regimen.”

Creighton (1986) emphatically explained that failure or omission to properly

instruct the patient relative to invasive procedures is tantamount to battery. Cisar
and Bell (1995) addressed this concept of battery related to medical treatment
exceedingly well. In addition to discussing Curtin’s Ethical Decision-Making
Model, which serves as a guide for healthcare providers facing an ethical dilemma,
the authors offered an explanation of the four elements making up the notion of
informed consent that is such a
vital aspect of patient education.
1. Competence, which refers to the capacity of the patient to make a
reasonable decision.
2. Disclosure of information, which requires that sufficient information
regarding risks and alternative treatments be provided to the patient to
enable him or her to make a rational decision.
3. Comprehension, which speaks to the individual’s ability to understand or to
grasp intellectually the information being provided. A child, for example,
may not yet be of an age to understand any ramifications of medical
treatment and must, therefore, depend on his or her parents to make a
decision that will be in the child’s best interest.
4. Voluntariness, which indicates that the patient has made a decision
without coercion or force from others.

3. Confidentiality
Confidentiality refers to privileged information or to a social contract or covenant
in legal terms. The nurse–patient relationship is considered to be privileged in
most states. As a consequence, the nurse may not disclose information acquired in
a professional capacity from a patient without the consent of the patient “unless
the patient has been the victim or subject of a crime, the commission of which is
the subject of legal proceeding in which the nurse is a witness” (Lesnik &
Anderson, 1962, p. 48).

This discussion of confidentiality gives rise to the need to distinguish between the
concepts of what is private, what is privileged, and what is confidential. The
diagnosis of acquired immune deficiency syndrome (AIDS) readily lends itself to the
clarification of these concepts. Despite its communicability, the person with a
diagnosis of AIDS is protected by laws promulgated by federal and various state
governments. Within this context, AIDS is considered to be private information. It
need not be disclosed in the workplace, the home, or other social settings. This
information is considered to be highly personal, the privacy of which is regarded as
a fundamental right of the person. AIDS is further considered to be privileged
information. Such information is “owned” by the patient alone and is subject to
disclosure only at his or her
individual discretion. Once this information is shared between the nurse and the
client, it cannot be shared with other health professionals unless authorized by the
client (Brent, 2001). The diagnosis of AIDS is also protected by law as confidential.
Thus anyone not involved in a client’s care has no right to private or privileged
information regarding the health status of the client (Brent, 2001).

4. Nonmaleficence

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Nonmaleficence, the principle of “do no harm,” is the ethical fabric of legal

determinations encompassing negligence and/or malpractice. According to Brent
(2001), negligence is defined as “conduct which falls below the standard
established by law for the protection of others against unreasonable risk of harm”
(p. 54). Brent further explains the concept of professional negligence, which, she
asserts, “involves the conduct of professionals (e.g., nurses, physicians, dentists,
and lawyers) that fall below a professional standard of due care” (p. 55). As
clarified by Lesnick and Anderson in 1962, Brent (2001) reiterates that for
negligence to exist, there must be a duty between the injured party and the person
whose actions (or nonactions) caused the injury. A breach of that duty must have
occurred, the breach of duty must have been the immediate cause of the injury,
and the injured party must have experienced damages from the injury. The term
malpractice, by comparison, still holds as defined by Lesnick and Anderson
(1962). Malpractice, they asserted, “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” (p. 234). Thus
malpractice is limited in scope to those whose life work requires special education
and training as dictated by specific educational standards, whereas negligence
embraces all improper and wrongful conduct by anyone arising out of any activity.

Reising and Allen (2007) describe the most common causes for malpractice claims
specifically against nurses, but these causes ara also relevant to the conduct of
other health professionals within the scope of their practice responsibilities:
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
The principle of beneficence (doing good) is legalized through adherence to critical
tasks and duties contained in job descriptions; in policies, procedures, and
protocols set forth by the healthcare facility; and in standards and codes of ethical
behaviors established and promulgated by professional nursing organizations.
Adherence to these various professional
performance criteria and principles, including adequate and current patient
education, speaks to the nurse’s commitment to acting in the best interest of the
patient. Such behavior emphasizes patient welfare and deemphasizes the provision
of quality care under threat of litigation.

6. Justice
Justice speaks to fairness and equal distribution of goods and services. The law is
the “Justice System.” The focus of the law is the protection of society; the focus of
health law is the protection of the consumer. This means that the nurse or any
other health professional can be subjected to penalty or to litigation for
discrimination in provision of care. Regardless of his or her age, gender, physical
disability, sexual orientation, or race, for example, the client has a right to proper
instruction regarding risks and benefits of invasive medical procedures. He or she
also has a right to proper instruction regarding self-care activities, such as home
dialysis, that are beyond normal activities of daily living for most people.

