FINALS NOTES
HEALTH EDUCATION
Implementing a health education plan
• Health education is one strategy for
implementing health promotion and disease
prevention programs. Health education
provides learning experiences on health topics.
Health education strategies are tailored to their
target population. Health education presents
information to target populations on particular
health topics, including the health
benefits/threats they face, and provides tools to
build capacity and support behavior change in
an appropriate setting.
How to conduct a health education class
Examples of health education activities include:
• Lectures
• Courses
• Seminars
• Webinars
• Workshops
• Classes
Characteristics of health education strategies include:
• Participation of the target population.
• Completion of a community needs assessment
to identify community capacity, resources,
priorities, and needs.
• Planned learning activities that increase
participants' knowledge and skills.
• Implementation of programs with integrated,
well-planned curricula and materials that take
place in a setting convenient for participants.
• Presentation of information with audiovisual
and computer-based supports such as slides
and projectors, videos, books, CDs, posters,
pictures, websites, or software programs.
• Ensuring proficiency of program staff, through
training, to maintain fidelity to the program
model.
• Examples of Health Education Interventions.
• The Oral Health Outreach Program,
implemented by the Eastern Shore Area Health
Education Center (AHEC), provides dental
education and outreach to children.
Where to conduct health education?
• The conduct of health education can be done in
the privacy of a patient's room which may
involve the patient and or his family, or in
outpatient department of hospitals and clinics,
health centers ad other health care settings. It
can also be done in the community barangay
hall involving different organized groups or
members of a health education class during the
conduct of home/ follow-up visits. Place where
people come together like an market places,
church, community centers or the town plaza
can be a good venue for discussing health-
related matters whether the health educator is
using formal or informal strategies of teaching.
• It is noteworthy that the UNESCO “Education
for all” and the United Nations Literacy Decade
have included health education activities as
strategies for goal attainment and involved
schools as academic partners and venues for
service delivery, thereby illustrating such
synergy.
• In line with this contention, serious efforts are
now directed to strengthen the school health
and nutrition programs which are actually the
springboards for more advanced health
education programs since the school health
teacher is the first contact in formal education.
Our schools have the mandate to provide
comprehensive health education so that the
students will understand the importance of
practicing healthful behavior for active,
productive and rewarding lives as individuals,
family members, and citizens leading to the
development of healthy communities and the
adoption of healthy lifestyles.
Who should do health education?
• All health workers are responsible for
promoting health and instituting preventive
aspects of care. Since the nurses belong to the
biggest professional organization in our country,
they are the primary agents for conducting
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 health education to the patient and or his
family, community health workers and
members of the community, student nurses,
staff nurses, members of organized groups,
persons of influence (PIFs), schoolchildren and
anybody who is in need of health information
and instruction.
How should health education be conducted?
1. DEMONSTRATION
- most useful method where the process of
doing a procedure is shown and the skills or techniques
are practice to return demonstration. An example is the
different positions of holding the baby while the mother
is breastfeeding.
2. Word of mouth
- is the most influential way of transmitting
information especially of oral traditions which are
usually conveyed by means of puppets or puppet
shows, dramatization or socio-drama, role-playing,
storytelling, music and songs. This can be planned and
performed by the local folks.
3. Use of audiovisual aids
- leaflets, charts, posters, flashcards, flip charts
and flannel graphs. The use of Komiks can also be a very
effective medium of instruction which can be easily
understood especially by the masses and are very
attractive and entertaining because of the colorful
illustrations and its simple language.
4. Film showing
- and the use of modular instructions is also
effective medium instruction where the learner uses his
or her senses of sight, hearing, touching, smelling and
even testing.
Characteristics of effective health education:
The following are essential characteristics of effective
health education according to Hubley, 1983:
1. It is directed at people who have influence in the
community who are also the opinion makers.
2. The lessons are repeated and reinforced over time
using different methods.
3. The lessons are adaptable and use existing channels
of communication like songs, drama and storytelling.
4. It is entertaining and attracts the community’s
attention.
5. Uses clear simple language with local expressions.
6. It emphasizes short-term benefits of action.
7. It provides opportunities for dialogue, discussion and
learner participation and feedback.
8. It uses demonstrations to show the benefits of
adapting and practices.
Steps in developing a health education/ promotion
program
The following are steps to consider in developing a
health education or health promotion program (Cottrell
et al, 2001):
1. assessing the needs of the target population;
2. developing appropriate goals and objectives;
3. creating and intervention that considers the
peculiarities of the setting;
4. implementing the intervention; and evaluating
the results.
Preparation and materials to be used
Preparing the teaching plan
Health education plan
- emphasize a phase of the behavior change
process that is related to the client’s health
needs/problems.
Planning
- is central to health education and health
promotion activities
- process of making thoughtful and systematic
decisions.
When preparing a teaching plan in a primary care
setting, the health educator should:
a. Get background information about the client
from the person’s record and any agency
reports that include description of the client’s
population group (demographic data- who,
what, where)
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 b. Conduct needs assessment of the participants,
the scope and content of the health education
class, possible actions/interventions to be
undertaken to address the needs, and the
possible approaches, strategies or
methodologies.
The six steps for planning a health promotion program:
STEP 1: MANAGE THE PLANNING PROCESS
- Plan to engage stakeholders, including clients
and staff, in a meaningful way. Establish a clear timeline
for creating a work plan. Plan how you will allocate
financial, material, and human resources. Consider the
data required to make decisions at each step and
include adequate time for data collection and
interpretation. Establish a clear decision‐making
process.
STEP 2: CONDUCT A SITUATIONAL ASSESSMENT
- This step involves identifying: what is the
situation; what is making the situation better and what
is making it worse; and what possible actions you can
take to address the situation.
STEP 3: IDENTIFY GOALS, POPULATIONS OF INTEREST,
OUTCOMES AND OUTCOME OBJECTIVES
- Ensure program goals, populations of interest
and outcome objectives are aligned with strategic
directions of your organization or group
STEP 4: IDENTIFY STRATEGIES, ACTIVITIES, OUTPUTS,
PROCESS OBJECTIVES AND RESOURCES
- Brainstorm strategies (e.g. health education,
health communication, organizational change, policy
development) for achieving objectives using one or
more health promotion frameworks. Prioritize ideas by
applying situational assessment results. Identify specific
activities for each strategy, including which existing
activities to start, stop, and continue. Select outputs and
develop process objectives.
