JENNIFER S.

CRUEL, RN, MN
HEALTH EDUCATION
OVERVIEW OF EDUCATION IN HEALTH
CARE
MID-1800's - started the roots of
historical evolution of teaching as an
essential role of the nurse through the
initiative and efforts of Florence
Nightingale
FLORENCE NIGHTINGALE - the mother of
modern 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 and
practiced by the public health nurses
HISTORICAL FOUNDATIONS FOR THE
EDUCATOR / TEACHING ROLE OF
NURSES
PERIOD OF EDUCATED NURSING - dates
back in 1800's when nursing was given
recognition as a discipline and health
education became a unique and independent
function of the nurse
Florence Nightingale, who has earned the
title "Mother of Modern Nursing", was the
epitome of the true nurse educator.
Founded the Florence Nightingale School
of Nursing at St. Thomas Hospital in
London in June 15, 1860
Her ideas were published in two books which are
"Notes on Nursing", and "notes on Hospitals."
In 1918, the National League of Nursing
Education (NLNE), now known as the National
League for Nursing (NLN)
In 1938, the NLNE declared " that a nurse was
fundamentally a teacher and an agent of health
regardless of the setting in which the practice
occurred".
In 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 International Council of Nurses (ICN)
has endorsed health education as an
essential requisite for the delivery of nursing
care.
today, Nurse Practice Acts (NPAs) in the
United States "universally include teaching
within the scope of nursing practice
responsibilities
In 1993, the Joint Commission on
Accreditation of Health Care Organizations
(JCAHO), delineated nursing standards or
mandates for patient education which are
based on positive outcomes of patient care.
In 1998, the Pew Health Professions
Commission released a follow-up on health
professional practice

ROLE OF THE NURSE AS EDUCATOR: (Bastable,
2003)
Provide clinically competent and coordinated care
to the public
Involve patients and their families in the decision
making process regarding health interventions
Provide clients with education and counseling on
ethical 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

EDUCATION PROCESS is a systematic,
sequential, planned course of action with teaching
and learning as its two major interdependent
functions and the teacher and learner as the key
players involved

The Education Process vis--vis The Nursing
Process
Similarities between the education process
and the nursing process
Both consist of the basic elements of assessment,
planning, implementation and evaluation
They are logical, scientifically-based frameworks for
nursing processes providing for a rational basis for
nursing practice rather than an intuitive one; and,
Both are methods for monitoring and judging the
overall quality of nursing interventions based on
objective data and scientific
Differences between the education
process and the nursing process
Nursing focuses on planning and
implementation 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

Education process: when changes knowledge,
attitudes and skills occur

TEACHING is a deliberate intervention involving the
planning and implementation of instructional activities
and experiences to meet the intended learner
outcomes based on the teaching plan

INSTRUCTION is just one aspect of teaching which
involves communicating of information about a
specific skill (cognitive, affective or psychomotor).

LEARNING a change in behavior (knowledge, skills
and attitudes) that can occur at any time or in any
place as a result of exposure to environmental stimuli.
PATIENT EDUCATION a 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.

PILLARS OF THE TEACHING-LEARNING
PROCESS:
teacher
learner
subject-matter
According to Wagner and Ash (1998), the
role of the educator is not primarily to
teach, but to promote learning and to
provide for an environment conducive to
learning --- to create the teachable
moment rather than just waiting for it to
happen.

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 assess
her performance; and,
has the desire to improve oneself and succeed
Effective Teachers (Flowers, 200) are:

committed they dont watch the clock,
they go the extra mile and work long hours
creative they stimulate intellectual
inquisitiveness, as well as, exploratory and
critical thinking
intuitive the teacher is able to identify
the students predominant style of
intelligence and based on this knowledge,
the teacher is able to build on the
students strength
The 6 Hallmarks of Effective Teaching in Nursing
(Jacobsen):
1. professional competence
2. 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 credits
to the students
is sensitive to their feelings and problems
conveys respect for the students
allows learners to freely express themselves and ask
questions
is accessible for conferences and consultations; and
conveys a sense of warmth





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.

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

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

SEVEN PRINCIPLES OF GOOD PRACTICE TEACHING IN
UNDERGRADUATE EDUCATION ( Chickering and
Gameson)

1. Encourage interaction between the teacher and the learner
2. Elicit cooperation among the students
3. Students should engage in active learning
4. Giving prompt feedback
5. Emphasizing time on task
6. communicating higher expectations
7. Respecting the diverse talents and ways of learning
APPLYING THEORIES OF LEARNING TO
HEALTH CARE PRACTICES

HUMAN DEVELOPMENT is the dynamic
process of change that occurs in the
physical, psychological, social, spiritual,
and emotional constitution and make-up of
an individual which starts from the time of
conception to death (from womb to tomb)
- it is the scientific study of the changes
that occur in people as they age or grow
older in years

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.
2. Actively Involve clients in the Learning
Process
3. Provide an Environment Conducive to
Learning
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


2. Actively Involve clients in the Learning
Process
3. Provide an Environment Conducive to
Learning
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
LEARNING THEORIES

Learning Theory is a coherent framework
and set of integrated constructs and
principles that describe, explain or predict
how people learn, how learning occurs, and
what motivates people to learn and change

The major learning theories that are widely
used in patient education and health care
practice are the:
Behaviorist
Cognitive
Social Learning

Behavioral Theories of Learnin

John B. Watson is the proponent of the
behaviorist theory which emphasizes the
importance of observable behavior in the study
of human beings.
- He defined behavior as muscle
movement and it came to be associated with
the Stimulus-Response psychology.
- He postulated that behavior results
from a series of conditioned reflexes and that
and all emotions and thoughts are product of
behavior learned through conditioning

Respondent Conditioning:
1. Classical or Pavlovian Conditioning a
process which influences the acquisition of
new responses to environmental stimuli
2. Systematic Desensitization is another
technique based on respondent conditioning
which is widely used in psychology and
even in medicine to reduce fear and anxiety
in the patient
3. Stimulus Generalization is the tendency
to apply to other similar stimuli what was
initially learned
4. Spontaneous Recovery is usually
applied in relapse prevention programs (rpp)
and explain why it is quite difficult to
completely eliminate unhealthy habits and
addictive behaviors (alcoholism, drug
abuse, smoking) which one may claim
having successfully kicked the habit or
extinguished it only to find out that it may
recover or reappear any time, even years
later
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.
Reinforcements are events that strengthen
responses
- it is one of the most
powerful tools or procedures used in
teaching and is a major condition for most
learning to take place

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


Classification of Educational Reinforcers:
1. Recognition
2. Tangible rewards
3. Learning activities
4. School responsibilities
5. Status indicators
6. Incentive feedback
7. Personal activities

Negative reinforcement is tantamount or
synonymous to PUNISHMENT

Cognitive Theories of Learning

COGNITION is more than knowledge acquisition
- it stresses that mental processes or
cognition occur between the stimulus and
response
- it deals with perception, memory,
thinking skills, and ways of processing and
structuring information

Theory of Multiple Intelligence states that
there are various types of talent or seven
forms of intelligence which may all be fully
developed in a gifted person or child

THEORY OF MULTIPLE INTELLIGENCE
(GARDNER)
Types of Intelligence:
1. linguistic
2. logical / mathematical
3. spatial / visual




4. musical / rhythmic
5. bodily kinesthetic
6. interpersonal intelligence
7. intrapersonal intelligence

Piagets four Major Periods of Cognitive ort
Intellectual Development
1. Sensorimotor stage birth to 2 years, determined
basically on actual perception of the senses and the
external or physical factors

Object of Permanence what and where it is
seen for the first time will still exist even though it
disappears
- it marks the development
of memory for the nursing object who is usually the
mother

2. Abstract thinking represents reality using symbols
that can be manipulated mentally

3. Logical thinking is more systematic; uses
scientific method

4. Assimilation and Accommodation -
characterized by hypothesis testing. Before
making conclusions, things must be tested
with logical pieces of evidence in search of
truth

METACOGNITION self-reflection wherein
ideas and imaginations are tried out to be
aware of existing realities; also known as
internal dialogue

Social learning Theories
- emphasize the importance of environmental or
situational determinants of behavior and their
continuing interaction

Reciprocal Determinism (by Albert Bandura) states
that environmental conditions shape behavior
through learning and the persons behavior, in return,
shapes the environment

Modeling or observational learning occurs
vicariously , even in infants, where the individual
learns of the consequences of a behavior by
observing another person undergoing the experience.

4 Operations Involve in Modeling:
1. Attentional process which determine
what a person can do and what he or she
can attend to
2. Retentional processes which determine
how experience is encoded or retained in
memory
3. Motor reproduction processes
determine what behavior can be performed
4. Motivational and reinforcement
processes determine the circumstances
under which learning is translated into
performance
Cognitive Variables (Walker Mischel):
1. competencies which refers to various
skills
2. encoding strategies and personal
constructs experiences that are retained
and categorized by the individual
3. subjective values what a person
considers as worth having or accomplishing
4. self-regulating systems or plans people
have different standard and rules for
regulating their behavior

PEDOGOGY is the art and science of helping children
learn
ANDRAGOGY is the art and science of helping adults
learn

Knowles Theory of Adult Learning (1990):

1. adult learning is more learner-centered than teacher-
centered
2. the learner becomes an independent self-directed
human being
3. previous experiences of the adult serves as a rich
source for learning
4. readiness to learn is more oriented to the
developmental tasks of social roles; and
5. there is a shift of learning orientation from being
subject-centered to problem-oriented

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 a series of related
conditioned responses or stimulus response connections

4. Verbal Association is a type of chaining and is easily
recognized in the process of learning medical
terminology
5. Discrimination Learning a great deal can be learned
through forming large numbers of stimulus-response or
verbal chains

6. Concept Learning is learning how to classify stimuli
into groups represent a common concept
7. Rule learning is a fairly sophisticated level of learning

Rule can be considered a chain of concepts or a
relationship between concepts

8. Problem Solving the learner must have a clear idea
of the problem or goal being sought and must be able to
recall and apply previously learned rules that relate to
the situation


Learning Styles of Different Age Group:

Prenatal Development the time from conception to birth

HEREDITY is the sum total of characteristics which are
biologically transmitted thru parents to offspring

Infancy from birth up to 18 or 24 months
- beginning of many psychological activities like
language, symbolic thought, sensorimotor coordination
and social learning

Sensorimotor Development- head turns to direction of
touch, lifts chin and head, holds head erect, reaches for
objects, sits with support, stands with help, crawls, walks
with support


Early Childhood from end of infancy to about 5-6 years, pre-school years
- develop school readiness skills like identifying letters and
following Instructions

Middle and Late Childhood from 6 to 11 years, elementary school year
- the fundamental skills of reading, writing and
arithmetic are mastered

Adolescence from 10 to 12 years and ending at 18-22 years old; pubertal
growth spurt marked by rapid gains in height and weight and changes in
body contour
- thoughts are more logical, abstract and idealistic

Puberty is marked by the development of sexual characteristics (breast
enlargement, development of pubic and facial hair, deepening of the voice),
production of sex hormones and physical capability of reproduction, onset of
menarche or
menstruation

Early Adulthood late teens or early twenties through the thirties
Establishing personal and economic independence
Career development
Selecting a mate
Intimate relationships
Starting a family

Middle Adulthood from 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; of
assisting next generation in becoming competent

Late Adulthood or senescence, from 65 to 80 years of age and lasting
until death
Time of adjustment to decreasing strength and health
Life review
Retirement
Adjustment to new social roles
Affiliations with members of ones age group

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

Course Outline is considered a contract between teacher and
learners

Syllabus is a plan of the entire course, course outline and
program of study that an educator prepares before the actual
health education course begins

B. Formulating Objectives
1. write objectives that have meaning not just for you
(instructor) but also for the learners
2. 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 have
learned what you have tried to teach
Third , objectives are essential from the learners perspective
C. Selecting Content
The general guidelines for course content are usually
prescribed by the curriculum of the school, health agency for
which the educator works
It is generally left to the instructors discretion to determine
exactly what to include on a particular topic and what can
safely be skipped over

D. Selecting Teaching Methods
Weston and Cranton (1986) believe that selection of
teaching methods is one of the most complex parts of
teaching, yet it receives the least attention in instructional
planning

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

4) Compatibility between teachers and teaching methods
is important, but so is compatibility between learners
and teaching methods
5) Another factor that influences the selection of teaching
methods is the number of people in the class
6) An educators instructional options are limited to the
resources 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 texts
so 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
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 and
how much they already know about the content of the
course
Sicola and Chesley suggested that in
choosing a textbook, the following should
be evaluated:
1. The content scope and quality
2. Credibility of authorship
3. Format (table of contents, index, organization,
length, graphics)
4. Issues like cost, permanency, quality of print and
the like

THE PLANNING SEQUENCE
1. Prepare the Teaching Plan
a) (primary care setting) health educator should get
background information about the client from the
persons record
b) Conduct Needs Assessment

Steps in Writing a Health Education Plan:
a) Assess the learning needs by answering the
following:
1. What are the characteristics and learning capabilities of the learner
or client?
2. What needs have been identified and prioritized in terms of health
promotion, risk reduction, and health problems?
3. What knowledge does he or she already have in relation to the
subject 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 of
techniques and strategies are done, the educator
must first determine what the learner needs to
accomplish by identifying the learning gaps in the
knowledge, skills, attitudes and values of the client.
c) Identification of needs is a prerequisite in
formulating behavioral objectives.
2. Formulate Goals and Behavioral Objectives

Behavioral Objectives act 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 Objectives are used to identify the intended
outcomes of
the education process

Behavioral or Learning Objectives make use of the modifier behavioral or
learning to
indicate that they are action-oriented rather than content-oriented and
learner-centered rather than teacher-centered

GOAL is the:
Final outcome or what is achieved at the end of the teaching-learning process
The desire3d outcome of learning
Long-term target

OBJECTIVE is;
A specific, single, unidimensional behavior
A statement of specific and short-term behavior
that must be achieve first before a goal is
reached
Derived from a goal and must be consistent with
it

Three Steps that link behavioral objectives
together include:
Identify the testing situation (condition)
State the learner and the learners behavior
(performance)
State the performance level (criterion)
TAXONOMY is a classification,
categorization or arrangement of things
based on their relationship with one another

Taxonomy of Educational Objectives by
Bloom (1956): Bloom Taxonomy
1. cognitive
2. Affective
3. psychomotor
these three domains are interdependent and can
be experienced simultaneously

Three Domains of Learning (Bastable):
1. Cognitive known as the thinking domain

The 6 Levels of Cognitive Behavior Include:
a. Knowledge ability to memorize, recall, define,
recognize or identify specific information like facts,
rules, principles conditions and terms
b. Comprehension ability of the learner to
understand or appreciate what is being
communicated by defining or summarizing it in hi or
her own words
c. Application learners ability to use or relate ideas,
concepts, abstractions and principles in particular
and concrete situations like figuring, writing, reading
or handling equipment

d. Analysis ability of the learner to recognize,
examine, scrutinize and structure information
by breaking it down into its constituent parts
and specifying the relationship between parts
e. Synthesis learners ability to put together or
merge parts and elements into a unified whole
by creating a unique product or output that is
written, oral, pictorial
f. Evaluation learners ability to judge, assess
or appraise the value, significance, importance
of something like an essay, design or action
using appropriate standards or criteria

2. Affective the feeling domain, it involves
increased internalization or commitment of feelings
expressed as emotions, interests, attitudes, values,
appreciations..and how these are incorporated
into ones personality or value system

The Levels of Affective Behavior:

a. Receiving ability of the learner to show awareness of
an idea or fact or consciousness of a situation or event
in the environment and motivation to selectively focus
on a data or stimulus
b. Responding learners ability to react to an
experience then voluntarily accept and enjoy this new
experience

c. Valuing learners ability to accept or regard
the worth of a theory, idea or event where there
is definite willingness and intention to behave in
a manner befitting that value
d. Organization ability of the learner to sort out,
categorize, classify and prioritize values and
integrating or adopting a new value into ones
present value system
e. Characterization learners ability to integrate
values into a total philosophy (way of life) or
world view (a paradigm, model or standard)
and showing firm commitment and consistency
in applying these values into value system

Teaching Methods most commonly used in
the Affective Domain:
a. Affective questioning increase interest and
motivation to learn about feelings, values,
beliefs and attitudes related to the lesson
b. Case study used to develop critical thinking
skills by exploring beliefs, values and attitudes
of the participants who are actively
participating rather than being neutral
observers
c. Role-playing provides opportunities to
practice new values learned, dissect the
situation and apply problem-solving to
personal problems
d. Simulation (limitation, mock) gaming
- process games (games
involving procedures) with flexible rules are
controlled by the participants and are used to
attain the affective behavioral objectives through
the learners active involvement in goal-directed
but not necessarily competitive activities instead
of content games which have more structured
roles and specific rules which are better used in
cognitive learning
e. Group discussion provides opportunities for
classifying personal, social and moral values
for increasing self-awareness, self-discovery
and self-acceptance

3. Psychomotor or the skills domain, involves motor
skills (fine or gross)

The five levels of Psychomotor Objectives:

a. Imitation the learner follows what was observed and
movements are gross, lacks refinement and time or
speed in its execution depends on the learners needs or
readiness
b. Manipulation the learner uses the written procedures or
handouts as the guide and the time and speed may vary
c. Precision logical sequence of actions is carried out and
the learners actions are more coordinated with lesser errors
d. Articulation logical sequence of actions, movements are
coordinated at a high level, errors are limited
e. Naturalization sequence of actions is automatic,
consistently high level of coordination of movements, and
errors are almost non-existent

C. Develop the Teaching Plan is the educators
compass in the voyage towards a successful
teaching-learning venture

Formats of a teaching Plan:
a. Topic
b. Purpose
c. Goal
d. 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

D. Approaches in Teaching

APPROACH- is a general plan or scheme to achieve
an objective

Components of Instruction:
1. Major goal of teaching
2. Nature of the subject matter
3. 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 be
employed

Two Traditional Approaches to Teaching:
1. Inductive Approach

Inductive Reasoning is a way of thinking from
specific observations to more general rules

2. Deductive Approach
a. Begins with general statements to specific
statements
b. Solving a problem or difficulty is done by applying
to its generalization that has already been formed

Inductive Method- trains the student to think logically

Deductive Method trains him to postpone judgment
until further verification is done


CHARACTERISTICS OF THE LEARNER
Learner Characteristic:

1. Culture / Ethnicity

CULTURE is defined as invisible patterns that form the normal ways of
acting, feeling, judging, perceiving and organizing
the world

2. Literacy the clients ability to read and understand what is being read is an
essential component of learning

3. Age as more of our population live longer, it is increasingly the aged who are
our clients

4. Education Level and Health Status
The more educated the client is, the one who seeks treatment earlier in the
disease process, and the less educated client is sicker.

5. Socioeconomic Level impact on learning has more to do with being able to
use the information being taught rather than the process of learning

THE DETERMINANTS OF LEARNING
1. Learning needs what the learner needs
to learn
2. Learning readiness when the learner is
receptive to learning
3. Learning style how the learner best
learns
Learning Needs are gaps in knowledge that
exist between a desired level of
performance and the actual level of
performance
Steps in the assessment of the Learning
Needs

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

Criteria for Prioritizing learning Needs:
1) Mandatory learning needs that must be
immediately met since thay are life
threatening or are needed for survival
2) Desirable learning needs that must be
met to promote well-being and are not life-
dependent
3) Possible nice to know learning needs
which are not directly related to daily
activities

LEARNING STYLES indicate how people
learn in uniquely different ways:

1. Some are global (holistic) thinkers and
some are analytic
2. Some learn better from auditory sources
than from visual stimuli
3. Some learn better when with the group
than independently or alone


Basic Concepts of cognitive Styles:

1. Holistic vs. Analytic Thinking
a. Holistic (global) Thinkers look at the global
or big picture immediately and are interested in
the gist of things, the essence, or the general
idea
b. They look at broad categories first before going
into details; they think deductively
c. Analytic Thinkers think logically and
objectively, looking at the detail first

2. Verbal vs. visual Representation
a. People with verbal approach represent in their
minds what they read, see or hear as in terms of
words or verbal associations
b. People with visual approach experience in their
minds what they read, see or hear as mental
pictures or images
LEARNING STYLE MODELS
Two of the most commonly used learning
style models that are frequently used in
nursing 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 unlike
the theory of tabula rasa by John Locke but that
the learner already has preconceived or
predetermined ideas
Kolbs Theory of Experiential Learning
Depicts a four-stage cycle or four modes of
learning which reflect two major dimensions of
perception or awareness of stimuli and
processing or dealing with the information
1. Concrete Experience (CE) Abilities learning
from actual experience
2. Reflective Observation (RO) Abilities learning
by observing others
3. Abstract Conceptualization (AC) Abilities
creating theories to explain what is seen
4. Active Experimentation (AE) abilities using
theories to solve problems
2. Anthony Gregorcs Cognitive Styles Model
(1982)
Gregorc has identified four sets of dualities
(situations that consist of two parts that are
complementary or opposed to each other).
The mind has the mediation abilities of
perception and ordering of knowledge which
affect how a person learns

1. Perception Ability the one receives or grasps
incoming information or stimulus in a continuum
or scale ranging from abstractness to
concreteness
2. Ordering Ability the way one arranges and
systematizes incoming stimuli in a continuum or
scale ranging from sequence to randomness

MOTIVATION AND BAHAVIOR CHANGE THEORIES

Health Belief Model explains behavior or predicts
whether behavior change will occur based on a set of
beliefs or perceptions, which include perceived
seriousness susceptibility, benefits and barriers

Social Cognitive Theory explains that behavior is the
result of an interaction among the person, the
environment, and the behavior itself

Self-Efficacy Theory has been presented as a means
by which behavior can be predicted or explained
- proposes that behavior change
occurs because of the expectations or expected result of
the new behavior and ones belief about his or her ability
to perform a specific behavior in a specific situation
4 Sources from which a Persons Degree of
Efficacy Arises:

1. Performance Accomplishment refers to
learning that occurs through personal
mastery of a particular skill or task
2. Vicarious Experience learning through
observation
3. Verbal Persuasion involves acting as the
coach and providing encouragement
4. Physiologic State

Transtheoretical Model / Stages of Change
Theory is useful when the targeted
behavior change is the discontinuation of an
unhealthy behavior

Theory of Reasoned Action proposes
that adoption of a new behavior results from
individual intention to engage in the behavior

Behavior Modification Theory is based
on the promise that behavior occurs because
of its Consequences

LITERACY AND READABILITY

Literacy is defined as " the ability of adults to read, understand, and
interpret information written at the eight grade level or above; the
relative ability of a persons to use printed and written material commonly
encountered in daily life

Health Literacy refers to how well an individual can read, interpret and
comprehend health information for maintaining a high level of wellness

Three Factors to Consider in Assessing Levels of Literacy:

1. Reading or Word Recognition the process of transforming letters
into words and being able to pronounce them correctly
2. Readability the ease with which written or printed information can be
read
3. Comprehension the degree to which individuals understand what
they have read; the ability to grasp the meaning of the message to
get the gist of it

Clues Manifested by Person/Patients with
Low Literacy :
1. Not even attempting to read printed material
2. Asking to take PEMs (printed educational
materials) to discuss with significant others
3. Claiming that the eyeglasses were left at
home
4. Stating that they cant read something
because they are too tired or dont feel well
5. Avoiding discussion of written material or
not asking any questions about it
6. Mouthing words as they try to read
Test to Measure Literacy:

1. REALM (Rapid Estimate of Adult Literacy
in Medicine)
- requires patients to pronounce
common medical and anatomical words
- it contains 66 words arranged
three columns in ascending order of number
of 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:

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 international
symbols 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 each
item first
To allow the nurse to evaluate progress and give positive reinforcement
5. Use multiple teaching methods and tools
6. Allow patients to restate information in their own
words
7. Keep motivation high
8. Build in coordination of procedures by using the
principles of:

Tailoring coordinating the patients regimens into
their daily schedules rather than forcing them to
adjust their lifestyle to regimens imposed to them

Cuing focuses on the appropriate combination of time
and situation using prompts and reminders to get a
person to perform a routine task
9. Use repetition to reinforce information