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Feinsod and Wagner (2008) point out that justice is a complex ethical principle
concerned with distributing benefits and burdens fairly to individuals in
institutions, but they question what it means to be fair. As defined by Tong (2007)
decision making for the fair distribution of resources includes the following
criteria:
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
According to Tong (2007), professional nurse may have second thoughts about the
application of these criteria in certain circumstances because one or more of the
criteria could be at odds with the concept of justice, “To allocate scarce resources
to patients on the basis of social worth and moral goodness or economic condition
rather than on the basis of their medical condition is more often than wrong”
(p.30).

THINK!

Directions: Answer the questions briefly (5-10 sentences only). Write/ encode your
answer on a short bond paper then send a digital copy (image/ picture/ softcopy) to the
respective email of your instructor. You will be graded using the rubrics provided.

Activity #2: choose one (1) ethical principle then site a hospital situation
wherein you can apply such principle.

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Lesson 3

 The Health Education

Team

A. Role of the Nurse as a Health Educator

Nurses as educators play a key role in improving the health of the nation. Educating
people is an integral part of the nurse’s role in every practice setting –school,
community, work sites, health care delivery sites, and homes. Health education
involves not only providing relevant information, but also facilitating health-
related behavior change. The nurse, using health education principles, can assists
people in achieving their goals in a way that is consistent with their personal
lifestyles, values, and beliefs.

For many years, organizations governing and influencing nurses in practice have
identified teaching as an essential responsibility of all registered nurses in caring
for both well and ill clients. For nurses to fulfill the role of educator, no matter
whether their audience consists of patients, family members, nursing students,
nursing staff, or other agency personnel, they must have a solid foundation in the
principles of teaching and learning.

The role of educator is not primarily to teach, but to promote learning and provide
for an environment conducive to learning—to create the teachable moment rather
than just waiting for it to happen (Wagner & Ash, 1998).
Also, the role of the nurse as teacher of patients and families, nursing staff, and
students certainly should stem from a partnership philosophy. A learner cannot be
made to learn, but an effective approach in educating others is to actively involve
learners in the education process (Bodenheimer et al., 2002).

Although all nurses are able to function as givers of information, they need to
acquire the skills of being a facilitator of the learning process (Musinski, 1999).
Consider the following questions posed:

 Is every nurse adequately prepared to assess for learning needs, readiness

to learn, and learning styles?

 Can every nurse determine whether information given is received and

understood?

 Are all nurses capable of taking appropriate action to revise the approach to
educating the client if the information provided is not
comprehended?

 Do nurses realize the need to transition their role of educator from being a
content transmitter to being a process manager, from controlling the
learner to releasing the learner, and from being a teacher to becoming a
facilitator (Musinski, 1999)?

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A growing body of evidence suggests that effective education and learner

participation go hand in hand. The nurse should act as a facilitator, creating an
environment conducive to learning that motivates individuals to want to learn and
makes it possible for them to learn (Musinski, 1999). The assessment of learning
needs, the designing of a teaching plan, the implementation of instructional
methods and materials, and the evaluation of teaching and learning should include
participation by both the educator and the learner. Thus, the emphasis should be
on the facilitation of learning from a nondirective rather than a didactic teaching
approach (Knowles, Holton, & Swanson, 1998; Musinski, 1999; Mangena & Chabeli,
2005; Donner et al., 2005). No longer should teachers see themselves as simply
transmitters of content. Indeed, the role of the educator has shifted from the
traditional position of being the giver of information to that of a process designer
and coordinator. This role alteration from the traditional teacher centered to the
learner-centered approach is a paradigm shift that requires skill in needs
assessment as well as the ability to involve learners in planning, link learners to
learning resources, and encourage learner initiative (Knowles et al., 1998; Mangena
& Chabeli, 2005). Instead of the teacher teaching, the new educational paradigm
focuses on the learner learning. That is, the teacher becomes the guide on the
side, assisting the learner in his or her effort to determine objectives and goals for
learning, with both parties being active partners in decision making throughout the
learning process. To increase comprehension, recall, and application of
information, clients must be actively involved in the learning experience (Kessels,
2003; London, 1995). Glanville (2000) describes this move toward assisting learners
to use their own abilities and resources as “a pivotal transfer of power” (p. 58).

When you think about it, nurses are the superheroes of health care. While they
don’t leap tall buildings in a single bound or race speeding bullets, these
extraordinary caregivers seek justice for their patients, especially society’s most
vulnerable. Requiring strengths such as courage, compassion, and competence, the
role of the nurse as patient advocate is a powerful one that’s taking health care
to the next level.

The dictionary defines an advocate as someone who pleads the cause of another. In
the nursing profession, advocacy means preserving human dignity, promoting
patient equality, and providing freedom from suffering. It’s also about ensuring
that patients have the right to make decisions about their own health. Examples of
advocacy range from lending patients a friendly ear to providing additional
information to a patient who is trying to decide whether or not to accept
treatment. But as a patient advocate, nurses must provide support in an objective
manner, being careful not to show approval or disapproval of a patient’s choices.

According to RN Central, however, nurses often face several barriers when trying to
effectively advocate for their patients, with the biggest hurdle being at the
institutional level. Depending on the employer, some nurses receive little or no
support from administrators, physicians, or peers when trying to carry out the
patient advocacy role.

B. Role of the Other Members of the Health Team

Healthcare is a team effort. Each healthcare provider is like a member of the team
with a special role. Some team members are doctors or technicians who help
diagnose disease. Others are experts who treat disease or care for patients'

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physical and emotional needs. In this part you will learn about different types of
healthcare providers, their jobs and role on the healthcare team.

1. Doctors
Doctors, or physicians, are key members of the healthcare team. They
have years of education and training. They may be primary care doctors
or specialists.
 Primary Care Doctors- When patients need medical care, they first
go to primary care doctors. Primary care doctors focus on
preventive healthcare. This includes regular check-ups, disease
screening tests, immunizations and health counseling. Primary care
doctors may be family practitioners, internal medicine or
Osteopathic Doctors (OD's). Pediatricians also provide primary care
for babies, children and teenagers. Primary care pediatricians treat
day-to-day illnesses and provide preventive care such as minor
injuries, viral infections, immunizations and check-ups.
 Specialists- Specialists diagnose and treat conditions that require a
special area of knowledge. Patients may see a specialist to diagnose
or treat a specific short-term condition or, if they have a chronic
disease, they may see a specialist on an ongoing basis. Examples of
specialties include: endocrinology, dermatology and obstetrics.

2. Pharmacists- Pharmacists give patients medicines that are prescribed,

or recommended, by a doctor. They tell patients how to use medicines
and answer questions about side effects. Sometimes pharmacists help
doctors choose which medicines to give patients and let doctors know if
combinations of medicines may interact and harm patients.
3. Dentists- Dentists diagnose and treat problems with teeth and mouth,
along with giving advice and administering care to help prevent future
problems. They teach patients about brushing, flossing, fluoride, and
other aspects of dental care. They treat tooth decay, fill cavities and
replace missing teeth.

4. Technologists and Technicians- Technologists and technicians have a

technical role in diagnosing or treating disease. They work in a variety
of settings. Examples of technologists and technicians include:

 Laboratory Technologists- help providers diagnose and treat disease

by analyzing body fluids and cells. They look for bacteria or parasites,
analyze chemicals, match blood for transfusions, or test for drug
levels in the blood to see how a patient is responding to treatment.
 Radiology Technologists- also called radiographers, help providers
diagnose and treat disease by taking x-rays. For some procedures
technologists make a solution that patients drink to help soft body
tissues can be seen. Radiology technologists are can specialize in
computed tomography (CT scans), Magnetic Resonance Imaging
(MRI’s) or mammography.
 Pharmacy Technicians- help pharmacists prepare prescription
medications. They also provide customer service and perform
administrative duties such as take prescription requests, count pills,
label bottles and prepare insurance forms.

5. Therapists and Rehabilitation Specialists- Therapists and rehabilitation

specialists help people recover from physical changes caused by a

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medical condition, chronic disease or injury. Types of rehabilitation

