CHAPTER 1

media and technology.

OVERVIEW OF EDUCATION ON HEALTHCARE 5. A means to communicate vital

AND CHANGE information.

Health education: it is the sum of all experiences 6. It is also a form of advocacy.

which favorably influences habits, attitudes and
knowledge relating to individual, community and Types of health education:
racial health.
- Health education focuses on the body and
The process of health education: how to take care of it.

- Physical health. - Health education and services make

- Emotional health. “sensible” use of health care resources.
- Mental health.
- Social health. - Health education related to the wider
- Spiritual health. environment.

Certain key aspects of the process of health Dimensions of health education process:
education:
- Health education is a complex process
- It is a planned opportunity of learning that requires electric knowledge, skills
through information about health guided and values on the part of the educator.
by specific goals, objectives, activities and
evaluation criteria. - This needs a conceptual framework
which envisions the totality of the learning
- It occurs in a specific setting. process and all its dimensions. It begins
with the formulation of objectives and the
- It is a program of series or events that anticipated outcome for each particular
introduces concepts at appropriate subject area which prepares the teacher
learning levels. and the learner to assume their roles and
responsibilities.
- It is based on what was previously learned
in order to determine what is to be learned The 4 dimensions of the educative process
in the future. (Heidgerken, 1971):

- It comprehensively emphasizes how the - Substantive or curricular dimension.

various aspects of health interrelate and - Procedural or methodological dimension.
how health affects the quality of life. - Environmental or social dimension.
- Human relations or interactional
- It includes interaction between the dimension.
qualified educator and learner.
Aspects of health education:
Purposes of health education:
1. Behavioral science.
1. A means of propagating health promotion 2. Public health.
and disease prevention. 3. Education.

2. Used to modify or continue health Importance of health education:

behaviors as necessary.
- Enhances knowledge awareness.
3. Provides health information and services. - Promotion of health, safety and security
4. Emphasizes good health habits and of the people.
practices as an integral aspect of culture, - Develop and improve community
 resources. imparting knowledge through sharing,
- Increase productivity and strength of clarifying, and synthesizing the substantive
character. content of the learning process in order to
- Disease prevention. arrive at positive judgement and well-
- Minimize cost. developed wisdom and behavior
- Self-reliant behavior. (Kozier:2004).

The change process: - Is likewise an application of several

itching and learning principles
- Perceived need for change. (Heidgerken:1971).
- Initiate group interaction.
- Implement the change one step at a time. Health: is a sense of being physically fit,
- Evaluate the overall result of change and mentally stable, and socially comfortable. It
make further adjustments. encompasses more than the state of being
free of disease (Kozier:2004).
Managing change:
- According to WHO, health is a “state
- Thinking-practice strategy. of complete physical, mental and
- Interest and commitment strategy. social well-being and not merely the
- Power and self discipline strategy. absence of disease or infirmity.”

Factors affecting change: Learning: is the acquisition of knowledge of

all kinds such as abilities, habits, attitudes,
- Culture. values and skills (Calderon:1998) primarily to
- Demographics. create change in an individual.
- Socioeconomic conditions and
environmental circumstances. Patient teaching: dynamic interaction
- State of wellness and development. between the nurse as the teacher and the
patient as the learner.
Change and its effect on the filipino health value
system: based on a list of change barriers, the Teaching: the process of providing learning
Philippines is a classic example of how scale materials, activities, situations, and
change can influence the state of the health care experiences to enable clients or learners to
system. acquire knowledge, attitudes, values, and
skills to facilitate self-reliant behavior
The 5 medical health remedies used by filipinos: (Calderon:1998).

- Home remedies. EDUCATION PROCESS

- Traditional healing techniques.
- Supernatural healing or the use of faith - Is a systematic, sequential, logical,
healers. scientifically based, planned course of
- Regulated drugs or medicines. action consisting of teaching and
- Over-the-counter drugs. learning (Bastable:2007).

Steps in the education process:

CHAPTER 2 1. Assessment: gathering of data about

the learner’s demographic profile,
skills and abilities needed in
CONCEPTS OF TEACHING AND LEARNING identifying the most appropriate
teaching strategy for a particular
Definition of terms: learner.
Education: is an interactive process of 2. Planning: a carefully organized written
 presentation of what the learner teaching the patient proper self-care, health
needs to learn and how the nurse promotion, illness or disease prevention,
educator is going to provide the factors affecting health and illness, and
teaching. treatment options.

