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ROOSEVELT COLLEGE SYSTEM

Institute of Nursing and Health Education

1

RESOURCE MATERIAL ON HEALTH EDUCATION

COURSE TITLE HEALTH EDUCATION

NO. OF UNITS

CONTACT HOURS

3 units lecture

54 hours

VENUE Amphitheater 1 (Lecture)

PROFESSOR Rovie V. Gonzales, RN, MAN

DEGREE PROGRAM

TERM OFFERED

Bachelor of Science in Nursing

2nd

Year, Summer

COURSE DESCRIPTION The course includes discussions of concepts, principles,

theories and strategies of clinical and classroom teachings. It

provides critical\ thinking activities for students to apply

concepts of learning and teaching and appreciate the nurse's

role as a teacher in various settings. It further provides

experiences to develop beginning skills in designing and

applying a teaching plan using the nursing process as a

framework in the Related Learning Experience and classroom

settings.

PRE-REQUISITE None

COURSE OBJECTIVES: At the end of the course, given relevant

situations/conditions, the student will be able to:

1. apply principles, theories and strategies of health

education in assisting clients to promote and maintain their

health

2. develop an instructional design to meet the learning needs

of clients

A. HEALTH EDUCATION PERSPECTIVE

1. Historical Development

Mid 1800s

the responsibility for teaching has been recognized as an important role of nurses as

caregivers.

Florence Nightingale the founder of modern nursing, was the ultimate educator.

Early 1900s public health nurses, role of the nurse as teacher in preventing disease and in

maintaining the health of society.

1918 National League of Nursing Education (NLNE)/ National League for Nursing (NLN)

-observed the importance of health teaching as a function within the scope of

nursing practice.

- recognized nurses as agents for promotion of health and prevention of illness

in all settings.

1950



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identified course content in nursing school curricula to prepare nurses to assume the

role as teachers of others.

1993 Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

- established nursing standards for patient education.

2001 teaching activities must be patient centered and family oriented.

2. Issues and Trends in Health Education

2.1 General Issues And Trends •Politicians and healthcare administrators alike recognize the importance of health education

to accomplish the economic goal of reducing the high costs of health services.

•Healthcare professionals are increasingly concerned about malpractice claims and

disciplinary action for incompetence.

•Consumers are demanding increased knowledge and skills about how to care for themselves

and how to prevent disease.

•The aging of the population are requiring an emphasis to be placed on self-reliance and

maintenance of a healthy status over an extended lifespan.

•Major cause of morbidity and mortality are those disease that are lifestyle related and

preventable through educational intervention.

•The increase in chronic and incurable conditions requires individuals and families become

informed participants to manage their own illnesses.

•Client education improves compliance.

•The increase number of self-help groups exist to support clients in meeting their physical

and psychosocial needs.

2.2 Specific Issues And Trends Current Mandates for Nurse as Educator

To increase the quality and years of healthy life

To eliminate health disparities among different segments of the population

To use theory and evidenced based strategies to promote desirable health behavior

Trends affecting Health Care

Social, economic, and political forces that affect a nurse‘s role in teaching:

Growth of managed care

Increased attention to health and well-being of everyone in society

Cost containment measures to control healthcare expenses

Concern for continuing education as vehicle to prevent malpractice and incompetence

Expanding scope and depth of nurses‘ practice responsibilities

Social, economic, and political forces that affect a nurse‘s role in teaching:

Consumers demanding more knowledge and skills for self-care

Demographic trends influencing type and amount of health care needed

Recognition of lifestyle related diseases which are largely preventable

Health literacy increasingly required

Consumers demanding more knowledge and skills for self-care

Demographic trends influencing type and amount of health care needed



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Recognition of lifestyle related diseases which are largely preventable

Health literacy increasingly required

Advocacy for self-help groups

REMEMBER THIS: “NURSES, YES YOU! ARE IN A KEY POSITION TO CARRY

OUT HEALTH EDUCATION”

•Most continuous contact with clients.

•Most accessible source of information for the consumer.

•Most highly trusted of all health professionals.

3. THEORIES IN HEALTH EDUCATION •A theory is a set of interrelated concepts, definitions and prepositions that presents a

systematic view of events or situations by specifying relations among variables in order to

explain and predict the events of the situation.

o Individual (Intrapersonal) Health Behavior Models/ Theories

o Interpersonal Health Behavior Theories

o Community Level Models/ Theories

o Individual (Intrapersonal) Health Behavior Models/ Theories

1.HEALTH BELIEF MODEL (Rodenstock, Becker, Kirscht, et. al) – 1950‘s

Adopted behavioral sciences to examine health problems

Help explain why people would or would not use available preventive services

(Xray=TB)

Researchers assumed that people feared diseases and that the health actions of people

were motivated by the degree of fear (perceived threat) and the expected fear of

actions

2. TRANSTHEORETICAL MODEL/ Stages of Change Model (Prochaska and

DiClemente)- 1979

Outlining the stages of an individual‘s readiness to change, or attempt to change,

toward healthy behaviors.

Evolved from smoking cessation and also the treatment of drug and alcohol addiction,

lately is for dietary modifications/changes

Behavior chagne is viewed as a process, not an event, with individuals at various

levels of motivation or ―readiness‖ to change

3. CONSUMER INFORMATION PROCESSING MODEL (Bettman, McGuire, et.al)

Developed out of the study of human problem solving and information process

Has many useful application in the area of health education

INFORMATION is a necessary tool in H.E. just like KNOWLEDGE is necessary but

not sufficient for behavior change, INFORMATION is necessary but not sufficient for

knowledge= limits to any person‘s information processing capacity= limitations upon

individuals in the amount of informatino they can acquire, use and remember

4. THEORY OF REASONED ACTION (Fishbein and Ajzen)

Based on the assumption that most behaviors of social elevance are under volitional

(willful) control

A person‘s intention to perform (or not perform) the behavior is the immediate

determinant of that behavior



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GOAL = not only predict human behavior but also to understand it

5. SOCIAL LEARNING THEORY OR SOCIAL COGNITIVE THEORY (Rotter and

Bandura)

Human behavior is explained in three-way reciprocal theory in which personal factors

(one‘s cognitive process), behavior, and environmental influences continually interact

in a process of reciprocal determinism or reciprocal causality.

