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JENNIFER S. CRUEL, RN, MN

HEALTH EDUCATION

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OVERVIEW OF EDUCATION IN HEALTHCARE

MID-1800's - started the roots ofhistorical evolution of teaching as anessential role of the nurse through the

initiative and efforts of FlorenceNightingale

FLORENCE NIGHTINGALE - the mother ofmodern nursing and founder of the first

school of nursing EARLY 1900's - the importance of

education in the promotion of health and

prevention of illness was recognized andracticed b the ublic health nurses

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HISTORICAL FOUNDATIONS FOR THEEDUCATOR / TEACHING ROLE OFNURSES

PERIOD OF EDUCATED NURSING - datesback in 1800's when nursing was givenrecognition as a discipline and health

education became a unique and independentfunction of the nurse

Florence Nightingale, who has earned thetitle "Mother of Modern Nursing", was the

epitome of the true nurse educator. Founded the Florence Nightingale School

of Nursing at St. Thomas Hospital inLondon in June 15, 1860

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Her ideas were published in two books which are"Notes on Nursing", and "notes on Hospitals."

In 1918, the National League of NursingEducation (NLNE), now known as the NationalLeague for Nursing (NLN)

In 1938, the NLNE declared " that a nurse wasfundamentally a teacher and an agent of health

regardless of the setting in which the practiceoccurred".

In 1950, NLNE specified the course contentdealing with teaching skills, developmental and

educational Psychology and principles of teachingand learning as part of the nursing curriculum of allnursing schools

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The International Council of Nurses (ICN)has endorsed health education as anessential requisite for the delivery of nursingcare.

today, Nurse Practice Acts (NPAs) in theUnited States "universally include teachingwithin the scope of nursing practiceresponsibilities

In 1993, the Joint Commission onAccreditation of Health Care Organizations(JCAHO), delineated nursing standards or

mandates for patient education which arebased on positive outcomes of patient care.

In 1998, the Pew Health ProfessionsCommission released a follow-up on health

professional practice

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ROLE OF THE NURSE AS EDUCATOR: (Bastable,

2003)

Provide clinically competent and coordinated careto the public

Involve patients and their families in the decisionmaking process regarding health interventions

Provide clients with education and counseling onethical issues

Expand public access to effective care

Ensure cost-effective and appropriate care for the

consumer Provide for prevention of illness and promotion of

healthy lifestyles for all Americans

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EDUCATION PROCESSis a systematic,sequential, planned course of action with teachingand learning as its two major interdependent

functions and the teacher and learner as the keyplayers involved

The Education Process vis--vis The NursingProcess

Similarities between the education processand the nursing process Both consist of the basic elements of assessment,

planning, implementation and evaluation

They are logical, scientifically-based frameworks fornursing processes providing for a rational basis fornursing practice rather than an intuitive one; and,

Both are methods for monitoring and judging theoverall quality of nursing interventions based on

objective data and scientific

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Differences between the education

process and the nursing process

Nursing focuses on planning andimplementation of care based on assessment

and diagnosis of the patients physical and

psychosocial needs while the education

process identifies instructional content and

methods based on an assessment of the

clients learning needs, readiness to learn and

learning styles;Bases of outcomes:

Nursing process: when the physical and

psychosocial needs of the client are met ccur

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Education process: when changes knowledge,attitudes and skills occur

TEACHINGis a deliberate intervention involving theplanning and implementation of instructional activitiesand experiences to meet the intended learneroutcomes based on the teaching plan

INSTRUCTIONis just one aspect of teaching whichinvolves communicating of information about aspecific skill (cognitive, affective or psychomotor).

LEARNINGa change in behavior (knowledge, skillsand attitudes) that can occur at any time or in anyplace as a result of exposure to environmental stimuli.

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PATIENT EDUCATIONa process of

assisting people to learn health-related

behaviors

(knowledge, skills, attitudes, values) which

can be incorporated into their everyday

lives.

Instead of the teacher teaching, the

paradigm has shifted to focus on the

learner learning.

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PILLARS OF THE TEACHING-LEARNINGPROCESS:

teacher learner

subject-matter

According to Wagner and Ash (1998),therole of the educator is not primarily toteach, but to promote learning and toprovide for an environment conducive tolearning --- to create the teachablemoment rather than just waiting for it tohappen.

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Effective Teacher:

is looked up to as a role model who is worthy

of imitation and emulation;

exhibits professional competence by showing

thorough knowledge of the subject matter and

demonstration of the proper skills in teaching; shows willingness to learn new roles and

teaching methods;

possesses the ability to reflect on or assessher performance; and,

has the desire to improve oneself and succeed

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Effective Teachers (Flowers, 200) are:

committedthey dont watch the clock,they go the extra mile and work long hours

creativethey stimulate intellectual

inquisitiveness, as well as, exploratory andcritical thinking

intuitivethe teacher is able to identifythe students predominant style ofintelligence and based on this knowledge,the teacher is able to build on thestudents strength

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The 6 Hallmarks of Effective Teaching in Nursing(Jacobsen):

1.

professional competence2. possession of skillful interpersonal relationships

The teacher:

takes personal interest in the welfare of the student

is fair and just especially in giving grades and creditsto the students

is sensitive to their feelings and problems

conveys respect for the students

allows learners to freely express themselves and askquestions

is accessible for conferences and consultations; and

conveys a sense of warmth

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Three Basic Approaches by which the

Instructor can increase Self-esteem and

reduce Anxiety are through:

emphatic listening

accepting the learners

communicating honestly

Principle of in loco parentis, which gives

the teacher the right to exercise the

parental role in the absence of the real

parents.

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3. desirable personal characteristics

4. teaching practices which include:

mechanics methods

skills in the classroom and clinical practice

5. evaluation practices which include: clearly communicating expectations

providing timely feedback on student progress

correcting the students tactfully

being fair in the evaluation processes; and, giving tests that are pertinent to the subject

matter and assignments

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6. availability to students especially in the laboratory,clinical and other skills application areas which are mostlymarked by stressful and/or critical situations or scenarios

SEVEN PRINCIPLES OF GOOD PRACTICE TEACHING INUNDERGRADUATE EDUCATION ( Chickering andGameson)

1.

Encourage interaction between the teacher and the learner2. Elicit cooperation among the students

3. Students should engage in active learning

4. Giving prompt feedback

5. Emphasizing time on task

6. communicating higher expectations7. Respecting the diverse talents and ways of learning

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APPLYING THEORIES OF LEARNING TOHEALTH CARE PRACTICES

HUMAN DEVELOPMENTis the dynamicprocess of change that occurs in the

physical, psychological, social, spiritual,and emotional constitution and make-up ofan individual which starts from the time ofconception to death (from womb to tomb)

- it is the scientific study of the changesthat occur in people as they age or growolder in years

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PRINCIPLES OF LEARNING

Use Several Senses

1. It has been shown that people retain

10% of what they read, 20% of what

they hear, 30% of what they see or

watch, 50% of what they see or hear,

70% of what they say, and 90% of what

they say and do.

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2. Actively Involve clients in the Learning

Process

3. Provide an Environment Conducive toLearning

4. Assess Learning Readiness

5. Determine the Relevance of Information

6. Repeat the Information

7. Generalize Information

8. Make Learning a Pleasant Experience

9. Be Systematic

10. Be Steady

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2. Actively Involve clients in the LearningProcess

3. Provide an Environment Conducive to

Learning4. Assess Learning Readiness

5. Determine the Relevance of

Information6. Repeat the Information

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7. Generalize Information

8. Make Learning a Pleasant Experience

9. Be Systematic

10. Be Steady

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LEARNING THEORIES

Learning Theoryis a coherent framework

and set of integrated constructs and

principles that describe, explain or predict

how people learn, how learning occurs, andwhat motivates people to learn and change

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The major learning theories that are widely

used in patient education and health care

practice are the:

Behaviorist

Cognitive

Social Learning

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Behavioral Theories of Learnin

John B. Watsonis the proponent of thebehaviorist theory which emphasizes theimportance of observable behavior in the studyof human beings.

- He defined behavior as musclemovement and it came to be associated withthe Stimulus-Response psychology.

- He postulated that behavior resultsfrom a series of conditioned reflexes and thatand all emotions and thoughts are product ofbehavior learned through conditioning

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Respondent Conditioning:

1. Classical or Pavlovian Conditioninga

process which influences the acquisition of

new responses to environmental stimuli

2. Systematic Desensitizationis another

technique based on respondent conditioningwhich is widely used in psychology and

even in medicine to reduce fear and anxiety

in the patient

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3. Stimulus Generalizationis the tendencyto apply to other similar stimuli what was

initially learned4. Spontaneous Recoveryis usually

applied in relapse prevention programs (rpp)and explain why it is quite difficult tocompletely eliminate unhealthy habits andaddictive behaviors (alcoholism, drugabuse, smoking) which one may claim

having successfully kicked the habit orextinguished it only to find out that it mayrecover or reappear any time, even yearslater

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Operant Conditioning:

- Operant condition was developed by B. F.

Skinner which focuses on the behavior of the

organism and the reinforcement that follows

after the response.

Reinforcementsare events that strengthenresponses

- it is one of the most

powerful tools or procedures used inteaching and is a major condition for most

learning to take place

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Ways of Employing Positive Reinforcement:

1. Verbal Ways

2. Non-verbal Ways

3. Citing in a class or publishing on the

bulletin board exceptional works or

outputs

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Classification of Educational Reinforcers:

1. Recognition

2. Tangible rewards

3. Learning activities

4. School responsibilities5. Status indicators

6. Incentive feedback

7. Personal activities

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Negative reinforcement is tantamount orsynonymous to PUNISHMENT

Cognitive Theories of Learning

COGNITIONis more than knowledge acquisition- it stresses that mental processes or

cognition occur between the stimulus andresponse

- it deals with perception, memory,thinking skills, and ways of processing andstructuring information

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Theory of Multiple Intelligencestates that

there are various types of talent or seven

forms of intelligence which may all be fullydeveloped in a gifted person or child

THEORY OF MULTIPLE INTELLIGENCE(GARDNER)

Types of Intelligence:

1. linguistic

2. logical / mathematical

3. spatial / visual

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4. musical / rhythmic

5. bodily kinesthetic

6. interpersonal intelligence

7. intrapersonal intelligence

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Piagets four Major Periods of Cognitive ortIntellectual Development

1. Sensorimotor stagebirth to 2 years, determined

basically on actual perception of the senses and theexternal or physical factors

Object of Permanencewhat and where it is

seen for the first time will still exist even though itdisappears

- it marks the developmentof memory for the nursing object who is usually themother

2. Abstract thinkingrepresents reality using symbolsthat can be manipulated mentally

3. Logical thinkingis more systematic; uses

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4. Assimilation and Accommodation -

characterized by hypothesis testing. Before

making conclusions, things must be testedwith logical pieces of evidence in search of

truth

METACOGNITIONself-reflection wherein

ideas and imaginations are tried out to be

aware of existing realities; also known asinternal dialogue

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Social learning Theories

- emphasize the importance of environmental orsituational determinants of behavior and their

continuing interaction

Reciprocal Determinism(by Albert Bandura) statesthat environmental conditions shape behavior

through learning and the persons behavior, in return,shapes the environment

Modeling or observational learningoccursvicariously , even in infants, where the individuallearns of the consequences of a behavior byobserving another person undergoing the experience.

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4 Operations Involve in Modeling:

1. Attentional processwhich determine

what a person can do and what he or shecan attend to

2. Retentional processeswhich determine

how experience is encoded or retained inmemory

3. Motor reproduction processesdetermine what behavior can be performed

4. Motivational and reinforcementprocessesdetermine the circumstancesunder which learning is translated into

performance

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Cognitive Variables (Walker Mischel):

1. competencieswhich refers to variousskills

2. encoding strategies and personal

constructsexperiences that are retained

and categorized by the individual

3. subjective valueswhat a person

considers as worth having or accomplishing

4. self-regulating systems or planspeople

have different standard and rules for

regulating their behavior

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PEDOGOGYis the art and science of helping childrenlearn

ANDRAGOGYis the art and science of helping adults

learn

KnowlesTheory of Adult Learning (1990):

1. adult learning is more learner-centered than teacher-centered

2. the learner becomes an independent self-directedhuman being

3. previous experiences of the adult serves as a rich

source for learning4. readiness to learn is more oriented to the

developmental tasks of social roles; and

5. there is a shift of learning orientation from beingsubject-centered to problem-oriented

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TYPES OF LEARNING:

1. Signal Learningor the conditioned response (the

person develops a general diffuse reaction to a stimulus)

2. Stimulus-Response Learninginvolves developing avoluntary response to a specific stimulus or combinationof stimuli

3. Chainingis the acquisition of a series of relatedconditioned responses or stimulus response connections

4. Verbal Associationis a type of chaining and is easilyrecognized in the process of learning medicalterminology

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5. Discrimination Learninga great deal can be learnedthrough forming large numbers of stimulus-response orverbal chains

6. Concept Learningis learning how to classify stimuliinto groups represent a common concept

7. Rule learningis a fairly sophisticated level of learning

Rulecan be considered a chainof conceptsor arelationship between concepts

8. Problem Solvingthe learner must have a clear idea

of the problem or goal being sought and must be able torecall and apply previously learned rules that relate tothe situation

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Learning Styles of Different Age Group:

Prenatal Developmentthe time from conception to birth

HEREDITYis the sum total of characteristics which arebiologically transmitted thru parents to offspring

Infancyfrom birth up to 18 or 24 months- beginning of many psychological activities like

language, symbolic thought, sensorimotor coordinationand social learning

Sensorimotor Development- head turns to direction oftouch, lifts chin and head, holds head erect, reaches forobjects, sits with support, stands with help, crawls, walkswith support

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Early Childhoodfrom end of infancy to about 5-6 years, pre-school years

- develop school readiness skills like identifying letters andfollowing Instructions

Middle and Late Childhoodfrom 6 to 11 years, elementary school year

- the fundamental skills of reading, writing andarithmetic are mastered

Adolescencefrom 10 to 12 years and ending at 18-22 years old; pubertal

growth spurt marked by rapid gains in height and weight and changes inbody contour

- thoughts are more logical, abstract and idealistic

Pubertyis marked by the development of sexual characteristics (breastenlargement, development of pubic and facial hair, deepening of the voice),production of sex hormones and physical capability of reproduction, onset of

menarche ormenstruation

Early Adulthoodlate teens or early twenties through the thirties

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Establishing personal and economic independence

Career development

Selecting a mate

Intimate relationships

Starting a family

Middle Adulthoodfrom 35-45 years old up to 65 years old Menopause for women

Climacteric or andropause for men

Time of expanding personal and social involvement and responsibility; ofassisting next generation in becoming competent

Late Adulthoodor senescence, from 65 to 80 years of age and lastinguntil death Time of adjustment to decreasing strength and health

Life review

Retirement

Adjustment to new social roles

Affiliations with members of ones age group

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PLANNING AND CONDUCTING CLASSES

A. Developing a Course Outline or Syllabus

General Guidelines should include: name of the course

name of the instructor a one-paragraph course description

list of course objectives

topical outline

teaching methods textbook or other readings

methods of evaluation

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Course Outlineis considered a contract between teacher andlearners

Syllabusis a plan of the entire course, course outline andprogram of study that an educator prepares before the actualhealth education course begins

B. Formulating Objectives1. write objectives that have meaning not just for you

(instructor) but also for the learners2. should reflect what the learner is supposed to do with what is

taught

The Value of Objectives:

Why do you need objectives? First, to guide your selection and handling of course materials

Second, to help you determine whether people in the class havelearned what you have tried to teach

Third , objectives are essential from the learners perspective

C S l ti C t t

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C. Selecting Content The general guidelines for course content are usually

prescribed by the curriculum of the school, health agency forwhich the educator works

It is generally left to the instructors discretion to determineexactly what to include on a particular topic and what cansafely be skipped over

D. Selecting Teaching Methods Weston and Cranton (1986)believe that selection of

teaching methods is one of the most complex parts ofteaching, yet it receives the least attention in instructionalplanning

Factors Affecting Choice of Method:1) The selection of method depends on the objectives and

types of learning you are trying to achieve

2) Course content also dictates methodology to some extent

3) Choice of teaching strategy also depends on the abilities

and interests of the teacher

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4) Compatibility between teachers and teaching methodsis important, but so is compatibility between learnersand teaching methods

5) Another factor that influences the selection of teachingmethods is the number of people in the class

6) An educators instructional options are limited to theresources of the institution

E. Choosing a Textbook / Reference To begin the process of textbook selection, talk to publishers

representatives or call publishers fro review copies of likely textsso you can examine them in some detail in order to make the

right decision The next step is to examine some of the chapters

Next, examine the books appearance

Consider the way in which the book will be used

Cost of the book should be considered

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F. Conducting the Class

The first Class:

The first session often sets the tone for the whole course The first session is the best time to communicate your

expectations for the course

Cover general classroom rules

To end this introductory portion of the course, try the whet

the learners appetites for what is to come

Subsequent Classes:

In each following class, it is important to begin by gaining

and controlling the attention of the learners As you begin the work of the course, you will need to

assess the learners to determine their backgrounds andhow much they already know about the content of thecourse

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Sicola and Chesley suggested that inchoosing a textbook, the following shouldbe evaluated:1. The content scope and quality2. Credibility of authorship

3. Format (table of contents, index, organization,length, graphics)

4. Issues like cost, permanency, quality of print andthe like

THE PLANNING SEQUENCE

1. Prepare the Teaching Plana) (primary care setting) health educator should get

background information about the client from thepersons record

b)

Conduct Needs Assessment

St i W iti H lth Ed ti Pl

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Steps in Writing a Health Education Plan:

a) Assess the learning needs by answering thefollowing:

1. What are the characteristics and learning capabilities of the learneror client?

2. What needs have been identified and prioritized in terms of healthpromotion, risk reduction, and health problems?

3. What knowledge does he or she already have in relation to thesubject matter?

4. Is the client motivated to change unhealthy behaviors?5. What are the barriers or obstacles to learning that the health

educator has identified?

b) Before content selection and determination oftechniques and strategies are done, the educator

must first determine what the learner needs toaccomplish by identifying the learning gaps in theknowledge, skills, attitudes and values of the client.

c) Identification of needs is a prerequisite in

formulating behavioral objectives.

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2. Formulate Goals and Behavioral Objectives

Behavioral Objectivesact as the guide or compass of the educator in planning,

implementation and evaluation of teaching and learning outcomes

Definition of Terms (Bastable):

Educational or Instructional Objectivesare used to identify the intendedoutcomes of

the education process

Behavioral or Learning Objectivesmake use of the modifier behavioral orlearning to

indicate that they are action-oriented rather than content-oriented andlearner-centered rather than teacher-centered

GOALis the:

Final outcome or what is achieved at the end of the teaching-learning process

The desire3d outcome of learning

Long-term target

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OBJECTIVE is;

A specific, single, unidimensional behavior

A statement of specific and short-term behaviorthat must be achieve first before a goal isreached

Derived from a goal and must be consistent with

it

Three Steps that link behavioral objectivestogether include:

Identify the testing situation (condition) State the learner and the learners behavior

(performance)

State the performance level (criterion)

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TAXONOMYis a classification,categorization or arrangement of things

based on their relationship with one another

Taxonomy of Educational Objectives by

Bloom (1956): Bloom Taxonomy1. cognitive

2. Affective

3.

psychomotor these three domains are interdependent and can

be experienced simultaneously

Th D i f L i (B t bl )

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Three Domains of Learning (Bastable):

1. Cognitiveknown as the thinking domain

The 6 Levels of Cognitive Behavior Include:

a. Knowledgeability to memorize, recall, define,recognize or identify specific information like facts,rules, principles conditions and terms

b. Comprehensionability of the learner tounderstand or appreciate what is beingcommunicated by defining or summarizing it in hi orher own words

c. Applicationlearners ability to use or relate ideas,concepts, abstractions and principles in particularand concrete situations like figuring, writing, readingor handling equipment

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d. Analysisability of the learner to recognize,

examine, scrutinize and structure information

by breaking it down into its constituent partsand specifying the relationship between parts

e. Synthesislearners ability to put together or

merge parts and elements into a unified whole

by creating a unique product or output that iswritten, oral, pictorial

f. Evaluationlearners ability to judge, assess

or appraise the value, significance, importanceof something like an essay, design or action

using appropriate standards or criteria

ff f

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2. Affectivethe feeling domain, it involvesincreased internalization or commitment of feelingsexpressed as emotions, interests, attitudes, values,

appreciations..and how these are incorporatedinto ones personality or value system

The Levels of Affective Behavior:

a. Receivingability of the learner to show awareness ofan idea or fact or consciousness of a situation or eventin the environment and motivation to selectively focus

on a data or stimulusb. Respondinglearners ability to react to an

experience then voluntarily accept and enjoy this newexperience

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c. Valuinglearners ability to accept or regardthe worth of a theory, idea or event where thereis definite willingness and intention to behave ina manner befitting that value

d. Organizationability of the learner to sort out,categorize, classify and prioritize values andintegrating or adopting a new value into onespresent value system

e. Characterizationlearners ability to integratevalues into a total philosophy (way of life) orworld view (a paradigm, model or standard)and showing firm commitment and consistencyin applying these values into value system

T hi M th d t l d i

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Teaching Methods most commonly used inthe Affective Domain:

a. Affective questioningincrease interest andmotivation to learn about feelings, values,beliefs and attitudes related to the lesson

b. Case studyused to develop critical thinking

skills by exploring beliefs, values and attitudesof the participants who are activelyparticipating rather than being neutralobservers

c. Role-playingprovides opportunities topractice new values learned, dissect thesituation and apply problem-solving topersonal problems

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d. Simulation(limitation, mock) gaming

- process games (games

involving procedures) with flexible rules arecontrolled by the participants and are used toattain the affective behavioral objectives throughthe learners active involvement in goal-directedbut not necessarily competitive activities instead

of content games which have more structuredroles and specific rules which are better used incognitive learning

e. Group discussionprovides opportunities for

classifying personal, social and moral valuesfor increasing self-awareness, self-discoveryand self-acceptance

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3. Psychomotoror the skills domain, involves motorskills (fine or gross)

The five levels of Psychomotor Objectives:

a. Imitationthe learner follows what was observed andmovements are gross, lacks refinement and time orspeed in its execution depends on the learners needs or

readinessb. Manipulationthe learner uses the written procedures or

handouts as the guide and the time and speed may vary

c. Precisionlogical sequence of actions is carried out andthe learners actions are more coordinated with lesser errors

d. Articulationlogical sequence of actions, movements arecoordinated at a high level, errors are limited

e. Naturalizationsequence of actions is automatic,consistently high level of coordination of movements, anderrors are almost non-existent

D l th T hi Pl i th d t

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C. Develop the Teaching Planis the educatorscompassin the voyage towards a successfulteaching-learning venture

Formats of a teaching Plan:a. Topic

b. Purpose

c. Goald. Venue

e. Participants

f. Learning objectives

g. Content outline

h. Method of instruction

i. Time frame (in minutes)

j. Instructional resources

k. Methods of evaluation

A h i T hi

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D. Approaches in Teaching

APPROACH- is a general plan or scheme to achievean objective

Components of Instruction:

1. Major goal of teaching

2. Nature of the subject matter3. Teaching-learning process

4. Roles and responsibilities of the teacher

5. Expectations from students

6. Kinds of evaluation techniques

7. Suitable teaching methods and strategies to beemployed

T T diti l A h t T hi

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Two Traditional Approaches to Teaching:1. Inductive Approach

Inductive Reasoningis a way of thinking fromspecific observations to more general rules

2. Deductive Approach

a. Begins with general statements to specificstatements

b. Solving a problem or difficulty is done by applyingto its generalization that has already been formed

Inductive Method- trains the student to think logically

Deductive Methodtrains him to postpone judgmentuntil further verification is done

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CHARACTERISTICS OF THE LEARNER

Learner Characteristic:

1. Culture / Ethnicity

CULTUREis defined as invisible patterns that form the normal ways ofacting, feeling, judging, perceiving and organizingthe world

2. Literacythe clients ability to read and understand what is being read is an

essential component of learning

3. Ageas more of our population live longer, it is increasingly the aged who areour clients

4. Education Level and Health Status

The more educated the client is, the one who seeks treatment earlier in thedisease process, and the less educated client is sicker.

5. Socioeconomic Levelimpact on learning has more to do with being able touse the information being taught rather than the process of learning

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THE DETERMINANTS OF LEARNING

1. Learning needswhat the learner needs

to learn

2. Learning readinesswhen the learner is

receptive to learning

3. Learning stylehow the learner best

learns

Learning Needsare gaps in knowledge that

exist between a desired level of

performance and the actual level of

performance

S i h f h L i

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Steps in the assessment of the LearningNeeds

1. Identify the learner

2. Choose the right setting

3. Collect data on the learner

4. Include the learner as a source of information

5. Include members of the health care team

6. Determine availability of educational

resources

7. Assess demands of the organization

8. Consider time-management issues

9. Prioritize needs

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Criteria for Prioritizing learning Needs:

1) Mandatorylearning needs that must be

immediately met since thay are life

threatening or are needed for survival

2) Desirablelearning needs that must be

met to promote well-being and are not life-dependent

3) Possiblenice to know learning needs

which are not directly related to dailyactivities

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LEARNING STYLESindicate how people

learn in uniquely different ways:

1. Some are global (holistic) thinkersand

some are analytic

2. Some learn better from auditorysources

than from visual stimuli

3. Some learn betterwhen with the group

than independently or alone

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Basic Concepts of cognitive Styles:

1. Holistic vs. Analytic Thinking

a. Holistic (global) Thinkerslook at the global

or big picture immediately and are interested in

the gist of things, the essence, or the generalidea

b. They look at broad categories first before going

into details; they think deductively

c. Analytic Thinkersthink logically and

objectively, looking at the detail first

2 Verbal vs visual Representation

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2. Verbal vs. visual Representationa. People with verbal approach represent in their

minds what they read, see or hear as in terms of

words or verbal associationsb. People with visual approach experience in their

minds what they read, see or hear as mentalpictures or images

LEARNING STYLE MODELSTwo of the most commonly used learningstyle models that are frequently used innursing are:

1. David Kolbs Cycle of Learning (1984)a. Also known as Cycle of learning

b. Believes that the learner is not a blank slate unlikethe theory of tabula rasaby John Lockebut thatthe learner already has preconceived or

predetermined ideas

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A th G C iti St l M d l

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2. Anthony GregorcsCognitive Styles Model(1982)

Gregorc has identified four sets of dualities(situations that consist of two parts that arecomplementary or opposed to each other).

The mind has the mediation abilities of

perceptionand ordering of knowledgewhichaffect how a person learns

1. Perception Abilitythe one receives or graspsincoming information or stimulus in a continuumor scale ranging from abstractness toconcreteness

2. Ordering Abilitythe way one arranges and

systematizes incoming stimuli in a continuum or

MOTIVATION AND BAHAVIOR CHANGE THEORIES

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MOTIVATION AND BAHAVIOR CHANGE THEORIES

Health Belief Modelexplains behavior or predicts

whether behavior change will occur based on a set ofbeliefs or perceptions, which include perceivedseriousness susceptibility, benefits and barriers

Social Cognitive Theoryexplains that behavior is theresult of an interaction among the person, theenvironment, and the behavior itself

Self-Efficacy Theoryhas been presented as a means

by which behavior can be predicted or explained- proposes that behavior changeoccurs because of the expectations or expected result ofthe new behavior and ones belief about his or her abilityto perform a specific behavior in a specific situation

4 Sources from which a Persons Degree of

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4 Sources from which a Persons Degree of

Efficacy Arises:

1. Performance Accomplishmentrefers to

learning that occurs through personal

mastery of a particular skill or task2. Vicarious Experiencelearning through

observation

3. Verbal Persuasioninvolves acting as thecoach and providing encouragement

4. Physiologic State

Transtheoretical Model / Stages of Change

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Transtheoretical Model / Stages of ChangeTheoryis useful when the targeted

behavior change is the discontinuation of anunhealthy behavior

Theory of Reasoned Actionproposesthat adoption of a new behavior results fromindividual intention to engage in the behavior

Behavior Modification Theoryis basedon the promise that behavior occurs becauseof its Consequences

LITERACY AND READABILITY

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Literacyis defined as " the ability of adults to read, understand, andinterpret information written at the eight grade level or above; the

relative ability of a persons to use printed and written material commonlyencountered in daily life

Health Literacyrefers to how well an individual can read, interpret andcomprehend health information for maintaining a high level of wellness

Three Factors to Consider in Assessing Levels of Literacy:

1. Reading or Word Recognitionthe process of transforming lettersinto words and being able to pronounce them correctly

2. Readabilitythe ease with which written or printed information can beread

3. Comprehensionthe degree to which individuals understand whatthey have read; the ability to grasp the meaning of the messagetoget the gist of it

Clues Manifested by Person/Patients with

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Clues Manifested by Person/Patients withLow Literacy :

1. Not even attempting to read printed material2. Asking to take PEMs (printed educational

materials) to discuss with significant others

3. Claiming that the eyeglasses were left athome

4. Stating that they cant read somethingbecause they are too tired or dont feel well

5. Avoiding discussion of written material ornot asking any questions about it

6. Mouthing words as they try to read

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Test to Measure Literacy:

1. REALM(Rapid Estimate of Adult Literacyin Medicine)

- requires patients to pronounce

common medical and anatomical words- it contains 66 words arrangedthree columns in ascending order of numberof syllables and increasing difficulty

2. WRAT(Wide Range Achievement Test)- the patient is asked to read aloud

from a list of 42 words of increasing difficulty

Teaching Strategies for Low Literate Patients:

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g g

1. Establish a trusting relationship

2. Use the smallest amount of information possible

3. Make points of information as vivid and as explicit as possible by: Explaining information in simple terms

Using visual aids

Using underlining, highlighting, color-coding, arrows and internationalsymbols to give directions or emphasize important information

4. Teach one step at a time: By teaching in increments

By organizing information into chunks to allow patients to understand eachitem first

To allow the nurse to evaluate progress and give positive reinforcement

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TH NK YOU