REVIEWER FOR HEALTH EDUCATION

SESSION 1 PERSPECTIVE ON TEACHING

Historical Foundations for Patient Education in Health Care
Teaching Role of Nurses

• Patient Educator
- Nurses' major component of standard quality service is not only focus on care but also
educating the sick.

• Nurse Educator
- Entrenched in the growth and development of the profession, the nurses should also educate
other nurses for professional practice

• Mid 1800s
- This period of time is where responsibility for teaching is recognized as an important role of
nurses as caregivers

• Florence Nightingale
- Founder of Modern Nursing and Ultimate educator - how to improve the health of people

• Early 1900s
- PHN's role as Nurse teacher in preventing disease and maintaining the health of society was
emphasized.

• Patient teaching
- Recognized as independent nursing function of nurses

• Nursing Education
- Educating others-patients, families, and colleagues

• Nursing Practice
- Expanded to include broader concepts of health and illness

• 1918 - National League of Nursing Education (NLNE)(now the National League for Nursing
[NLN])
- Observed the importance of health teaching as a function within the scope of nursing practice

• Nurses as Agents
- Promotion of health and Preservation of illness in all settings which they practiced.

• 1950- NLNE identified course content in nursing school curricula

- prepare nurses to assume the role as teachers

• International Council of Nurses (IC)

- Endorsed nurse's role as educator as essential component of nursing care delivery

• Nurse Practice Acts (NPAs)

- Teaching with Scope of nursing practice responsibilities.
• 1970- Patient's Bill of Rights-
- Ensure patients' complete and current information concerning their diagnosis, treatment and
prognosis

• 1980- Nurse as Educator, a paradigm shift-

Evolved from disease oriented approach to prevention oriented approach. Focused on teaching
for promotion and maintenance of health-

• Grueninger (1995)- Transition toward wellness

From disease-oriented patient education (DOPE to prevention-oriented patient education
(POPE) to ultimately become health-oriented patient education (HOPE).

• Role of the Nurse – changed-

- From one wise healer to expert advisor/teacher to facilitator

• From Simple Information Disseminator

- Now emphasizes on empowering patients their potentials, abilities, and resources to the
fullest.

• 995 - The Pew Health Professions Commission

- Published a broad set of competencies it believed would mark the success of health
professions in the 21st century

Role of today's educator

Training the Trainer Continuing nursing staff education, in-service
programs, and staff development to maintain
and improve their clinical skills and teaching
abilities
Professional Nurses Preparation to effective teaching services
performance that meet the needs to many
individuals and groups in different
circumstances across a variety of practice
settings
Clinical Instructor Another very important role of the nurse as
educator serving students in the practice
setting.
Role of Clinical Educator Dynamic one that requires teacher to actively
engage students to become competent and
caring professionals

6 QSEN Competencies
1. Patient-centered care: The patient has control of and is full partner in the provision of holistic,
compassionate, and comprehensive care based on the patient's values, needs, and
preferences.

2. Teamwork and collaboration: Nurses and other health professionals must collaborate
effectively with open communication, respect, and mutual decision making to achieve high-
quality care
3. Evidence-based practice: Current evidence must be integrated to support clinical expertise in
providing optimal health care

4. Measure data and monitor patient outcomes to develop changes in methods to continuously
improve the quality and safety in healthcare delivery.

5. Informatics: Use information technology to effectively communicate, manage knowledge,

eliminate error, and support collaborative decision making

6. Safety: Minimize the risk of harm to patients and healthcare providers through self and
system evaluation.

PHASE II is dedicated to teaching strategies and resources. A second goal of this phase was to
collaborate with organizations that represent advanced practice nurses in developing
competencies for graduate education.

PHASE III the goal of this phase was to develop the faculty expertise needed to. teach
competencies in textbooks, implement innovative teaching strategies, and assist in the licensure
and accreditation process

Barriers to education are those factors impeding the nurse's ability to deliver educational
services.