Person can shape the environment as well as the environment shaping the person

o INTERPERSONAL HEALTH BEHAVIOR THEORIES 1. SOCIAL NETWORKS/ SOCIAL SUPPORT THEORIES (Eng, Israel, et. al)

Social network= kin, work groups, friends, neighbors

Types of characteristics of SN:

Structural = size (number of people) and density (how they really know each other)

Interactional = reciprocity ( mutual sharing), durability (length) intensity (frequency

of interaction) and dispersion (ease with each other to contact one another)

Functional = social support, connections to social contacts, maintenance of social

identity

o COMMUNITY LEVEL MODELS/ THEORIES

1. COMMUNITY ORGANIZATIONS Emerged from a specific field of activity within social work in the late 1800‘s into

broader process

Involves working with people as they attempt to ―define their own goals, mobilize

resources, and develop action plans‖ = meet their needs that they identified

collectively

2. DIFFUSION OF INNOVATIONS THEORY (Rogers and Shoemaker) Provides an explanation for how new ideas, products and social practices diffuse or

spread within a society or from one society to another.

Diffusion can be thought of as a special type of communication in which messages are

concerned about a new idea

3. ORGANIZATIONAL CHANGE THEORIES Organizations are complex and layered social systems.

Change may be influenced at each other

4. ECOLOGICAL MODELS Focus attention on the individual and the social environmental factors as the targets

for any interventions

LIFESTYLE & HEALTH BEHAVIOR = direct attention toward changing

individuals, rather than changing the social and physical environment which can serve

to reinforce unhealthy behaviors

B. PERSPECTIVE ON TEACHING AND LEARNING

1. Overview of Education in Health Care

•Purpose, Benefits, and Goals of Patient, Staff and Student Education

Purpose: to increase the competence and confidence of patients to manage their own self-

care and of staff and students to deliver high-quality care



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Benefits of education to patients: - increases consumer satisfaction

- improves quality of life

- ensures continuity of care

- reduces incidence of illness complications

- increases compliance with treatment

- decreases anxiety

- maximizes independence

Benefits of education to staff: - enhances job satisfaction

- improves therapeutic relationships

- increases autonomy in practice

- improves knowledge and skills

Benefits of preceptor education for nursing students: - prepared clinical preceptors

- continuity of teaching/learning from classroom curriculum

- evaluation and improvement of student clinical skills

Goal: to increase self-care responsibility of clients and to improve the quality of care

delivered by nurses

2. Concepts of Teaching, Learning, Education process vis-à-vis Nursing Process,

Historical Foundations for the Teaching Role of the Nurse

THE EDUCATION PROCESS DEFINITION OF TERMS:

Education Process: a systematic, sequential, planned course of action on the part of both

the teacher and learner to achieve the outcomes of teaching and learning

Teaching/Instruction: a deliberate intervention that involves sharing information and

experiences to meet the intended learner outcomes

Learning: a change in behavior (knowledge, skills, and attitudes) that can be observed and

measured, and can occur at any time or in any place as a result of exposure to

environmental stimuli

Patient Education: the process of helping clients learn health-related behaviors to achieve

the goal of optimal health and independence in self-care

Staff Education: the process of helping nurses acquire knowledge, attitudes, and skills to

improve the delivery of quality care to the consumer

ASSURE Model A useful paradigm to assist nurses to organize and carry out the education process.

Analyze the learner

State objectives

Select instructional methods and materials

Use teaching materials

Require learner performance

Evaluate/revise the teaching/learning process



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Historical Foundations of The Nurse Educator Role •Health education has long been considered a standard care-giving role of the nurse.

•Patient teaching is recognized as an independent nursing function.

•Nursing practice has expanded to include education in the broad concepts of health

and illness.

Organizations And Agencies Promulgating Standards And Mandates: 1. NLN

–first observed health teaching as an important function within the scope of

nursing practice

–responsible for identifying course content for curriculum on principles of teaching

and learning

2. ANA

- responsible for establishing standards and qualifications for practice, including

patient teaching

3. ICN

- endorses health education as an essential component of nursing care delivery

4. State Nurse Practice Acts

- universally includes teaching within the scope of nursing practice

5. JCAHO

- accreditation mandates require evidence of patient education to improve outcomes

6. AHA

- Patient‘s Bill of Rights ensures that clients receive complete and current information

7. Pew Health Professions Commission

- puts forth a set of health profession competencies for the 21st century; over one-half

of recommendations pertain to importance of patient and staff education

3. Role of The Nurse As A Health Educator •With at least 3 yrs hospital stays, organizations expect that staff nurses will have to be

skilled teachers

•They will need to learn the basic principles of teaching and how to apply them

•Nurses who spend the majority of their time in the education role such as staff development

instructors or educators in collegiate settings have more formal preparation for the educator

role.

•Provide a holistic approach to care delivery.

•Act as facilitators.

•Clarify confusing information.

•Serves as a coordinator of care.

•Assist colleagues in gaining knowledge and skills necessary for the delivery of professional

nursing care.

CREATE A GROUP, DISCUSS AND ANSWER THE FOLLOWING (seatwork) 1.Is every nurse capable of taking appropriate action to revise the approach to educating the

client if the

information provided is not comprehended? How?

2.Can every nurse determine whether information given is received and understood? How?



