SAINT TONIS COLLEGE, INC.

Formerly: Kalinga Christian Learning Center

Bulanao, Tabuk City, Kalinga
Philippines

COLLEGE OF NURSING

Course Title : HEALTH EDUCATION

Course Code : NCM 102

Module No. : 1

Course Content : CONCEPTS OF HEALTH EDUCATION IN RELATION TO HEALTH CARE

Learning Theories Related to Health Care Practice

Learning Outcomes :

At the end of the module the students will be able to:

1. Distinguish the different theories and strategies used in health education.

Introduction :

In this module you will learn the historical developments of health education, the current
trends and issues particularly those involved in promoting optimal health and the theories that
are commonly applied in the conduct of health education.

It will also enable you as a student nurse to assume the role of a health educator to
effectively and efficiently empower the learner through the development of critical thinking
skills and abilities in whatever setting and planning and conducting health education.

Preassessment

True or False. Write T if the statement is correct and False if the statement is wrong on the
blank provided before the number.

______ __1. Health education contributes to health and well being by promoting sedentary lifestyle.
_________2. The teacher is the only player in the education process.
_________3. Learning occur in one setting.
_________4. When the physical and psychosocial need of a client occur is an outcome of the education
process.
_________5. Health teaching is based on the needs of the health educator.
_________6. The nursing process focus on instructional content and methods based on the client’s
learning needs, readiness to learn and learning styles.
_________7. Learners have the same learning style.
_________8. Improvement of health is the responsibility of the government alone
_________9. Health education must move from concept of health as lack of disease to the concept of
health as optimal well-b
eing.
_________10. The health personnels have the primary responsibility for the health of the children.
Learning Discussion

CONCEPTS OF HEALTH EDUCATION IN RELATION TO HEALTH CARE

A. Overview of Education on Healthcare
 Health education
> A process concerned with designing , implementing, and evaluating educational
programs that enable families, groups, organizations and communities to play active
roles in achieving, protecting and sustaining health.

> Any combination of learning experiences designed to facilitate voluntary

adaptations of behaviour conducive to health (Greene et al., 1980).

> Its purpose is to contribute to health and well-being by promoting lifestyles,

community actions and conditions that make possible to live healthful lives (The Code
of Ethics for Health Educators, Association for the Advancement of Health Education).

 The general principles of health education are the following:

1. Health teaching should be based on the needs and interest of children, and of their
families and communities.
2. In teaching health, full consideration should be given to the psychological, sociological,
cultural and economic factors which have bearing upon health behavior.
3. Scientifically sound health facts should be used.
4. Students should be given the opportunity, commensurate with their level of maturity to
learn through the participation in practical problem solving situations.
5. Health teaching should be an integral part of the school curriculum and should be
guided by sound principles of learning.
6. Health teaching should be an integral part of the total school- community health
program and other efforts which contribute to the well- being of the individual and
society.

 There are other principles of health education each learner should understand.
1. Based on legal, social, psychological and environmental factors, HE’s keystone to better
health is the individual in relation to better society- that he must take action to improve
his health so that he can be of service to society. A strong and productive citizen uses his
intellectual, emotional, social and physical potentials to improve his life.
2. There is no “perfect health”. Not because a person has physical infirmities, he is no
longer healthy. All the conditions of health are never separated but integrated. What
counts is the striving of a person to achieve a high level of health to the best of his
ability, to be productive member of the society.
3. HE centers on people and their behaviors. It begins with the person possessing
adequate knowledge to apply what he has learned. He understands what his problems
are and decides on things to be done health wise. Health is shown not by what an
individual knows but what he/ she does.
4. HE is both health and education- with health as the content and education as the
process. It means changes in the development of better behavior and views of people
and their needs, the efforts and disciplines of a person’s care and management of
himself.
5. Improvement of health cannot be achieved by the government alone. If people have
right to health services, they should likewise perform the duties and responsibilities
related to the wise use of such services and involvement in activities designed to
promote and maintain personal and social health.
6. HE must move from:
a. Concept of health as lack of disease or illness to the concept of health as optimal
well- being.
b. Memorizing and/ or parroting facts to learning experiences involving investigation,
critical thinking and problem solving.
 c. Irrelevant health services to those related to health needs, interest and
developmental characteristics of learners.
d. Telling what is right and wrong to creating opportunities to make wise decisions.
e. Employing untrained individuals to employing professional health educators.
f. Thinking that “health can be thought of without being taught” to allocating specific
time for HE to take place.
7. Parents have the privilege and primary responsibility for the health of children and
youth. The school and community have vital secondary role.
8. The school through its health education programs contributes by providing students
with learning experiences that help them acquire accurate information that can help
them develop attitudes, values, and beliefs needed in utilizing the information in making
health decisions and taking sound health action. Such programs include the diversity of
teaching methods to accommodate learning abilities and styles of students.
9. A unified approach to health teaching- that is, a planned, sequential in HE through the
years, necessary for students to be continually encourages to develop a lifestyle that
fosters good health.
10. Health topics should be dealt with honesty in order to compliment the family’s
responsibility to provide values as well as answers.

Health then is on one hand a highly personal responsibility and on the other hand a
major public concern. It thus involves the joint efforts of the whole social fabric, such as the
individual, the community and the state to protect and promote health.

 IMPORTANCE OF STUDYING HEALTH EDUCATION

Health education is a unique and separate academic discipline for it influences

individual, family, and societal development, knowledge, attitudes and behavior. To be healthy
is one thing that everybody should pay attention to whether in formal or non-formal way. Some
importance of studying health education are the following:

1. Life is God’s greatest gift to us. It is meant to be enjoyed to its fullest, in its beauty, in its
joy, in its challenges, in its accomplishments and in its reality. Without proper becomes
a bore, a liability, a problem, a burden, or a curse.
2. Knowledge on health and its care is not only everyone’s right but everyone’s
responsibility- to God, to himself, to his family and to his fellowmen.
“With failing health our usefulness to humanity is hindered, our usefulness to our family
is hampered, our self- respect is lowered, and our duty to God and giving glory to Him is
greatly forfeited”
3. Knowledge on health care is not only to be a “guarded secret od a select few”, but is a
privilege of everyone.
“Ordinary people provided with clear, simple information can prevent and treat most
common health problems in their homes earlier, cheaper, and often better that can
doctors” ( Warner, David, Where There is no Doctor)
4. Lack of knowledge on health and its care is expensive, dangerous, and suicidal.
a. Millions of lives could have been saved from premature deaths.
b. Millions of pesos could have been saved from hospitals, doctors, and medicine bills.
c. Countless heartaches could have been prevented, and
d. Thousands of invalids could have escaped their miseries and lot if only man had
adequate knowledge regarding preventive and curative health care.
5. Our body is the temple of God’s spirit and we are expected to keep it in its best
condition for His dwelling.
“ Do you not know that your body is temple of the Holy Spirit, who is in you, whom you
have received from God? You are not your own “ ( I Cor.6:19, NIV)
“Don’t you know that you yourselves are God’s temple is sacred, and you are that
temple.” (I Cor. 3:16,17,NIV)
6. Well- balanced health is a prerequisite to a well- balanced character.
“the body is the only medium through which the mind and the soul are developed for
the up- building of character.”- (E.G.White)

 GENERAL OBJECTIVES OF HEALTH EDUCATION (PHILIPPINE CONSTITUTION, 1987)

1. Promote health habits conducive to a high quality of health care and living.
Establish proper habits at a proper time and as early as possible. Follow them up so that
they can contribute to a high quality of living which is personally satisfying and socially
useful.
2. Work for a progressive healthy personality characterized by satisfaction with one’s
weakness and development of one’s potential.
Health educators should work towards the contribution to the development of the
students’ integrated personality. They should motivate the students to look into
themselves in eliminating behavior which affects health and strengthening those that
enhance health. Such steps are essential for optimal health.
3. Clarify superstitious beliefs and fallacies and obtain accurate and credible information
on personal and public health.
Not everything old is bad. Not everything new is good. Retain what is good in the old
and the new. Acquire reliable and accurate data on what you are certain of and act
accordingly.
4. Make provisions for a growing feeling of security based on acquiring correct
information, positive viewpoint and intelligent behaviors.
Many health fears and uncertainties are lessened due to the results of studies and
researches. These lessen the doubts of man making them more experienced
emotionally in taking sound health action.
5. Participate in the progress of the community through the development of citizens who v
iew health education as a necessary step towards the welfare of the majority.
Personalism and family-centeredness should be charged to people empowerment for
health. We should act as a nation in terms of health and other worthy endeavors.

 The Legal Basis of Health Education in the Nursing Curriculum

One of the more important functions of the nurse is as health educator and this is
explicitly stated in The Duties of a Nurse in Rule IV, Art. VI, Sec. 28 of the Philippine
Nursing Act of 2002 also known as RA 9173, among which are to:
a. Provide health education to individuals, families and communities
b. Teach guide and supervise students in nursing education
c. Implement programs including the administration of nursing services in varied
settings like hospitals and clinics.
Specifically, it states that “The nursing education program shall provide sound
general and professional foundation for the practice of nursing taking into
consideration the learning outcomes based on national and universal nursing
competencies. The learning experience shall adhere strictly to specific requirements
embodied in the prescribed curriculum as promulgated by the Commission on Higher
education’s (CHED) policies and standards of nursing education”.

 Recent developments in the field of health care

> The important role of education in helping the patients and their families assume
responsibility for self-care management (Bastable, 2003).

> With the current third-party payor system, nurses are expected to be the prime
movers in delivering high quality, effective and efficient nursing care and patient
education which will result to shorter hospital confinement and continuation of
recovery and rehabilitation through home care or community based nursing care.
 Education for health begins with people and aims to develop in them a sense of
responsibility for health conditions and to motivate them with whatever interests they
may have in improving their living conditions.

In communicable disease control, health education commonly includes an

appraisal of what is known by a population about a disease, an assessment of habits
and attitudes of the people as they relate to spread and frequency of the disease, and
the presentation of the specific means to remedy observed deficiencies.

 Emerging Trends in Health Care

1. New “Health Care Economics”
a. Emphasis on primary care and the continuing development of managed care which
advocates the early discharge of clients from the hospital to reduce health care
insurance and prevent “overtreatment of patients” which are unethical practices of
some doctors and hospitals. This is mandated by the managed care programs in the US
(Rodwin 1993, Vandenburgh 1999)
A new stress on health outcomes, as opposed to structures or processes of care
(Health Outcomes Methodology) is being done to find out if the centers have the
requisite number of qualified medical directors, nurses, physical therapist, autoclaves,
elevating beds, policies and so forth. Recommendations were also issued by the
agency for Health Care Research and a quality which attempted to standardize medical
practice for several disease based on studies determining the most effective care.

b. Providers will increasingly establish centers of excellence to provide services

effectively and at moderate cost (Weiss 1999). Only a few centers will perform given
operations. Physician resistance will occur, but the balance of power in health care has
already swung to payers(ex. the insurance and managed care companies) who will use
these facilities instead of local hospitals, where cost and quality are currently not as
subject to the rigorous controls (Folland, Goodman, and Stano 1997).

c. Decentralization of care, also known as Medical Prosumerism, is an emergent issue.

Prosumerism is a movement away from purchasing completed goods and services in
favour of purchasing portions of them piecemeal similar to the do-it-yourself
movement in home improvement.” In health care, similar posumerism is encouraged
by significant patient opportunities to gain knowledge through the Internet and
medical data bases. Patients now frequently make their own choices as to diagnoses,
treatments, medical products and practitioners “. (Toffer 1980).

d. Alternative medicine. Consumers use wide variety of folk practices to promote

health and and potentially cure diseases. (Traditional herbs, meditation or guided
imagery, acupuncture, acupressure, aromatherapy, yoga, massage therapy )

e. Medical globalization. Like other industries, health care is increasingly subject to

globalization. U.S. citizens cross borders to purchase inexpensive medications once not
available in the country.
They also make the journey to Canada or Mexico to obtain surgery or other
complex procedures at cheaper prices.
 Medical globalization is a trend which is not new to the Philippines. It is now
called medical tourism, where centers of excellence or hospitals and centers with
world class facilities or amenities have become one of the foremost tourist attractions
in the country.
Added to this is the reality that people from other countries obtain services and costs
of treatments and medications at a very reasonable and affordable price.

2. Advances in medical technology

The most current development in managed care is disease management.
Disease management systems “seek to improve patient compliance with optimal
health behaviour by promoting proper appointment keeping, self administration of
treatments and proper general health behaviour in terms of lifestyle issues.
These systems range from simple ticlers, where a nurse reminds patients to
have their lab vaues monitored, to home terminals or computers through which data
are monitored and clinical instructions received.
A common tool for patient education to conserve time and energy is closed-
circuit television where patient stays in his room to watch the presentation. Drawbacks
of this method include fixed or specific time of showing which may not be conducive to
learning, absence of follow-up to clarify or explain and difficulty of assessing the
effectiveness of the program.

 Future Directions For Patient Care (Watson and Anderson, 1993; Abruzzese, 1992,
Anderson, 1990)
1. New settings and environmental linkages
a. most teaching will occur in the ambulatory care setting
b. inter-organizational linkages to enhance cooperative endeavours in the patient
education enterprise will increase
c. more people are unhappy with orthodox medicine and are turning to alternative
medicine
d. changing demographics resulting in proportionally older population and greater
number of minority (ethnic groups) with unique health challenges

2. New Technologies

a. the use of computer-based instruction for hospitals, ambulatory care settings,

physician’s offices or homes will increase
b. the use of interactive video programs will increase, resulting to greater access to
reliable information
3. Greater emphasis on wellness
a. wellness screening programs will increase
b. emphasis on illness prevention and health promotion such as nutrition, diet,
exercise with various accompanying educational offerings, will increase.
4. Increased third- party reimbursement as cost benefit ratios demonstrate the cost -
effectiveness of consumer education as shown by shorter hospital stay, effective and
efficient home and self-managed care, lesser incidence of complications and hospital
admission.
B. CONCEPTS OF TEACHING, LEARNING, EDUCATION PROCESS
 T he 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 (Bastable, 2003).

 Teaching is a deliberate intervention involving the planning and implementation of

instructional activities and experiences to meet the intended learner outcomes based
on teaching plan.
>Intruction is just one aspect of teaching which involves communicating information
about a specific skill (cognitive, affective or psychomotor). It is sometimes used
interchangeably with teaching.

>Learning is a change in behaviour (knowledge, skills and attitudes) that can occur at
anytime or in any place as a result of exposure to environmental stimuli.

> Learning is an action by which knowledge, skills and attitudes are consciously or
unconsciously acquired and behaviour is altered which can be seen or observed.

>Patient education is a process of assisting people to learn health-related behaviors

(knowledge, skills, attitudes, values) which can be incorporated into their everday
lives.

>Staff education. Amidst all mandates and requirements that the nurse as a health
educator faces is the need to be knowledgeable about the principles of teaching and
learning. Instead of the “teacher teaching”, the paradigm has shifted to on the “learner
learning” . The nurse needs to know not only the subject matter but also her role in
the teaching-learning process and the nature of the learner.

The three pillars of the teaching-learning process are the:

1. teacher
2. learner
3. subject matter

Each component has its own contribution to the whole process of teaching and
learning. Studies have shown that:
a. the vital role of the teacher is motivating students to learn
b. inspiring them to get out of their comfort zones, to stretch and develop the 98%
portion of their brain which is still untapped and unused.

C. COMPARISON OF THE NURSING PROCESS AND THE EDUCATION PROCESS SIMMILARITIES

(Bastable, 2003)
1. Both consist of the basic elements of assessment, planning, implementation and
evaluation
2. They are logical, scientifically-based frameworks for nursing processes providing a
rational basis for nursing practice rather than an intuitive one
3. Both are methods for monitoring and judging the overall quality of nursing
interventions based on objective data and scientific criteria

 Differences between Nursing Process and Education Process

1. Nursing process focuses on planning and implementation of care based on
assessment and diagnosis of the patient’s physical and psychosocial needs while th e
2. Education process identifies instructional content and methods based on assessment
 of the client’s learning needs, readiness to learn and learning styles
3. Bases of outcomes:
> Nursing process : When the physical and psychosocial needs of the client are met
> Education process : When changes in knowledge, attitudes and skills occur

According to Wagner and Ash (1998), “the role of the educator is not primarily to
teach, but to promote learning and to provide for ab environment conducive to learning
--- to create the teachable moment rather than just waiting for it to happen.

 ASSURE MODEL AS EDUCATION PROCESS PARADIGM

The ASSURE model is a guide to assist teachers in making instructional materials. It is an
acronym which stands for:
1. A—Analyze the learner. Identify who your learners are based on;
a. General characteristics – like age, highest educational attainment or grade level,
socioeconomic factors, ethnicity and culture

b. Specific learner competencies like knowledge, skills and attitudes regarding the
topic;
 Information-processing habits like analytical/ global, focused/ nonfocused,
reflective/impulsive, narrow/broad categorization, tolerant/intolerant of
incongruities.
 Motivational factors like attention span
, factors which may interfere with learning like anxiety, depression, etc.

c. Learning styles which refer to perceptual preferences and strengths like visual,
auditory, tactile and kinaesthetic.

2. S --- State the objectives using SMART (specific, measurable, attainable, realistic and
time-bound) based on the course syllabus.

3. S --- Select the instructional media and materials by:

a. Selecting the available materials
b. Modifying existing materials
c. Designing, revising or making new materials

4. U --- Use the materials and the instructional media by;

a. Reviewing the materials and maximizing the use of the materials
b. Practicing the use of the materials and the instructional media
c. Preparing the classroom, equipment and facilities
d. Presenting the materials using your skills and teaching styles

5. R --- Require learner participation by preparing activities that will encourage students
to respond and actively participate; the teacher should give appropriate feedback to the
students’ responses.

6. E--- Evaluate and Revise. To evaluate the effectivity of the presentation, the following
questions may be asked:
a. Was the visual materials able to help me make a clear, coherent and interesting
presentation?
b. Was it able to help the learners/trainees meet the objectives of the lesson?

Based on this evaluation, you may make revisions or modifications and even
reinforce or strengthen facets of the presentation that contributed to effective teaching
 and learning.

D. HISTORICAL FOUNDATIONS FOR THE TEACHING ROLE OF NURSES

 The historical evolution of teaching as an essential role of the nurse traces its roots to
the mid-1800s throughout the initiative of and efforts of Florence nightingale, the
mother of modern nursing and founder of the first school of nursing.

 Nightingale taught nurses, physicians and other health officials about the importance of
clean, well ventilated and well-lit environment in the hospital and at home in assisting
the patients to get well and improve their sense of well-being.

 She also founded the Florence Nightingale School of Nursing at St. Thomas Hospital in
London in June 15,1860 which trained nurses, physicians and other health officials on
the importance of manipulating the environment so that nature can act on the patient
recovery and healing process. Her ideas were published in 2 books, Notes on Nursing
and Notes on Hospitals.

 By the early 1900s, the importance of education in the promotion of health and
prevention of illness was recognized and practiced by the public health nurses. Today,
teaching is included within the scope of nursing practice responsibilities.

E. CHARATERISTCS OF A TEACHER:
1. Teacher clarity – deals with behaviors that teachers use to make what is to be learned
as intelligible, comprehensible and learnable as possible. A clear teacher is one who
logically organizes instruction, explains what is to be learned, uses simple terms in
presenting new materials, constantly assess whether student can understand and follow
the teacher’s train of thought, uses examples, whenever possible and uses repetition
and summarization.
> Studies show that teacher clarity has a positive correlation with student
achievement and attitudes towards classroom learning and instruction.

2. Teacher style involves interpersonal, professional and personal aspects of good

teaching; it includes:
a. a blend of form or content which is a combination of certain ways of talking, moving,
relating and thinking, scholarliness, intelligence and sincerity
b. the teaching persona which s the ability to stimulate the student’s interest and
enthusiasm for the subject
c. a pleasant speaking voice
d. the use of a variety of teaching strategies, humor
e. good timing wherein the teacher knows how to adapt the speed of delivery for
individual learners or the whole class and knowing when they are ready for a new
material, when to stop and when to shift gears.

F. SIX HALLMARKS OF GOOD OR EFFECTIVE TEACHING IN NURSING (Jacobsen)

1. Professional competence evidenced by:
a. thorough knowledge of the subject matter and proper demonstration skills
b. reading, researching, undertaking Continuing Professional Education (CPE), and has
clinical practice and expertise.

2. Possession of skilful interpersonal relationships with students which was rated as the
most important.The teacher:
a. takes personal interest in the welfare of the student
b. is fair and just in giving grades and credits to students
 c. allows learner to freely express themselves and ask questions
d. conveys respect for students;
e. allows learner to freely express themselves and ask questions
f. accessible for conferences and consultations
g. conveys a sense of warmth;

Three basic approaches by which the instructor can increase self-esteem and reduce anxiety are
through:
a. emphatic listening- by listening to the learner and seeing the world through his /her
own eyes
b. accepting the learners as they are whether you like them or not; avoid imposing your
own prejudices or standards
c. communicating honestly with your students by letting them know your expectations
are and what their responsibilities are. The bottom line is that the teacher is expected to
respect the learners, care about their concerns and try to understand the world as the
learners experience it.
 In the performance of the duties and responsibilities as a mentor , the teacher is
guided by the principle of “in loco parentis” which give the teacher the right to
exercise the parental role in the absence of the real parents. This also allows the
teacher to impose appropriate disciplinary measures for minor offenses committed by
the student in his/her presence.

This is the dilemma that new or beginning instructors face. They have a difficulty
in performing these functions and at the same time maintaining professionalism and
setting limitations and boundaries in their relationship with their students.

3. Desirable personal characteristics of the teacher which include charisma or personal

magnetism, enthusiasm, cheerfulness, self control, patience, flexibility, sense of humor,
good speaking voice, self-confidence, willingness to admit error or lack of knowledge and
a caring attitude (Kotzabassaki, 1997 and Fanbrother, 1996).

4.Teaching practices which include:

 Mechanics
 Methods
 Skills in the classroom and clinical practice
 The teacher has thorough knowledge of the subject matter
 Presents the materials in clear, interesting, logical and organized manner.

5. Evaluation practices which include;

 Clearly communicating expectations
 Providing timely feedback on student progress
 Correcting the student’s tactfully
 Being fair in the evaluation processes
 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;
instructors dilemma is being in two or more places at the same time. This can be remedied
by communicating where he/she can be located and endorsing the students to a
knowledgeable member of the staff during her absence in the area.
Summary
The role of health education in the promotion of health and healthy lifestyles as well as
the prevention of illness is a responsibility that largely falls on the shoulders of the nurses being
the largest group of health providers. Its legal basis is found in RA 9173. Health education
should be viewed as moral understanding and responsibility not only to the nurse but by other
health care providers as well. To do this effectively one needs to know the role of the nurse in
health education.

Post assessment

Modified TRUE or FALSE. Write True if the statement is correct and if the statement is False
Underline the word/s that make the stamen wrong and write the correct word/s on the blank
provided before the number.

______ __1. Health education contributes to health and well being by promoting sedentary lifestyle.
_________2. The teacher is the only player in the education process.
_________3. Learning occur in one setting.
_________4. When the physical and psychosocial need of a client occur is an outcome of the education
process.
_________5. Health teaching is based on the needs of the health educator.
_________6. The nursing process focus on instructional content and methods based on the client’s
learning needs, readiness to learn and learning styles.
_________7. Learners have the same learning style.
_________8. Improvement of health is the responsibility of the government alone
_________9. Health education must move from concept of health as lack of disease to the concept of
health as optimal well-being.
_________10. The health personnels have the primary responsibility for the health of the children.

Learning Evaluation:

I. Multiple choice. Choose the best answer and write the letter of the correct answer on the
blank provided before the number.
______1. This category is related to the doctrine of “in loco parentis” which is all of the
following except:
A. The teacher has the right to impose to impose disciplinary measures for minor offenses.
B. The teacher manifest a caring attitude in the exercise of this right
C. The teacher has the right to exercise parental roles in the absence of real parents
D. The teacher has the right to inflict corporal punishment to discipline erring students

______2. Mrs. Pedro is known for her ability to make learning easy and intelligible by citing
concrete examples to illustrate concepts and using simple easy –to – understand words and
phrases. This illustrates;
A. Desirable personal characteristics of the teacher
B. Availability to students especially in the clinical area
C. Teacher clarity in teaching
D. Skillful interpersonal relationship with the student

______3. Teacher Claire is known for his ability to exude cheerfulness, enthusiasm, patience
and a caring attitude towards his students. This ability illustrates:
A. Professional competence B. Teacher clarity C. Teaching practices D. Teaching style

______4. This hallmark of effective teaching was rated as the most important in the learning
process:
A. desirable personal characteristics of the teacher
B. Availability to students especially in the clinical area
C. Skillful interpersonal relationship with the student
D. Teacher clarity in teaching

_____ 5. Miss Helena , a clinical instructor , usually entertains her friends and relatives who
visit her when she is on clinical duty. She is usually busy texting or chatting with some hospital
employees to the dismay of her students who are left to defend themselves. This is a violation
of a CI’S role which is:
A. Professional competence
B. Skillful interpersonal relationship with the student
C. Desirable personal characteristics of the teacher
D. Availability to students especially in the clinical area

______6. Which of the following is true to health education, except?

A. aims to promote health empowerment health empowerment
B. designs, implements and evaluates health-related educational programs
C. deals with learning experiences designed to promote healthy behaviour
D. designed to promote the interest of the government

______7. The latest health care economics dictates that;

A. patients should be treated with respect and tender love and care
B. patients should be discharge at the earliest possible time
C. patients should not be discharged until client is completely healed
d. patients should maximize the use of their hospitalization benefits

______8. The latest reform in the healthcare system, known as managed care is intended to;
A. help the Health Maintenance Organizations save on hospital cost
B. put the burden of recovery and rehabilitation on the patient and family.
C. bridge the gap between hospital confinement and community-based services.
D. implement early hospital discharge to save on hospitalization cost

______9. When other countries cross borders to purchase inexpensive medications is also
known as;
A. decentralization of care B. prosumerism c. medical tourism D. none of these

______10. Which of the following future directions for patient care, promotes the use of
interactive programs, computer-based instruction for hospitals and ambulatory care setting.
A. new settings and environmental linkages C. new technologies
B. greater emphasis on wellness d. increased third party reimbursement

II. Answer the questions properly

1. Identify 2 concepts of health you have learned in this module and explain each in not more
than 3 sentences. (5 pts)
2. Discuss at least 2 similarities and 2 differences between the nursing process and the
education process. (5 points)

3. Read the situation below. What will you do if you are in that situation?

A group of nursing students was assigned to conduct a health education program in

Barangay Modesta, a remote area. One day a four-year old boy suffered from diarrhea. All
known local remedies and even rituals were given by quack doctors available in the area. The
condition of the child is getting worst. Due to far distance to the hospital or health clinic and
lack of transportation to provide proper medical help and the prevailing belief that diseases are
caused by spirits, the parents refused to bring the child to the hospital.
A. AS health educator student, what simple home remedies or treatment can you or your
group can do to help and save the life of the child? (5 points)

B. What other education principles or advice can you give to the parents and the community to
help prevent such disease. (5 points)

“Food for Thought”

“In resolving conflict, how you say it is important as what you say”.

“The greatest gift you can give someone is your time”.

Purpose – driven life-

Lifted from:
Asperas, Carlito M. Strategies of Health Education, Is ted., Manila. Eductional Publishing
House,2005
Bastable, Susan B. Nurse Educator: Principles of Teaching and Learning for Nursing Practice, 2 nd
ed, Boston: Jones and Barlett Pub. 20
Castro, Cecilia. Health Education for Nursing and Other Allied Professions, Is ted, Educational
Publishing House,2011
 SAINT TONIS COLLEGE, INC.
Formerly: Kalinga Christian Learning Center
Bulanao, Tabuk City, Kalinga
Philippines

COLLEGE OF NURSING

Course Title : HEALTH EDUCATION

Course Code : NCM 102

Module No. : 2

Course Content : PRINCIPLES & THEORIES IN TEACHING AND LEARNING

Principles of Teaching and Learning

Learning Outcomes :

At the end of the module the students will be able to:

1. Distinguish the different theories and strategies used in health education.

Introduction :

In this module the students will learn the different theories and principles in teaching
and learning. As a student educator one must know the appropriate strategies and methods of
teaching when the learner is ready to learn.

Pre assessment

TRUE or FALSE. Write True if the statement is correct and False if the statement is wrong.
_________1. Learners have the same learning styles.
_________2. Reading has the highest retention of what has been learned.
_________3. Emotional status affects readiness to learn
_________4. Learning theories explain why people learn and predict what they will learn.
_________5. Development is a dynamic process that involves sudden changes in character.
_________6. Reinforcement are events that weaken responses.
_________7. Reflective observation is from actual experience.
_________8. Active experimentation learning style involve creating theories to explain what is
seen.
_________9. Piaget’s sensorimotor development occurs during adulthood.
_________10. The social learning theory believes that behaviour should be performed and
reinforced for learning to occur.

Learning Discussion

 What is Learning?
 It is relatively permanent change in mental processi, emotional functioning and/or
behaviour as a result of experience (Bastable, 2003).
 Learning is lasting or permanent change in behaviour as a result of experience which is
determine or influenced by the environment where the person is situated.

 How does learning occur?

  Learning occurs as the individual interacts with his/her environment and incorporates
or applies new information or experiences to what one already knows or has learned.
Environmental factors affect learning like society and culture, the structure or pattern of
the stimuli, the effectiveness or credibility of role models and reinforcements, feedback
for correct and incorrect responses and opportunities to process apply learning to new
situations (Bastable 2003).
 Learners also have their own way of taking in and process information (learning styles
and the type , nature and level of motivation also affects learning.

 COMMON PRINCIPLES OF LEARNING

10 Learning Principles that can Help Motivate the Learner
1. Use several senses
When dealing with the question of how much people are able to retain what has
been learned, 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 and hear, 70%
of what they say and 90% of what they say and do.

 The Learning Experience Cone

We Tend to Remember: Our Level of Involvement

10% of what we read

Reading Verbal Receiving
20% of what we hear
Listening

30% of what we see Looking at charts Visual Receiving

and diagrams
50% of what we see, Watching a film or
video
hear or read
Watching a demonstration
Receiving and Participating
70% of what Participating in a discussion
we say
Making a presentation

Participating in a role play

90 % of what Simulating/ participating the real thing Doing

we both say
and do Doing the real thing

This is the importance RLE(Related Learning Experience) which nursing students undergo in the
Nursing Skills Laboratory where;

 they are made to imitate the procedure that are demonstrated by the instructors (role-
modelling) and
 are graded according to the skills they exhibit and the degree of comprehension of the
rationale behind the steps in the procedure as they perform the return demonstration.
It is expected that by imitating, they would be able to retain 70% of the lesson.

By applying these skills and knowledge in the actual care of patients in the hospital, this
would be further reinforced by additional practice and review of the principles and procedures
and the extra care and caution in their application and performance resulting to 90% retention.
2. Actively involve the patients or clients in the learning process
 Use more interactive methods involving the participation of the learners like role- playing, buzz
sessions, Q & A format, case studies, small group discussion, demonstration and return
demonstration.

3. Provide an environment conductive to learning

 Always consider the comfort and convenience of the learner room temperature, the chairs and
seating arrangements or space, noise level, adequate acoustics and sound system, and an
environment that is clean, pleasant- smelling and smoke and dust-free.

4. Assess the extent to which the learner is ready to learn

 Readiness to learn is affected by factors like emotional status(anxiety fear and depression) and
physical conditions ( pain, visual or auditory impairment, anesthesia, etc.)

5. Determine the relevance of the information

Anything that is perceived by the learner to be important or useful will be easier to learn and
retain.

6. Repeat the Information

 Continuous repetition of information over a period of time enhances learning; applying the
information to a different situation or rewording it and giving practical applications will help in
the learning process.

7. Generalize Information
 Cite applications of the information to a number of applications or situation.
 Give examples which will illustrate or concretize the concept.

8. Make learning a pleasant experience

 Give frequent encouragement, recognize accomplishments and give positive feedbacks.

9. Begin with what is known; move toward the unknown

 A pleasant and encouraging learning experience if information is presented in an organized
manner and with information that the learner already knows or is familiar with.

10. Present information at an appropriate rate

 This refers to the pace in which information is presented to the learner are you talking too fast
so that the learner has a difficulty in catching up with what you are saying or are you too slow
because the learner is already knowledgeable about the topic you are discussing?

 What helps ensure that learning becomes relatively permanent?

a) By organizing the learning experience so that it becomes meaningful and
pleasurable; and by presenting the information at the learner’s pace to ensure
effective and efficient processing of information.
b) Practicing and rehearsing new information mentally or physically to retain and
strengthen learning;
c) Applying reinforcement through rewards or recognition to make the learner
know the learning occurred;
d) Assessing or evaluating whether learning has taken place immediately after the
experience or some later point in time. An evaluation feedback can be used to
revise, modify, revitalize, or revamp the learning experiences.

 LEARNING THEORIES
 A learning theory is a coherent framework and set of integrated constructs and
principles that describe, explain or motivates people to learn, how learning
 occurs, and what motivates people to learn and change.( Bigge and Shermis,
1992; Hilgard and bower, 1996; Hill 1990)
 Learning theories, teaching and learning techniques and strategies based on
scientific studies and principles and assessment and evaluation techniques have
been given more emphasis i what is now the trend of “ mentoring the mentor”
or “training the trainer”.

 EDUCATIONAL PSYCHOLOGY AS BEING RESEARCH- BASE

 The start of the twentieth century saw the emergence of a new field known as
Educational Psychology which became the catalyst for the scientific study of
teaching, learning and assessment (Berliner and Calfee, 1996; Gage and Berliner,
1998; Woolfolk 2001). As such, it is concerned are used to test theories and
hypotheses about learning.
 WHY THE HEALTH PROFESSIONAL NEEDS TO KNOW THE NATURE OF THE LEARNER
 Learning theories put together concepts and propositions t explain “ why people
learn and predict under what circumstances they will learn” (de Young, 2003)
 There is no single theory that can be considered as the best answer to these
questions. The definition of learning generally depends on the perspective of the
learning theory that is being used.

CONTRIBUTIONS OF LEARNING THEORIES

1. Learning theories have helped us understand the process of teaching and learning or
how individuals acquire knowledge and change the way they think, feel, and behave.
2. In the practice of healthcare, these theories have helped the health professionals to
employ sound methods and rationales in their health education efforts involving
patients/ clients, staff training and education and in carrying out continuing health
education and promotion programs.

Basic principles involved in the development and maturation of the individual, the health
professional needs to know. 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 of death (from womb to womb). It is the
scientific study of the changes that occur in people as they age or grow older in years. These
changes may entail:

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

As the person grows and develops, two major processes take place which are:

1. Learning- any relatively permanent change in behaviour brought about through

experience
2. Maturation- bodily changes which are primarily a result of heredity or the traits that a
person inherits from his parents which are genetically determined. Pre-programmed
inherited biological patterns are reflected in maturation.
THE MAJOR LEARNING THEORIES THAT ARE WIDELY USED IN PATIENT EDUCATION AND
HEALTH CARE PRACTICE ARE:

a. Behaviorist
b. Cognitive
c. Social learning

I. BEHAVIORIST THEORIES OF LEARNING (John B. Watson)

 is the proponent of behaviourist theory which emphasizes the importance of
observable behaviour in the study of human beings.
 He defined behaviour as muscle movement and it came to be associated with the
Stimulus- Response psychology.
 He postulated that behaviour results from a series of conditioned reflexes and that all
emotions and thoughts are a product of behaviour learned conditioning (de Young,
2003.
 Learning, then is a result of the conditions or stimuli (S) in the environment and the
learner’s response (R) that follow. This known as the S-R model of learning or the
stimulus- response theory.
 Behavioural scientist usually observe the responses and then change (Hilgard and
Bower, 1996; Bigge and Shermis, 1992; Hill, 1990)
 To bring about the intended change in the attitudes and responses of the subject, some
stimuli in he environment are altered or the effects or consequences of a response is
change.
 Motivation to change is brought about by the desire to reduce some drive or DRIVE-
REDUCTION
Consequence: Satisfied, complacent or satiated individuals have little motivation to
change and learn.
 For this behaviour to be applied or transferred from the initial learning situation to
other settings or circumstances is possible through practice or formation of habits.

BEHAVIORAL LEARNING

 Is based on respondent conditioning and operant conditioning procedures.

1. RESPONDENT CONDITIONING

A. Classical or Pavlovian conditioning

 a process which influences the acquisition of new responses to environmental

stimuli:
 a neutral stimuli(NS) elicits an unconditional response (UCR) through repeated
pairings with an unconditioned stimulus (UCS). A neutral stimulus (NS) is a stimulus
that has no particular value, significance or meaning to the learner. When the NS is
repeatedly paired with the unconditioned stimulus(UCS) and the unconditioned
response (UCR), there comes a time when the NS, even without the UCS, elicit the
same UCR.
SITUATIONAL ILLUSTRATION:

Cecilia Belle, a pretty and lively three- year old, accidentally touched the flame (NS) of
the candle. She felt intense pain (UCS) and quickly withdrew her hand (UCR). Two days later,
the same experienced happened and part of her finger was burned. Consequently, the flame of
the candle (NS) came to be associated with the pain (UCS) that, even in its absence, just the
sight of the flame makes her withdraw her hand. Hence, the neutral stimulus (NS), which is the
flame, has now become the conditioned stimulus (CS) and the automatic withdrawal of her
hand has become the learned response.

- Principles of respondent conditioning may also be used to extinguishing a previously

learned response:
- Learned responses may eventually be unlearned if the occurrence of a CS is not
accompanied by the UCS for a long period of time or interval.

2. Systematic desensitization
 Is another technique based on respodent conditioning which is widely used in psychology
and even in medicine to reduce fear and anxiety in the patient (Wolpe, 1982)
 This is based on the principle that repeated and gradual exposure to fear- inducing
stimulus under relaxed and non- threatening circumstances will give the patient that
sense of security that no harm will come so that he or she no longer fears the stimulus.
 This is also a stress- reducing strategy that is adapted to help preoperative patients,
rehabilitating drug addict and tension j=headaches and phobias, among others(Bastable,
2003)

3. Stimulus generalization
 Is the tendency to apply to other similar stimuli what was initially learned.
 Discrimination learning develops later when varied experiences eventually enable the
individual to differentiate among similar stimuli.
 Discrimination learning is often involved in professional education and clinical practice.

4. Spontaneous recovery
 Is usually applied in relapse prevention programs (rpp) and may explain why it is quite difficult
to completely eliminate “unhealthy habits and addictive behaviour” (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.

B. OPERANT CONDITIONING
 Developed by B.F. Skinner which focuses on the behaviour of the organism and the
reinforcement that follows after the response ( Alberto & Troutman, 1990).

Reinforcements are events that strengthen responses. It is one of the most powerful
tools or procedures used in teaching and it is the most condition for most learning to
take place. Its beginnings are traced back to Thorndike’s Law of Effect (1911) which
states that:

1. Of several responses made to the same situation, those which are accompanied or
closely followed by satisfaction will, other things being equal, be more firmly connected
with the situation so that when the situation recurs, these responses will be more likely
to recur;
2. Those responses which are accompanied or closely followed by discomfort will, other
things being equal, have their connections with that situation weakened, so that when
the situation recurs, the response will be less likely to recur.
 3. A reinforcer is a stimulus or event that is given, applied or elicited after a response to
strengthen or reinforce the possibility that the response will be repeated.
4. When specific responses are reinforced on a proper schedule, the behaviour can be
increased or decreased.
Example: The child who is given a positive reinforcement like a reward or praise every
time he/ she excels in school will be encourage or motivated to maintain this behaviour.

 STUDIES IN POSITIVE REINFORCEMENT BY VERPLANCK (1955 A0 REVEAL THAT):

1. In verbalization of opinions: each time the students says” i believe” or “ I think that”
and the experiments would reinforce these by saying “YOU’RE RIGHT” or “ I agree with
you “, or they would smile or nod, the students would volunteer their opinions more
readily.
2. When reinforcers were withdrawn and the answers were ignored or statement like “
I certainly disagree with you on that” the number of opinion statements by the students
sharply declined. Anderson, White and Wash ( 1966) conducted studies related to acts
of praising vs. Reproof:
a. HYPOTHESES:
H1 Praised students will perform better than reproved students.
H2 Reproved low achievers and praised high achievers will perform better than
praised low achievers and reproved high achievers.
b. SUBJECT OF THE STUDY:
University students enrolled in a course in educational psychology.
Testing and evaluation: an objective test of the subject matter was given as
criterion test and an objective test in mathematics was given to determine if
behavio rs would be transferred to a different subject area.
c. RESULT OF THE STUDY:
There was greater achievement increment in performance affecting educational
psychology and mathematics using praise rather than reproof with both the low
achieving and the high achieving students.
 APPLICATION TO HEALTHCARE/ IMPLICATIONS OF THE STUDY
1. Praise may assist in the transfer of learning from one area to another.
2. Learning under the control of reward is usually preferable to learning under the
control of punishment (Hilgard, 1956).
 WAYS OF EMPLOYING POSITIVE REINFORCEMENT:

1. Verbal ways
A. Saying praise words or phrase like ”good”, “well-done” when the students responds.
B. Statement like “That was a well- expressed opinion” or “I like the way you answered
the question of the patient’s mother” are morale- boosters.
C. Requesting the student to share his success story with his classmates. This gives
recognition to the students and increases level of prestige with his classmate

2. Non- verbal ways like nodding, smiling, looking pleased, writing student’s comments
on the board, and giving the “thumbs up” sign specially were group work is concern.

3. Citing in class or publishing. On the bulletin board exceptional works or outputs

 Classification of Educationaal Rainforcers (Tosti and Addison 1979):
1. Recognition-includes
 Praise, certification of accomplishments
 Formal acknowledgements (awards, letters of recommendation, testimonials
  Informal acknowledgements (private conversations, “pat” on the back

2. Tangible rewards-Grades, food (free lunch), prizes, certificates of appreciation or

citations

3. Learning activities-Opportunity for desirable enrichment assignment like

membership in “ honors” class, more interesting or more difficult clinical assignments.

4. School Responsibilities –
a. Opportunities for increased self- management and more participation in decision-
making
b. Acceptance of suggestions for improving the curriculum
c. Greater opportunity for selecting own goals for learning experiences.
d. Greater opportunity to control own schedule and set own priorities.

5. Status Indicators
a. Appointment as a peer tutor
b. Having own space( study corner, desk)

6. Incentive feedback
a. Increased knowledge of examination scores
b. Knowledge of individual contributions (helping others)

7. Personal activities
a. Opportunity to engage in special projects
b. Extra time off

Note: Remember that reinforcement should be appropriate or directly linked to the learning tasks and
student’s accomplishments. Its indiscriminate use may result to happy student but not to productive
students (Totsi and Addispn, 1979). Negative reinforcement is tantamount or synonymous to
punishment. Behaviours may be decreased through:
1. Nonreinforcement by ignoring the behaviour, (whether it is desirable or undesirable)
2. Or applying punishment immediately after the response and must be consistent and at
the highest “reasonable level. Cardinal rule of Operant conditioning is to punish the
behaviour, not the person”.

II. COGNITIVE THEORIES OF LEARNING

 Cognition is more than knowledge acquisition. It stresses that mental processes or
cognition occurs between the stimulus (S) and the response(R).
1. The learners goals and expectations are more important and the tension,
disequilibrium and imbalance that they cause which will act as their motivators.
2. Transfer of learning occurs when the learner mediates or ‘acts on” the information
he/ she gets or applies it in certain situations.
3. It involves intelligence which is the ability to solve problems or fashion products that
are valued in more than one setting.
4. It stresses the importance of “what goes on inside the learner” which involves the
individual’s cognitive processes of perception, thinking skills, memory, and ways of
processing and structuring information.(Palinscar, 1998) like:
 Perceiving the information;
  Interpreting it based on what is already known, and finally,
 Recognizing the information to come up with new insights or understanding.

 PERSPECTIVES OF THE COGNITIVE LEARNING THEORY (Bastable, 2003)

A. GESTALT- refers to the configuration or patterned organization of cognitive elements

reflecting the maxim that the “whole is greater than the sum of its parts”.

 The Gestalt perspective emphasizes the importance of perception in learning which

focuses on the configuration or organization of a pattern or stimulus. Look the figure
below.
What do you see? Are you seeing the figure or the background? what did you see
first …a young lady or an old woman? Which was easier to recognize the young lady
or the old woman?

 Some principles of Gestalt which are related to healthcare:

1. Psychological organization is directed toward simplicity, equilibrium and regularity.
Example: Give the patient a clear and simple explanation of his diseased condition to
allay his fears and uncertainties.
2. Perception is selective which means that no one can attend or pay attention to all the
surrounding stimuli at the same time. An individual normally orients himself/ herself to
particular stimuli and screens out other stimuli which is similar to fine-tuning of
perception.
3. What individuals pay attention to or what they ignore may be affected by factors like
needs, personal motives, past experiences and the particular structure of the stimulus
or situation.
Example: a patient who is in pain or is worried about the payment of his/her hospital
bills may give very little attention to the health teachings that the nurse is giving
because at the moment, that is not his/ her primary consideration.

 IMPLICATIONS TO HEALTH CARE

Knowledge of this Gestalt principle will help the health educator on how he/ she
approaches any learning situation with an individual or group. One approach may be effective
to a particular clients or group but may not work with another. Because individuals vary or differ
from one another, the way they perceive, interpret and respond to the same event may be in
different ways and manner.

B. INFORMATION PROCESSING- is a cognitive perspective that emphasizes the thinking

processes like:
1. Thought
2. Reasoning
3. The way information is encountered and stored
4. Memory functioning

This perspective is particularly useful for assessing problems in acquiring, remembering

and recalling information.

 Stages in the memory process:

 1. 1st stage: involves paying attention to the environmental stimuli; Attention is the key to
learning. Knowing this principles will help the health professionals to avoid some pitfalls or
difficulties when giving health teachings.

Example: A mother who is experiencing intense pain from her operation will not be able
to pay attention to the nurse who is demonstrating the proper positioning for successful
nipple latching. Her attention will be focused on the pain since this is the stronger and
more dominant stimulus.

 2nd stage: the information is processed by the senses. The client’s preferred mode of
sensory processing which may be visual, auditory or motor manipulation must be
considered by the health educator.

 3rd stage: the information is transformed and incorporated or encoded briefly into short
term memory and later may be disregarded or forgotten or stored in long-term memory
by using strategies for storage like imagery, association, rehearsal, chunking( breaking
the information into smaller units or chunks).

 4th stage: involves the action or response that the individual makes on the basis of how
the information was processed and stored.

C. COGNITIVE DEVELOPMENT is third perspective that focuses on qualitative changes in

perceiving, thinking and reasoning as individuals mature grow and mature (Baltes et al, 1999).

 Jean Piaget is the best- known cognitive developmental theorist. By watching, listening,
and hearing children ask questions, Piaget found out children’s perceptions at different
ages and he identified four sequential stages of cognitive development.

 PIAGET’S FOUR MAJOR PERIODS OF COGNITIVE OR INTELLECTUAL DEVELOPMENT

1. Sensorimotor stage: birth up to 2 years old. This is determined basically on actual
perception of the senses and the external or physical factors. Children think due to
coordination of sensory input and motor responses.
 Intelligence is non-verbal or non-symbolic because the child has not developed language
yet.
 How learning takes place depends on what is experienced in the beginning which can be
learned through visual pursuits.
 This will later be known as “object permanence “ what and where it is seen for the first
time will still exist even though it disappears.
 It marks the development of memory of the nursing object who is usually the mother.

2. Abstract thinking: represents reality using symbols that can be manipulated mentally.
Ex: symbolism in bible stories; use of X in algebraic expressions.
- Logical thinking is more systematic; uses scientific method
3. In formal operation, “perspective thought” or relativism is formed which is a new
perspective of other people possessing varied thinking on the same stimulus or
situation. There is awareness on different views rather than on one single thought.
 It recognizes individual differences and that “No two individuals are alike”.
 4. Assimilation and accommodation characterized by hypothesis testing before making
conclusions, things must be tested with logical pieces of evidence in search of truth.
 Being “teenagers” at this stage, they have their “own mind, known as metacognition
(self-reflection) wherein ideas and imaginations are tried out to be aware of existing
realities; also known as internal dialogue.
 “Experiencing is the best teacher” where self- correction in solving problems is applied.
 Understand that “No two individuals are alike”

III. SOCIAL LEARNING THEORIES

1. Emphasize the importance of environmental or situational determinants of behaviour
and their continuing interaction. Reciprocal determinism by Albert Bandura states that
“environmental conditions shape behaviour through learning and the person’s
behaviour, in return, shapes the environment.”
2. Further believes that behaviour need not be performed and reinforced for learning to
occur.
 Modelling or observational learning occurs vicariously, even in infants, where the
individual learns of the consequences of a behaviour by observing another person
undergoing the experience.

 FOUR OPERATIONS INVOLVED IN MODELING ARE:

1. ATTENTION PROCESSES
- 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 PRODUCTION PROCESSES
- Determine what behaviour can performed
4. MOTIVATIONAL AND REINFORCEMENT PROCESSES
- Determine the circumstances under which learning is translated into performances.

 HOW BEHAVIOR OCCURS (BANDURA):

 There are 3 interrelated determinants of behaviour which are antecedents,
consequences, and cognitive factors:
 Behaviour is based on the past (antecedents) as we have seen it, but it is also influenced
by its results (consequences) and how we are motivated (cognitive factors).
 The social learning theory of personality development by Bandura assumes that all
actual behaviour patterns must be learned through traditional learning (by
reinforcement) and observational learning (by modelling). It emphasizes the role of
modelling and other types of learning with no direct rewards or reinforcements.
Instead, behavioural is shaped by people’s expectations. These expectations are formed
from experience and by watching other persons.
 The social learning theory approach to personality focuses directly on a person’s behaviour
(what did he do?) and not on his motives. A relatively enduring quality or characteristics is called
a trait. Instead of traits, Walker Mischel (1993) dealt with cognitive variables like:
a. Competencies which refer to various skills like intellectual; abilities, social and
physical skills like and other special abilities.
b. Encoding strategies and personal constructs-experiences that are retained and
categorized by the individual
 Example: being asked to sing in a big gathering may be perceived by a person as a
welcomed opportunity to show off his talent in singing but may be seen by another
as a threat to his or her ego.
c. Subjective values-what a person considers as worth having or accomplishing
Example: a student may perform ingratiating tactics like giving food to the teacher
just so her or she can pass the course. Another student may also do the same but
his/her purpose is for the teacher to make him or her number one in class.
d. Self-regulating systems or plans- people have different standards and rules for
regulating their behaviour ( like self-imposed rewards for successful behaviour or
punishment for failures) including their plans for reaching his or her goals.

 LEARNING STYLES

Learning styles are ways in which an individual processes information or different

approaches or methods of learning.

 The habitual manner in which learners receive and perceive information, process it,
understand it, value it, store it and recall it (de Young 2003).
 It involves affective, psychomotor and cognitive styles.

Benefit of knowing the learning styles of students:

1. The teacher can intervene once the learner experiences difficulty by adapting
techniques or strategies that are suited to the student’s learning style.
2. Enhancement of effective learning by improving on the teaching strategies and the
instructional materials that are used.
 BASIC CONCEPTS OF COGNITIVE STYLE
1. Holistic Vs. Analytic thinking
 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,
 They look at the broad categories first before going into details; they think deductively.
 Analytic thinkers- think logically and objectively, looking at the details first

2. Verbal Vs. Visual representation

 People with verbal approach represent in their minds what they read, see or hear as in
terms of words or verbal associations.
 People with visual approach experience in their minds what they read, see or hear as
mental pictures or images.

Nobody is a purely holistic thinker or a totally verbal or visual learner but they weave or
blend together as shown in the following models.

 LEARNING STYLE MODELS

Two of the most commonly used learning style models that are frequently used in
Nursing are David Kolb’s Cycle of learning (1984) and Anthony Gregorc’s Cognitive Styles model
(1982).

I. KOLB’S MODEL, also known as the Cycle of Learning, believes that the learner is not
a blank slate unlike the theory of tabula rasa by John Locke but that the learner
 already has pre-convinced or predetermined ideas. According to Kolb, learning is a
continuous process which is a cumulative result of previous or past experiences,
hereditary and interaction with the environment.

IMPACT OF KOLB’S LEARNING STYLE ON THE EDUCATOR:

Knowing the learner’s preferred learning style will enable the teacher to assist the
learner in modifying, refining or even changing these preconceived ideas so that real or
better learning can occur.

Kolb’s Theory of Experiential learning- depicts a 4- stage cycle or four modes of learning
which reflects two major dimensions of perceptions or awareness of stimuli and processing
or dealing with the information.

Kolb describes each learning style as a combination of four basic learning modes which
are:

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

 Four Learning styles and their corresponding characteristics where one style type will
be predominantly manifested by the learner(Kolb):
1. Converger: learner by AC and AE: good at decision-making problem solving and
prefers dealing with technical work than interpersonal relationship; uses deductive
reasoning to solve problems; uses facts and data and has skills for technology and
specialist careers.
learning Methods : learns best through demonstration return demonstration
method assisted by hand outs, diagrams, charts, illustrations
2. Diverger: stresses CE and RO: people and feeling- oriented and likes to work in
groups;
Learning Methods: learns best through group discussions and brain storming
sessions,; considers different perspective and points of view when looking at a
concrete situation or experience.
3. Accommodator: relies heavily on CE and AE : impatient with other people; a risk-
taker, often using trial and error methods of solving problems; acts more on
intuition, instinct or gut feeling rather than on logic; an achiever;
Learning Methods: enjoys role- playing, gaming and computer simulations.
 These learners are the most challenging to educators because they learn best
through new and exciting learning experiences and are not afraid of taking
risks which may sometimes endanger their safety.
4. Assimilator: emphasizes AC and RO : more concerned with abstract ideas than
people; very good in inductive reasoning, creating theoretical models, and
integrating ideas and actively applying them; uses logical thinking.
Learning Methods: they learn best through lectures, one- to- one instruction, and
self- instruction methods with ample reading materials. I
 IMPLICATIONS:
 By using different teaching strategies that suited to these four learning styles, a match or
fit can be created by the teacher in relation to the methods of teaching that will be used where, for
every group of learners 25% will fall into each of the four categories. Using only one method, like
lecture method, will selectively exclude 75% of all the learners in that particular class.
When teaching group of learners, instruction should begin with activities suited to the:

1. Divergent thinker (group discussions and brainstorming session);

2. And progress sequentially to activities for assimilator (lectures, one- to –one instruction,
and self- instruction methods with ample reading materials);
3. Converger (demonstration- return demonstration methods assisted by hand-outs,
diagram, charts, illustration);
4. Accommodator (enjoys role- playing, gaming, and computer simulation) in that order
(Arnt and Underwood, 1990)

Based on the above mentioned:

A. What kind of thinker are you?
B. What learning style/s will best suit your needs?

 GARDNER’S SEVEN TYPES OF INTELLIGENCE

(a theory specific to children’s learning styles)

The theory of multiple intelligence (Gardner) states that there are various type of talent or
seven forms of intelligence which may all be full developed in a gifted child but on the average,
about three to four types may be possessed or developed by an individual or child. All learners
have all the seven kinds of intelligence but in different proportions (Bastable, 2003). Another
fact of intelligence is termed as Naturalist which refers to flora and fauna, has a green thumb,
enjoys pets, enjoy nature, classifies species, discriminates among plants and animals, concern
for environment. These are presented below:

TYPES OF INTELLIGENCE DOMAIN OF DESCRIPTION FACETS OF

INTELLIGENCE AND INTELLIGENCE
AREA OF THE BRAIN (features, aspects, or
characteristics of
intelligence
1. Verbal/ linguistic Reading, writing, Deals with written Understanding the
speaking and spoken words or order and meaning
-found in broca’s language; the use of words; convincing
area in left side of and meaning of someone, verbal
brain language(s) debate; explaining in
words, teaching;
telling or enjoying
verbal joke; creative
writing and
appreciation poetry.
2. Logical/ Calculations, Refers to inductive Pattern recognition,
mathematical problem solving, and deductive making predictions,
logical reasoning and reasoning; estimating using
analysis statistics. abstraction and inductive and
-involves both sides discernment of deductive reasoning,
of the brain numerical patterns; discerning
relationships and
connections,
 performing complex
calculation, scientific
reasoning, performs
experiments, seeking
explanation,
categorizing
information,
computer
programming
3. Spatial/ visual Arts, craft, maps, Involves the ability Recognizing
geometry, design visualize an object or relationships of
-right side of the to create internal or object in space,
brain mental images; sense of direction,
forming and routing finding your way
mental images around, drawing,
painting, sculpting;
color discrimination,
visual perspective
taking, active
imagination
4. Musical/ Appreciation, vocal, Sensitivity to rhythm Understanding
rhythmic instrumental, and beat, recognition structure of music,
composition, rhythm of tonal patterns and creating melodies/
-found in right side pitch, and rhythms, sensing
of brain appreciation of qualities of a tone,
musical expression; playing an
instrument,
repeating a tune,
recognizing
composers.
5. Bodily Athletics, dance, Taking in and Hand- eye
kinesthetic acting, manual, processing of coordination,
dexterity, exercise knowledge through mimetic (imitating or
-basal ganglia and the use of bodily impersoning)
cerebellum and sensation; learning is abilities, speed,
other structures. accomplished agility and strength;
through the use of endurance, working
body language or with tools, need for
physical movement; constant movement
or exercise
6. Interpersonal Community service, Emphasis on Verbal/ non-verbal
intelligence role-playing, conflict, communication and communications,
resolution, interpersonal discerning underlying
leadership, relationships intentons, behaviour
teamwork & perspective,
-prefrontal lobe empathy, working
cooperatively
sensitivity to other’s
moods, motives and
feelings, leading
others, making &
keeping friends
7. Intrapersonal Journaling, personal Related to inner Accurate self-
 intelligence assessments, thought processes perception, self-
reflections, goal such as reflection reflective, self-
setting, progress and metacognition; directed, sense of
report includes spiritual values, intuitive,
-prefrontal lobe awareness/ independent,
development and awareness and
self- knowledge. expression of
feelings.

Summary:

This module dealt with the tools of trade that an educator must possess namely the
theories and principles of teaching and learning. Knowing the learning needs of the clients as
well as their learning styles is of primary importance in the planning, implementation and
evaluation of the health education programs. It also guides the educator in the journey
towards the attainment of healthy community through healthy lifestyles.

Post assessment

Modified TRUE or FALSE. Write True if the statement is correct and if the statement is False
underline the word/s that make the statement wrong and write the correct word/s on the
blank provided.
_________________1. Learners have the same learning styles.
_________________2. Reading has the highest retention of what has been learned.
_________________3. Emotional status affects readiness to learn
_________________4. Learning theories explain why people learn and predict what they will
learn.
_________________5. Development is a dynamic process that involves sudden changes in
character.
_________________6. Reinforcement are events that weaken responses.
_________________7. Reflective observation is from actual experience.
_________________8. Active experimentation learning style involve creating theories to
explain what is seen.
_________________9. Piaget’s sensorimotor development occurs during adulthood.
_________________10. The social learning theory believes that behaviour should be
performed and reinforced for learning to occur.

Learning Evaluation

I. Learning styles are ways in which an individual perceives, processes, understands, stores, and
recalls information. These are :

A. Accommodator B. assimilator C. converger D. Diverger

A. Write the letter of the learning style that correctly describes the situation on the space
provided.

_____1. Jake is a person who likes dealing with technical work and learns best through
demonstration and return- demonstration, the use of charts, diagrams, and illustrations.
_____2. Yna is often called an extrovert because she enjoys working with others in a group and
is often considerate of the feelings and opinions of others. She learns best through
brainstorming and group discussion.

_____3. Cathy learns best through role- playing and using computer games and simulation.

_____4. Rey is often called “the great thinker” because he would often argue with his
classmates using inductive reasoning and theories which would support his arguments. He also
reads a lot of books.

_____5. It is a learning style that is a combination of Active Experimentation (AE) OR “DOING”

and Concrete Experience (CE) or “feeling”.

B. Write the letter of the correct answer.

Gadner’s Theory of multiple intelligence identified 7 types of talents or intelligences.

A. Spatial/visual C. Linguistic E. Bodily kinesthetic G. Interpersonal

B. Musical/ rhythmic D. Intrapersonal F. Logical /Mathematical

_____1. Lina is a very accomplished pianist at the age of 12. He started playing the piano when
he was 4 years old. What type of intelligence is this?

_____2. Christine is very talented ballet dancer and wushu player. This type of talent is :

_____3. Danielle Steele is a very prolific writer of several books of fiction. This type of
intelligence is :

_____4. Being able to visualize the placement of furniture and accessories to attain harmony
and beauty is categorized under what type of talent or intelligence?

_____5. Being able to discern or recognize numerical patterns involves the type of intelligence
which is known as ?

C. Based on the Experience Cone, write the letter of the correct answer.

A. 10% B. 20% C. 30% D. 50% E. 70% F. 90%

_____1. Watching the procedure of preparing herbal plants allows the learner to remember
what percentage of the subject matter or experience?

_____2. You are asked to make a teaching plan of the topic that you will be presenting in class.
The percentage of learning will be

_____3. Role playing the dilemma of a drug addict helps the student remember

_____4. When the clinical instructor demonstrates a procedure, how much does the student
remember?

_____5. Performing the return demonstration helps the student remember

_____6. In listening to a taped lecture, the student tend to remember

_____7. As a nurse educator conducting health education classes among a group of no read, no
write peasants, what percentage of your teachings will be remembered if you ask them to
actually perform the proper way of washing their hands after using pesticides?

_____8. The chart of human anatomy will help the learner remember what percentage of the
lesson?

Choices for numbers 9 and 10

A. Verbal receiving B. Receiving and participating C. Visual receiving D. Doing

_____9. By injecting vitamin K intramuscularly in the vastus lateralis of a new born, a student
nurse’s level of involvement is in

_____10. The level of involvement when one takes an active role in a discussion is

D. Answer the questions properly. (10 points each)

1. Identify and explain Piaget’s cognitive or intellectual development.

2 . Write a reflective essay on the 3 major learning theories that are widely used in patient education
and health care practices.

Lifted from:

Castro , Cecilia Estrada. Health Education For Nursing And other Allied Professions (With Teaching
Strategies and Principles of Teaching and Learning), Educational Publishing House, 2009 First Edition

Corpuz,Brenda B. PhD et. Al., The Child and Adolescent Learners and learning Principles, Published by
Lorimar Publishing Inc. @ 2018

Marquez, Ramil M. Health Education . BOOK ATBP.PUBLISHING CORP. ©2016

 SAINT TONIS COLLEGE, INC.
Formerly: Kalinga Christian Learning Center
Bulanao, Tabuk City, Kalinga
Philippines

COLLEGE OF NURSING

Course Title : HEALTH EDUCATION

Course Code : NCM 102

Module No. : 3

Course Content : PRINCIPLES OF TEACHING AND LEARNING RELATED TO HEALTH

Learning Outcomes :

At the end of the module the students will be able to:

1. Distinguish the different theories and strategies used in health education across the lifespan.

Introduction :

In this module the students as health educators in the future will learn the characteristics of
learners with respect to their developmental stage in life. An individual’s developmental stage
significantly influences the ability to learn and the appropriate teaching strategies to be used
across the lifespan.

Pre assessment

True or False. Write Tue if the statement is correct and False if the statement is wrong on the
blank provided before the number.

___________1. Development is either growth or decline.

___________2. Adolescence is middle and late childhood stage.

___________3. Play is a great need of children in early childhood.

___________4. The most rapid physical changes occurs in infancy to toddlerhood stage of
development.

___________5. Cognitive processes involves changes in the individual’s relationships with other
people, changes in emotions and changes in personality.

___________6. Learning is ineffective when differences in learners’ linguistic, cultural and

social backgrounds are taken into account.

___________7. Adolescence use peers for support and influence.

___________8. The body is in its optimal functioning capacity during young adulthood.
___________9. Older adulthood focus on past life experiences.

___________10. The individual is at in peak in career during middle-aged adulthood.

Learning Discussion

Developmental Stages of Learners Across the Lifespan

Musinski (1999) describes three phases of learning: dependence, independence

and interdependence. These passages of learning ability from childhood to adulthood, labelled
by Covey (1990) as the “maturity continuum”, are identified as follows:
A. Dependence – is characteristic of the infant and young child, who are totally dependent to
others for direction, support, and nurturance from a physical, emotional, and intellectual
standpoint (unfortunately, some adults are considered to be stuck in this stage if they
demonstrate manipulative behaviour, do not listen, are insecure, or do not accept responsibility
for their own actions).

2. Independence – occurs when a child develops the ability to physically, intellectually, and
emotionally care for himself and make his own choices, including taking responsibility learning.

3. Interdependence – occurs when an individual has advanced in maturity to achieve self-

reliance, a sense of self-esteem, the ability to give and receive, and when that individual
demonstrates a level of respect for others. Full physical maturity does not guarantee
simultaneous emotional and intellectual maturity.

 INFANCY (First 12 Months)– Toddlerhood (Birth -1-2 years)

General Characteristics : Physical, Cognitive and Psychosocial Development

 Physical maturation so rapid during the period of development from infancy to

toddlerhood
 Dependent on environment, explores self and environment
 Needs security
 Natural curiosity
 Cognitve development is sensorimotor (Piaget) – this period refers to coordination and
integration or motor activities with sensory perceptions.
 As children mature from infancy to toddlerhood, learning is enhanced through sensory
experiences, movements and manipulation of objects.
 The toddler has the capacity for basic reasoning, understands object permanence, has
the beginning of memory
 Have short attention span, easily distracted, egocentric in their thinking and are not
amenable to correction of their own ideas.
 Asking question is the hallmark of this age, respond to simple step –by-step commands
and obey such directives as “kiss grandma, go get your teddy bear”
 Language skills are acquired rapidly during this period
 Psychosocial development is trust versus mistrust (Erikson) in the period of infancy.
during this time, children must work through their first major dilemma with their
primary care giver.
 As the infant matures to toodlerhood, autonomy versus shame and doubt emerges.
Here toddlers must learn to balance feelings of love and hate and learn to cooperate
and to learn control of wilful desires.

Suggested teaching strategies to convey information to members of this age group:

A. Short term learning

 Read simple stories from books with lots of pictures

 Use dolls and puppets to act out feelings and behaviors
 Use simple audiotapes with music and videotapes with cartoon character
 Role-play to bring to bring the child’s imagination closer to reality
 Give simple, concrete, nonthreatening explanations to accompany visual and tactile
experience
 Perform procedures on a teddy bear or doll first to help the child anticipate what an
experience will be like.
 Allow the child something to do –squeeze your hand, hold a band-aid, cry if it hurts – to
channel their responses to unpleasant experience.
 Keep teachings brief no longer than 5 minutes because of the child’s short attention
span.
 Avoid analogies and explain things straightforward and simple terms
 Cluster teaching sessions close together so that children can remember what they have
learned from one instructional encounter to another
 Individualize the pace of teaching to the child’s responses and level of attention

B. Long term learning

 Focus on rituals, imitation, and repetition of information in the form of words and
actions to hold the child’s attention.
 Use reinforcement as an opportunity for children to achieve permanence of learning
through practice.
 Employ teaching methods of gaming and modelling as a means by which children can
learn about the world and test their ideas over time. Stimulate all senses.
 Encourage parents to act as role models because their values and beliefs serve to
reinforce healthy behaviors and significantly influence the child’s development of
attitudes and behaviors.
 Orient teaching to caregiver usually less time for illness care and considerably more
time for aspects of normal development, safety, health promotion and disease
prevention. When the child is ill, assess caregivers’ and child’s anxiety levels and help
them cope with their feelings of stress related to anxiety and guilt about the cause of
the illness. Anxiety on the part of the child and caregiver adversely affect their readiness
to learn. Teaching activities are primarily directed to the main caregiver, older toddler
should not be excluded from healthcare teaching and can participate to some extent in
the educational process.
 Provide physical safety and emotional security

 EARLY CHILDHOOD (3 – 5 years)

General characteristics- Physical, Cognitive and Psychosocial

 Physical maturation during early childhood is an extension of the child’s prior growth.
 Fine and motor skills become increasingly more refined and coordinated so that children
can carry out activities of daily living with greater independence.
 Cognitive development (Piaget) is preoperational period. This stage emphasizes the
child’s ability to think things out through logically without acting it out and is the
transitional period when the child starts to use symbols (letters and numbers) to
represent something.
 Begin to develop the capacity to recall past experiences and anticipate future events
  Continues to be egocentric- essentially unaware of other’s thought or the existence of
others point of view.
 Thinking remains literal and concrete – they believe what is seen and heard. Precausal
thinking allows young children to understand that people can make things happen, but
they are unaware of causation as the result of invisible physical and mechanical forces.
 Believes illness self-caused and punitive. Their ideas regarding illness are primitive with
respect to cause and effect. Illness as seen as a punishment for something they did
wrong, either through omission or commission. Health on the other hand, may be
identified with doing things right.
 Limited sense of time. For children of this age, being to wait 15 minutes before they can
do something is too long. However, they do understand the timing of familiar events in
their lives, such as when breakfast and dinner is eaten or when they can play or watch
their favourite program television program.
 Fears bodily injury is the greatest threat in the preschool child, which significantly
affects his /her willingness to interact with health care personnel.
 Animistic thinking (objects possess life or human characteristics of an object).
 Mix fact and fiction, tend to generalize, think magically, develop imaginary playmates
and believe they can control events with their thoughts.
 Psychosocial maturation level (Erikson) is the period of iniative versus guilt.Children
take on tasks for the sake of being involved and on the move.
 Active imagination prone to fears - of separation, disapproval, pain, punishment and
aggression from others
 Appropriate social behaviour demands that they learn to wait for others, give others a
turn and recognize the needs of others.
 Play is his/her work – equally productive as adult work. It helps the child act out feelings
and experiences to master fears, develop role skills and express joys, sorrows and
hostilities

Teaching Strategies:

A. Short term learning

 Provide physical and visual stimuli because language ability is still limited, both for
expressing ideas and for comprehending verbal instructions
 Keep teaching sessions short no more than 15 minutes and schedules sequentially at
close interval so that information is not forgotten.
 Relate information needs to activities and experiences familiar to the child.
 Encourage the child to participate in selecting between a limited number of teaching-
learning options, such as playing with dolls or reading a story, which promotes active
involvement and helps to establish nurse-client rapport.
 Arrange small group sessions with peers as away to make teaching less threatening and
more fun.
 Give praise and approval, through verbal and nonverbal gestures, which are real
motivators fr learning.
 Give tangible rewards such as badges, small toys, immediately followinga successful
learning experience as reinforcers in the mastery of cognitive and psychomotor skills.
 Allow the child to manipulate equipment and play with replicas or dolls to learn about
body parts to provide hands on experience.
  Use story books to emphasize the humanity of healthcare personnel

B. Long term learning

 Enlist the help of parents, who plays a vital role in modelling a variety of healthy habits,
such as practicing safety measures and eating a balance diet.
 Reinforce positive health behaviour and acquisition of specific skills.

 MIDDLE AND LATE CHILDHOOD (6-12 year)

General characteristics Physical, Cognitive and Psychosocial

 Middle and late childhood, have progressed in their physical, cognitive and psychosocial
skills to the point where most begin formal training in structured school system.
 They approach learning with enthusiastic anticipation, and their minds are open to new
and varied ideas.
 They are motivated to learn because of their natural curiosity and their natural curiosity
and their desire to understand about themselves, their world and the influence that
different things in the world have on them.
 Motor abilities of school-aged are more coordinated
 Involvement in all kinds of curricular and extracurricular activities helps the refine their
psychomotor skills.
 Toward the end of this developmental period girls experience pre pubescent bodily
changes and tend to exceed the boys in physical maturation
 Cognitive development (Piaget) is concrete operation – during this time, logical rational
thought processes and the ability to reason inductively and deductively develop
 Children are more objective and are willing to listen to others
 They begin to use syllogistical reasoning- that is they can consider 2 premises and draw
conclusions from them.
 Understands seriousness and consequences of actions
 Shift from precausal to causal. The child begins to incorporate the idea that illness is
related to cause and effect and can recognize that germs create disease.
 The school environment in particular, facilitates their gaining a sense of responsibility
and reliability
 Psychosocial development (Erikson) is industry versus inferiority. During this period ,
children begin to gain awareness of establish self their unique talents and special
qualities that distinguished them from one another. They begin to establish self -
concept as members of a social group larger than their own nuclear family and start to
compare family values with those of the outside world.

Teaching Strategies

A. For Short- Term Learning

 Allow school-aged children to take responsibility for their own health care because they
are not only willing but also capable of manipulating equipment with accuracy. Because
of their adeptness in relation to manual dexterity, mathematical operations and logical
thought processes, they can be taught to calculate their own insulin or asthma inhaler.
  Teaching sessions can last as long as 30 minutes each because the increased cognitive
abilities of school-aged children in the retention of information.
 Use diagrams, models, pictures, videotapes printed materials, and computer adjuncts to
various teaching methods because an increased facility with language both written and
spoken as well with mathematical concepts allows for these children to work with more
complex instructional tools.
 Choose audiovisual and printed materials that show peers undergoing similar
procedures or facing similar situations.
 Clarify any scientific terminology and medical jargon used.
 Use analogies as an effective means of providing information in meaningful terms, such
as “Having a chest X-Ray is like having your picture taken” or “White blood cells are like
soldier cells that can attack and destroy infection”.
 Use one-to-one teaching sessions as a method to individualize learning relevant to the
child’s own experiences and as a means to interpret results of nursing interventions
particular to the child’s own condition.
 Provide time for clarification, validation and reinforcement of what is being learned.
 Select individual instructional techniques that provide opportunity for privacy, who
often feel quite self conscious and modest when learning about bodily functions
 Employ group teachings sessions with others of similar age and with similar needs to
avoid feelings of isolation.
 Prepare children for procedures in advance to allow them time to cope with their
feelings and fears, to anticipate events and to understand the what the purpose of each
procedure and how much time it will take.
 Encourage participation in planning for procedures and events because active
involvement will help the child to assimilate information more readily.
 Provide much–needed nurturance and support, always keeping in mind that young
children are not just small adults. Praise and rewards will help motivate and reinforce
learning.

B. For Long-Term Learning:

 Help school-aged children acquire skills that they can use to assume self-care
responsibility for carrying out therapeutic treatment regimen on an ongoing basis with
minimal assistance.
 Assist them in learning to maintain their own well-being and prevent illnesses from
occurring.

 ADOLESCENCE (12-19 years)

General Characteristics – Physical, Social and Psychosocial

 Marks the transition from childhood to adulthood.

 How adolescents think about themselves and the world significantly influences many
healthcare issues facing them from anorexia to diabetes.
 Known to be among the nation’s most at –risk populations
 For physical maturation, they must adapt to rapid, dramatic and significant bodily
changes, which can temporarily result in clumsiness and poorly coordinated movement.
  The aappearance and development of secondary sex characteristics, bring about a
significant preoccupation with their appearance and a strong desire to express sexual
urges.
 Cognitive development (Piaget) is formal operation.
 They are capable of abstract thought and complex logical reasoning described as
propositional opposed to syllogistic.
 Formal operational thought enables adolescents to conceptualize invisible processes
and make determination about what others say and how they behave.
 They are able to understand the concept of health and illness, the multiple causes of
diseases, the influence of variables on health status and the ideas associated with health
promotion and disease prevention. Parents and healthcare providers are their most
frequent sources of health-related information.
 They recognize that illness is a process resulting from dysfunction of a part/s of the body
and can comprehend, the outcomes or prognosis of an illness.
 They can identify health behaviors but may reject practicing them or begin to engage in
risk-taking behaviors because of social pressures they receive from peers as well as
their feeling of invincibility – second type of social of thinking as the personal fable,
leads adolescents to believe that they are invulnerable – other people grow old and die,
but not them, other people may not realize their personal ambitions, but they will.
 The psychosocial dilemma adolescents face as one of identity versus role confusion
(Erikson) – indulge in comparing their self-image with an ideal image. They struggle to
establish their own identity, match their skills with career choices, and determine their
self. They work to emancipate themselves from their parents, seeking independence
and autonomyso that they can emerge as more distinct individual personalities
 Teenagers have a strong need for belonging to a group, friendship, peer acceptance, and
peer support. Tend to rebel against any actions/recommendations by adults they
consider authoritarian.
 Their concern over personal appearance, need to look and act like their peers drive
them to conform to the dress and behaviour of this age group, which is usually
contradictory, nonconformist, and in opposition to the models, codes and values of their
parents’ generation.
 Conflict, toleration, stereotyping or alienation characterizes the relationship between
adolescents and their parents and other authority figures. They seek to develop new
trusting and trusting relationships outside the home but remain vulnerable to the
opinions of those they emulate.
 Adolescents demand personal space, control, privacy and confidentiality. To them,
illness, injury, and hospitalization means dependency, loss of identity, a change in body
image and functioning, bodily embarrassment, confinement, separation from peers and
possible death. Due to this many issues, the need for coping skills is profound and can
influence the successful completion of this stage of development.

Teaching Strategies:

 20% is estimated in United States teenagers have at least one srious health problems
such as asthma, learning disabilities, eating disorders (obesity, anorexia or bulimia),
diabetes, a range of disabilities as a result of injury or psychological problems as a result
of depression/physical or emotional maltreatment.
  They are considered at high risk for teen pregnancy, the effects of poverty, drug or
alcohol abuse and sexually transmitted diseases like venereal disease and AIDS.
 The 3 leading causes of death in adolescents are accidents, homicide and suicide. 50% or
more of all adolescents deaths are a result of accidents and most involve motor
vehicles.
 The potential topics for teaching are numerous ranging from sexual adjustment,
contraception, and venereal disease to accident prevention, nutrition, and substance
abuse.

A. For Short-Term Learning

 Use one-to-one instruction to ensure confidentiality of sensitive information

 Choose peer group discussions as effective approach to deal with health topics as
smoking, alcohol and drug use, safety measures and teenage sexuality.
 Use face-to-face or computer group discussion, role playing, gaming as methods to
clarify values and problem solve, which feed to the teenagers need to belong and to be
actively involved.
 Employ adjunct instructional tools, such as complex models, diagrams and specific
detailed materials, which can be used competently by many adolescents.
 Clarify any scientific terminology and medical jargon used.
 Share decision making whenever possible because controlis an important issue for
adolescents.
 Include them in formulating teaching strategies, expected outcomes and determining
what needs to be learned and how it can best be achieved to meet their needs for
autonomy.
 Approach them with respect, tact, openness and flexibility to elicit their attention and
encourage their responsiveness toteaching-learning situations.
 Expect negative responses, which are common when their self-image and sel-integrity
are threatened.
 Avoid confrontation and acting like an authority figure. Instead of directly contradicting
their opinions and beliefs, acknowledge their thoughts and then casually suggest an
alternative view point or choices.

B. For Long-Term Learning

 Accept adolescent’ personal fable and imaginary audience as valid, rather than
challenging their feelings of uniqueness and invincibility.
 Acknowledge that their feelings are very real because denying them their opinions
simply will not work.
 Allow them the opportunity to test their convictions. Let them know, for example , that
while some other special people may get away without taking medication others
cannot. Set up a trial period with medications scheduled farther apart or in lowering
dosages to determine how they can manage.

Although patient education should be done directly with adolescents to respect

their right to individuality, privacy and confidentiality, teaching effectiveness may be
enhanced by including their families to some extent. The nurse as educator can give
guidance and support to families, helping them to better understand adolescent
 behaviour. Parents should be taught how to set realistic limits and at the same time
foster the adolescent’s sense of independence

 YOUNG ADULTHOOD (20-40 years)

General characteristics: Physical, Cognitive, and Psychosocial

 Physical abilities for most young adults are at their peak, and the body is at its optimal
functioning capacity.
 The cognitive stage of young adult is formal operation (Piaget). These experiences add
to their perception, allow them to generalize to new situations and improve their
abilities to critically analyze, problem solve and make decisions about their personal,
occupational and social roles.
 The psychosocial development (Erikson) is intimacy versus isolation. During this time
the individuals work to establish a trusting, satisfying , and permanent relationship with
others.
 They strive to establish commitment to others/make decisions in their personal,
occupational and social lives.
 They are now working to maintain to the independence and self-sufficiency they worked
to obtain in adolescence.
 Autonomous and self-directed
 Uses personal experiences to enhance or interefere with learning
 The new experiences and multiple decisions they must make regarding choices for a
career, marriage, parenthood and higher education can be quite stressful.
 Young adults realize that the avenues they pursue will affect their lives for years to
come.

Teaching Strategies

 They are generally healthy, tend to have limited exposure to health professionals prior
to the emergence of chronic diseases that characterize the middle-age and older adults.
 The crucial period for the establishment of behaviour that help individuals to lead a
healthy lives. Encourage health promotion and disease prevention measures.
 Health promotion is the most neglected aspect of healthcare teaching at this stage of
life. They are the most likely group to lack health insurance coverage.
 Establish positive health practices for preventing problems with illness in the future
 Knowledge of the individual’s lifestyle can provide cues to concentrate on when
determining specific aspects of education for the young adult. Example, if the individual
is planning marriage , then teaching about family planning, contraception, and
parenthood are potential topics to address.
 They are stimulated to learn so as to maintain their independence and return to normal
life patterns when they are faced with acute or chronic illnesses. They view illness and
disability as serious setback to achieving their immediate or future life goals.
 Encourage active participation in the educational process and allow them the
opportunity for mutual collaboration in health education decision making. They should
 be encouraged what to learn and how they want materials to be presented and which
indicators will be used to determine the achievements of learning goals.
 Draw on meaningful experiences that can serve as a foundation on which to build new
learning to the teaching-learning situation. Experiences to make learning relevant,
useful and motivating.
 Encourage young adults to seek information that expands their knowledge base, helps
them control their lives and bolsters their self-esteem.
 Allow to set own pace, self-directed in learning. They do well with printed patient
education materials, and audiovisual tools including computer assisted instructions.
 Group discussion is an attractive method for teaching and learning because it provides
the young adult with the opportunity to interact with each others of similar age and
situation, such as parenting groups, prenatal classes or marital adjustment sessions.
 Present concepts logically from simple to complex and to establish conceptual
relationships through specific application of information.

 MIDDLE-AGED ADULTHOOD (41-64 years)

General Characteristics: Physical, Cognitive and Psychosocial

 Midlife is the transition period between young adulthood and older adult adulthood
 Middle-aged Americans make-up about one fifth of the population and this current
cohort has typically been labelled the baby boomers generation
 The baby boomers are receiving increasingly more attention by developmental
psychologist and health care providers.
 The middle-age adult are the best educated, most affluent in history and they have the
potential for healthier life than ever before due to medical discoveries that can slow
down the aging process. Life expectancy has increased by 30 years.
 During this stage, many individuals are highly accomplished in their careers, their sense
of who they are is well developed, their children are grown, and they have time to share
their talents, serve as mentors to others.
 Physiological changes begin to takes place. The skin and muscle tone decreases,
metabolism slows down, body weight tends to increase, endurance and energy levels
lessen, hormonal changes bring about variety of symptoms, hearing and visual acuity
start to diminish.
 The cognitive development is labelled as formal operation stage (Piaget). According to
Piaget the cognitive development stopped with this stage (the ability to perform
abstract thinking) that was achieved during adolescence. The adult thought processes
go beyond logical problem solving to include dialectical thinking – as the ability to
search for complex and changing understandings to find a variety of solutions to any
given situation or problem or in other words, adults are able to see the biggest picture.
 The accumulations of life experiences and their proven record of accomplishments often
allow them to come to teaching-learning situations with confidence in their abilities as
learners.
 Physical changes such as hearing and vision may impede learning well.
 Erikson labelled the psychosocial stage of adulthood as generativity versus self-
absorption and stagnation. Midlife marks a point that half of their potential life has
been spent. This realization may cause them to question their level of achievement and
 success. May modify aspects of their lives that they perceive as unsatisfactory or adopt
a new lifestyle as a solution to distraction.
 The later years of midlife are the phase in which productivity and contributions to
society are valued. Oriented to be away from self and family to the larger community.
 As they move toward retirement years, they plan for what they want to do after
culminating their career, this sparks their interest in learning financial planning,
alternative lifestyles, and ways to remain healthy as they approach the later years.

Teaching Strategies

1. Focus on maintaining independence and re-establishing normal life patterns

2. Assess positive and negative past experiences with learning

3. Assess potential sources of stress due to midlife crises issues such as menopause, physical
changes in their bodies, responsibility for their own parents declining health status.

4. Provide information to coincide with life concerns and problems related to chronic illnesses
that can arise at this phase of life

 OLDER ADULTHOOD (65 years of age and Older)

Cognitive stage –Formal operations

Psychosocial Stage – Ego entegrity versus despair

General Characteristics- Physical, Cognitive and Psychosocial

 There 3 categories of older adults: the young old (65-74 years old); the middle old
(75-84 years of age); and the oldest-old (85 years and greater).
 Most older people suffer from at least one chronic condition and many have multiple
conditions.
 They are hospitalized longer than persons in other age and require more teaching to
broaden their knowledge of self-care.
 Patient education needs are greater and more complex than those of other
developmental stage. Due to low educational level, sensory impairments, the disuse of
literacy skills once learned and cognitive changes.
 Studies show that older adults can benefit from health education programs. Their
compliance, if given specific health direction can be quite high. In terms of healthcare
expenditures for older person, education program to improve their health status would
be a cost effective measure.
 Ageism describes prejudice against older person. This discrimination based on age, exist
in most American society, perpetuates the negative stereotype of aging as a period of
decline. It interferes with interactions between the older adult and younger age groups,
must be counteracted because it prevents older people from living lives as actively and
happily as they might.
 Age changes, which begin in young and older adulthood, progress significantly in older
adult stage of life. These changes often create barriers to learning unless nurses
understand them and can adapt appropriate teaching interventions to meet the older
person’s needs.
 Erikson labelled the psychosocial developmental task at this stage in life as ego integrity
versus despair. The older adulthood includes dealing with the reality of aging, the
acceptance of the inevitability that we all will die, the reconciling of past failures with
present and future concerns and developing a sense of growth and purpose for those
years remaining.
 The most common psychosocial tasks of aging involve changes in lifestyle and social
status as a result of; retirement (mandatory at 65 in the Philippines), illness or death of
spouse/ relatives or friends, moving away of children/ grandchildren and friends,
relocation to an unfamiliar environment such as extended care facility or senior
residential living center.
 Depression, loneliness and isolation, once thought to be common traits among older
persons, have been found by researchers less frequent as found in middle adulthood
due to fewer economic hardships and increased religiosity.

 The following changes are based from findings of numerous authors.

1. Cognitive changes
- Decreased ability to think abstractly, process information, increased reaction time.
- Decreased short-term memory. Older adults sometimes have difficulty remembering
events or conversations that occurred just hours or days before. However, long-term
memory often remains strong, such as the ability to clearly and accurately remember
something from their youth.

- Increased test anxiety. Older adults are especially anxious about making mistakes
when performing; when they make an error, they are easily frustrated, they take an
amount of time to respond to questions, particularly on tests that are written rather
than verbal.

- Stimulus persistence (afterimage). Older adults can confuse a previous symbol or word
with a new word or symbol just introduced.

- Altered time perception. For older person, issues of the here and now tend to be more
important and adhere to the philosophy, “I’ll worry about that tomorrow.” This way of
thinking can be detrimental when applied to health issues because it serves as a vehicle
for denial or delay in taking action.

- Focuses on past life experiences

2. Sensory /motor deficit

- Auditory change. Hearing loss, especially high-pitched tones, consonants (S,Z,T,F & G0,
and rapid speech)

- Visual changes. Farsighted (needs glasses to read. Lenses become opaque (glare
problem). Smaller pupil size (decreased visual adaptation to darkness). Decreased
peripheral perception.
Yellowing of lenses (distorts low-tone colors: blue, green, violet).

3. Distorted depth perception, Fatigue/decreased energy levels

4. Pathophysiology (Chronic illness)

 5. Psychosocial changes. Decreased risk taking, selective learning, intimidated by formal
learning

Sociocultural factors that affect how older adults see themselves as competent individual;

1. Independence. The ability to provide one’s needs is the most important aim of the
majority of the older adults, regardless of their state of health. It gives them a sense of
self-respect, pride and self functioning as not to be a burden to others. Health teaching is
the tool to help them maintain and regain independence.
2. Social adaptability. The approval from others is common goal of many older adults. It is
derived from health, a sense of vigor and feeling and thinking young.
3. Adequacy of personal resources. Life patterns, which include habits physical and mental
strengths and economic situation, should be assessed to determine how to incorporate
te aching to complement existing regimens and resources with new required behaviors.
4. Coping mechanism. The ability to cope with change during the aging process is indicative
of the person’s readiness for health teaching. The emphasis in teaching is on exploring
alternatives, determining realistic goals allows them the opportunity to enjoy the smaller
pleasures in life, whereas less well-adapted individuals may be frustrated with personal
inadequacies.

Teaching Strategies:

- Use concrete examples

-Build on past life experiences

- Make information relevant and meaningful

-Present one concept at a time

-Allow time for processing /response (slow pace)

-Use repetition and reinforcement of information

-Avoid written exams

-Use verbal exchange and coaching

-Establish retrieval plan (use one or several cues)

-Encourage active involvement

-Keep explanation brief

-Use analogies to illustrate abstract information

-Speak slowly, distinctly, use low pitched tones, face client when speaking, minimize
distractions, avoid shouting.

-Use visual aids to supplement verbal instruction, avoid glares, use soft white light, provide
sufficient light, use white background and black print, use large letters and well –spaced print,
avoid color coding with blues, greens, purples and yellows

-Increase safety precautions /provide safe environment

 The Role of the Family in Patient Education

 The role of the family is considered one of the key variables influencing positive patient
care outcomes. Involving family members in the care delivery and decision-making
 process are to decrease the stress of hospitalization, reduce costs of care and
effectively prepare the client for self care management outside the health care setting.
 Family caregivers provide critical emotional, physical, and social support to the patient.
 In the most recent Joint Commission accreditation standards, new demands have placed
on healthcare organization to show evidence that the family is included in patient
education efforts. The standards mandate that the instruction of patients and significant
others be considered an essential part in the healthcare team approach to providing
care.
 Providers are responsible for assisting patients and their family membersto gain the
knowledge and skills necessary to meet ongoing healthcare goals, particularly the first of
the Healthy People 2010 Initiatives to Increase the Quality and Years of Healthy Living
(U.S> Department of Health and Human Services). Interdisciplinary collaboration is a
major resource for ensuring continuity of client teaching about healthy lifestyle s in and
across healthcare settings.
 Including the family members in the teaching – learning process helps to ensure a win-
win situation for both the client and the nurse educator. Family role enhancement and
increased knowledge on the part of the family have positive benefits for the learner as
well as the teacher. Clients derive increased satisfaction and greater independence in
self-care and nurses experience increased job satisfaction and personal gratification in
helping clients to reach their potentials and achieve successful outcomes.
 The family must make decision as to who is the most appropriate person to take the
primary responsibility as the caregiver, because in health education is difficult to
coordinate the instruction to different people. The more people involved, the greater
the potential for misunderstanding of instruction.
 Sometimes the family members need more information than the patient to compensate
for any sensory /cognitive impairments the client may have. Anticipatory teaching with
the family caregivers can reduce anxiety, uncertainty, and lack of self-confidence.
 The family can be the educator’s greatest allay in preparing the patient for safe
discharge and in helping the patient to become independent in self-care.

Post assessment

Modified True or False. Write True if the statement is correct and if False underline the word/s
that make the statement wrong and write the correct word/s on the blank provided before the
number.

_____________________1. Development is either growth or decline.

_____________________2. Adolescence is middle and late childhood stage.

_____________________3. Play is a great need of children in early childhood.

_____________________4. The most rapid physical changes occurs in infancy to toddlerhood

stage of development.

_____________________5. Cognitive processes involves changes in the individual’s

relationships with other people, changes in emotions and changes in personality.

_____________________6. Learning is ineffective when differences in learners’ linguistic,

cultural and social backgrounds are taken into account.

______________________7. Adolescence use peers for support and influence.

______________________8. The body is in its optimal functioning capacity during young
adulthood.

_____________________ _9. Older adulthood focus on past life experiences.

______________________10. The individual is at in peak in career during middle-aged

adulthood.

Matching Type. Match Column A to Column B. Letter only.

Piagett’s Stages of Cognitive Development

Column A Column B

_________1. Sensori-motor stage A. Can solve abstract problems and hypothesize

_________ 2. Preoperational stage B. Use logical explanations

_________ 3. Concrete operations C. Egocentric

_________ 4. Formal operations D. Focuses on the senses and muscle movement

Summary

This module emphasizes that it is important to understand the specific and varied tasks
associated with each developmental stage to individualize the approach to education in
meeting needs and desires of patients and their families. The assessment of physical, cognitive
and psychosocial maturation within each developmental period is crucial in determining the
strategies to be used to facilitate the teaching-learning process.

Learning Evaluation

Answer the questions properly. (10 points each)

1. What are the salient characteristics at each stage of development that influence the ability to
learn?

2. How do you compare your adolescent developmental stage with what you have learned
about , physical, cognitive and psychosocial characteristics during adolescence period?

3. Explain the role the role of the family in the teaching and learning process across life span?

4. Write your reflections why is there a need for a student nurse as health educator to know the
different developmental stage across the lifespan in not more than 10 sentences.

Lifted from:

Bastable, Susan B. Nurse as Educator: Principles of Teaching and Learning for Nursing
Practice, Fifth Edition (2019).Jones and Barlet Learning Publish

Corpuz Brenda et al. The Child and Adolescent Learners and Learning Principles.(2018).Lorimar
Publishing,Inc.
 SAINT TONIS COLLEGE, INC.
Formerly: Kalinga Christian Learning Center
Bulanao, Tabuk City, Kalinga
Philippines

COLLEGE OF NURSING

Course Title : HEALTH EDUCATION

Course Code : NCM 102

Module No. : 4

Course Content : Health Education Process

A. Assessing the Learner
Determininants of Learning

Learning Outcomes :

At the end of the module the students will be able to:

1. Assess the learning needs of the individual client related to the current health status

Introduction :
The learner is the center of instruction. In this module you will learn to comprehensively
assess the learning needs, motivation and behavior of the learner and learning styles, literacy
of the individual client.

Pre assessment

True or False. Write True if the statement is correct and False if the statement is wrong.

________1. The nurse prescribe the learning needs of the learner.

________2. Confidential information can be shared anytime in any setting.
________3. Learning needs to be attended immediately are the health promotive activities.
________4, The client is receptive to learn when in pain.
________5. The client asks questions to the nurse is a sign of readiness to learn.
________6. Motivation drives the learner to learn.
________7. Instruct low literate clients with technical terms.
________8. Cognitive ability includes remembering oo memorizing of concepts.
________9. Story typing is used for high- level readers in teaching functional skills.
________10. In Maslow’s hierarchy of need s securing one’s safety is a basic physiologic need.

Learning Discussion

A. Assessing the Learner

The learner’s characteristics that will influence learning which an educator must be aware of
are:
 1. Learning needs
2. The learner’s perceptual abilities
3. Motivational abilities or readiness
4. Reading abilities
5. Developmental stage
-learning styles
-physical abilities

 Determinants of Learning

A. Learning needs – what the learner needs to learn

B. Readiness – when the learner is receptive to learning
C.Learning style – how the learner best learn

 LEARNING NEEDS
These are gaps in knowledge that exist between a desired level of performance
(Healthcare Education Association, 1985). I is the gap or difference between what
someone knows and what someone needs to know due to the lack of knowledge,
attitudes or skills.

 Assessing Learning Needs

1. Identify the learner – who is the learner, it is an individual or a group, what are the
learning needs?
2. Choose the right setting – establish a trusting environment by ensuring the privacy
and confidentiality if confidential information will be shared.

3. Collect data on the learner – by determining the characteristic learning needs of the
target population or any recipient of the learning material.

4. Include the learner as a source of information – allow the learner to actively

participate in identifying his needs and problems.

5. Include members of the healthcare team – collaborate with the other healthcare
professionals who may have knowledge of the patient.

6. Determine availability of educational of educational resources – the materials and

equipment used to demonstrate procedures should be appropriate, available,
affordable, easy and simple to manipulate by the learner.

7. Assess demands of the organization – examine the organizational climate, its

philosophy, vision, mission and goals to know its educational focus. It is more on health
promotion and disease prevention rather than rehabilitative care? Its focus or emphasis
will dictate the learning needs of its clients and staff.

8. Consider time management issues.

> Allow learners to identify their learning needs
> Identify potential opportunities to assess the patient anytime, anywhere
> Minimize distractions/interruptions during planned assessment interviews

9. Prioritize needs – based on Maslow’s hierarchy of needs where the basic lower level
physiologic needs must first be met before one can move up to the higher, more
abstract level of needs. It follows a hierarchy.
  Maslow’s Heirarchy of needs in Relation to Needs Assessment

Hierarchy of Needs Explanation of the 5 need categories

Self- actualization needs; Self-fulfillment -Recognition and realization of one’s potential, growth,
health and autonomy
Esteem needs; Self-respect and respect and recognition -Sense of self-worth, self respect, independence,
from others, prestige, dignity dignity, privacy and sel-reliance
Love and belonging -Affiliation, affection, intimacy, support
Safety and security -Safety from physiologic & psychological threats,
protection, stability
Physiologic needs -Oxygen, food, elimination, temperature control, sex,
movement, rest, comfort

 The Criteria for Prioritizing Learning Needs (Healthcare Education Assoc, 1985)
1. Mandatory –learning needs that must be immediately met since they are life
threatening or are needed for survival. Ex. Patient with history of recent heart attack
should be taught the signs and symptoms of an impending attack and what the
emergency measures are or what medicines to take.

2. Desirable – learning needs that must be met to promote well-being and are not life-
dependent. Ex. Patient with pulmonary tuberculosis needs to understand and
appreciate the importance of taking her medicines regularly until the regimen ends to
be totally cured.

3. Possible – “nice to know” learning needs which are not directly related to daily
activities. Ex. An obese patient who has just lost weight of diabetes may not necessary
need information on “tummy tucking” as a surgical and aesthetic procedure to
“remove” the sagging abdominal muscles”. