Compilation of NURSING BULLETS: Health Education

BULLETS ON HEALTH EDUCATION Compiled by: Ms. Shaia Marie B. Mayo, RN-MAN Health is defined in the Constitution of the World Health Organization (1946) refers to the state of complete physical, mental and social well-being and not merely the absence of disease and infirmity. Components of health are social, mental, emotional, spiritual, sexual, societal, environmental and physical. Wellness refers to an active process of becoming aware of and making choices toward a higher level of well-being. One of the most important functions of the nurse is as a health educator which is explicitly stated in the Duties of a Nurse in Rule IV, Art VI, Sec.28 of the Philippine Nurses Act of 2002 which are to: (1) provide health education to individuals, families and communities and, (2) teach, guide and supervise students in nursing education programs including the administration of nursing services in varied settings like hospitals and clinics. According to Heidgerken (1965) defined the role functions of the nurse educator as instructional, faculty and individual roles. Health Education is a process concerned with designing, implementing and evaluating educational programs that enable families, groups, organizations and communities to play active roles in achieving, protecting and sustaining health. Health Education instruction in the Philippines is legally founded on the Constitution of the Philippines. Teaching Strategies in Health Education is intended to equip people with the basic foundations of how to teach properly. It is designed for the student nurses, nurse educators/practitioners, health workers and other health guru and advocates who are involved in the promotion of health and wellness education. In the Code of Ethics of Society for Public Health Education, Inc. states that Health educators take on profound responsibilities in using educational processes to promote health and influence well-being. Managed care is aimed at bridging the gap between in-patient services and community based services through involvement in client-teaching for self-care management, discharge planning and providing for continuing care. A paradigm shift in the concept of health from being is disease-centered focusing on positive health as part of human development, a change from physician-dependent cure or treatment modality to preventive care and sustained health through peopleempowered healthy options. Instruction refers to one part of the curriculum, it is a process in which teachers attempt to make learning sensible and students attempt to make sense of learning, the content or subject matter teachers teach, and the methods or strategies used by teachers to teach it. Teaching is an integral part of nursing process and the nurse is teaching whether directly or indirectly, in every contact with potential learners.

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Compilation of NURSING BULLETS: Health Education

Learning is a change in behavior (KSA) that occurs at any time or in any place as a result of exposure to environmental stimuli. Patient Education is a process of assisting people to learn health-related behaviors which can incorporate into their everyday lives. A paradigm shift of the educational process from teacher teaching to focus on the learner learning. The three pillars of teaching-learning process are the teacher, learner and subjectmatter. The vital role of the teacher is motivating students to learn. The six hallmarks of effective or good teaching in nursing (Jacobsen) are professional competence, possession of skill interpersonal relationships, desirable personal characteristics, teaching practices, evaluation practices, and availability to students. Patricia Benner provided a model From Novice to Expert, where she contends that as a nurse gains experience, clinical knowledge becomes a blend of practical and theoretical knowledge. The five levels of competency in nursing practice are novice, advance beginner, competent, proficient and expert. Stages of Nursing Expertise: Stage I Novice : has no experience, with limited , inflexible and governed by context-free rules and regulations rather than experience (student nurse); Stage 2 : Advance Beginner: mentally acceptable performance, recognizes meaningful aspects of real situation and has experienced enough real situations to make judgments; Stage 3 Competent: has 2 to 3 years of experience , has organizational and planning activities, can differentiates important aspects from less important aspects of care and who coordinates multiple complex care demands; Stage 4 Proficient : has 3 to 5 years of experience, perceives situations as whole rather than in terms of parts, as in stage 2, uses maxims as guides, has holistic understanding of client and focuses on long term goals; Stage 5 Expert : performance is fluid, flexible and highly efficient and inclined to take actions because it felt right The eleven nursing core competencies include the following safe and quality nursing care, management of resources and environment, health education, legal responsibility, ethic-moral responsibilities, personal and professional development, quality improvement, research, records management, communication and collaboration and teamwork. Florence Nightingale, who earned the title of Mother of Modern Nursing, was the epitome of the true nurse educator as she advocated the important function of teaching to promote health and recovery through a clean, pleasant and inhabitable environment. She founded the Florence Nightingale School of Nursing at St. Thomas Hospital in London in June 15, 1860 which trained and taught, nurses, physicians and health officials on the importance of manipulating the environment so hat nature can act on the patient in his recovery and healing process. Learning needs are gaps in knowledge that exist between a desired level of performance and the actual level of performance (Healthcare Education Association, 1985). Learning readiness is the time when the patient is willing to learn or is receptive to information.
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Compilation of NURSING BULLETS: Health Education