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4. Hallmarks of Effective Teaching In Nursing I.Professional Competence:

a. Through knowledge and subject matter

b. Polishes skills throughout her career

c. Maintains and expands her knowledge in reading, research, clinical practice

and continuing education

d. Portrays excellent clinical skills and judgment become a positive role model

for learner.

II.Interpersonal Relationship with Students

a. Taking personal interest in learners

b. Being sensitive to their feelings and problems, conveying respect for them.

c. Alleviating their anxieties

d. Being accessible for conferences

e. Being fair, permitting learners to express differing points of view

III. Teaching Practices

•Defined the mechanics, methods, and skills in classroom and clinical teaching.

IV.Personal Characteristics

•Qualities such as personal magnetism, enthusiasm, cheerfulness, self-control,

patience, flexibility, a sense of humor, a good speaking voice, self-confidence,

willingness to admit errors, and a caring attitude are all desirable characteristic

teachers.

V. Evaluation Practices

•Valued by students include clearly communicating expectations, providing timely

feedback on student progress, correcting students tactfully, being fair in the evaluation

process, and giving test that are pertinent to the subject matter.

VI. Availability to students

•This may take the form for educators of being there in stressful

classroom and clinical situations, physically helping students give nursing

care, giving appropriate amounts of supervision, freely answering

questions and acting as a resource person during clinical learning experiences.

5. Principles of Good Teaching Practice In Undergraduate Education 1.Encourage student-faculty contact

2.Encourage cooperation among students

3.Encourage active learning

4.Give prompt feedback

5.Emphasize time on task

6.Communicate high expectations

7.Respect diverse talents and ways

6. Barriers to Teaching and Obstacles to Learning

Barriers to Teaching – Factors that impede the nurse‘s ability to deliver

educational services.

Obstacles to Learning – Factors that negatively affect the ability of the learner to

pay attention to and process information.

Barriers to Teaching 1. Lack of time.

2. Do not feel confident or competent with their teaching skills.



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3. Personal characteristics of the nurse educator plays an important role in determining the

outcome of a teaching-learning interaction.

4. Low priority was often assigned to patient and staff education by administration and

supervisory personnel.

5. The environment in the various settings where nurses are expected to teach is not always to

carrying out the teaching-learning process.

6. An absence of third-party reimbursement to support patient education relegates teaching

and learning to less than high priority status.

7. Some nurses and physicians question whether patient education is effective as a means to

improve health outcomes.

8. The type of documentation system used by healthcare agencies has an effect on the quality

and quantity of patient teaching.

Obstacles to Learning

1.Lack of time to learn.

2.The stress of acute and chronic illness, anxiety, and sensory deficits in patients.

3.Low literacy and functional health illiteracy.

4.Negative influence of the hospital environment.

5.Personal characteristic of the learner.

6.The extent of behavioral changes needed.

7. Lack of support and lack of ongoing positive reinforcement from the nurse and significant

others.

8. Denial of learning needs, resentment of authority, and lack of willingness to take

responsibility.

9. The inconvenience, complexity, inacessiblity, fragmentation and dehumanization of the

healthcare system.

7. Applying Learning Theories To Health Education Practices

a. Principles of Learning

Different principles vary and apply to different aspects of learning and teaching.

1.Use of general senses – learning is more likely to occur if clients are allowed to practice

what they are being taught.

2.Actively involve the patients or clients in the valuing process – relates to teaching method;

include lecture, videos, print materials or methods that engage the participants, as discussion,

role-playing, small group discussion, question and answer.

3.Provide an environment conducive to learning – should have good lightning and

temperature control and comfortable seating with enough space between students.

4.Assess the extent to which the learning is ready to learn – Assessment data can be obtained

directly from the client or families or it can be gathered for a variety of other sources such as

charts or reports.

5.Determine the perceived relevance of information – Willing to learn what they perceive as

being important

6.Repeat Information – Repetition enhances learning. When new information is presented, it

be presented several times, in a variety of ways.



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7.Generalize information – Using variety of examples . and applying the information to

specific situations in the client‘s life promotes learning and contributes to a better chance of

compliance

8.Make learning a pleasant experience – can be accomplished through the frequent

encouragement and positive feedback.

9.Begin with what is known, move toward what is known – It should begin with the basics or

general information that is known and move toward new information that which is unknown.

10.Present information as in appropriate rate – The rate of information is taught must be

suitable to the client, depending on the client‘s knowledge level, a faster or slower phase may

be necessary.

b. Learning Theories

1. Behaviorist Theories – is a result of a series of conditioned reflexes, and all

emotion and through a result of behavior learned through conditioning

2. Cognitive Theories – An active process in which the learner constructs memory

base on own knowledge and view of the world.

3. Social Learning Theory – A person is motivated when she sees the possibility of

valued outcomes or opposed to rewarding or punishing outcomes.

c. Types Of Learning

1.Signal Learning – or the conditioned response, the person develops a general diffuse

reaction to a stimulus.

2.Stimulus-Response Learning – Involves developing a voluntary response to a

specific stimulus or combination of stimuli.

3.Chaining – is the acquisition of the series of related conditioned responses or S-R

connections.

4.Verbal Association – A type of chaining that easily recognized in the process of

learning medical terminology.

5.Discrimination Learning – To learn and retain large numbers of chains, the person

has to be able to discriminate among them.

6.Concept Learning – Learning how to classify stimuli into groups represented by a

common concept.

7.Rule Learning – chain of concepts or a relation of between concepts.

8.Problem Solving – Must be able to recall and apply previously learned rules that

relate to the situation.

d. Learning Styles

As the habitual manner in which the learner receive and perceive information, process it,

understand it, value it, store it, and recall it.

A. Learning Style Models – People who have a habitual verbal approach to learning

represent, in their brains, information they read, see or hear in terms of words or

verbal association.

B.Cognitive Styles Model – The perception and ordering of knowledge affects how

the person learns.