Obstacles to learning are those factors that negatively affect the ability of the learner to attend to
and process information

SESSION 2: Ethical, Legal, and Economic Foundations of the Educational

Process

Application of Ethical and Legal Principles to Patient Education

6 Ethical Principles
1. Autonomy
2. Veracity
3. Confidentiality
4. Nonmaleficence
 Negligence
 2. Malpractice
 3. Duty
5.Beneficence
6. Justice

1.AUTONOMY is derived from the Greek words auto ("self") and nomos ("law") and refers to the
right of self-determination. Laws have been enacted to protect the patient's right to make
choices independently

2. Veracity or truth telling, is closely linked with informed decision making and informed consent.
An individual has the fundamental right make decisions about his or her own body.
This ruling provided a basis in law for patient education of instruction recarding invasive medical
procedures, including the truth regarding risks or benefits involved in these procedures.
3.Confidentiality refers to personal information that is entrusted and protected as privileged
information via a social contact, healthcare standard or code, or legal covenant.

4.Nonmaleficence is defined as "do not harm" and refers to the ethics of legal determinations
involving negligence and or malpractice
Negligence is define as "conduct which falls below the standard established by law for the
protection of others against unreasonable risk of harm"
Professional Negligence "involves the conduct of professionals that falls below a professional
standard of due care"

5. Beneficence is defined as "doing good" for the benefit of others.

It is a concept that 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.

6.Justice speaks to fairness and equal distribution of goods and services.

The law is the "Justice System."

Four Elements Making Up the Notion of Informed Consent

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 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.

SESSION 3: Applying Learning

• Behaviorist Theory
1. Concepts: stimulus conditions, reinforcement, response, drive
2. To change behavior, change the stimulus conditions in the environment and the
reinforcement after a response.
3. Behaviorist Dynamics
4. Motivation: drives to be reduced, incentives
5. Educator: active role; manipulates environmental stimuli and reinforcements to direct
change Transfer: practice and provide similarity in stimulus conditions and responses
with a new situation
• Motor Learning
1. Motor learning is useful in addition to theories of psychological learning.
2. Examples of skills taught
3. Walking with crutches
4. Putting on a colostomy bag
5. Operating sophisticated medical equipment

• Stages of Motor Learning

Cognitive stage - Learner works to develop cognitive map.
Associative stage - More consistent performance, slower gains, fewer errors
Autonomous stage - Automatic stage, achieving advanced level

• Humanistic Learning Theory

1. Learning occurs on the basis of a person's motivation, derived from needs, the desire to
grow in positive ways, self-concept, and subjective feelings.
2. Learning is facilitated by caring facilitators and a nurturing environment that encourage
spontaneity, creativity, emotional expression, and positive choices.

SOCIAL LEARNING THEORY

EXTERNAL PROCESSES

Role model demonstrates behavior, which is percieved by the learner to reinforced (various
reinforcement): model may facilitate or inhibit learning a behavior

Internal Process
➡️Attentional Phase
-Observation of role model
➡️
Retention Phase
-Processing and representation in memory
➡️
Reproduction Phase
-Memory guides performance of model’s actions
➡️
Motivational Phase
-Influence by vicarious reinforcement and punishment

Covert cognitive activity, consequences of behavior, and self-

reinforcement and punishment

External processes
➡️Performance

SESSION 4: Determinants of Learning

•Educator's Role in Learning
The role of educating others is one of the most essential interventions that a nurse performs.
She/he must both identify the information of learners need and consider their readiness to learn
and their styles of learning.
The learner - not the teacher - is the single most important person in the education process.
•The educator plays a crucial role in the learning process by:
1. assessing problems or deficits
2. providing information in unique ways
3. identifying progress made
4. giving feedback and follow-up
5. reinforcing learning
6. determining education effectiveness

•Assessment of Learning Needs

 Identify the learner.
 Choose the right setting.
 Collect data about, and from, the learner.
 Involve members of the healthcare team.
 Prioritize needs.
 Determine availability of educational resources.
 Assess demands of the organization.
 Take time-management issues into account.
1. Identify the learner.
•Who is the audience? The development of formal and informal education programs for patients
and their families, nursing staff, or students must be based on accurate identification of the
learner

2. Choose the right setting

•Establishing a trusting environment will help learners feel a sense of security in confiding
information, believe their concerns are taken seriously and considered important, and feel
respected.

