TEACHING STRATEGY IN NURSING HEALTH EDUCATION PERSPECTIVE A.

Historical development in health education Mid-1800s Nursing was acknowledged as unique discipline Teaching as an important role of nurses as caregivers: promoting the health of the well public Educating other nurses for professional practice Florence Nightingale Ultimate educator Teaching nurses, physicians and health officialsimportance of proper conditions in hospitals and homes to improve the health of people. Importance of teaching patients of the need for adequate nutrition, fresh air , exercise, and personal hygiene to improve the well being Early 1900s ---public health nurses in this country clearly understood the significance of the role of the nurse as teacher in preventing disease and in maintaining the health of society. For decades, then, patient teaching has been recognized as an independent nursing function. nurses has always educated otherspatients, families and colleagues It is from this roots that nurses have expanded their practice to include the broader concepts of health and illness In 1918, The National League of Nursing Education in the US (Now NLN National League for Nurses) observed the importance of health teaching as a function within the scope of nursing practice. 2 decades later, this organization recognized nurses as agents for the promotion of health and the prevention of illness in all settings in which they practiced By 1950,, the NLNE had identified course content in nursing school curricula to prepare nurses to assume the role as teachers of others. Recently, the NLN developed the first certified nurse educator (CNE) exam to raise the visibility and status of the academic nurse educator role as am advanced professional practice discipline with a defined practice setting American Nurses Association has for years put forth statements on the functions, standards and qualifications for nursing practice of which, patient teaching is a key element. The ICN (International Council of Nurses) has long endorsed the nurses role as educator to be an essential component of nursing care delivery.

Today, all state nurse practice acts (NPAs) include teaching within the scope of nursing practice responsibilities. Nursing career ladders often incorporate teaching effectiveness as a measure of excellence in practice. By teaching patients and families as well as health care personnel, nurses can achieve the professional goal of providing cost effective, safe, and high quality care.

As early as 1993 the Joint Commission (JC) formerly the Joint Commission on Accreditation of Health care Organizations (JCAHO) established nursing standards for patient education. These standards , known as mandates, describe the type and level of care, treatment and services that must be provided by an agency or organization to receive accreditation 1980s the role of the nurse as educator has undergone a paradigm shift, evolving from what once was a disease oriented approach to a more prevention oriented approach. Education , once done as part of discharge plans at the end of hospitalization As described by Grueninger (1995) this transition toward wellness has entailed a progression from disease oriented patient education (DOPE) to prevention oriented patient education (POPE) To ultimately become a health oriented patient education (HOPE) This new approach has changed the role of nurse from one of wise healer to expert advisor/teacher to facilitator of change. The emphasis is now on empowering patients to use their potentials, abilities and resources to the fullest (Glanville 2000) Role of the nurse as health educators 1. Serving as a clinical instructor for students in the practice setting. 2. Clinical preceptors and mentors to ensure that nursing students meet their expected learning outcomes The role of the clinical educator Is a dynamic one that requires the teacher to actively engage students to become competent and caring professionals Role training the trainer That is preparing the nursing staff through continuing education, in service programs, and staff development to maintain and improve their clinical skills and teaching abilities The key to the success of our profession is for nurses to teach each other nurses The professional teacher Licensed professional who possesses dignity and reputation with high moral values as well as technical and professional competence FRIAS 2A 1/6

Nurses as Teachers With shorter hospital stays, increase in community based care, and the growth of health care consumerism, we can expect that staff nurse will have to be skilled teachers. Health education Is a process concerned with designing, implementing, and evaluating educational programs that enable families, groups, organizations and communities to play active roles in achieving, protecting and sustaining health. Purpose Is to contribute to health and well being by promoting lifestyles, community actions and conditions that make it possible to live healthful lives Health education= is also defined as any combination of learning experience designed to facilitate voluntary adaptations of behavior conducive to health. Refers to the act of providing information and learning experience for purposes of behavior change for health betterment of the client. It is a process with intellectual , psychological and social dimensions relating to activities that increase the abilities of people Process of health education 1. Physical Health 2. Emotional health 3. Mental health 4. Social health 5. Spiritual health Key aspects 1. Planned opportunity 2. Specific setting 3. Program series or events 4. Based on what was previously learned 5. Comprehensively emphasizes how various aspects of health interrelate and how health affects the quality of life 6. Interaction between qualified educator and learner Purposes why health educators plan and conduct heath teachings Be aware of the values of health Develop skills Acquire and apply concepts and information received Develop and discuss opinions Formulate accurate and effective decision making Purposes of health education 1. Propagating health promotion and disease prevention 2. Maybe used to modify or continue health behaviors if necessary 3. Provides health information and services 4. Emphasis on good health habits and practices 5. Means for communication 6. Advocacy

Types 1. 2. 3.

of health education Information Health services A friendly environment

Purposes, Goals, and Benefits of Client and Staff Education Purpose: To increase the competence and confidence of clients for self management Goal: To increase the responsibility and independence of clients for self-care Benefits of Client Education: Increase consumer satisfaction Improve quality of life Ensure continuity of care Decrease client anxiety Effectively reduce the complications of illness and incidence of disease Promote adherence to treatment plans Maximize independence in the performance of ADL Energize and empower consumers to become actively involved in the planning of their care Discipline A branch of knowledge or instruction Profession is an occupation that properly involves a liberal, scientific or artistic education Characteristics of a profession by Upton 1. Provide a unique and essential social services 2. Require of its members an extensive period of preparation ( BSN, MAN) 3. Have a theoretical base underlying its practice 4. Have a system of internal controls that tends to regulate the behavior of its members 5. Have a culture peculiar to the profession 6. Be sanctioned by the community 7. Have an association that is representative of all and can speak on behalf of all the members of the occupation PRINCIPLES OF HEALTH EDUCATION 1. Good health practices 2. Use of preventive services like immunization, screening, antenatal and child health clinics 3. The correct use of medications and the pursuit of rehabilitation regimen 4. The recognition of early symptoms of disease and promoting early referral 5. Community support for primary health care and government control measures. 2. Issues and trends in health education In the USA , patients are being discharge quicker and earlier due to: New health care economics Advances in medical technology Nurses greater involvement 1. Client teaching in self care management 2. Discharge planning 3. Providing for continuing care FRIAS 2A 2/6

Practice in particular and the health care system in general Lifestyle related and preventable thru educational intervention Increase in chronic and incurable conditions requires the individual and families become informed participants to manage their own illnesses Advance technology Increasingly aware that client health literacy is an essential skill if health outcomes are to be improved . Client education improves Increasing number of self help groups The call for developing global health strategies with the integration of health education and action is now a clamor that can no longer be ignored. 3. Theories in health education 1. Banduras Self Efficacy Theory 2. Penders Health Promotion Theory 3. Health Belief Model 4. Greens Precede-Proceed Model B. Perspective on teaching and learning 1. Overview of education on health care Teaching function will always be an integral part of the duties of a professional nurse. This dates back to the time when Nursing was given recognition as a discipline in the 1800s and health education became a unique and independent function of the nurse.. This was regarded as the period of educated Nursing. Florence Nightingale, who has earned the title of Mother of Modern Nursing, was the epitome of the true nurse educator as she advocated the important function of teaching to promote health and recovery through a clean, pleasant and inhabitable environment 1918- The NLNE recognized the importance of health teaching as a responsibility of the nurse for the promotion of health and prevention of illness in different settings. 1950- NLNE specified the course content dealing with teaching skills, developmental and educational Psychology and Principles of teaching and learning as part of the nursing curriculum of all nursing schools THE ICN has endorsed health education as an essential requisite for the delivery of nursing care. Today, NPAs in USA universally include teaching within the scope of nursing practice responsibilities. They are expected to assist clients to maintain health, prevent disease, manage illness and render supportive care to family members through health teachings/education as a means to providing cost-effectiveness, safe and high quality care.

1993- JCAHO delineated nursing standards or mandates for patient education which ARE BASED on positive outcomes of patient care. the teachings must be patient and family oriented. 1998- The Pew Health Professionals Commission released a follow up on health professional practice and more than half of the recommendations were on the importance of patient and staff education and the role of the nurse as educator.

Concepts of teaching, learning, education process vis-a-vis nursing process, historical foundation s for the teaching role of the nurse Education Process is a systematic, sequential planned course, planned course of action with teaching and learning as its two major interdependent functions. Key players: 1. Teaching is a deliberate intervention involving the planning and implementation of instructional activities and experiences. Instruction involves communicating of information about a specific skill: cognitive, affective, psychomotor. 2. Learning a change in behavior (knowledge, skill, attitudes) - Acquisition of knowledge of all kinds such as: Abilities, Habits, Attitudes, Values, Skills Patient education a process of assisting people to learn health related behaviours (knowledge, skill, attitudes, values) Education is an interactive process of imparting knowledge through sharing, explaining, clarifying and synthesizing the substantive content of the learning process in order to arrive at a positive judgment and well developed wisdom and behavior Patient teaching is the process of influencing patient behavior and producing changes in knowledge, attitudes and skills necessary in maintaining or improving health. Purposes of patient teaching: 1. Increase clients awareness 2. Increase clients satisfaction 3. Improve quality of life 4. Ensure contuinity of care 5. Decrease patient anxiety 6. Increase self reliant behavior 7. Reduce effectively the incidence of complications of illness 8. promote adherence to health crea treatments 9. Maximize indpendence in the performance of ADL S to become actively involved in the planning of their care Health is the sense of being physically fit, mentally stable and socially comfortable. It FRIAS 2A 3/6

encompasses more than the state of being free from diseases. 3 Pillars of the Teaching-Learning Process 1. Teacher 2. Learner 3. Subject matter Contributions of teaching and learning: 1. The vital role of the teacher is motivating students to learn 2. Inspiring them to go out of their comfort zones, to stretch and develop the 98% portion of their brain which is still untapped and unused. Education Process vs. Nursing Process Assessment Nursing process: Appraise physical and psychosocial needs Education process: Ascertain learning needs, readiness to learn, and learning styles Planning Nursing process; Develop care plan based on mutual goal setting to meet individual needs Education process: Develop teaching plan based on mutually predetermined behavioral outcomes to meet individual needs Implementation Nursing process: Carry out nursing care interventions using standard procedures Education process: Perform the act of teaching using specific instructional methods and tools Evaluation Nursing process: Determine physical and psychosocial outcomes Education process: Determine behavior changes in knowledge, attitudes and skills Nurse Educator 1. The primary source of knowledge of learners in nursing 2. The primary catalyst for the learning process 3. A role model for nursing students 4. An active facilitator, who demonstrates and teaches patient care to nursing students in the classroom and clinical settings 5. A source of health care information and patient care to clients of care 6. Is diligent; keeps abreast of developments in his or her field through continuing education, reading of nursing journals and active participation in workshops and seminars Role of the Nurse as a Health Educator 1. Provide clinically competent and coordinated care to the public 2. Involve patients and their families in the decision making process regarding health interventions

3. Provide clients with education and counselling on ethical issues 4. Expand public access to effective care 5. Ensure cost effective and appropriate care for the consumer 6. Provide for prevention of illness and promotion of healthy lifestyle for all Americans Effective health education programs are envisioned to cut health care costs and prevent the premature onset of disease and disability The battle cry is to attain and maintain healthy lifestyle through health education since the leading cause s of morbidity and, mortality are lifestyle related diseases. Health Educator Is a practitioner professionally prepared in the field of health education, who demonstrate competence in both theory and practice and accepts responsibility in advancing the aims of the health education process. A health educator performs the following: 1. Collaborates with health specialists and civic groups in assessing community health needs and availability of resources and services and in developing goals for meeting health needs of clients 2. Designs and conducts evaluation and diagnostic studies to assess the quality and performance of health education programs. 3. Develops and implements health education and promotion programs such as training workshops , conferences and school or community projects 4. Develops operational plans and policies necessary to achieve heath education objectives and services Hallmarks of a Good Teaching What constitutes good teaching? 1. Following: behaviors of both nursing students and faculty generally agree contribute to effective teaching in nursing, especially clinical teaching 2. Effective teaching in more general terms Hallmarks of Effective Teaching in Nursing In 1966, Jacobson 6 major categories: Professional Competence Interpersonal Relationship Teaching Practices Personal Characteristics Evaluation Practices Availability to students 1. Professional competence A. Thorough knowledge of subject matter B. Proper demonstration of skills C. Expands knowledge through reading, research, clinical practice and continuing education FRIAS 2A 4/6

2. Interpersonal relationships with students most important A. Takes personal interest in the welfare of the student; B. Sensitive to their feelings and problems; C. Conveys respect for them; D. Alleviates their anxieties; E. Accessible for conferences; F. Fair G. Permits learners to express differing points of view H. Creates an atmosphere in which they feel free to ask questions I. Conveys a sense of warmth 3 basic therapeutic approaches for the educators can help learners maintain self esteem and minimize anxieties 1. Empathetic Listening teachers listen to learners and try to see the world through their eyes. 2. Acceptance accept learners as they are; whether or not you like them. Affirming the fact that learners are worthwhile people, even though different from yourself, enhances their self esteem and convince s them that you have faith in their desire and ability to learn. 3. Honest communication need to know something about the teachers thoughts regarding the topic and regarding the learners abilities and performance. Openness between the educator and students creates a relaxed atmosphere 3. Desirable personal characteristics A. Charisma (personal magnetism) B. Enthusiasm C. Cheerfulness D. Self-control E. Patience F. G. H. I. J. K. Flexibility A sense of humor A good speaking voice Self-confidence Willingness to admit errors Caring attitude

giving appropriate amounts of supervision, freely answering questions and acting as a resource person during clinical learning experiences One of the great stressors for teachers in nursing is trying to be available to students or patients who need instructions, at the precise time they need it. The reality is that teachers usually have many other students or patients they are working with and they cannot be in six places at once.

4. Teaching practices A. Mechanics B. Methods C. Skills in the classroom and clinical practice 5. Evaluation practices A. Clearly communicating expectations B. Providing timely feedback on student progress C. Correcting the students tactfully D. Being fair in the evaluation processes E. Giving tests that are pertinent to the subject matter and assignments 6. Availability to students Nursing students, especially those taking courses, expect the instructor to be available to them when needed. This may take the form of being there in stressful clinical situations, physically helping students to give nursing care,

Other important characteristics of a teacher include 1. Teacher clarity Deals with behaviors that teachers use to make what is to be learned as intelligible, comprehensible and learnable as possible. A clear teacher is one who: Logically organizes instruction Explains what is to be learned Uses simple terms in presenting new materials Constantly assesses whether student can understand and follow the teachers train of thought Uses examples, whenever possible Uses repetitions and summarizations Commonalities (common characteristics 1. Viewing a learner as collaborators , which lead to the teachers being respectful and supportive of the learners 2. Admitting weaknesses. They made themselves somewhat vulnerable when they admitted to students that they did not know an answer or had no experience in a certain field of knowledge 3. They recognized when their students were having difficulty and were able to figure out what to do help. To be a good teacher, you have to really have the desire to be good because it takes a lot of work to succeed in every aspect of teaching. Is also a form of parenting-caring about students , knowing when to set boundaries and knowing a students potential A good teacher is concerned with more than just what students know, he or she should also be concerned wit students beliefs, values, and relationship. In short a good teacher cares. Are committed And creative. They are committed in that they dont want the clock, often working long hours. Creative in the attempts to stimulate intellectual inquisitiveness in their students and to help students explore their world. 2. Teacher style involves interpersonal, professional and personal aspects of good teaching which includes: A blend of form or content which is a combination of certain ways of talking, FRIAS 2A 5/6

moving, relating and thinking; scholarliness, intelligence and sincerity; The teaching persona which is the ability to stimulate the students interest and enthusiasm for the subject; A pleasant speaking voice The use of a variety of teaching strategies, jokes, humor Good timing wherein the teacher knows how to adapt the speed of delivery for individual learners or the whole class and knowing when they are ready for a new material, when to stop and when to shift gears. Effective means to change the style Discuss your teaching with a knowledgeable peer or consultant Reading books on teacher style Seven Principles of Good Practice Teaching 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 of learning. Barriers to education Factors impeding the nurses ability to deliver educational services: 1. Lack of time to teach 2. Many nurses admit that they do not feel competent or confident with regard to their teaching skills 3. Personal characteristics of the nurse educator 4. Low priority 5. The lack of space and privacy in the various environmental settings 6. An absence of third-party reimbursement 7. Some nurses and physicians question whether patient education is effective as a means to improve health outcomes. 8. There seems to be a malfunction of the healthcare team 9. Both formal and informal teaching Obstacles to Learning Factors that negatively affect the ability of the learner to attend to and process information: 1. The stress of acute and chronic illness, anxiety, sensory deficits, and low literacy in patients. 2. The negative influence of the hospital environment itself, resulting in loss of control, lack of privacy, and social isolation, can interfere with a clients active role in health decision making and involvement in the teaching-learning process. 3. Lack of time to learn due to rapid patient discharge from care can discourage and frustrate the learner, impeding the ability and willingness to learn. 4. Personal characteristics of the learner have major effects on the degree to which

predetermined behavioral outcomes are achieved. A. Readiness to learn B. Motivation to learn C. Compliance D. Developmental stage characteristics E. Learning styles F. The extent of behavioral changes needed can overwhelm learners and dissuade them from attending to and accomplishing learning objectives and goals. Lack of support and ongoing positive reinforcement from the nurse and significant others serves to block the potential for learning. Psychological obstacles to accomplishing behavioral change: Denial of learning needs Resentment of authority Lack of willingness to take responsibility - The inconvenience, complexity, inaccessibility, fragmentation, and dehumanization of the healthcare system often result in frustration and abandonment of efforts by the learner to participate in and comply with the goals and objectives for learning. Principles of Learning 1. Satisfying stimulus 2. Reinforcement 3. Over learning 4. Verbal and non-verbal associations 5. Cognitive perceptual readiness and internal motivation 6. The ordering principles 7. Stimulus response associations and discrimination abilities 8. Cognitive construct 9. Multiple discrimination and generalization responses 10. Previous knowledge 11. Critical thinking skills 12. Flexibility and adaptation 13. Feedback 14. Balanced growth and development patterns Changes :

Growth which is quantitative involving increase in the size of the parts of the body Development which is qualitative involving gradual changes in character

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