C.Field Independence Style – In which items are perceived relatively independently

of their surrounding field.

D.Matching Learning Styles – To instruction- the effectiveness of matching teaching

style to learning styles; and student shown more satisfaction when the teacher matches

the student‘s learning style.



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8. Planning and Conducting Classes

a. Developing a course outline/syllabus

The course outline should include the name of the course, name of instructor, a one-

paragraph course description and a list of course objectives, topical outline, teaching method

used, the textbook or other readings and methods of evaluation. It helps the learner to gauge

first ‗what is to be learned‘ and ‗what is expected of them.‘

b. Formulating Objectives

To write objectives that have meaning not just for you but also for the learners. It

should reflect what the learner is supposed to do with what is taught.

c. Selecting Content

The best way to determine how long it will take you to teach the content is to plan it

out and then rehearse it orally, (preferably in front of a mirror). Build in time for questions

and any active learning techniques you plan to use.

d. Selecting Teaching Methods

Factors affecting choice of method:

-Selection of method depend on the objectives and type of learning you are trying to

achieve.

-Course content also dictates methodology to some extent. A class on isolation

technique may be taught by demonstration, computer simulation or hands-on practice.

-Choice of teaching strategy also depends on the abilities and interest of the teacher.

-Compatibility between teacher and teaching methods is important, but so

compatibility between learners and teaching methods.

-Factors that influences the selection of teaching methods is the number of people in

the class

e. Choosing a textbook/references

Considerations should guide you when choosing a textbook, suggest evaluating the

content scope and quality, credibility of authorship, format, and issues like cost, permanency,

gravity of point.

f. Conducting the classes

Begin by introducing yourself, Tell a class little about yourself. First session is the

best time to communicate your expectations for the course. Review the course syllabus or

outline and have time to answer portions about content, methods and assignment. A positive

way to end the introductory portion of the course is to try to stimulate the learner‘s appetites

for what is to come.

C. CHARACTERISTICS OF THE LEARNER

1. Determinants of Learning

a. Learner‘s Characteristics

-Includes among other culture/ethinicity, literacy, age, health status, educational level, and

socio economic status.

1.Culture

Defined as invisible patterns that form the normal ways of acting, feeling,

judging, perceiving and organizing the world.

2.Literacy

The client ability to read and understand what is being read is and essential

component of learning. Establishing the reading level and using materials that are

consistent with the client‘s ability.

3.Age



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Older adults tend to learn best when the information is relevant to them and

has a practical application. Teaching the older adult student present some challenges,

although none are irresponsible.

4.Education Level and Status

It has been well documented that education level is significantly associated

with health status (more educated, more healthier). The more educated the client is the

one who seeks treatment earlier in the disease process and the less educated is sicker.

5.Socioeconomic Level

The impact of socio-economic level on learning has more to do with being

able to use the information being taught rather than the process of learning.

b. Assessment of the Learner

•To assess the learners to determine their background and how much they already

know about the content of the course. Assessment can be done formally by giving

pretests or short questionnaire or more informal by asking questions during class.

c. Assessing Learning Needs

•Assessment aims to provide information about what client wants to know and want

to learn. Their beliefs, family dynamics, housing situation, skills, educational levels,

fear or concerns about their condition.

2. Motivation and Behavior of The Learner

a. Learning Principles

1.Use of general senses – learning is more likely to occur if clients are allowed to practice

what they are being taught.

2.Actively involve the patients or clients in the valuing process – relates to teaching method;

include lecture, videos, print materials or methods that engage the participants, as discussion,

role-playing, small group discussion, question and answer.

3.Provide an environment conducive to learning – should have good lightning and

temperature control and comfortable seating with enough space between students.

4.Assess the extent to which the learning is ready to learn – Assessment data can be obtained

directly from the client or families or it can be gathered for a variety of other sources such as

charts or reports.

5.Determine the perceived relevance of information – Willing to learn what they perceive as

being important

6.Repeat Information – Repetition enhances learning. When new information is presented, it

be presented several times, in a variety of ways.

7.Generalize information – Using variety of examples . and applying the information to

specific situations in the client‘s life promotes learning and contributes to a better chance of

compliance

8.Make learning a pleasant experience – can be accomplished through the frequent

encouragement and positive feedback.

9.Begin with what is known, move toward what is known – It should begin with the basics or

general information that is known and move toward new information that which is unknown.



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10.Present information as in appropriate rate – The rate of information is taught must be

suitable to the client, depending on the client‘s knowledge level, a faster or slower phase may

be necessary.

3. Literacy and Readability

a. Reading Levels of Clients

• Many factors that contribute to reading difficulty of PEMS (Printed Educational

Materials), factors are readability formulas, long sentence and fully syllabus words.

b. Assessing Literacy

•People with low literacy often inadvertently give us clues that lead to realization that

may have reading comprehension problem.

–Not even attempting to read printed materials

–Asking to take PEMs at home to discuss with a significant other

–Claiming eyeglasses were left at home

–Stating that they can‘t read anything, because they‘re too tired or don‘t feel well

–Avoiding discussion of written material or asking no questions about it.

–Mouthing words as they try to read.

c. Teaching Strategies for Low Literate Clients

1. Important to set osbjectives that are realistic for the people‘s level of

understanding.

2. Choose the information that will meet the objectives

3. Overload must be avoided when teaching people with low literacy

4. Keep instructions simple by breaking them down into smaller units.

5. Evaluation should take place so you know how the person has learned.

6. Be creative in the way you evaluate learning.

d. Developing Educational Printed Materials

Whether you are developing a brochure, a pamphlet, or an instruction sheet, the guidelines

for maintaining a low readability level and attractiveness for the low literate person are the

same.