3. Implementation and application of - Teaching plays an essential role in the

the teaching: the point where efficient and effective dissemination
theoretical and practical aspects of of information and in developing
the teaching-learning process meet as practical clinical skills of students.
the teacher applies the plan to the
learners.

4. Evaluation: the measurement of CHAPTER 3

teaching-learning performance of
both teacher and learners.
NURSE EDUCATOR
NURSING PROCESS
“Teaching is not a matter of change, it is a matter
- This emphasizes the need to manage of choice. It is not something you are destined or
and maximize health by preventing obliged to do but something you have chosen to
risk factors and encouraging healthy do. Blessed are the teachers for they are god’s gift
behaviors. everyone.

Nature of the nursing process: Definition and roles of a nurse educator:

- The nursing process is dynamic and - The primary source of knowledge of

cyclic. learners in nursing.
- It is planned and goal-directed.
- It is an intellectual process. - The primary catalyst for the learning
process; and a role model for learners.
Characteristics of the nursing process:
- An active facilitator, who demonstrates
- Systemic. and teaches patient care to nursing
- Dynamic. students in the classroom and clinical
- Interpersonal. settings.
- Goal-oriented.
- Universally applicable. - A source of healthcare information and
care to clients and is diligent; keeps
Steps in the nursing process: abreast of developments in his or her field
through continuing education, reading of
1. Assessment: data collection and nursing journals and online materials and
recording of all information. active participation in workshops and
seminars.
2. Planning: setting priorities, goals and
objectives, and treatment options. Functions of a health educator:

3. Implementation: putting the plan into “A health educator is a practitioner professionally

action. prepared in the field of health education, who
demonstrates competence in both theory and
4. Evaluation: assessing the patient, if practice and accepts responsibility in advancing
the desired outcomes have been met. and the aims of the health-education process.”
(DE YOUNG:2003)
Implications of the concepts of teaching and
learning in nursing practice: nursing means A health educator performs the following:
 such as number of programs completed,
- Collaborates with health specialists and nursing actions implemented, and
civic groups in assessing community individuals assisted.
health needs and availability of resources
and services and in developing goals for - Maintains databases, mailing lists,
meeting health needs of clients. telephone networks, and other
information to facilitate the function of
- Formulates operational plans and policies health education programs.
necessary to achieve health education.
PATIENT TEACHING
- Conducts and coordinates health needs
assessment and other public health - Defined by the american Academy of
surveys. family physicians, is the process of
influencing patient behavior and
- Designs and conducts evaluation and producing changes in knowledge,
diagnostic studies to assess the quality altitudes skills necessary in maintaining
and performance of health education or improving health.
programs.
- Patient teaching is a holistic process with
- Plans and implements health education the legal goals of changing or affirming a
and promotion programs such as training patient's behavior to benefit health status.
workshops, conferences and school or
community projects. - Patient teaching refers to only one
component of the patient education
- Prepares and distributes health education process which is giving the patient
materials, such as reports, bulletins, healthcare information.
online websites and visual aids like films,
videotapes, photographs and posters. - Patient teaching is more than imparting
information. The skilled patient educator
- Provides guidance to agencies and assists the patient in interpreting,
organizations in the assessment of health integrating and applying the information
education needs in the development and given. Patient teaching ends with an
delivery of health education programs. evaluation of patient learning. It is a
process that occurs overtime, requiring
- Disseminates health program information ongoing assessment of a patient's
to the public by preparing and issuing knowledge, attitudes and skills, patient
press releases, conducting media readiness or motivation to change
campaigns, and or maintaining program- behaviors and the obstacles that the
related websites. patient faces to make behavioral changes
are important factors to consider
- Promotes and maintains cooperative (Falvo:2003).
working relationships with agencies and
organizations interested in public health Purposes of client teaching:
care.
- Provides and maintains health education - Increase client’s awareness and
libraries to provide resources for staff and knowledge of their health status.
community agencies. - Increase client satisfaction.
- Improve quality of life.
- Formulates prepares and coordinates - Ensure continuity of care.
grant applications and grant-related - Decrease patient-anxiety.
activities to obtain funding for health - Increase self-reliant behavior.
education programs and related work. - Reduce effectively the incidence of
complications of illness.
- Documents activities, records information - Promote adherence to health care
 treatment plans. responsible decisions about their own
- Maximize independence in the health care.
performance of activities of daily living.
- Energize and empower consumers to Applying the following principles will help nurses
become actively involved in the planning become effective teachers:
of their care.
1. Assess teaching needs of clients or
*The role of nurses as health educators in turn teaching that is required in a particular
enhance their job satisfaction when they situation.
recognize that their teaching actions have the
potential of forging therapeutic relationships with 2. Assess readiness of the client to learn
patients, allowing for greater patient-nurse and the relevance of the content must be
autonomy, raise their accountability for practice, considered in order for learning to occur.
and create change that truly makes a difference in
the lives of others. 3. Assess what the client knows and begin
from what she knows.
*Health teaching is an essential role of today’s
nurses. Nurses care for their clients, prepare them 4. The nurse should consider language
for diagnostic procedures or surgery. Using barriers, literacy, ethic, or cultural
knowledge of growth and development, and from background, age and emotional status of
nursing theories, nurses teach individuals and the patient. Otherwise, teaching and
their families need information as well as learning can be difficult, placing the
emotional support so they can cope with the patient at risk.
anxiety and uncertainty of a client's illness.
Nurses also work with the client’s significant 5. Interactive discussions increase learning.
others to prepare them to assume responsibility The client should be involved in the
for care at home after the client is discharged teaching - learning process and not act as
from the hospital. a passive learner or viewer. A discussion
format in which all can participate
*Education is essential to promote health. The stimulates more learning than hearing a
nurse applies the principles of teaching and straight lecture.
learning to change the behavior of clients and
their family members. Nurses motivate clients 6. Demonstrate tasks to be done for the
and their families to take charge of and make active practice. Repetition of skills
responsible decisions about their own health care. increases retention and promotes a
For teaching to be effective, it must incorporate feeling of competence.
the cultural and family values and clients’ health
care beliefs. 7. Praise and positive feedback motivates
learning. This is important when the client
Factors that influence client’s learning: is trying to master a task, such as
capillary blood glucose test and self
- Stage of development. insulin injection for diabetic clients.
- Cultural values.
- Language used. 8. Role modeling is an effective method for
- Physical environment. demonstrating behavior. Nurses must be
- Previous experiences. aware that their behavior is scrutinized
- Knowledge and skill of the teacher. carefully at all times and that it may be
copied later.
Principles of client teaching and learning:
9. Conflicts and frustrations impede
- Education is essential to promote health. learning, and should be recognized by the
The nurse applies the principles of nurse and resolved for learning to
teaching and learning to change the progress.
behavior of clients towards making
 10. Structured teaching and presentation of values, beliefs and customs.
simple tasks must be done before
complex tasks in order to enhance Guidelines to therapeutic communication:
learning. For example, the nurse teaches
the client how to care for the umbilical 1. A peaceful and calm environment
cord, which is a simple task, before provides privacy, reduces distractions and
teaching how to bathe and shampoo the minimizes interruptions.
newborn, which is more difficult for
inexperienced parents. 2. Begin interactions by introducing oneself
and the nurse's role. This will describe the
11. A variety of teaching methods is nurse’s purpose and sets the discussion
necessary to illustrate concepts and process. For example “My name is
maintain interest of clients. Posters, Sameera Daham, I am here to complete
videos, models online and printed the health instructions that were started
materials can supplement lectures and yesterday.”
discussion.
3. Therapeutic communication should be
12. Present information in small segments focused and directed towards meeting
over a period of time for better retention the needs of clients. For example
and appreciation. Short hospital stays do focusing interactions - “How do you feel
not support this practice, making follow- about the treatment received today?”.
up care particularly important.
4. Communicate more powerful messages
- Complex procedures need to be taught to the client through non-verbal behaviors
well. Injection techniques, handouts, rather than spoken words.
visuals, aids, and actual equipment should
be used. The client should demonstrate - Eye movements and facial expressions
the learned procedure in order that the can confirm, or contradict what is said.
nurse can evaluate the effectiveness of
the teaching process. The substance or - Repetitive hand gestures such as tapping
content and skills taught should be the fingers or twirling hair may indicate
documented in appropriate health frustration.
records. Using these principles.
- Body posture, stance and gait can convey
Roles and responsibilities of the nurse as health energy, depression or discomfort.
educator and in-patient teaching:
- Voice tone, pitch, rate and volume may
Therapeutic communication: the nurse has to indicate joy, anger or fear. Grooming also
carry out many roles and one of the most conveys messages about the nurses’ self-
important roles required of the nurse is the skill in image.
therapeutic communication. Nursing care
becomes personal, humane and sensitive to a - Talking to a young child may require that
client's needs if the nurse can effectively the nurse sit or squat to get to the child’s
communicate and reach out to clients. In this way, level.
therapeutic communication must be purposeful,
goal directed and focused. 5. Active listening requires that the nurse
attend to what is being said as well as to
Guidelines for therapeutic communication: as the the nonverbal clues. Behavior that convey
health professional who is close to the client, the the nurse’s interest and sincere desire to
nurse informs families of treatments and listen and understand which include the
procedures, making sure that the families following:
understand the process and are involved directly
in making decisions and activities related to their - Eye contact signals readiness to interact.
care. The nurse should be sensitive to the client’s
 - Calm and relaxed posture, with the upper over chest, interruptions, providing false
portion of the body inclined toward the reassurance, inappropriate self-disclosure, giving
client. unsolicited advice and failure to acknowledge
comments or feelings (Wong et al 2010).
- Encouraging nonverbal cues such as
nodding, smiling and leaning closer. Documentation of client teaching:
Verbal cues include “Go on, uh huh. Tell Communication among members of the health
me about that” or “can you give me an care team is essential if this is to be coordinated
example?”. and consistent to the principles of client teaching.
Although communication takes place through
- Touch can be a powerful response when word of mouth, another method used is
words would break a mood or fail to documentation of patient teaching.
convey the depth of feeling experienced
between the client and nurse.
Such documentation not only communicates what
- Clarifying communication involves a is taught to the client but also communicates the
unique process of the client receiving the client's level of understanding and further
message as intended by the nurse. The reinforcement of information may be necessary
nurse can ask questions if the meaning of (Le Fevre: 2005). Such information prevents
the statement is not clear, for instance, redundancy and can assist in the evaluative
the nurse might say “I’m not sure If I process.
understand you.”