Learning styles indicate how people learn in uniquely different ways. Different styles include holistic (global) vs analytic thinking, verbal vs visual representation and group vs independent learning. Maslows Hierarchy of Needs is used in relation to needs assessment. The criteria for prioritizing learning need are mandatory (must to know), desirable (good to know) and possible (nice to know) Kolbs Learning Style Inventory identified the four learning styles: converger, diverger, accommodator and assimilator. A converger learns best through demonstration; return demonstration methods assisted by hand-outs, diagrams, charts and illustrations. A diverger learns best through group discussions and brainstorming sessions; considers different perspectives and points of view when looking at a concrete situation or experience. An accommodator enjoys role-playing, gaming and computer simulations. They learn best through new and exciting learning experiences and are not afraid of taking risks which may sometimes endanger their safety. An assimilator learns best through lectures, one-to-one instruction and self-instruction methods with ample reading materials. When dealing with question of how much people are able to retain what has been shown that people retain 10% of what they read, 20% of what they hear, 30% of what they see or watch, 50% of what they see and hear, 70% of what they say and 90% of what they say and do (Learning Experience Cone by Gregorc). John B. Watson is the proponent of behaviorist theory which emphasizes the importance of observable behavior in the study of human beings. Stimulus Response Theory or S-R Model of Learning defines learning as a result of the conditions and stimuli in the environment and the learners responses that follow. Classical or Pavlovian Conditioning is a process which influences the acquisition of new responses to environmental stimuli. Systematic desentisitization is based on the principle that repeated and gradual exposure to fear-inducing stimuli under relaxed and non-threatening circumstances will give the patient the sense of security that no harm will come so that he or she no longer fears the stimuli. Operant condition was developed by B.F. Skinner which focuses on the behavior of the organism and the reinforcement that follows after the response. Reinforcements are events that strengthen responses. Positive reinforcement is defined as any consequences of behavior that lead to an increase in the probability of its occurrence. Educational Reinforcement are classified as ways of recognition, tangible rewards, learning activities, school responsibilities, status indicators, incentive feedback, personal activities. Different types of intelligence according to Howard Gardner include: linguistic, logical/mathematical, spatial/visual, musical/rhythmic, bodily kinesthetic, interpersonal intelligence, and intrapersonal intelligence.
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Lorma Colleges, Nursing Enhancement Class 2012

Compilation of NURSING BULLETS: Health Education

Piagets Four Major Periods of Cognitive Development are: Sensorimotor (object permanence), abstract thinking (symbolism), logical or formal operations (perspective thought or relativism) and assimilation and accommodation (hypothesis testing). Reciprocal Determinism by Albert Bandura states that environmental conditions shape behavior through learning and the persons behavior, in return, shapes the environment. Bandura believes that behavior needs not to be performed and reinforced for learning to occur. This is related with modeling or observational learning. Albert Banduras Social Learning Theory posits that people learn from one another, via observation, imitation, and modeling. People learn through observing others behavior, attitudes, and outcomes of those behaviors. According to Bandura: Most human behavior is learned observationally through modeling: from observing others, one forms an idea of how new behaviors are performed, and on later occasions this coded information serves as a guide for action. Social learning theory explains human behavior in terms of continuous reciprocal interaction between cognitive, behavioral, and environmental influences Pedagogy is the art and science of helping children learn. Andragogy is the art and science of helping adults learn. Syllabus is the course plan that a health educator prepares before actual health education instruction begins. Steps in the planning sequence for teaching are as follows: prepare the teaching plan, conduct needs assessment, formulate behavioral objectives and develop the teaching plan. The three steps that link behavioral objectives are condition, performance and criterion. Taxonomy of Educational Objectives by Bloom et.al. (1956) is a toll for the systematic classification of behavior objectives. It is divided into three broad categories or domains which are the cognitive (thinking domain), affective (feeling domain) and psychomotor (skill domain). Behavioral Objectives describe what the learner is expected to do at the end of the learning situation. It uses modifier behaviors to indicate action-oriented and learner oriented outcomes. Steps in formulating behavioral objectives are condition, performance and criterion. Example: After 20 minutes of demonstrating the different postures for breastfeeding (condition), Maria will be able to demonstrate (performance) three out of five (criterion) breast feeding postures. The six levels of cognitive behavior include knowledge, comprehension, application, analysis, synthesis, and evaluation. The levels of affective behavior include receiving, responding, valuing, organization and characterization. Teaching methods used in affective domain are affective questioning, case study, role playing, simulation and group discussion. The five levels of psychomotor objectives include imitation, manipulation, precision, articulation and naturalization. Teaching methods most commonly used in the psychomotor domain include demonstration-return demonstration, self-directed study, role playing and peer teaching

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Compilation of NURSING BULLETS: Health Education