Organizational Factors

1.Include a short but descriptive title

2.Use brief headings and subheadings

3.Incorporate only one idea per paragraph, and be sure the first sentence is the topic

sentence

4. Divide complex instructions into small steps

5. Consider using a question/answer format

6. Address no more than three or four main points

7. Reinforce main points with summary at the end

Linguistic Factors

1.Keep the reading level at grade 5 or 6 to make the material understandable to most low

literate persons

2.Use mostly one or two syllable words or short sentences

3.Use a personal and conversational style. For example, ―You should weigh yourself

everyday‖, is preferable to ―The person with congestive heart failure should measure

body weight everyday.‖

4.Define technical terms if they must be used.

5. Use words consistently throughout the text. For example, stay with the word pill rather

than switching between pill and medicine.

6. Avoid the use of idioms that might mean different things to different people. For

example, the term junk food may not be clear to all people.



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7.Use graphics and language that are culturally and age relevant for the intended audience

8.Use active rather than passive voice; for example, ―Take one pill every morning‖ rather

than ―A pill should be taken every morning.‖

9.Incorporate examples and simple analogies to illustrate concepts

Appearance Factors

1.Avoid a cluttered appearance by including enough white space.

2.Include simple diagrams or graphics that are well labeled

3.Use upper- and lowercase letters. All capitals are difficult for everyone to read.

4.Use 10-14 point type in a plain font (serif is preferred).

5.Place emphasized words in bold or underline them, but do not use capitals because they

are difficult to read.

6.Use lists when appropriate

7.Try to limit line length to no more than 50 of 60 characters.

D. TEACHING STRATEGIES AND METHODOLOGIES FOR TEACHING AND

LEARNING

1. Traditional Teaching Strategies

a. Lecturing

means of conveying facts, information and ideas that could not readily be obtained

elsewhere. A great deal of information can be communicated in an one hour lecture.

b. Discussion

a.Formal Discussion – the topic is answered in advance and the class is asked to

prepare to take part in the discussion by reading certain materials or watching a

videotape.

b.Informal Discussion – May take place spontaneously at any point during the class

including at the end of a lecture when the teacher asks ―are there any questions?‖

c. Questioning

To assess learner‘s comprehension but don‘t give much thought to using questioning

as a teaching strategy. A teacher asks some questions that are designed to wake the

students aware of their ignorance.

d.Using audiovisuals

Audiovisuals simply become time filled and entertaining, serving no real purpose. A

range of traditional audiovisuals can be used effectively, from picture and charts to

overhead transparencies, slides and videotapes.

e. Interactive Lecture

The technique of lecture, discussion, questioning and audiovisuals can be effectively

blended together into an interaction, illustrated lecture, utilizing the advantages of all the

methods and reducing their disadvantages.

2. Activity Based Strategies a.Cooperative Learning

Is based on the premise that learners work together and are responsible for not only

their own learning but also for the learning of other group members.

b. Simulation

They are exercises that learners engage in to learning about the real world without the

risks of the real world.

FOUR TYPES OF SIMULATION

–Simulation Exercise – A controlled representation of a piece of reality that

learners can manipulate to better understand the corresponding real situation.



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–Simulation Game – A game that represents real-life situations in which learners

compete according to a set of rules in order to win or achieve an objective.

–Role-playing – A form of drama in which learners spontaneously act out roles in

an interaction involving problems or challenges in human relations.

–Case study – An analysis of an incident or situation in which characters and

relationships are described, factual or hypothetical events transpire, and problems

need to be resolved or solved.

c. 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.

d.Self-learning Modules

also called self-directed learning modules, self-paced learning modules, self-

learning packets, and individualized learning activity packages.

–Component of Self-learning Modules:

a.Introduction and instructions

b.Behavioral Objectives

c. Pretest

d. Learning Activities

e. Self-Evaluation

f. Post-test

3. Computer Teaching Strategies a. Computer-assisted instruction

there can be very effective in the hands of a nurse educator, to be effective, it requires

that the program be aimed toward instructional objectives and be on high quality, that

learners have sufficient access to computer that there is sufficient technological support

and the computer is judged to be the best way to teach the given content.

b.Internet

a massive complex of computer connections across continents, connecting million of

computers. With internet node or a modem, potentially anyone can connect to the internet.

c.Virtual reality

a computer-based simulated three dimensional environment in which the participant

interacts with a virtual world. Advantages of virtual reality simulation over paper and pencil

or other computers are many. The ability to practice invasive procedure in a life-like scenario

is an extraordinary advantage over previous stimulation format.

4. Distance Learning

a.Interactive TV classes

learning site to be visible and heard and to allow maximum interaction between

teacher and students; and between students and students. Each remote site is similarly

equipped, so transmission can occur from any site.

b.Via Internet

Classes delivered via the internet an online or web-based classes. Such courses are

expanding exponentially as academia, business and health care organization are all getting

into the business of distance learning and believe that online courses can be cost effective.

5. Teaching Psychomotor Skills

a. Approaches to Teaching Skills

Teaching psychomotor skills in a college or hospital laboratory can be done in variety

of ways. Factors include the type of program, the number of educators available, nature of the



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student body or number of practicing nurses to be taught, availability of technology and

philosophy of the program.

b. Assessment of Psychomotor Skills Learning

Skill performance checklist are common means of organizing skill learning and

assessment. Every nurse is familiar with skills checklist because they have been using it.

Checklist contain a rating scale with description such as Adequate, Good and Excellent or

Poor, Fair and Good or it may be numbered of scale that is added to give a total score.

6. Clinical Teaching a. Purpose of Clinical Laboratory

A.It is in the clinical laboratory that many skills are perfected, complex psychomotor

skills may be practiced initially in a skills laboratory, but to be mastered. They often require a

live rather than simulated situation.

B.In the clinical laboratory, the opportunity for observation is an essential element of

clinical learning. The skill of observation can be taught in simulated situations.