- Emotions are part of communication, and

nurses must often reflect feelings that are Characteristics of Documentation in Client
expressed verbally and non-verbally. The Teaching:
nurse might suggest “you looked forward 1. Covers all aspects of patient care;
to going home today but disappointed
that you needed to stay longer for more 2. Critical for communication among team
diagnostic workup.” members;

- Cultural differences greatly influence 3. Provides a legal record;

communication. In some cultures, such
as Chinese and Southeast Asian, 4. Supports quality assurance efforts;
prolonged eye contact is considered 5. Promotes continuity of care; and
confrontational while Middle Eastern or
Native Americans are sometimes 6. Facilitates reinforcement.
uncomfortable with touch or are disturbed
by unsolicited touching (Kozier:2008).
However, Filipinos are very comfortable
with touch and the feelings of safety and Good documentation reflects the following:
security are enhanced by touch. 1. Initial assessment and reassessment of
pertinent data;
Therapeutic communication techniques: involve
responding as well as listening, and the nurse 2. Nursing diagnoses and client learning needs;
must learn to use responses that facilitate rather
than block communication. Communication 3. Interventions provided;
techniques focus on both content of the message
and the feelings that accompany the message. 4. Client's response and outcomes of care;
These techniques include clarifying, reflecting,
5. Discharge plan of care; and
being silent, questioning and directing. In addition,
the nurse must be aware of blocks to 6. Ability of the client and family to manage needs
communication such as conveying lack of after discharge.
interest, sense of hate, closed posture in hands or
Review of the components of the documentation nurses' notes/
system illustrates how documentation of client
teaching can be integrated into the patient record. The method of charting assumes that all
The components are as follows: abnormal findings or variances are charted,
referred to as "charting by exception." If flow
sheets are used to record patient teaching, data
entered should be the documentation of the
1. Admission Assessment patient's understanding of what was taught rather
The nurse educator: than the subject matter being taught.

a. Make a complete patient profile and history.

b. Assesses the clients' functional ability to aid in 5. Progress Notes

the formulation of nursing diagnoses.

c. Identifies ways of individualizing teaching, such Narrative notes show the patient's progress
as the client's readiness, language, and physical perceived by all health care professionals involved
capability. in patient care. Evaluation of the patient's
d. Designs assessment forms to high-risk responses to nursing interventions should be
patients, in order to pinpoint potential problems evident. Every problem is referenced with a
that identify specific learning needs. number corresponding to the problem list.

Patient teaching can be effectively documented in

the progress notes section of the medical record.
2. Problem List Patient teaching is a problem-solving process
hence, documentation includes a clear statement
a. The patient's chart has a list of actual and
of needs or problems, significant data and the
potential health problems identified individually or
plan of care. It is also important to document the
collaboratively. It also includes medical and
outcomes of care. Narrative notes also encourage
nursing diagnoses;
charting in a patient's own words to illustrate
b. The nurse has to enter the data next to each outcomes of patient education and evidence of
problem as it is identified and when the problem is individualized care.
resolved. Standardized care plans may be
generated based on nursing diagnoses.
6. Discharge Summary

Summaries of reports written at the time of

3. Care Plan or Critical Pathway
discharge or transfer of the client to another
An individualized care plan for each patient health care facility serve as a needed source of
assessment of medical and nursing diagnoses, information for other health care providers about
patient goals, interventions and desired the patient's needs for reinforcement of health
outcomes. teaching and continued learning. Notes and
telephone consultations can be used to
communicate assessments and ongoing learning
needs of clients to continuing care providers.
4. Flow Sheets (Optional)

Flow sheets contain observations and lists of

patients name and data in a clear, concise, check- MEMORY AID
off format to encourage fast and immediate
documentation. Findings or patient responses
outside of normal limits must be recorded in the
1. Functions of Health Educator
a. Collaborates with health specialists and civic
groups in determining community health needs,
the availability of services, and goals for meeting 4. Principles of Client Teaching and Learning
needs.

b. Designs and conducts evaluation and a. Assess teaching needs of the patient or
diagnostic studies to assess the quality and teaching that is required in a particular situation;
performance of health education programs.
b. Assess what the patient knows and begin from
c. Develops and implements health education and what she knows; and
promotion programs such as training workshops,
conferences and school or community c. Consider language barriers, background, age
presentations. and emotional status of the patient, literacy,
ethnic and cultural background, age and
emotional status of the patient; otherwise,
2. Patient Teaching Defined teaching and learning can be impaired, placing the
patient at risk.

Patient teaching is the process of influencing

patient behavior and producing changes in 5. Characteristics of Documentation
knowledge, attitudes and skills necessary to a. Covers all aspects of patient care.
maintain or improve health.
b. Critical in regard to communication among
Patient teaching is also a holistic process with the team members
goal of changing or affirming patient behavior to
improve health status. Patient teaching refers to c. Provides a legal record.
only one component of the patient education
d. Supports quality assurance efforts.
process which is providing detailed information
regarding health status. e. Promotes continuity of care. f. Facilitates
reimbursement.

3. Purposes of Client Teaching is to:

6. Documentation Should Reflect the Following:
a. Increase health awareness;
a. Initial assessment and reassessments of
b. Increase client satisfaction; c. Improve quality
pertinent data.
of life;
b. Nursing diagnoses and patient learning needs.
d. Ensure continuity of care;
c. Interventions provided.
e. Decrease patient anxiety, reduce the
d. Patient's response and outcomes of care.
g. Further adherence to health care treatment
e. Discharge plan of care.
plans;
f. Ability of the patient and family to manage
f. Effectively incidence of illness and
needs after discharge.
complications;
7. Components of the Documentation System
h. Maximize independence in the performance of
activities of daily living; and a. Admission Assessment; b. Problem List;
i. Energize and empower consumers to become c. Care Plan or Critical Path Way;
actively involved in planning their care.
d. Flow Sheets (Optional):

e. Progress Notes; and f. Discharge Summary