Traditional and modern methods of teaching employ the inductive and deductive processes of teaching and learning that have originated from thoughts and ideas of early philosophers and psychologists of western civilization. The inductive method is a discovery method where a learner may arrive at a fact, principle, truth or generalization. The deductive starts with a generalization that is applied to specific cases. There are different approaches of health education; they are the discovery approach, conceptual approach, inquiry approach and process approach. The discovery approach is actually an inductive method of guiding learners to discuss and organize ideas and processes by themselves. It is a way of helping them use ideas already known and acquired in discovering new ideas. Conceptual approach is a process of instruction that emphasizes the development of concepts or ideas that may eventually lead to the formulation of an expected generalization, a conclusion or a principle. Inquiry approach is another creative way of developing critical thinking among the students. The process approach pertains to the development of scientific attitudes and scientific methods of inquiry in addition to basic concepts and generalization. Health education involves the teaching of health related concepts/issues. Information dissemination takes the form of presenting strategies that are teacher centered, media centered and content centered. Teacher centered presenting strategies are believed to be teacher centered or the teaching performing the role of a facilitator or group leader. Lecture/lecture demonstration, forum lecture and panel discussion are teacher centered presenting strategies. Media supported by lecture, self-learning programs, mini-courses, video-taped instruction, audio taped instruction and computer-assisted instruction can be availed of usually from an institutions media or audio-visual centers. Discussion by means of exposition, panel, debate, buzz session, dialogues, interview and brainstorming together with student lecture or oral reports independent study and situation analysis fall under content oriented presenting strategies. Group dynamics may take the forms of (1) classroom discussion where the whole class participates and (2) small group discussion. Lecture is a formal exposition which makes only incidental use of narrative and description in setting forth the basic and all inclusive structure of an entire topic. An informative talk given before an audience and usually prepared beforehand. Laboratory is a planned learning activity dealing with original or raw data in the solution of problems. Role playing is acting out problems or situations in a more candid and spontaneous manner by the students who perform their respective roles or assignments quite similar to those real stage/ film actors and actresses.

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Compilation of NURSING BULLETS: Health Education

Sociodrama is an impromptu or unrehearsed presentation depicting a scene that involves the solution of a real-life problem or situation. Set roles are performed by selected members of the class. Case studies are detailed examinations of a single participant, group or phenomenon to understand low complex process dynamically interact in peoples everyday lives. Simulation as a teaching strategy takes the forms of role-playing, sociodrama. Instructional strategies are useful and effective tools to provide a more interesting, exciting and meaningful approach to the teaching of health related components /topics. They provide for an active participation of every learner in the classroom, thus making more pleasurable and longer-lasting. Process Recording is a verbatim account for a visit for the purpose of bringing out the interplay between the nurse and the patient in relation to the objectives of the visit (Walker). Demonstration- Return Demonstration is a structured teaching that is planned in advance according to a definite teaching guide/outline and scheduled specific time/place for one or several learners. It is teaching by exhibition and explanation. During a return demonstration, the teacher should not interfere by asking questions which require a cognitive or affective response while the learner is performing the procedure as mastery of skills require a great deal of concentration and focus. Clinical Supervision is a process by which an expert practitioner guides and directs the performance of a less expert worker in order to help his practice and find satisfaction in his work, with the ultimate purpose of achieving and maintaining excellent care. Problem-based Learning is an approach to learning that involves confronting students with real-life problems that provide a stimulus for critical thinking and self-taught content. It is centered on the learning that emanates from a real problem, learning is important than the solution of the problem. Self-directed learning modules are self contained unit or package of study materials for use by an individual. Adults are the best audience for the use of modules. Distance Learning or Online Education incorporates virtual teaching and learning opportunities offered through web pages, email, synchronous chat rooms, and forums and documents and screen sharing. Concept Mapping is a technique to allow students: to visually represent and inter-relate connections and/or relationships between concepts, ideas or information, drawing on existing and newly introduced knowledge. Evaluative Devices in Teaching include essay, objective examinations (multiple choice, true or false, matching type questions) , objective problem situation test, standardized tests (intelligence tests, achievement tests and prognostic tests) and rating scales. True and False and Matching Type items evaluate the lowest level of knowledge which is knowledge and comprehension. Multiple Choice items used in NLE and certification examinations are tests for comprehension, application and evaluation.

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Compilation of NURSING BULLETS: Health Education

Essay Type Questions test the highest levels of knowing which are synthesis, analysis and evaluation.

Reference: 1. Asperas, Carlito M., (2005). Strategies of Health Education A Text Workbook (First Edition). Educational Publishing House, Inc. Manila 2. Estrada-Castro, Cecilia (2009). Teaching Strategies in Health Education with Principles of Teaching and Learning (First Edition). Educational Publishing House, Inc. Manila 3. http://nursingrevieweronline.wordpress.com/2010/05/13/benners-stages-of-nursingexpertise/

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