STEP 5: DEVELOP INDICATORS
- For each outcome and process objective
consider the intended result and whether: the intended
result can be divided into separate components; the
intended result can be measured; there is appropriate
time for observing a result; required data sources are
accessible; and the resources needed to assess the
result are available
STEP 6: REVIEW THE PROGRAM PLAN
- Review the plan to determine whether:
strategies effectively contribute to goals and objectives;
short-term objectives contribute to long-term
objectives; the best activities were chosen to advance
the strategy; activities are appropriate to the audiences;
and the resources are adequate to implement the
activities.
types of health learning materials:
1. Printed- Printed can be used as a medium in
their own right or as support to other kinds of
media. Some printed health learning materials
that you will already familiar with include
posters, leaflets, and flip charts.
a. POSTER
- it consists of words and pictures or symbols
that include a message on it, it communicates
health messages both to literate and illiterate
people. It has a high value to communicate
messages to illiterate people because it can serve as
a visual aid.
b. LEAFLETS
- are the most common way of using print
media in health education. It is usually short, often
urgent and written message printed.
c. FLIP CHARTS
- are useful to present several steps or aspects
that are relevant to a central topic. A flip chart is
made up of posters on a related subject that are
shown one after then other.
2. Visual- Visual are one of the strongest methods
of communicating messages, especially where
literacy status is low. It includes something
seen, for example models, real object and
photographs.
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3. Audio- Audio includes anything heard such as
the spoken word, a health talk, sound or music.
Examples are radio and audio cassettes that are
common audio aids.
4. Audio-visual- Audio-visual combine both seeing
and listening. They convey messages with high
motivational appeals. It show real life situation.
These materials include TV, films or videos
which provides a wide range of interest and can
convey messages with high motivational appeal.
Evaluating the Teaching Program
Evaluation – a process of ascertaining or
judging the value of something though careful
appraisal.
- involves continuous process of
gathering data and recording, assembling and
interpreting information for purposes of
creating change that will promote better
performance or accomplish desired objectives.
- in nursing, it requires
assessment of the cognitive outcomes of
knowledge and understanding a delineation of
what is and what shall be.
Criteria for selection of evaluative devices
1. Sampling of the objectives – defined carefully
and clearly the behaviors implicit in the
educational objectives will be aware of all the
objectives as basis for developing good tests.
2. Sampling of the content – enough items
representative of the range of the course
content taught emphasizing what the students
“must know” rather than the “nice to know”
component of the course.
3. Validity – degree to which a test measures
anything and measure it accurately, is the
reliability of the test.
4. Reliability – determined through application
and statistical computation.
5. Practicality – development of evaluation
devices capable of being administered and
scored with reasonable ease and within the
limits of time and resources imposed by
circumstances.
6. Usefulness – test is used for various purposes.
• Essay Examinations- Refer to the subjective
type of evaluation in which students are given
questions requiring critical analysis of situations
based on concepts of principles learned.
• Objective Examinations- Students’ answers are
indicated by marking the correct response to a
particular question in a prescribed manner.
Types of Objective Examinations:
• Multiple choice questions – these could help
students get familiar with the type of test and
determine the level of knowing, recall, and
beyond recall.
• True or false questions – designed to test the
learner’s ability to identify the correctness of
the statement of facts or principles but limited
to test the lowest level of knowing, knowledge
and comprehension.
• Matching questions – used to test the lowest
level of knowing which is useful in determining
the learner recall of the memorized relationship
between two things such as terms and
definitions, dates or events.
Objective Problem-Situation Test
• Describes a situation, not previously presented
to the student with sufficient detail to point out
the problem involved.
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• Advantages Disadvantages 1. Major elements and sub-elements concerning
the rating.
Used to represent Requires great skill to 2. The relative importance of each element.
patterns of behavior prepare valid, reliable
that constitute problem-situations 3. The range of scale used.
nursing competence 4. Test blueprint

Less time Time consuming to

consuming to prepare
Formative process evaluation
answer
• Formative evaluation measures or evaluates the
Useful to determine Requires considerably processes and progress, along with the goal and
the students’ ability more space than objective, the level of students’ learning and
to apply principles objective tests. progress of the educational program.
to new or related
• It is the on-going feedback given to the learners
situations
throughout the learning process.

Easily analyze the • Help the learners identify the strengths and
type of errors made weakness in order to find solutions for
by the students in improvement.
the use of basic
• A written formative evaluation rate is also called
principles and
as anecdotal records or clinical progress notes.
concepts
Summative evaluation

• Summative evaluation is given at the end of the

Standardized Tests
• Intelligence tests – attempts to indicate the
capacity, the brightness or native intelligence of
students as compared to the norm of her age.
• Prognostic tests – intended to discover the
possibilities of a student’s success in a particular
area.
• Achievement tests – designed to indicate the
accomplishment of the student in the particular
subject areas of the curriculum.
learning experience in order to assess whether
the learner has achieved the objectives and is
ready to move on to the next experience.
• This is similar to goal-based evaluation which
compares the results of the students
performance to overall goals of the program
Determine the students level of achievement and
extent to which learning outcome has been met.

• Rating Scales -A standardized method of

recording interpretations of behavior. Students
are rated on a scale from low to high with
respect to a particular or specific unit.
EVIDENCED-BASED PRACTICES RELATED TO HEALTH
Evaluating Student Learning
EDUCATION
Criteria to determine effectiveness of student
learning:
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EVIDENCED BASED PRACTICED (EBP) or Evidence based
is “the integration of best research evidence with
clinical expertise and patient values” which when
applied by practitioners will ultimately lead to improved
patient outcome.
In the original model there are three fundamentals
component of evidenced based practice.
 best evidence which is usually found in
clinically relevant research that has been
conducted using sound methodology
 clinical expertise refers to the clinician’s
cumulated education, experience and clinical
skills
 patient values which are the unique
preferences, concerns and expectation each
patient brings to a clinical encounter.