C.Problem-Solving and decision making skills are also referred at the CL. Students

should learn the basis of these skills prior to entering the clinical setting.

D.Learners also gain organization and time management skills in clinical settings, It is

a real clinical practice with the help of the instructor, that learners find how to organize all the

data that bombards them. All the intellectual and psychomotor tasks the must perform.

E.Cultural Competence – is a skill that can be learned well in the CL. Learners may

know a lot of things about how to approach clients from different countries, but they become

comfortable and more expert with cross-cultural care when they care for culturally diverse

clients.

F.Learners of nursing becomes socialized in the CL. They learn which behavior and

values are professionally acceptable and learn about professional responsibility.

b. Models Of Clinical Teaching

Some models of clinical education have been used with some success. A model that

relies on keeping nursing students in a skill laboratory until they are proficient with skills.

They are sent to the clinical area and are assigned to practice psychomotor and other skills.

c. Preparation: Clinical Instruction

•Arrangements have been made for clinical units, the educator should set up a

meeting with the agency staff that will be involved with the education process. That may

include a staff development educator, unit manager, or head nurse. At that meeting, the

expectations of both parties can be discussed and actual implementation of the learning

experience can be worked out. This is the appropriate time to share clinical learning

objectives with the manager or the head nurse. If the staff are familiar with the learning

objectives, they can assist learners in meeting them.

•After these arrangements have been made, the educator can proceed with the final

preparation for clinical. This last step involves making specific assignments for learners on a

weekly or daily basis. (if the learners are not working with preceptors).

•Staff input can be invaluable in planning assignments. Staff members usually know

the patients and families better than the educator does. If the staff are aware of the learning

objectives, they can direct the instructor to suitable assignments.

•Educators and learners together may choose assignments. In some cases, especially

with students who are nearing completion of their educational program, students may choose

their own assignments.

d. Conducting A Clinical Laboratory Session



16

•Preconferences

During the preconference, planning of patient care continues. Learners usually share

some of the results of their research from the previous day. Tentative nursing diagnoses are

discussed, and the assigned learner can discuss possible nursing interventions with the other

learners and the instructor.

•The Practice Session

Combinations of strategies like demonstration with explanations, asking and

answering questions, and coaching techniques can be used. Questioning can be used to assist

learners in developing problem-solving and decision making skills. Coaching strategies can

be used to help learners set goals for themselves, to guide learners through psychomotor

skills, and to help them refine their thinking processes.

•Observation assignments

Learners may be assigned to observe nurses or other professionals performing various

aspects of health care that learners usually cannot perform. Learners might be placed, for

instance, in an endoscopy room or cardiac catheterization lab for few hours of observation.

Given some guidelines to channel their observations, they usually find this a valuable

experience. If they can be paired off with nurses whom they can both observe and question,

the learning experience may be even better.

•Nursing Rounds

The purpose of nursing rounds is to expose learners to additional nursing situations

and to encourage them to consult each other in planning and evaluating care. Nursing rounds

provide many opportunities to apply classroom theory to patient situations and to compare

and contrast patient care.

•Shift Report

Identify shift report as a unique time for learning. Whether the shift report is live or

taped, it is a way for students to learn the uniqueness of nursing communication and is a

means of professional socialization.

•Learning Contracts

Defined as written agreement between instructor (or supervisor) and learner spelling

out the learner‘s outcome objectives. The learning objectives, the learning resources needed

to achieve them, the learning experiences planned, a timeline, and an evaluation plan are

included.

•Written Assignments

The individualized nursing care plan is a standard teaching device. Care plans help

learners think like a nurse, in that they use problem-solving techniques to address patient

problems, and they use their knowledge of the interdisciplinary health care team as a

resource.

•Postconferences

Postconference time is ideal opportunity for pointing out applications of theory to

practice, for analyzing the outcome of hypothesis testing, for group problem solving and for

evaluating nursing care.

E. ASSESSMENT AND EVALUATION a.Learning Assessment of Clients

Patient Assessment Skills

- Standard I. Assessment

In an assessment the nurse must use all of his or her senses. These include hearing,

touching, visual, and therapeutic communication. The cephalocaudal approach is most always

used. In other words, assessing a patient from head to toe. The nurse must self aware to be



17

able to conduct a thorough assessment. Data collection forms the basis for the next step in

standards of care which is diagnosis.

- Standard II. Diagnosis

A nursing diagnosis is a formal statement that relates to how a client reacts to a real or

perceived illness. In making a diagnosis the nurse attempts to formulate steps to assist the

client in alleviating and or mediating how they respond to real or perceived illness.

-Standard III. Outcome Identification

In this process the nurses uses the assessment and diagnosis to set goals for the patient

to achieve to attain a greater level of wellness. Such goals may simply be that the patient now

comprehends the regime of testing their blood sugar, or perhaps a new mother gleans a sense

of security now that she has been instructed in the correct method of breast feeding.

•Standard IV. Planning

The planning standard is designed around the clients activities while in the hospital

environment. Therefore the nurse must plan to teach and demonstrate tasks when the patient

is free to learn.

•Standard V. Implementation

This standard requires that the nurse put to the test the methods and steps designed to

help the client achieve their goals. In implementation, the nurse performs the actions

necessary for the client‘s plan. If teaching is one of the goals then the nurse would document

the time, place, method and information taught.

•Standard VI. Evaluation

- Evaluation is the final standard. In this step the nurse makes the determination whether or

not the goals originally set for the client have been met. If the nurse concludes that the

goal or goals have not been met, then the plan has to be revised and documented as such

b.Methods of Evaluation

Evaluation of Health Education Programs:

There should be continuous evaluation.

• Evaluation should not be left to the end but should be done from time to time for

purpose of making modifications to achieve better results.

1. Questionnaires

Questionnaires are simple and effective tools for collecting information from a large

number of people. Compared with other ways of collecting information, questionnaires are

relatively inexpensive to administer. They can be used to gather information about the

community-building process itself (process evaluation) or the results it produced (outcome

evaluation).

2. Focus Groups

Group interviews are another way to collect information from many people. Most

people are familiar with focus groups. A focus group is a small-group gathering conducted

specifically to collect information from the group members. During a focus group discussion,

between 6 and 12 people, who are similar in one or more ways, are guided through a

facilitated discussion on a clearly defined topic (Krueger and Casey, 2000).

3. Interviewing

Interviews should be structured, yet conversational. Begin by making the key

informant comfortable. Maintain a neutral attitude throughout the interview. Don‘t try to

defend your community-building project or argue with the key informant‘s assessment of a

situation. Be prepared to probe or use follow-up questions to gather additional information

that might clarify why the key informant sees the situation as he or she does. Be sure to take

detailed notes—they are essential to accurate analysis.



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4. Observation

The aim of observation is to document behavior through watching and listening.

Through observation it is possible to see what people are doing, when they do it, where they

do it, and how they are doing it. You can use observation to gather information about the

community-building process itself (i.e., process evaluation) or the results it produced (i.e.,

outcome evaluation).

c. Qualities of Good Measurement

A test's usefulness, according to Bachman and Palmer (2000), can be determined by

considering the following measurements qualities of the test: reliability, construct validity,

authenticity, interactivity, impact, and practicality. These qualities can easily describe a good

language test's usefulness.

1. Test Reliability:

The term reliability refers to consistency of measurement. Elaborately, they go on to say that

a reliable test score is consistent across different characteristics of the testing situation.

Moreover, if test scores are inconsistent, they provide no information about the ability being

measured.

2. Construct Validity:

The test's reliability and validity are strongly correlated. Any valid test is considered a

reliable test; however, not all reliable tests can be can be considered valid (Alderson, 2000).

Recently, according to Alderson (2000), ―the term construct validity is used to refer to the

general, overarching notion of validity‖. Therefore, the main focus of discussing the test's

validity is construct validity, in addition to some issues regarding this test's content validity.

According to Bachman and Palmer (2000), the term construct validity refers to the extent to

which people can interpret a given test score as an indicator of the abilities or constructs that

people want to measure. However, no test is entirely valid because validation is an ongoing

process (Weir, 2005).

3. Authenticity:

Bachman (1991) defines authenticity as the appropriateness of a language user‘s response to

language as communication. However, this definition was too general. Therefore, Bachman

and Palmer (2000) divided this idea into two parts. The first relates to the target language's

use, which they refer to as authenticity; and they define the second according to its relation to

the learners involved in the test. Below is a detailed explanation of authenticity and its

implications for the current test. Authenticity relates a test's task to the domain of

generalization to which we want our scores' interpretations to be generalized. It potentially

affects test takers' perceptions of the test and their performance (Bachman, 2000).

4. Interactiveness:

Interactiveness, according to Bachman and Palmer (2000), is ―the extent and type of

involvement of the test taker‘s individual characteristics in accomplishing a test task‖ (p. 25).

Does the test motivate students? Is the language used in the test's questions and instructions



19

appropriate for the students' level? Do the test's items represent the language used in the

classroom, as well as the target language? All these questions represent the crucial elements

that affect a test's interactiveness. Many recent views consider this notion the core of

language teaching and learning.

5. Impact:

According to Bachman and Palmer (2000), impact can be defined broadly in terms of the

various ways a test's use affects society, an educational system, and the individuals within

them. In general terms, a test operates at the macro level of a societal educational system

while corresponding to individuals, i.e., test takers, at the micro level. According to the test's

developer , society, educational systems, and individuals correlate strongly to this test.

6. Practicality:

―Practicality is the relationship between the resources that will be required in design,

development, and use of the test and the resources that will be available for these activities‖

(Bachman and Palmer,2000). They illustrated that this quality is unlike the others because it

focuses on how the test is conducted. Moreover, they classified the addressed resources into

three types: human resources, material resources, and time.

Based on this definition, practicality can be measured by the availability of the resources

required to develop and conduct the test. Therefore, our judgment of the language test is

whether it is practical or impractical.

d. Interaction Process Analysis/ Process Recording

Why should a student do a process recording?

Process recordings allow students to:

enhance their ability to attend to a conversation with a client and remember it without

relying on recording devices

converge listening skills and self-awareness

review the conversation in detail and therefore possibly identify patterns

to write clearly and coherently about the complex thoughts, actions and feelings that

comprise their human services practice

reflect on their work, integrating theoretical concepts, skills and values that are being

taught in the curriculum

Example:

PROCESS RECORDING ACTIVITY

Observation of Setting Analysis and Recommendations

(Identify what facilitated the exchange, what were barriers,

and positive and negative aspects of the exchange)

The student had introduced herself and stated

the purpose of the interview to the patient the

evening prior to this process recording.

Facilitators:

Introduced self the night before and stated purpose

Curtains drawn between beds

Client relaxed and verbalized excitement about

talking with student



20

This communication exchange took place at

about 9 o‘clock in the morning. The patient,

Mrs. M., was in a semi-private room in bed

number one which is the bed closest to the door.

As a consequence, the room was quite noisy

during the exchange since there were other

health care workers coming in and out of the

room to attend to the other patient. The curtain

was drawn between the beds to minimize the

noise. Mrs. M., however, requested that the

door be left open in case someone wanted to

come in and visit. Mrs. M. appeared rather

relaxed and verbalized that she was excited to

be able to talk with a nursing student. The

television was on when the student entered the

room but was turned off, with permission,

before the process recording began. The room

itself was rather cluttered and cramped making

it difficult for the student to maneuver in the

room. Mrs. M. also had balloons, flowers, and

cards that added to the overall atmosphere of the

room. Those items made the hospital room look

warmer and more comfortable.