3. Collect data on the learner

•Once the learner is identified, the educator can determine characteristic needs of the
population by exploring typical health problems or issues of interest to that population.

4. Include the learner as a source of information

• Learners themselves are usually the most important source of needs assessment data.

5. Involve members of the healthcare team

•Other healthcare professionals may have insight into patient or family needs or the educational
needs of the nursing staff or students as a result of their frequent contacts with consumers as
well as caregivers.

6. Prioritize needs.
•A list of needs can become endless and seemingly impossible to accomplish. Maslow's (1970)
hierarchy of human needs may help the educator prioritize identified learning needs.

Methods to Assess Learning Needs

 Informal conversations
  Structured interviews
 Focus groups
 Questionnaires
 Tests
 Observations
 Documentation

Informal Conversations
• Often learning needs will be discovered during informal conversations that take place
with other healthcare team members involved in the care of the client, and between the
nurse and the patient or his or her family.
Structured Interviews
 The nurse asks the learner direct and often predetermined questions to gather
information about learning needs.
Focus Groups
• Focus groups involve getting together a small number (4 to 12) of potential learners
(Breitrose, 1988) to determine areas of educational need by using group discussion to
identify points of view or knowledge about a certain topic.
Self-Administered Questionnaires
• The learner's written responses to questions about learning needs can be obtained by
self administered questionnaires. Checklists are one of the most common forms of
questionnaires.
Tests
• Written pretests given before teaching is planned can help identify the knowledge level
of the potential learner regarding a particular subject and assist in identifying specific
needs of the learner.
Observations
• Observations can provide useful data related to needs. Observing health behaviors in
several different time periods can help to determine established patterns of behavior.
Documentation
• Create patterns that reveal learning needs. Physicians' progress notes, nursing care
plans, nurses' notes, and discharge planning forms can also provide information on
learning needs

Determining Readiness to Learn

• Educator must understand what needs to be taught, collect and validate information,
assess learning needs

• Timing is important: learner must be ready

Types of Readiness to Learn

P = Physical readiness
E = Emotional readiness
E = Experiential readiness
K = Knowledge readiness

Readiness to Learn Components

1. Physical readiness
- measures of ability
- complexity of task
- environmental effects
- health status
- gender

2. Emotional readiness
- anxiety level
- support system
- motivation
- risk-taking behavior
- frame of mind
- developmental stage

3. Experiential readiness

- level of aspiration
- past coping mechanisms
- cultural background
- locus of control
Experiential readiness refers to the learner's past experiences with learning.

4. Knowledge readiness
- present knowledge base
- cognitive ability
- learning disabilities
- learning styles

Gardner's Eight Types of Intelligence (# 8 identified in 1999-naturalistic)

• Musical intelligence
• Logical-mathematical intelligence
• Intrapersonal intelligence
• Linguistic intelligence
• Spatial intelligence
• Bodily kinesthetic intelligence
• Interpersonal intelligence

VARK Learning Styles

Four preferences that reflect learning style experiences and preferences of students
1.Visual
• Fast talkers
• Impatient
• Use words and phrases that evoke visual images:
 • See and visualize
2.Aural
• Slow speakers
• Natural Listeners
• Linear thinkers
• Prefer explanation than text
• Listen and verbalize
3.Read/write
• Prefer written text
• Emphasize text. based input and output
• Enjoy reading and writing
4.Kinesthetic
• Slowest talkers
• Slow to decide
• Use all senses to engage in learning
• •Do and solve
• Prefer hands-on approaches
• Learn through trial and error
•
SESSION 5: Developmental Stages of the Learner
Piaget’s stages of development
Infancy and Toodlerhood (Sensory Motor Stage)
-Learning is through sensory experiences and through movement and manipulation of
objects, eventual object permanence and casuality

