Health Teaching Intervention Among Selected Nursing Students Regarding Achieving Self-care of Hospital patients

Partial Requirement for the fulfillment of the Degree, Bachelor of Science in Nursing Cacananta, Chrysa C. Calingasan, Armida M. Esquivias, Marielle Joyce G. Gonzaga, Peter Francis O. S.Y. 2011-2012

CHAPTER I INTRODUCTION AND ITS BACKGROUND

Health traditionally termed as the absence of a disease. Nightingale also defines health as a state of being well and using every power the individual possesses to the fullest extent. Health is the balance or homeostasis of a person, both within one s being, physical, mental, and spiritual and in the outside world natural, communal, and metaphysical. Also health defines as a highly individual perception (Kozier et al, 2008). So, nurses should be aware of their own definitions of health and appreciate that every individual has its own definitions as well. By understanding this definition the nurses may have a holistic care for their patients. They supervise in the hospital in their performances of duties such as Vital Signs taking, do the Tepid Sponge Bath if fever has arise, and assist in taking health history and conduct health teachings. More so, a nurse should promote good health to achieve a higher level of health and well-being of our patient. Health promotion is important component of nursing practice. It is a way of thinking that revolves around a philosophy of wholeness, wellness, and well-being.

Teaching is a system of activities intended to produce learning. The teaching-learning process is intentionally designed to produce specific learning. A nurse must know how to educate his/her patient, because it may affect the nurse-patient interaction (Kozier et al, 2008). In preparing medication, a nurse understands the drug and its action, side effects, and health precautions. In this way a nurse helps his/her patient understanding the dosage of every medication given. The role of nurses as teacher is not just to be the giver of information, but to promote learning and provide for an environment conductive to learning- to- create the teachable moment rather than just waiting for it to happen (Wagner and Ash, 1998). A learner cannot be made to learn, but an effective approach to teaching others is to actively involve learners in the education process. The nurse should act as facilitator, creating situations. That motivates the individuals to want to learn and that make it possible for them to learn. The assessment of learning needs, the planning and designing of a teaching plan, the implementation of teaching methods and instructional materials, and the evaluation of teaching and learning should include participation by both the nurse and the patient/family (Knowles, Holton and Swanson, 1998) (Bastable, 2006)

The role of nurse as information brokers significantly influence how patients and the families cope with their illnesses, benefit from education directed at prevention of disease and promotion of health, and gain competency and confidence in self- care management. Historically, nurses have provided education to patients and their families as part of their standard care- giving functions. However, the teaching role is becoming even more important and more visible as nurses respond to the social, economic and political trends impacting on health care today. (Bastable, 2006) Many challenges and opportunities lie ahead for nurses in the delivery of health care. The foremost challenge for nurses is to overcome barriers to teaching and reduce the obstacles that interfere with learning. This requires nurses to have a solid understanding of the education process and be able to apply principles of teaching and learning to meet the needs of individuals in a variety of practice settings. A definite link exists between patient education and positive behavioral outcomes of the learner. For patient education to be effective and efficient, nurses must work in partnership with patients and families to achieve mutually established goals. The responsibility and accountability of nurses for the delivery of high quality care to the consumer can be demonstrated through an ongoing commitment to carrying out their role in patient education. (Bastable,2006)

Patient education is a process of assisting people to learn health-related behaviors so that they can incorporate those behaviors into everyday life. As stated obviously, the purpose of patient education is to help the clients to achieve the goal of optimal health and independence in self-care. It involves a relationship between the teacher and learner so that the information needs (cognitive, affective, and psychomotor) of a client can met through the process of education (Bastable, 2006). Nurses play an important role in providing care for every individual to meet quality life of man. These become a challenged in their efforts to meet quality care especially in critical care settings which emphasizes curative and aggressive lifesaving treatment. Behind of these challenges, they continuously provide care for the promotion of health, prevention of illness, and the care of the ill, disabled, and dying patients to reach the optimum level of wellness for the patients.

OBJECTIVES:
1. To understand the standard health teaching intervention. 2..To determine the hindrances of giving effective and proper health teaching. 3. To improve the delivery of health teaching techniques. 4. To enhance the self care activities through proper health education. 5. To know the effect of proper health education used by the nursing students to the self- care activities of their patients. 6. To explain the different health teaching intervention strategies used by the nursing students. 7. To demonstrate health teachings to the upcoming nursing students. 8. To evaluate the results of the study in order to formulate recommendations.

STATEMENT OF THE PROBLEM:

This study aims to determine the Health Teaching Intervention among Selected Nursing Students Regarding Achieving Self- care of Hospital Patients The study specifically aims to find answers to the following problems: 1. What is the different health teaching intervention strategies the nurse should understand? 1.1 Video presentation 1.2 Demonstration
1.3 Picture-Base Teaching

1.4 Print out 2. What are the hindrances on giving effective and proper health teaching? 2.1 2.2 2.3 2.4 Lack of Nurse-Patient Interaction Lack of Time Low Self confidence Lack of Prioritization

3. What are the techniques to improve the delivery of health teaching intervention? 3.1 Building Trust 3.2Motivation 4. What are the proper health education used by the nursing students and its effects in improving self-care of their patients? 4.1 Establishing Rapport 4.2 Self- confidence 4.3Prioritization 4.4 Good Environment 5. Is there a significant relationship between the health teaching interventions among selected nursing students and achieving self-care of hospital patients? 6. What are the implications of health teaching interventions of the selected nursing students in regards to the achievement of patient s self-care?

HYPOTHESIS:
HO: There is no significant relationship between the health teaching interventions among selected nursing students and achieving self-care of hospital patients. H1: There is significant relationship between the health teaching intervention among selected nursing students and achieving self- care of hospital patients.

ASSUMPTIONS:
The study aims to determine how the nursing students of Pamantasan ng Cabuyao provide Health Teaching Intervention Regarding Achieving Self-care of Hospital Patients. 1. The respondents (Nursing Students) are aware of the health teaching intervention used by the nursing students of Pamantasan ng Cabuyao. 2. The respondents (Nursing Students) are capable of evaluating the health teaching intervention strategies.

DEFINITION OF TERMS
Nursing. It is the person who gave health teaching and helps to maintain the homeostasis of the patient. A person who minimizes, stabilize or control the effects of the diseases. Health. It is the homeostasis of a patient. Lack of Time. One of the factors why a nurse can have enough time to interact with each of the patient because of many tasks they do in their shift. Low Self-Confidence. One of the reasons why the nurse can t able to do their tasks well. Building the Trust. It is the action of nurse to gain good rapport. Motivation. It is important action of nurses to encourage the patient and gain cooperation. Video Presentation. Audio visual material that will help the patient to visualize certain procedures related to the topic. Demonstration. Acting out of procedures which can sometimes be helpful for the patient to understand further topics. Picture-Based Teaching. A material which may help the patient to visualize and to come up with good understanding related to the topic. Print Out. A hard copy which may provide the patient some information and picture related to the topic.

THEORETICAL FRAMEWORK
This investigative study is based on the theory of Dorothea Orem, Self-care Deficit Theory of Nursing. Nursing systems are action systems formed by nurses through the exercise of their nursing agency for persons with health-derived or health-associated limitations in self-care or dependent care. It includes deliberate action, intentionally, diagnosis, prescription, and regulation. Self-care is a regulatory function by man. It is deliberate and is performed by the person himself or have they performed by another person for them in order to maintain life, health, development, and well-being. There are four concepts of Self-care Theory namely Nursing Agency, Self-care Requisites (Universal Self-care Requisites, Developmental Selfcare Requisites, Health Deviation Requisites), Therapeutic Self-care Demand, Self-care Agency (Dependent-care Agent, Self-care Agent). The elements of the theory clearly emphasize the need to understand the importance of self-care in the promotion and maintenance of health and wellbeing. It is thus important for the nurse of today to focus on the patient s capacity and/or ability to perform self-care activities in order to determine which self-care activities will be totally performed for the patient and which the patient activities can already be performed by the patient to a certain degree.

What is clear in the model of Orem is the emphasis on education and supportive measures. It becomes clear that nurses today should not move away from this very important aspect of clinical nursing- health teachings. According to Dorothea Orem, this model has three interrelated theories. These are nursing systems, self-care, and self-care deficit. The focus of Orem s model is to enhance the person s ability for self-care and this also extends to the care of dependents (Bautista, 2008). So, we use this theory to correlate our study in achieving self-care of hospital patients. Also this theory helps us to investigate more about health teaching intervention giving by the nursing student

Rel

Rel

Level of Satisfaction: Good Feedback Improvement Wellness

Hindrances on Giving Effects and Proper Health Teaching: Lack of Nurse-Patient Interaction Lack of Time Low Self-Confidence Lack of Prioritization

Proper Health Teaching in 1. Improving Self-Care: 2. Establishing Rapport 3. Self-Confidence 4. Prioritization 5. Good Environment Health Teaching Intervention Strategies: 1. Video Presentation 2. Demonstration 3. Picture-Based Teaching 4. Print Out

Rel

Rel

Figure 1: Health Teaching Intervention among Selected Nursing Students Regarding Achieving Self-care of Hospital Patients

ANALYSIS:
We used this theory of Dorothea Orem because it is our duty and obligation to recognize and identify the hindrances in order to define a support modality or intervention. A nurse must have an idea on how to become an effective health care provider. The elements of the theory clearly emphasize the need to understand the importance of self-care in the promotion and maintenance to health and well-being. It is thus important for the nurse of today to focus on the patient s capacity and/or ability to perform self-care activities in order to determine which self-care activities will be totally performed for the patient and which patient activities can already be performed by the patient to a certain degree. What is clear in the model of Orem is the emphasis on education and supportive measures. It becomes clear that nurses today should not move away from this very important aspect of clinical nursing- health teachings.

SCOPE AND DELIMINATION

This study is regarding to the health teaching intervention in achieving self-care of hospital patients. It involves all the nursing students of Pamantasan ng Cabuyao, College of Nursing and Affiliated Hospitals like Ospital ng Cabuyao, St. James Hospital, Panlalawigang Pagamutan ng Laguna, and Los Banos Doctor s Hospital. It also includes the different health teaching intervention strategies of the nursing students, the significant relationship between health teaching interventions among selected nursing students and achieving self-care of hospital patients. The study is further delaminated to the result of the questionnaire, checklist which will serve as getting tool.

SIGNIFICANCE OF THE STUDY

The study will be used in understanding certain topic to health teaching intervention among selected nursing students regarding achieving self-care of hospital patients. This study will assess the Health Teaching Intervention Regarding Achieving Self-care of Hospital Patients. It will Determine the worth and values of nursing students in giving health teaching intervention. The findings of the study will serve as basis in improving the Health Teaching Intervention among Hospital Patients.

To the Clinical Instructors. This study will help them to improve better their Health Teaching Strategies when they handled their patient. It gives another idea how to be more a fully equipped nurse when it comes to disease condition of the patients. To the Administrations. This study will help them to give an idea how health teaching strategies is important in our life. They can be a good health educator to their students as well as to their family regarding the importance of health teachings. To the Patients. This study will help them to understand what the appropriate Health Teachings will be apply in a simple interventions regarding from their disease so they can have enough knowledge to treat the disease if ever it will happen again. To the Nursing Students. This study will help them to be able to understand in giving health teaching interventions and to improve the delivery of health teachings properly. To the Researchers. This study will help them in making further study regarding the problem. It would be also offer them some facts that may be used to enhance related studies for future use.

CHAPTER II REVIEW OF THE RELATED LITERATURE AND STUDIES

This chapter contains the related literature and studies that will help the researchers about Health Teaching Intervention Regarding Achieving Self-care of Hospital Patients. Health is a state of being. According to the World Health Organization, health is the state of complete physical, mental, emotional, social and spiritual wellbeing and not necessarily the absence of disease or infirmity . It means that a person who has no disease or any disfigurement but may have ill thoughts or cannot socialize normally with his/ her peers is not really a healthy person. In order for a person to be considered healthy, he/ she should be complete physical fitness, with a sound mind, attuned with his/ her feelings, is able to socialize and relate to others, and has a distinct relationship with a higher Being. (Bautista, 2008)

Nursing is caring. This description already epitomizes the ideals of a profession that is holistic in approach and grounded in unwavering service to mankind. The nursing profession is a lifelong commitment to quality service and excellence, a calling, and not just as a means to make ends meet. Nurses care for patients and the many things importantto the patients. (Bautista, 2008) Nursing competence is three-fold: Knowledge, skills and attitude. Knowledge in nursing pertains to the information-concepts, theories, principles, guidelines- that will be relevant and significant in carrying out nursing responsibilities. The skills competent of nursing centers on the acquisition of technical know- how on the different processes and procedures related to the delivery of nursing care. The attitude component relates to the art in nursing. A caring, compassionate, committed, confident, and competent nurse is always said to be the one with a real nurse attitude. Attitude, sad to say, cannot be taught nor learned. It is inherent in each one of us. How the two other components- knowledge and skills- will be appreciated and valued by the person will ultimately spell the direction of the attitude that same person will show of nursing as a profession. (Bautista, 2008)

According to Kozier et.al, nurses understanding of health and wellness largely determine the scope and nature of nursing practice. Client s health beliefs also influence their health practices. Some people think of health and wellness (or well- being) as the same thing or; at the very least, as accompanying one another. However, health may not always accompany well being. A person who has a terminal illness may have a sense of well being; conversely, another person may lack a sense of well being yet be in a state of good health. For many years the concept of disease was the yardstick by which health measured. In the late 19th century the how of disease (Pathogenesis) was the major concern of health professionals. The 20th century focused on finding cures for diseases, currently health care providers are increasing their emphasis on promoting health and wellness in individual, families, and communities. Nurses may teach individual clients in one to one teaching episodes. For example, the nurse may teach about wound care while changing a clients dressing or may teach about diet, exercise and other lifestyle behaviors that minimize the risk of a heart attack for client who has a cardiac problem. The nurse may also involve in teaching family members or other support people who are carrying for the client. www.healthcareerjournal.com

Because of decreased length of hospital stays, time constants on client education may occur. Nurses need to provide client education that will ensure the clients safe transition from one level of care to another and make appropriate plans for follow up education in the client s home. Discharge plans must include information about clients has been taught before transfer or discharged and what remains for the client to learn to perform self care in the home or other residence. Being an educator or teacher is an important and primary role for the nurse. Clients and families have right to health education in order to make informed decisions about their health. The nurse is in position to promote healthy lifestyle through the application of health knowledge, the change process, learning theories, and the nursing and teaching process when teaching clients and their families. Patient education goes hand-in-hand with improved patient outcomes and quality of life. Educating the patient is an integral part of the nurse's role in patient care. In order to ensure the success of the patient teaching plan, the processes involved in developing a nursing patient teaching plan should be centered around the patient and inclusive of the family. www.healthcareerjournal.com

According to Dorothea E. Orem (2008) Nursing is a helping profession of assisting patients overcome or compensate for the health-associated limitations and engaging in actions to regulate their own functioning and level with other members of the health team, development or that of their dependents. According to Lydia Hall (2008) Nursing is a distinct body of knowledge that provide nursing care to patients who are in need of nursing need of nursing care in support of medical interventions, in collaboration of the with other members of the health team, or exclusively and independently by the nurse itself. According to Orem she developed the Self-care Deficit Theory of Nursing (her general theory), which is composed of interrelated theories: (1) the theory of self-care, (2) the self- care deficit theory, and (3) the theory of nursing systems. Incorporated within these three theories are six central concepts and one peripheral concept. Understanding these central concepts of self- care, self- care agency, therapeutic self- care demand, self- care deficit, nursing agency, and nursing systems, as well as the peripheral concept of basic conditioning factors, is essential to understanding her general theory.

Nightingale advocated the separation of nursing training from the hospital to a more appropriate learning environment in the school or university setting. This was advocated because nightingale believed the nursing student s role is to learn the art and sciences in nursing before being employed in the nursing service .She addressed the concern that hospitals might take advantage of the presence of nursing students in their service areas in form of assigning patients to these students instead of their regular employed nursing personnel. (Bautista, 2008) A review of the patient and health education literature in nursing indicates there is no clear definition of an educational setting in which client teaching occurs and little attempt has been made by authors to comprehensively categorize such settings (Redman, 1993; Whitman, Graham, Gleit, & Boyd, 1992). A "setting" is generally implied to be that place where health teaching occurs.

Various authors refer to education taking place in a hospital, a client's home, a physician's office, or unit-based environments for cardiac care, kidney dialysis, or intensive care (Haggard, 1989; Rankin & Stallings, 1990; Redman, 1993). Others identify teaching taking place in an acute, episodic, rehabilitative, or long-term practice area. The implication is that these identified "areas" for practice serve a variety of clients with different educational needs requiring different teaching approaches (Cupples, 1991). Graham and Gleit (1992) describe the setting of practice and the teaching role of nurses from the perspective of community versus inpatient settings. Redman (1993) refers to the larger organizations or agencies where health or patient education is provided as health care delivery systems and presents client teaching situations within the context of a system, focusing on describing the tools needed for organizing, evaluating, and documenting teaching content. Cupples (1991) and Lechrone (1991) present data from various studies on the effectiveness of teaching in a variety of "situations" which they identify as settings.

Nurses must have a broader, more comprehensive understanding of the delivery of client health education in a rapidly changing health care environment in order to better provide for that component of professional nursing practice. While an increasing amount of nursing care is delegated to less-prepared assistive personnel, client health teaching remains within the domain of professional nursing practice. Therefore, nurses who understand and effectively provide client health education in different and varied educational settings not only have a professional advantage over other colleagues but can meet the needs of the evolving health care system and the larger community of health care consumers more effectively. In this overview, the three types of educational settings for client health teaching are defined and described, and the effects of organizational, environmental, and clientele variables are discussed.(http:// findarticles.com)

CHAPTER III RESEARCH METHODOLOGY

This chapter involves discussion of research method used; how the respondents were selected from the population; the sampling techniques used; the instrument by which data are gathered in the study; the procedure taken to gather data; and the statistical treatments applied in order to come up with answers to the formulated problems laid out in chapter 1. This chapter provides all necessary information about the study that includes Research Design, Research Locale, Research Instruments, Data gathering procedure, Statistical Treatment Data.

RESEARCH DESIGN
The researchers will be using quantitative method. Calderon states that descriptive research is purposive process of gathering and analyzing. Tabulating and classifying the data about the conditions belief, practices, trends, processes, and cost effects relationship and then making adequate interpretation about such views of statistical method. It was descriptive because it analyze and interpreted the present nature of composition, which are the most effective health teaching intervention since the main concern deals with the improvement of the health teaching used by the nursing students, that will help students to be competitive in the near future.

RESEARCH LOCALE
The subjects of the study will be the nursing students; it involves the nursing students of Pamantasan ng Cabuyao year 2011-2012, the school was located at Katapatan Village, BanayBanay, Cabuyao, Laguna. The setting for the study is in the College of Health Allied Sciences Nursing Building. It is a four-storey building contained by the university library on the second floor, on the third floor skills laboratory for nursing students. The equipments are sufficient enough to provide knowledge to the students. And in the 4th floor is engineering department.

RESEARCH INSTRUMENT
The method of collecting data used will be the normative survey. The word survey indicates the gathering of data for the current conditions. The word normative referred to the subject as the main concern and because survey was conducted to ascertain teaching strategy was preferred by the respondents. The instrument used in gathering data will be questionnaire. The questionnaire will be preferred for the purpose of identifying effectiveness of teaching strategies of the clinical instructor at Pamantasan ng Cabuyao that affects the way they render quality nursing care.

DATA GATHERING PROCEDURE

Authorization will be held from the Dean of College of Health Allied Sciences to perform the study among selected nursing students of Pamantasan ng Cabuyao. The adviser will include in the form of the questionnaire suggestions and comments. Upon approval of the Dean, respondents (Nursing Students) were asked to answers the questions.

STATISTICAL TREATMENT
The following statistical tools will be used in the study. 1. Frequency and percentage will be used to describe the profile of the respondents. The Formula: Percentage=

f N

X 100

Where: f= frequency N= number of respondents

2. Weighted mean will be used to determine the Health Teaching Intervention Regarding Achieving of Self-care of Hospital Patients. It was also used to determine the level of satisfaction in providing knowledge/ learning of the students. The Formula: Weighted mean= fx N Where: f= frequency x= assigned weight N= number of respondents = summation of symbol

3. Pearson r will be used to determine the degree of relationship between level of satisfaction in providing knowledge/ learning of the students and level of effectiveness of nursing students in giving health teaching intervention regarding achieving self-care of hospital patients. The Formula: r= [n X2 n XY - X Y ( X2)][n Y2- ( Y)]

Where: r = degree of relationship between x and y x = the observed data for the independent variable y = the observed data for the dependent variable n = sample size

4. T-test for the significance of the Pearson r was used to determine if there is significant relationship between level of satisfaction in providing knowledge/ learning of the students and level of effectiveness of the nursing students in giving health teaching intervention regarding achieving self- care of hospital patients. The Formula: t= r n-1 1-r2 Where: r = Person r value n = number of respondents

5. Z-test will be used to determine if there is significant difference in the level of satisfaction in providing knowledge/learning to the students. The formula: X1 X2 s12 + s22 N1 Where: X1 = mean of the first group X2 = mean of the second group s12 = variance of the first group s22 = variance of the second group N1 = number of respondents in the first group N2 = number of the respondents in the second group N2

Z=