Turned TV off

Room had personal touches

Barriers:

Semi-private room with roommate present

Room entered by care providers for bed 2

Noisy and cramped space

Door open—Mrs. M. looking for visitors could

prevent her full participation in interaction

Interviewer:

(Student)

Interviewee: (Mrs.

M.)

Identify Communication

Technique

Analysis of Interaction

(was technique effective, why

or why not? Was there

anything else that could have

been explored?)

―Good morning Mrs.

M. We‘re going to go

ahead and start the

short interview that we

talked about

yesterday, if that‘s

―Sure, come on in.

You can just go ahead

and do anything you

want, honey.‖

(smiling)

Providing Information Telling Mrs. M. what she was

doing would put her at ease and

make her feel safe and secure.



21

okay with you.‖

(using direct eye

contact and a friendly

tone of voice)

Student pulls up a

chair and sits near the

head of the bed at

patient‘s eye level)

―Well, let‘s go ahead

and get started. (using

direct eye contact).

―Why don‘t you tell

me how you feel about

going home today?‖

―Um-huh. (nodding

head, using good

posture)

Student continues to

nod intermittently as

well as saying ―um-

huh‖ or ―yes‖

―Well (Mrs. M. sighs)

I have mixed feelings

you see because I

really would like to

get home so I can

work on my

geneology records

I‘ve been doing. But

(pauses) I don‘t want

to go home until I‘m

completely better.

You see, I was in here

before and I got this

disease from the lady I

was sharing the room

with. I just know I

got it from sitting in

the same armchair as

her. Then, (sighs and

frowns), when I got

home I was sick. I

started coughing and

vomiting. I ended up

right back here again

(puts emphasis on

again).

Student positioned herself

for active listening

(SOLER)

Asking relevant questions

Continued use of active

listening

Enhances trust

Facilitates

communication

Conveys interest and

involvement

Eye contact conveys

sincerity, interest, and

professionalism

To seek information

To allow client to take

the lead in the

conversation and give

pertinent information

Using positive non-

verbal messages lets

client know student is

interested

Use of paraphrasing or

clarifying may have

been helpful here

―So, you really aren‘t

sure you want to go

home yet.‖

―I (um) Oh, I don‘t

know. (puzzled tone

of voice and puzzled

look on face) You see

my daughter, she lives

in Springfield, and

takes care of my

Reflecting and Focusing

Trying to keep

conversation focused

May have needed to

use a close-ended

question here to zero in

on only one area.



22

―Has your daughter

been in to visit you

since you‘ve been in

the hospital?‖

―I see you‘ve gotten

balloons and flowers

all over there. But no

one has been in to

visit?‖

husband who has

Alzheimer‘s Disease.

She thinks that I ought

to stay in here for a

while longer to be

sure I am better before

I go home. She takes

care of my husband in

a home, you know, so

she knows a lot about

hospitals and stuff like

that.

―Mary?‖ (Mrs. M.

pauses) No. But I

have one son and

three daughters you

know. They‘re spread

out all across the

United States. My

son just got out of the

hospital with some

prostate problems so

he couldn‘t be here.

He‘s a lawyer too so

he‘s very busy. And

then there are the

twins (chuckling).

Well, they aren‘t

really twins. They are

9 years apart but they

look just alike.‖

―My son called me

this morning. He is

doing pretty good. He

just got discharged

yesterday. But my

neighbor came to see

me yesterday.‖

Probing

(Interpreting Information

and attempting refocusing

Trying to keep

conversation on track

An effective way to get

more information but

sometimes you get

more information than

you need

Focusing could have

been helpful here

Would be interesting to

know what prompted

this question. If

wanting to know why

daughter wanted her to

remain in the hospital,

a more direct question

may have worked

better.

Conversation was

becoming idle, needed

to ask something like

―How do you plan to

manage when you go

home?‖ or asking

about the neighbor

could be used to focus

the conversation.



23

was intent of the student)

Changing the subject

―Well good. It sounds

like you‘ve been

keeping pretty busy in

here, then.‖

―Well my time is up.

Thank you for

allowing me to talk

with you. (direct eye

contact) I hope all

goes well for you at

home.‖

―Oh yes. And I am so

glad. It is boring in

here, you know.‖

―Oh you‘re welcome

honey. (smiles)

Always glad to help a

student. I hope I

won‘t have to come

back here for a long

time.‖

Summarizing

Terminating interaction

Used to let Mrs. M.

know the conversation

was near the end.

Did not really

summarize key points

Brought closure but

was somewhat abrupt

EVALUATION

(What is your overall impression of this communication exchange? Was the goal of the interview achieved?

Were there any recurring themes in the exchange? What were the interviewers strengths or weaknesses? What

was the social value of this exchange?)

This process recording conveyed that the student was comfortable talking with Mrs. M. It did convey some

difficulty staying focused on the particular issue of concern. Mrs. M. shared a lot of information that was not

really relevant to what the student wanted to know. Being comfortable and proficient with the use of

paraphrasing, clarifying, and focusing may have helped the student gather the pertinent data needed with the

client getting off the subject. Active and attentive listening can give cues to what is really important to a client.

In this interaction the client‘s family was very important to her.

All in all the interaction was therapeutic, although the primary objective of finding out how she felt about going

home was never really met. Follow-up questions were needed to guide the conversation back to that focus and

get the information that was sought. The social interaction would have been beneficial to the client regardless of

whether the main objective was realized or not.

My goals for further communication growth would be:

1. Learn to use additional techniques such as paraphrasing, clarifying, and focusing redirect conversation

so I can achieve the intended information.

2. Learn to use a variety of techniques naturally without having to think about them.

"The most important practical lesson that can be given to nurses is to teach them what

to observe.“ Florence Nightingale

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