Early childhood (PREOPERATIONAL PERIOD)

-Egocentric; thinking is literal and concrete; precasual thinking

Middle and Late childhood (CONCRETE OPERATIONS STAGE)

-Developing logical thought processes and syllogistic reasoning; understand cause and
effect and conservation

Adolescence( Formal Operations Stage)

Abstract thought;propositional reasoning; adolescent egocentrism (imaginary audience)

Erikson's stages of development

Infancy and Toodlerhood TRUST VS MISTRUST
(birth to 12 months) autonomy vs shame and doubt (1-3 years)
-Building trust and establishing balance between feelings of love and hate; learning to control
willful desires

Early childhood INITIATIVE VS GUILT

-Taking on task for the sake of being involved and on the move; learning to express feelings
through play

Middle and Late childhood INDUSTRY VS INFERIORITY

-Gaining a sense of responsibility and reliability; increase suspectibility to social forces outside
the family unit; gaining awareness of uniqueness of special talents and qualities

Adolescence (Identity VS. Role Confusion)

-Struggling to establish own identity; seeking independence and autonomy

Silent Characteristics

• Cognitive
Example: cognitive capacity is fully developed but continuing to accumulate new knowledge and
skills

• Psychosocial
Example: autonomous; independent; stress related to the many decisions being made regarding
career, marriage, parenthood, and higher education

Children
Teaching Strategies
• Use problem-centered focus.
• Draw on meaningful experiences.
• Focus on immediacy of application.
• Allow for self-direction and setting own pace.
• Organize material.
• Encourage role play.

Adults
Teaching Strategies
• Maintain independence and reestablish normal life patterns.
• Assess positive and negative past learning experiences.
• Assess potential sources of stress.
•
SESSION 6: Compliance, Motivation, and Health
Compliance -a submission or yielding to predetermined goals through regimens prescribed or
established by others
As such, this term has a manipulative or authoritative undertone that implies an attempt to
control the learner's right to decision-making.

-Is observable can be measured healthcare provider viewed as authority learner viewed as
submissive

Noncompliance: nonsubmission or resistance of an individual to follow a prescribed,

predetermined regimen

× As such, this term carries a negative connotation of the learner but may in fact be a resilient
response or defensive coping mechanism.

Adherence-A commitment or attachment to a prescribed, predetermined regimen

This term is used interchangeably with compliance in the measurement of health outcomes.
-Refers to the ability to maintain health-promoting regimens outcomes determined largely by
healthcare provider

Nonadherence: the patient declines to follow a previously agreed-upon treatment

recommendation May be intentional or unintentional
• Socioeconomically related
• Patient related
• Condition related
• Therapy related
•
Selected Health Behavior Models/Theories of the Learner
• Health Belief Model
• Health Promotion Model (revised)
• Self-Efficacy Theory
• Protection Motivation Theory
• Stages of Change Model
• Theory of Reasoned Action
• Theory of Planned Behavior
• Therapeutic Alliance Model

Roll with resistance

• Resistance is a legitimate concern for the clinician because it is predictive of poor treatment
outcomes and lack of involvement in the therapeutic process. One view of resistance is that the
client is behaving defiantly.

Four Types of Client Resistance

• Arguing
• Denying
• Interrupting
• Ignoring

Affirmations of the positives

• When it is done sincerely, affirming your client supports and promotes self-efficacy. More
broadly, your affirmation acknowledges the difficulties the client has experienced. By affirming,
you are saying, "I hear; I understand," and validating the client's experiences and feelings

SESSION 7: Literacy in the Adult Client Population (Part 1)

Definition of Terms
 1. Literacy: the ability of adults to read, write, and comprehend information at the 8th-grade
level or above
2. Illiteracy: the ability of adults to read, write, and comprehend information at the fourth-
grade level or below, or not at all
3. Low Literacy (marginally literate or illiterate): the ability of adults to read, write, and
comprehend information between the fifth to eighth-grade levels of difficulty
4. Functional Illiteracy: in adults, the lack of fundamental reading, writing, and
comprehension skills needed to operate effectively in today's society
5. Health Literacy: the ability to read, interpret, and comprehend health information to
maintain optimal wellness
6. Readability: the ease with which written or printed information can be read
7. Numeracy: the ability to read and interpret numbers
8. Reading (word recognition): the ability to transform letters into words and pronounce
them correctly
9. Comprehension: the degree to which individuals understand and accurately interpret
what they have read

Little attention has been paid to the role of oral communication in the assessment of illiteracy.

loralacy: the inability to comprehend simple oral language communicated through speaking of
common vocabulary, phrases, or slang words

Literacy Relative to Computer Instruction

-The ability to use computers for communication is an increasingly popular issue with respect to
learner literacy
-As an educational tool, the potential for computers is increasingly being realized and
appreciated by healthcare providers.
Computers are used to convey as well as to access information.
The opportunity to expand knowledge base of learners through telecommunications requires
nurse educators to attend to computer literacy levels (e-health literacy).

Myths, Stereotypes, and Assumptions

Myth #1:
People who are illiterate have below-normal IQs.

Myth #2:
People who are illiterate can be recognized by their appearance.

Myth #3:
The number of years of schooling completed correlates with literacy skills.

Myth #4:
Most who are illiterate are foreign born, poor, and of an ethnic or racial minority.

Myth #5:
People who are illiterate freely admit to having problems with reading, writing, and
comprehension.

SESSION 8: Literacy in the Adult ClientPopulation (Part 2)

Measurement Tools to Test Literacy Levels

• The most widelv used standardized readability formulas rate high on reliability and
predictive validity.

• Formulas evaluate readability levels using the average length of sentences and the
number of multisyllabic words in a passage.

• Computerized readability analysis has made evaluation of written materials quick and
easy.

Techniques for Writing Effective Health Materials

• Write in a conversational style with an active voice, using the personal pronouns "you" and
"your."
• Use short words and common vocabulary.
• Spell words rather than using abbreviations or acronyms.
• Organize information into chunks.
• Use numbers and statistics only when necessary.
• Keep sentences and lists short (preferably 20 words and 7 items).
• Define any technical or unfamiliar words in parentheses.
• Use words consistently throughout text.
• Avoid value judgment words.
• Put the most important information first.
• Use advance organizers and subheadings.
• Limit use of connective words.
• Make the first sentence of a paragraph the topic sentence.
• Limit each paragraph to a single message or action, and include only one idea per sentence.
• Do not exceed 30 to 40 characters per line.
• Allow for plenty of white space.
• Keep right margins unjustified.
• Use design layouts that encourage eye movement from left to right.
• Use color to emphasize key points and to organize topics.
• Create a simple cover page.
• Limit length of document to cover only essential information.
• Select simple type style (serif) and large font (14-16). Avoid using italics and all CAPITALS.
• Highlight important ideas or words with bold type or underlining.
• Select non-glossy paper and color that contrasts with typeface.
• Use bold line drawings and simple diagrams.
• Include a summary section using bullet points or numbered list.
• Determine readability by applying two formulas.

Teaching Strategies to Promote Health Literacy

• Establish a trusting relationship before starting the process.
• Use the least information possible to achieve behavioral objectives.
• Make information points vivid and explicit.
• Teach one step at a time.
• Use multiple teaching methods and tools requiring fewer literacy skills.
• Allow learners to restate information in own words and to demonstrate procedures being
taught.
• Keep motivation high.
• Build in coordination of procedures.
•Use repetition.