It is the integration of these three components that
defines a clinical decision evidence-based. This
integration can be effectively achieved by carrying out
the five following steps of evidence based practice.
THE FIVE STEPS:
FORMULATE AN ANSWERABLE QUESTIONS
One of the fundamental skills required for EBP is the
asking of well-built clinical questions. By formulating an
answerable question you to focus your efforts
specifically on what matters. These questions are
usually triggered by patient encounters which generate
questions about the diagnosis, therapy, prognosis or
etiology.
FIND THE BEST AVAILBALE EVIDENCE
The second step is to find the relevant evidence. This
steps involves identifying search terms which will be
found in your carefully constructed question from step
one; selecting resources in which to perform your
search such as PubMed and Cochrane Library; and
formulating an effective search strategy using a
combination of MESH terms and limitations of the
results.
APPRAISE THE EVIDENCE
It is important to be skilled in critical appraisal so that
you can further filter out studies that may seem
interesting but are weak. Use a simple critical appraisal
method that will answer these questions: What
question did the study address? Were the methods
valid? What are the results? How do the results apply to
your practice?
IMPLEMENT THE EVIDENCE
Individual clinical decisions can then be made by
combining the best available evidence with your clinical
expertise and the patients values. These decisions
should then be implemented into your practice which
can then be justified as evidence based.
EVALUATE THE OUTCOME
The final step in the process is to evaluate the
effectiveness and efficacy of your decision in direct
relation to your patient. Was the application of the new
information effective? Should this ne information
continue to be applied to practice? How could any of
the 5 processes involved in the clinical decision making
process be improved the next time a question is asked?
* these steps may be more memorable if remembered
as:
 ASK
 ACQUIRE
 APPRAISE
 APPLY
 AUDIT
TOWARDS AN IDEAL TYPOLOGY OF EVIDENCE
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 • One type of evidence can be found without
meeting the causality criterion but where the
different elements of an intervention work as a
whole to produce the desired outcome.
• Intervention that may have limited repeatability
– for example, only at the level and within a
certain period – can be classified as another
type of evidence so long as the intervention
work.
THE FOUR CLASSIFICATION USED IN TYPOLOGY OF
EVIDENCE:
o SYSTEMATIC REVIEW
Evidence of implemented interventions that meet the
criteria for scientific fact- that is, they proved
predictable, and repeatable, regardless of time and
place.
o GUIDELINES & SUMMARIES
Evidence from interventions that produce desired
outcomes and are predictable but are repeatable only
at a local level within a certain period of time.
o RANDOMIZED CONTROLLED TRIAL
Evidence from interventions that works as predicted to
produce desired outcome, without meeting the
causality criterion, and are repeatable at any time and
anywhere. Acupuncture is an example for treating some
illness conditions such as pain relief.
o COHORT STUDY
Evidence from interventions that work as predicted,
without meeting the causality criterion, and are
repeatable only at a local level within a certain period of
time.
KNOWLEDGE BASED HEALTH PROMOTION
 Conscientious and judicious use of evidence is
only one competency element of health
promotion. It is necessary but not sufficient for
achieving effective health promotion.
 Health promotion practitioners are required to
be bale to absorb and use knowledge in many
competency areas as specified in a review
report.
 In policy formulation, while the strength of
evidence is a base for policy development, there
are also other considerations, for example, the
socio-political and fiscal climate within which
governments and organizations operate as well
as the vested interests.
 Effective health promotion often uses a
combination of behavioral, social, and
environmental strategies that work in synergy.
The relation between the outcome variables
and predictor variables are complex and not
linear.
ETHICO-MORAL and LEGAL FOUNDATIONS OF CLIENT
EDUCATION
 A differentiated view of ethics, morality and
the law
  the terms ethical, moral, and legal are often
used in synchrony. It should be made clear,
however, that although these terms are
certainly interrelated, they are not necessarily
synonymous.
 Ethics refers to the guiding principles of
behavior, and ethical refers to norms or
standards of behavior
  Moral refers to an internal value system (the
moral fabric of one’s being); this value system,
defined as morality, is expressed externally
through ethical behavior
 Legal rights and duties, in contrast, refer to
rules governing behavior or conduct that are
enforceable under threat of punishment or
penalty, such as a fine, imprisonment, or both.
 1. Natural law (basis)
 2. Deontological (Golden Rule)
 proposes that the mortality of a decision is not
determined by its consequences
 3. Teleological (greatest good for the greatest
number)
 looks to the consequences of an action in
judging whether that action is right or wrong
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Ethico-Moral and legal Foundations of client education
 The intricate relationship between ethics and
the law explains why ethics terminology, such
as informed
consent, confidentiality, nonmaleficence,
and justice, can be found within the language of
the legal system.
 In keeping with this practice, nurses may cite
professional commitment or moral obligation to
justify the education of clients as one dimension
of their role
 1. Honor the human dignity of all patients and
coworkers.
 2. Establish appropriate nurse-patient
boundaries, and focus on interdisciplinary
collaboration.
 3. The nurse-patient relationship is grounded in
privacy and confidentiality.
 4. The nurse is accountable for the personal
actions and the behaviors of those persons to
whom the nurse has delegated responsibilities.
 5. The nurse is responsible for maintaining
competence, preserving integrity and safety,
and continuing personal growth.
 6. The nurse has a responsibility to deliver
quality care to patients.
 7. The nurse contributes to the advancement of
the profession.
 8. The nurse participates in global efforts for
health promotion and disease prevention.
 9. Involvement in professional nursing
organizations supports the development of
social policy
EthicAL, legal & Economic foundations
of the educational process
Economic Factors of Patient Education: Justice and Duty
Revisited Challenge for healthcare providers:
Challenge for healthcare providers:
• Efficient & cost-effective patient education •
Legal responsibility of all nurses
• Little preparation on prelicensure level
 Financial Terminology
 Direct Costs:-those that are tangible and
predictable, such as rent, food, heating, etc.
 Fixed Costs: -those that are stable and ongoing,
such as salaries, mortgage, utilities, durable
equipment, etc.