specialists include physical therapists, occupational therapists and
speech therapists.
 Occupational Therapists- help patients perform tasks needed for
every-day living or working. They work with patients who have
physical, mental or developmental disabilities. This includes
stroke patients who have lost function on one side of their body,
heart or lung disease patients with activity or breathing
limitations, or diabetes patients who have had a limb amputated.
Occupational therapists help clients find new ways to dress,
cook, eat or work. They may visit patients in their home or
workplace to find adaptive equipment or teach patients new
ways to do things.
 Physical Therapists- help patients when they have an injury,
disability or medical condition that limits their ability to move or
function. Physical therapists test a patient's strength and ability
to move and create a treatment plan. The goal of treatment is to
improve mobility, reduce pain, restore function or prevent
further disability. PT's may treat patients who have had an
amputation, stroke, injury or chronic disease.
 Respiratory Therapists- treat and care for patients with
breathing problems. They work with all types of patients
including premature babies, older people with lung disease, or
patients with asthma or emphysema.
 Speech Therapists- are also called speech-language pathologists.
They work with patients who have problems related to speech,
communication or swallowing. These problems may be caused by
cancer, stroke or brain injury. Speech therapists tailor care plans
to each patient's needs. If a patient has a problem speaking, the
therapist may teach them to use communication devices, sign
language or alternative ways to communicate. For problems
swallowing, they may teach patients to strengthen muscles or
new ways to swallow food and liquids without choking.

6. Emotional, Social and Spiritual Support

The team members we have talked about so far provide physical
support. There are many healthcare team members who provide
emotional, social and spiritual support.

 Mental Health Professionals- help with the emotional aspect of

living with a chronic disease.
 Psychiatrists- are medical doctors (MD's) who diagnose
and treat mental, emotional and behavioral disorders.
This includes disorders of the brain, nervous system and
drugs or chemical abuse.
 Psychologists- deal with mental processes, especially
during times of stress. They are not medical doctors, but
have a Doctor of Psychology (PsyD) or a doctor of
philosophy degree (PhD). Most psychologists do not
prescribe medicine, but treat patients with counseling
and psychotherapy ("talk" therapy).

 Social Workers- in a clinical or hospital setting help patients and

families cope with emotional, physical and financial issues

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related to an illness. Depending on a patient's need a social

worker may help coordinate services such as housing,
transportation, financial assistance, meals, long-term care, or
hospice care. Social workers may also refer patients to mental
health professionals for emotional or substance abuse support.
 Clergy- Religion or spirituality can be important for people
coping with illness. Members of the clergy such as priests,
ministers and rabbis provide patients with spiritual support. They
may listen to patients, counsel them on religious or spiritual
philosophy. They may also perform religious sacraments or rites
such as special blessings, communion or last rights.

7. Community Health Workers- Community health workers and patient

navigators play an important role on the healthcare team. Community
Health Workers, or Outreach Workers, work in community settings. They
link patients to primary care providers, health information, health
screening, financial assistance or transportation. Patient navigators
usually work in a clinic or a hospital. They work closely with patients to
reduce the barriers that keep them from getting Healthcare. Barriers
may be related to low income, transportation, childcare, language or
ability to read forms and understand the healthcare system.

C. Role of the Family in Health Education

Family is the fundamental institution of organization in society. Families
provide the millieu where individuals are born, nurtured, learn to socialize and
where an individual’s behaviour and views take shape. Socio-cultural traditions
and economic influences including those that affect health are extended
through families to individuals and impact health behaviour. Interventions
designed to modulate education and empowerment of individuals through
families are an opportunities for contributing to health development of
societies. The tradition of “family” in South-East Asia is particularly strong.
However, factors like globalization, economic boom, inequities vis-a-vis social
determinants of health, urbanization, gender issues and so on are influencing
the traditional joint family norm. Traditional roles ascribed to men, women and
the aged are undergoing a metamorphosis. The increasing participation of
women in the workforce is challenging the stereotype of the woman as a home-
maker and man as the breadwinner.

The Family
 A group of persons usually living together and composed of the head and
other persons related to the head by blood, marriage or adoption(NCSB,
2008)
 Social unit interacting with the larger society (Johnson, 2000)
 Characterized by people together because of birth, marriage, adoption, or
choice (Allen et.al., 2000 p.7)
 Two or more persons who are joined together by bonds of sharing and
emotional closeness and who identify themselves as being part of the family
(p.10)
Kinds of Family

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1. Nuclear Family- Family of marriage, parenthood, or procreation;

composed of a husband, wife, and their immediate children—natural,
adopted or both (Friedman et al., 2003, p.10)
2. Dyad Family - newly married couples
3. Extended Family – consisting of three generations
4. Blended Family - union where one or both spouses bring a child or
children from previous marriage into a new living arrangement
5. Compound Family - one man has more than one spouse.
6. Cohabiting Family – commonly described as “live-in”
7. Single Parent

 Whatever the nature of family – it will continue to play a pivotal role in

nurturing and socializing children and influencing the development of
adolescents, serving as a support structure for family members, influencing
health impacting behaviours – both positive and negative and providing
opportunities and role models for healthy living.

Functions of a Family
Residence:
 To provide clean and descent home to its members
Division of labour:
 The male had the sole duty to earn a living and support the
family.
 The female had the total responsibility for day to day care of
children and running the household.
 Now a days here are less difference between functions of
men and women—the coming together and sharing
responsibility.
Reproduction and bringing up of children:
 The mother take absolute care of infant and children during
certain age.
 The father provides for the education and teaches the social
tradition and customs.
Socialization:
 The family is bridge between generations and between father
and son.
 The cultural pattern relating to eating, cleanliness, dress,
speech, language, behaviour and attitude transmitted
through the family.
Economic function:
 The family hold the properties and ownership like farms,
shop, dwelling are handed down to the children.
Social care:
 The family provides social care by:
 Giving status in the family
 Protecting its members from insult
 Regulating marital activities to its members
 Regulating to a certain extent political, and general
social activities
 Regulating sex elations through incest-taboos

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“The basic unit so strongly influences the development of an individual

that it may determine the success or failure of that person’s life”
(Friedman et al. 2003, p.4).

Role of Family in Health and Disease

 The family is ultimately the unit with which one has to deal if concerned
with medicine or public health.
 There are certain function which are related with health and health
behavior.

Child Rearing:
 It refer to process by whereby individuals develop qualities essential for
functioning effectively in the society.
 Teaching the young, the values of the society and transmitting information,
culture, belief, conducts by citing examples.
 In some societies the young are given freedom to develop into individuals—
to take initiative.

Personality Formation:
 The capacity of individual to withstand stress and strain.
 Family acts as the “placenta” to filter ill influences.

Care of Dependent Adults:

 The family acts like the cushion and gives the front-line care for such
individuals.
 Sometimes individual are excluded from fulll ramge of benefits.
 Adults become dependent either through injury, illness or because of
biological limtation.
 The kind of illness is important—attitude of society.

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THINK!

Directions: Answer the questions briefly (5-10 sentences only). Write/ encode your
answer on a short bond paper then send a digital copy (image/ picture/ softcopy) to
the respective email of your instructor. You will be graded using the rubrics
provided.

Activity #3: As a nurse, aside from providing competent health care to

your clients, how can you fulfil your role as an educator?

 LEARNING ACTIVITY

1. Not only in Nursing or Health Education, Why do you think there is a need
for Evidenced-Based Practice?

2. Why is the Nurse Code of Ethics so important to nurses in carrying out

their roles and responsibilities to the public?

3. Kindly elaborate this statement “The secret of national health lies in the
homes of the people”.

 MODULE SUMMARY

Before EBP health professionals relied on the advice of more experienced

colleagues, often taken at face value, their intuition, and on what they were
taught as students. This is not to say that clinical experience is not important - it is
in fact part of the definition of EBP. However, rather than relying on clinical
experience alone for decision making, health professionals need to use clinical
experience together with other types of evidence-based information. EBP is
important because it aims to provide the most effective care that is available, with
the aim of improving patient outcomes. Patients expect to receive the most
effective care based on the best available evidence. EBP promotes an attitude of
inquiry in health professionals and starts us thinking about: Why am I doing this in
this way? Is there evidence that can guide me to do this in a more effective way?

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As health professionals, part of providing a professional service is ensuring that our

practice is informed by the best available evidence. EBP also plays a role in
ensuring that finite health resources are used wisely and that relevant evidence is
considered when decisions are made about funding health services.

Ethical and legal dimensions of human rights provide the justification for patient
education, particularly as it relates to issues of self-determination and informed
consent. Patient education is a nursing duty that is grounded in justice; that is, the
nurse has a legal responsibility to provide patient education and, regardless of
their culture, race, ethnicity, and so forth, all clients have a right to health
education relevant to their physical and emotional needs. Justice also dictates that
education programs should be designed to be consistent with organizational goals
while meeting the needs of patients to be informed, self-directed, and in control
of their own health.

Nurses are considered information brokers—educators who can make a significant

difference in how patients and families cope with their illnesses, how the public
benefits from education directed at prevention of disease and promotion of health,
and how staff nurses gain competency and confidence in practice through
continuing education activities. To be effective and efficient, nurses must be
willing and able to work collaboratively with other members of the healthcare
team to provide consistently high-quality care to the consumer. The responsibility
and accountability of nurses for the delivery of care to the consumer can be
accomplished, in part, through education based on solid principles of teaching and
learning. The key to effective education for patients, families, and nursing staff is
the nurse’s understanding of and ongoing commitment to the role of educator.

Module II