 -Variable Costs: those related to fluctuation in
volume, program attendance, occupancy rates,
etc.
 Indirect Costs: those that may be fixed but not
necessarily directly related to a particular
activity, such as expenses of heating, lighting,
housekeeping, maintenance, etc.
 Cost Savings: -money realized through
decreased use of costly services, shortened
lengths of stay, or fewer complications resulting
from preventive services or patient education.
 Cost Benefit: -occurs when the institution
realizes an economic gain resulting from the
educational program, such as a drop in
readmission rates. Cost Recovery: occurs when
revenues generated are equal to or greater than
expenditures.
 Revenue Generation:-profit realized when fees
for an educational program exceed the
aggregate costs of program preparation and
delivery.
 Program Planning and Implementation
Relationship of Costs and Outcomes
 1. Cost-Benefit Analysis
 2. Cost-Effectiveness Analysis
 Cost-Benefit Analysis: -the relationship (ratio)
between actual program costs and actual
program benefits, as measured in monetary
terms, to determine if revenue generation was
realized.
 Cost-Effectiveness Analysis:- refers to
determining the economic value of an
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 educational offering by making a comparison
between two or more programs, based on
reliable measures of positive changes in the
behaviors of participants as well as evidence of
maintenance of these behaviors, when a real
monetary value cannot be assigned to the
achievement of program outcomes.
Evolution of Ethical and legal principles in health care
 • Charitable Immunity
 • Cardozo Decision of 1914
 -Justice Benjamin Cardozo explained that
reasoning in the court's opinion: “Every human
being of adult years and sound mind has a right
to determine what shall be done with his own
body; and a surgeon who performs an
operation without his patient's consent
commits an assault for which he is liable in
damages
Cardozo Decision
A. Informed Consent
-the right to full disclosure; the right to make one’s own
decisions
B. Right to self-determination
-the right to protect one’s own body and to determine
how it shall be treated
 Government Regulations & Professional
Standards
 1. National Commission for the Protection of
Human Subjects of Biomedical and Behavioral
Research
 -was the first public national body to shape
bioethics policy in the United States. Formed in
the aftermath of the Tuskegee Experiment
scandal. The Commission, created as a result of
the National Research Act of 1974, was charged
with identifying the basic ethical principles that
should underlie the conduct of biomedical and
behavioral research involving human subjects
and developing guidelines to assure that such
research is conducted in accordance with those
principles
 2. President’s Commission for the Study of
Ethical Problems in Medicine and Biomedical
and Behavioral Research
 -is an advisory panel of the nation's leaders in
medicine, science, ethics, religion, law and
engineering. The Bioethics Commission advises
the President on bioethical issues arising from
advances in biomedicine and related areas
of science and technology.
 3. American Nurses Association’s Code of
Ethics for Nurses with Interpretative
Statements
 -is the oath/promise that nurses are doing their
best to provide care for their patients and their
communities and are supporting each other in
the process so that all nurses can fulfill
their ethical and professional obligations.
 4. American Hospital Association’s Patient’s
Bill of Rights
 -The American Hospital Association presents A
Patient’s Bill of Rights with the expectation that
it will contribute to more effective patient care
and be supported by the hospital on behalf of
the institution, its medical staff, employees, and
patients. The American Hospital Association
encourages health care institutions to tailor this
bill of rights to their patient community by
translating and/or simplifying the language of
this bill of rights as may be necessary to ensure
that patients and their families understand their
rights and responsibilities.
 AHA Patient’s Bill of Rights
 These rights can be exercised on the patient’s
behalf by a designated surrogate or proxy
decision-maker if the patient lacks decision-
making capacity, is legally incompetent, or is a
minor.
 The patient has the right to considerate and
respectful care.
 The patient has the right to and is encouraged
to obtain from physicians and other direct
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 caregivers relevant, current, and
understandable information concerning
diagnosis, treatment, and prognosis.
 Except in emergencies when the patient lacks
decision-making capacity and the need for
treatment is urgent, the patient is entitled to
the opportunity to discuss and request
information related to the specific procedures
and/or treatments, the risks involved, the
possible length of recuperation, and the
medically reasonable alternatives and their
accompanying risks and benefits.
 Patients have the right to know the identity of
physicians, nurses, and others involved in their
care, as well as when those involved are
students, residents, or other trainees.
 The patient also has the right to know the
immediate and long-term financial implications
of treatment choices, insofar as they are known.
 The patient has the right to make decisions
about the plan of care prior to and during the
course of treatment and to refuse a
recommended treatment or plan of care to the
extent permitted by law and hospital policy and
to be informed of the medical consequences of
this action. In case of such refusal, the patient is
entitled to other appropriate care and services
that the hospital provides or transfer to another
hospital. The hospital should notify patients of
any policy that might affect patient choice
within the institution.
 representatives, or other mechanisms available
in the institution. The patient has the right to be
informed of the hospital’s charges for services
and available payment methods.
 The patient has the right to have an advance
directive (such as a living will, health care proxy,
or durable power of attorney for health care)
concerning treatment or designating a
surrogate decision-maker with the expectation
that the hospital will honor the intent of that
directive to the extent permitted by law and
hospital policy. Health care institutions must
advise patients of their rights under state law
and hospital policy to make informed medical
choices, ask if the patient has an advance
directive, and include that information in
patient records. The patient has the right to
timely information about hospital policy that
may limit its ability to implement fully a legally
valid advance directive.
 The patient has the right to every consideration
of privacy. Case discussion, consultation,
examination, and treatment should be
conducted so as to protect each patient’s
privacy.
 The patient has the right to expect that all
communications and records pertaining to
his/her care will be treated as confidential by
the hospital, except in cases such as suspected
abuse and public health hazards when reporting
is permitted or required by law. The patient has
the right to expect that the hospital will
emphasize the confidentiality of this
information when it releases it to any other
parties entitled to review information in these
records.
 The patient has the right to review the records
pertaining to his/her medical care and to have
the information explained or interpreted as
necessary, except when restricted by law.
 The patient has the right to expect that, within
its capacity and policies, a hospital will make
reasonable response to the request of a patient
for appropriate and medically indicated care
and services. The hospital must provide
evaluation, service, and/or referral as indicated
by the urgency of the case. When medically
appropriate and legally permissible, or when a
patient has so requested, a patient may be
transferred to another facility. The institution to
which the patient is to be transferred must first
have accepted the patient for transfer. The
patient must also have the benefit of complete
information and explanation concerning the
need for, risks, benefits, and alternatives to
such a transfer.
 The patient has the right to ask and be informed
of the existence of business relationships
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 among the hospital, educational institutions,
other health care providers, or payers that may
influence the patient’s treatment and care.
 The patient has the right to consent to or
decline to participate in proposed research
studies or human experimentation affecting
care and treatment or requiring direct patient
involvement and to have those studies fully
explained prior to consent. A patient who
declines to participate in research or
experimentation is entitled to the most
effective care that the hospital can otherwise
provide.
 The patient has the right to expect reasonable
continuity of care when appropriate and to be
informed by physicians and other caregivers of
available and realistic patient care options when
hospital care is no longer appropriate.
 The patient has the right to be informed of
hospital policies and practices that relate to
patient care, treatment, and responsibilities.
The patient has the right to be informed of
available resources for resolving disputes,
grievances, and conflicts, such as ethics
committees, patient
Application of Ethical and legal principles in health care
 Definition of Principles
 1. Autonomy
 2. Veracity
 3. Confidentiality
 4. Nonmaleficence – Negligence – Malpractice –
Duty
 5. Beneficence
 6. Justice
Application of Ethical principles to patient education
1. Autonomy - the right of a client to self determination
In the clinical setting, this principle is violated when a
nurse disregards client's subjective accounts of their
symptoms (e.g. pain) • Patients should give informed
consent before tests and procedures are carried out.
nurses recognize the individual’s uniqueness, the right
to be what that person is, and the right to choose
personal goals •
Nurses who follow the principle of autonomy respect a
client's right to make decisions even when those choices
seem not to be in the client’s best interests.
2. Veracity: truth telling; the honesty by a professional
in providing full disclosure to a client of the risks and
benefits of any invasive medical procedure
 As a nurse should I tell the truth when it is known that
doing so will cause harm? • Does tell a lie when it is
known that the lie will relieve anxiety and fear? •
Should I lie to dying people?
 3. Confidentiality: a binding social contract or
covenant to protect another’s privacy; a
professional obligation to respect privileged
information between health professional and
client.
As a nurse, you are not allowed to freely share any
information about your client as you are bound to keep
it in private.
4. Nonmalfeasance: the principle of doing no harm
A. Negligence: the doing or nondoing of an act,
pursuant to a duty, that a reasonable person in the
same circumstances would or would not do, with these
actions or nonactions leading to injury of another
person or his/her property.
B. Malpractice: refers to a limited class of negligent
activities that fall within the scope of performance by
those pursuing a particular profession involving highly
skilled and technical services.
C. Duty: a standard of behavior; a behavioral
expectation relevant to one’s personal or professional
status in life.
5. Beneficence:
The principle of doing good; acting in the best interest
of a client through adherence to professional
performance standards and procedural protocols.
6. Justice:
11
 Equal distribution of goods, services, benefits, and
burdens regardless of client diagnosis, culture, national
origin, religious orientation, sexual preference, and the
like.
HEALTH EDUCATION TEAM
What is a Health Educator?
A Health Educator is a practitioner professionally
prepared in the field of health education, who
demonstrates competence in both theory and practice
and accepts responsibility in advancing the aims of the
health-education process (De Young: 2003).
A health educator performs the following:
 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.
 Formulates operational plans and policies
necessary to achieve health education
objectives and services.
 Conducts and coordinates health needs
assessment and other public health surveys.
 Designs and conducts evaluation and diagnostic
studies to assess the quality and performance of
health education programs.
 Plans and implements health education and
promotion programs such as training
workshops, conferences, and school or
community projects.
 Prepares and distributes health education
materials, such as reports, bulletins, online
websites and visual aids like films, videotapes,
photgraphs and posters.
 Provides guidance to agencies and organizations
in the assessment of health education needs
and in the development and delivery of health
education programs.
 Disseminates health program information to the
public by preparing and issuing press releases,
conducting media campaigns, and or
mainatining program-related websites.
 Promotes and maintains cooperative working
relationship with agencies and organizations
interested in public health care.
 Provides and maintains health education
libraries to provide resources for staff and
community agencies.
 Formulates, prepares and coordinates grant
applications and grant-related activities to
obtain funding for health education programs
and related work.
 Documents activities, records information such
as number of programs completed, nursing
actions implemented, and individuals assisted.
 Maintains databases, mailing lists, telephone
networks, and other information to facilitate
the function of health education programs.
In the design/implementation of strategies and
methods, health educators have an obligation to two
principles:
1. the people have a right to make decisions
affecting their lives;
2. there is moral imperative to provide people
with all relevant information and resources
possible to make their choice freely and
intelligently (Conttrell, Girvan, & Mckenzie,
2001).
ROLE OF A NURSE AS A HEALTH EDUCATOR
 Giver of information
 Facilitator of learning
 Coordinator of teaching
 Client advocate
Patient/Client Teaching
Patient teaching is the process of influencing patient
behavior and producing changes in knowledge,
attitudes and skills necessary in maintaining or
improving health.
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 Patient Teaching is a holistic process with the change the behavior of clients and their family
goal of changing or affirming patient’s behavior to members. Nurses motivate clients and their families to
benefit health status. Patient teaching refers to only take charge of and make responsible decisions about
one component of patient education process which is their own health care. For teaching to be effetive, it
giving the patient healthcare information. must incorporate the cultural and family values and
clients’ health care beliefs.
Patient teaching is more than imparting
information. The skilled patient educator assists the Factors that Influence Client’s Teaching
patient in interpreting, integrating, and applying the
1. Stage of Development
information given. Patient teaching ends with an
2. Cultural values
evaluation of patient learning. It is a process that occurs
3. Language used
overtime, requiring an ongoing assessment of patient’s
4. Physical environment
knowledge, attitudes and skills. Patient readiness or
5. Previous experience
motivation to change behaviors and the obstacles that
6. Knowledge and skill of the teacher
the patient faces to make a behavioral change are
Principles of Client Teaching and Learning
important factors to consider.
 Assess teaching needs of the client, or teaching
Purposes of Client Teaching that is required in a particular situation.
 Assess readiness of the client to learn and the
Nurse educators teach clients in order to:
relevance of the content must be considered in
 Increase clients’ awareness and knowledge of
order for learning to occur.
their health status;
 Assess what the client knows and begin from
 Increase client satisfaction;
what she knows.
 Improve quality of life;
 The nurse should consider language barriers,
 Ensure continuity of care;
literacy, ethnic, or cultural background, age and
 Decrease patient anxiety;
emotional status of the patient. Otherwise,
 Increase self-reliant behavior;
teaching and learning can be difficult, placing
 Reduce effectively the incidence of
the patient at risk.
complications of illness;
 Interactive discussions increase learning. The
 Promote adherence to health care treatment
client should be atively involved in the teaching-
plans;
learning process and not act as a passive
 Maximize independence in the performance of
listener or viewer. A discussion format in which
activities of daily living; and
all can participate stimulates more learning
 Energize and empower consumers to become
than hearing a straight lecture.
actively involved in the planning of their care.
 Demonstrate tasks to be done for active
The Role of the Nurse in Client Teaching
practice. Repetition of skills increases retention
Health teaching is an essential role of today’s
and promotes a feeling of competence.
nurses. Nurses care for their client, prepare them for
 Praises and positive feedback motivates
diagnostic procedures or surgery. Using knowledge of
learning. This is important when the client is
growth and development, and from nursing theories,
trying to master a task, such as capillary blood
nurses teach individuals and their families at various
glucose test and self insulin injection for
levels of understanding. Clients and their families need
diabetic clients.
information as well as emotional support so they can
 Role modeling is an effective method for
cope with the anxiety and uncertainty of client’s illness.
demonstrating behavior. Nurses must be aware
Nurses also work with the client’s significant others to
that their behavior is scrutinized carefully at all
prepare them to to assume responsibility for care at
times and that it may be copied later.
home after the client is discharged from the hospital.
Education is essential to promote health. The
nurse applies the principles of teaching and learning to
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  Conflicts and frustrations impede learning, and o Many experts in the field (Watson and Anderson,
should be recognized by the nurse and resolved 1993; Abruzzese, 1992; Anderson, 1990) predict that
for learning to progress. patient education will take on new dimensions.
 Structured teaching and presentation of simple
This dimension might include, but are not limited to the
tasks must be done before complex tasks in
following:
order to enhance learning. For example, the
Ø Most teaching will occur in the ambulatory
nurse teaches the client how to care for the
care setting.
umbilical cord, which is simple task, before
Ø Use of computer-based instructions for
teaching how to bathe and shampoo the
hospital, ambulatory care settings, physicians’
newborn, which is more difficult for
offices, or home will increase.
inexperienced parents.
Ø Use of interactive programs will increase.
 A variety of teaching methods is necessary to
o Multiple sources of educational tools is utilized.
illustrate concepts and maintain interest of
Examples include one-on-one teaching, demonstrations,
clients. Posters, videos, models, online and
and analogies or word pictures to explain concepts. You
printed materials can supplement lectures and
can also use one or more of the following
discussion.
teaching tools:
 Present information in small segments over a
• Brochures or other printed materials
period of time for better retention and
Podcasts
appreciation. Short hospital stay do not support
• YouTube videos
this practice, making follow-up care particularly
• Videos or DVDs
important.
• PowerPoint presentations
ROLE OF OTHER MEMBERS OF THE HEALTH TEAM
• Posters or charts Models or props
• Group classes
• Trained peer educators
FUTURE DIRECTIONS FOR CLIENT EDUCATION
A. Greater Emphasis on Wellness
Hospitals and other health care organizations have long-
o The term wellness is a part of a parallel
standing commitment to patient education. This process
transformation in the definition of health toward a
as we have known it usually occurred at the bedside, in
more holistic perspective that is interrelational, positive
clinic, in clinic waiting rooms, or in group on the hospital
in nature, and focuses on the examination of healthy
premises. Some aspects of this familiar educational
human functioning. o Wellness deals with namely well-
process will certainly continue because it plays an
being, quality of life, life of wellness satisfaction,
important role in discharge planning for patient and in
happiness, and general satisfaction.
the long run is cost effective for the institution.
Core areas of wellness are:
o Patient educators have used newer technologies to
accomplish tasks associated with education. Ø As being a combination of having a strong
sense of identity
-Close-circuit-television
Ø A reality-oriented perspective, a clear
o Patients can remain in their rooms during the purpose in life
presentation, and use of this technology releases Ø The recognition of a unifying force in one’s
nursing personnel for other duties when they might life.
otherwise be involved with live demonstrations of baby Ø The ability to manage one’s affairs creatively
baths or preparation of insulin for injection. and
Ø Maintain a hopeful view, and the capability of
inspired, and open relationships.

The 7 Dimensions of Wellness

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Physical Wellness
 Physical wellness includes physical activity,
nutrition, and self-care, and involves
preventative and proactive actions that take care
of one’s physical body.
 Physical wellness encompasses maintenance of
cardiovascular fitness, flexibility, and strength.
Emotional/ Psychological Wellness
 Emotional wellness is awareness and control of
feelings, as well as realistic, positive, and
developmental view of the self, conflict and life
circumstances, coping with stress, and the
maintenance of relationships with others.
 wellness as related to one’s level of depression,
anxiety, wellbeing, self-control, and optimism.
Emotional wellness includes experiencing
satisfaction, curiosity.
Intellectual Wellness
 Intellectual wellness is the degree to which
one engages in creative and stimulating
activities.
 The use of resources to expand knowledge
and focus on the acquisition, development,
application, and articulation of critical
thinking.
 Intellectual wellness is having a curiosity
and strong desire to learn.
Social Wellness
 Social wellness is getting along with others and
being comfortable and willing to express one’s
feelings, needs, and opinions, supportive,
fulfilling relationships.
 Social wellness also includes the ability to
maintain intimacy, to accept others different
from yourself, and to cultivate a support
network of caring friends and/or family
members
Spiritual Wellness
 The spiritual dimension of wellness involves
seeking meaning and purpose in human
existence.
 It includes the development of a deep
appreciation for the depth and expanse of life
and natural forces that exist in the universe.
 Becoming spiritually well is when your actions
become more consistent with your beliefs and
values
Environmental Wellness
 It is important to lead a lifestyle that is
respectful of our environment. It includes
respecting nature and those species living in it.
Also, respect for others living in our
environment is just as necessary as respect for
the physical environment itself.
 Environmental wellness is an awareness of the
precarious state of the earth and the effects of
your daily habits on the physical environment.
Occupational Wellness
 The occupational dimension of wellness is
involved in preparing for work in which one
will gain personal satisfaction and find
enrichment in one's life through work.
 Occupational development is related to one's
attitude about one's work.
B. Increase Third Party Reimbursement
Third party reimbursement is compensation
for services provided by a third party, rather than the
person receiving the services. This is most commonly
seen in a health care context, where a patient receives
treatment and an insurance company pays the service
provider.
15
Ø Third-party reimbursement will increase as a cost-
benefit ratios demonstrate the cost-effectiveness of
consumer education.
Cost-benefit ratio
The measurement of the cost against monetary gains,
which is the cot of education for patient divided patient
by the total savings per patient (Euromed Infor, 2017).
Ø Interorganizational linkages to enhance cooperative
endeavors in the patient education enterprise will
increase.
Examples of third-party payers o government agencies
o insurance companies
o health maintenance organizations (HMOs) o
and employers
Ø Methods of reimbursement include fee-for-service
and episode-of-care.
o Fee-for-service (FFS)– separate payments
made for each individual service provided
-Traditional retrospective -Self-pay
o Episode-of-care – payment of one sum for
providing all services or care during a illness or
time frame
-Capitation -Prospective payment -Global payment
Benefit of Third-party Reimbursement
Ø Third part reimbursement acknowledges the value of
services provided by the healthcare professionals
because payment reflects the value that ensures the
pubic place on covered services (Mittelstadt, 1993).
Ø Third-party reimbursement aids the profession’s
growth through professional accountability and quality
assurance ( M.J. Cleary, 1993)
Ø Actively seeking third-party reimbursement will
advance health education's emergence as a profession
as well as increase its legitimacy in the eyes of other
professions.
Ø O’Brien states that the services not covered by
insurance are not available at established health care
facilities and, therefore, are not offered to patients
How It Works?
The patient provides proof of insurance before receiving
services, usually by showing the receptionist an
insurance card that includes the name of the insurance
company and an insurance identification number. After
receiving the bill, the third party will either pay the
entire bill, send a partial payment to cover only certain
services or expenses, or refuse the bill if the services are
not part of the patient’s insurance coverage. If this
happens, the service provider will then bill the patient
for the outstanding balance.
Third-Party Endorsement
Third party endorsement is defined as solicited or
unsolicited recommendation from an entity or
individual who is neither manufacturer nor seller of the
product/service. This recommendation maybe from
loyal customer or from a business associate who are
well known to the customers
Example:
A signature is an endorsement. For example, when an
employer signs a payroll check, it authorizes or endorses
the transfer of money from the business account to the
employee. The act of signing the check is
considered an endorsement, which serves as proof of
the payer's intent to transfer funds to the payee
FILIPINO CULTURAL CHARACTERISTICS & HEALTH CARE
BELIEFS & PRACTICES IN HEALTH EDUCATION
What is Culture?
 Totality of socially transmitted patterns of thoughts,
values, meanings, and beliefs (Purnell, 2005).
 It is not limited to any specific ethnic group,
geographical area, language, religious belief,
manner of clothing, sexual orientation, and
socioeconomic status (Fisher, 1996).
 Culture is inscribed in our bodies and in our minds
(Tan, 2008).
 The relationship of culture and health is important
to understand as it impacts an individual’s
worldview and decision-making process (Purnell,
2005).
 Like in other fields of medicine the impact of
cultural beliefs is increasingly being recognized as
an essential component in the genetic counselling
process (Cohen et all., 1998; Penn et al., 2010).
Filipino Culture
 Being an archipelago consisting of 7,107 islands,
cultural influence in the Philippines is important
to recognize given the existence of 175
ethnolinguistic groups each with their own
16
 unique cultural identity and health beliefs and
practices (Summer Institute of Linguistics 2012).
 Evolved as a mixture of indigenous as well as
imported and borrowed elements.
 The cultural background of Filipino nurses may
have a strong influence on their selection of
nursing as a profession, because caring for
others is emphasized and valued, especially
among females.
Cultural Awareness
 Cultural awareness is a prerequisite prior to
achieving cultural competency. It is the
understanding that a cultural divide exists
between the patient and health professional
(Winkelman 2009).
 Cultural awareness is the first step towards
gaining intercultural competences.
 Observing and being conscious of similarities
and contrasts between cultural groups. In
medicine, we are especially interested in the
way in which culture may affect different
people's approach to health, illness and healing.
Cultural Sensitivity
 Being aware that cultural differences and
similarities between people exist without assigning
them a value – positive or negative, better or worse,
right or wrong.
 Is a set of skills that enables us to learn about and
understand people who are different from
ourselves, thereby becoming better able to serve
them within their own communities
Cultural Values
 Kapwa – sense of shared identity with others
 Pakiramdam – shared inner perception; having
a heightened awareness and sensitivity to
others
 Accomodative
• Utang na loob (gratitude/solidarity
versus debt of gratitude)
• Hiya (sense of propriety versus shame)
 Confrontative
• Bahala na (determination versus
fatalism)
• Lakas ng loob (internal strenght)
Traditional Perceptions of Health and Illness
(Philippine)
 Definition of health is considered to be in a
state of balance.
Factors that play a role in balance include hot
and cold factors, food, and diet.
Balance is a key concept in the Filipino culture.
It is also referred to as Timbang and relates to hot and
cold shifts and diet. When there are too many hot and
cold shifts, then the person may become ill (McBride,
n.d.).
Balance is disrupted when a person becomes ill.
Another factor that can affect the balance of someone
is sudden changes in weather patterns (McBride, n.d.)
 Illness is when the body, mind, and spirit are
out of balance or when the person and the
environment are in a sense of disharmony
(Spector, 2013).
According to the Filipino population, illness is
also defined as the body being out of balance which
usually pertains to a rapid change in hot and cold
(McBride, n.d.)
Three Theories of Illness
Mystical Theory
Is that if there are unfulfilled obligations from ancestors
then this could result in mystical experiences and
behaviors. It also goes as far to say that during sleep the
soul can be lost or if you are having nightmares then
they are often the result of consuming a heavy meal and
it could eventually lead to death (McBride, n.d.)
Personalistic Theory
Is that evil spirits or witches seeking retribution or social
punishment can cause illness. This theory can be
protected by wearing religious objects or using holy oils
(McBride, n.d.)
Naturalistic Theory
This theory states that stress, infection, food and drugs,
and natural events such as thunder, lightning, and drafts
are all causes of illness (McBride, n.d.)
17
The basic logic of health and illness consists of
prevention (avoiding inappropriate behavior that leads
to imbalance) and curing (restoring balance); it is a
system oriented to moderation. Parallel to this holistic
belief system is the understanding of modern medicine
with its own basic logic and principles for treating
certain types of diseases.
Filipino Cultural Beliefs
Namamana (Inheritance)
Acquiring a behavioral or disease trait from a parent. It
is a belief that when a relative has the condition, it is
possible that he/she will pass on the trait to the
younger generation.
The passing on of a trait to the younger
generation.
Lihi (Conception or Maternal Cravings)
During the lihi period, also referring to the first
trimester of pregnancy, the pregnant woman
experiences a number of physical discomforts including
feelings of dizziness, nausea, irritability, and general
weakening of the body (Jocano, 1973).
It is also during this time that the pregnant woman
develops intense craving for certain foods and intense
liking for certain objects.
Pasma (Hot and Cold Syndrome)
The interaction of hot and cold elements is the basis of
the pasma concept. Pasma is roughly defined as an
“exposure illness” which occurs when a condition
considered to be “hot” is attacked by a “cold” element
and vice versa (Tan 2008).
Sumpa and Gaba (Curse)
In sumpa, the curse is inflicted by a human being.
In contrast, gaba is a curse inflicted by a divine
being and it is usually God.
This is inflicted to a person because he/she
committed a social sin.
Namaligno (Mystical and Supernatural Causes)
Namaligno is a Filipino belief that a disease is caused by
an intervention of a supernatural or a mystical being
(Abad 2013).
Namaligno is used as an explanation in
conditions which remain to be mysteries because of the
absence of an apparent cause.
Kaloob ng Diyos (God’s Will)
When a Filipino individual experiences an unexpected
event in their life, whether negative or positive, it is
typically attributed to the grace of God.
Highlights the Filipino value of religiosity and
faith to a higher being, as someone who is all-knowing
and almighty.
Filipino Health Practices
Traditional forms of Self-medication
Oils or ointments, which serve as cure in relaxing,
heating, and comforting the muscles or providing relief
for dizziness, colds, headaches, sore throats, and so
forth.
Folk Healing Techniques
Ventosa is used for treating joint pains believed to be
caused by the presence of bad air.
Alternative therapy
People go for Hilot for relief of pain and aches instead of
seeking medical attention. In an alternative context,
Hilot may refer to a practitioner or the practice of
chiropractic manipulation and massage for the diagnosis
and treatment of musculoligamentous and
musculoskeletal ailments.
Home Remedies
Form of medicinal plants are also popular for Filipino
nurses who believe that plants can heal common
ailments.
Seeking the help of a local healer who may
utilize a variety of treatments including the use of herbs
and roots (McKenzie and Chrisman, 1977).
18

Health Promotion/ Treatment Concept
Flushing
The body is thought to be a vessel or container that
collects and eliminates impurities through physiological
processes such as sweating, vomiting, expelling gas, or
having an appropriate volume of menstrual bleeding.
Heating
Adapts the concept of balanced between “hot” and
“cold” to prevent occurrence of illness and disorders.
Protection
Safeguards the body’s boundaries from outside
influences such as supernatural and natural forces.
Health Behaviors
Response to Illness
Filipino older adults tend to cope with illness with the
help of family and friends, and by faith in God.
Before seeking professional help, Filipino older
adults tend to manage their illnesses by self-monitoring
of symptoms, ascertaining possible causes, determining
the severity and threat to functional capacity, and
considering the financial and emotional burden to the
family.
Utilizing traditional home remedies such as
alternative or complimentary means of treatment (Yeo,
1998)
Coping Styles
● Patience and Endurance (Tiyaga): the ability to
tolerate uncertain situations
● Flexibility (Lakas ng Loob): being respectful and
honest with oneself
● Humor (Tatawanan ang problema): the capacity
to laugh at oneself in times of adversity
● Fatalistic Resignation (Bahala Na): the view that
illness and suffering are the unavoidable and
predestined will of God, in which the patient,
family members and even the physician should
not interfere.
● Conceding to the wishes of the collective
(Pakikisama) to maintain group harmony
Response to Mental Illness
 Devastating shame (Hiya)
 Sensitivity to criticism (Amor Propio)
Common Perceptions of Filipinos about Mental Illness
 Unwillingness to accept having mental illness,
which leads to the avoidance of needed mental
health services due to fear of being ridiculed.
 Involvement of other coping resources such as
reliance on family and friends or indigenous
healers, and dependence on religion which can
diminish the need for mental health services.
 Prioritizing of financial and environmental
needs which preclude the need for mental
health services.
 Limited awareness of mental health services
resulting in limiting access.
Common Perceptions of Filipinos about Mental Illness
 Difficulty in utilizing mental health services
during usual hours because of the unavailability
of working adult family members.
 Mental illness connotes a weak spirit, and may
be attributed to divine retribution as a
consequence of personal and ancestral
transgression.
 Lack of culturally oriented mental health
services.
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NEW TECHNOLOGIES, NEW SETTINGS &
ENVIRONMENTAL LINKAGES

20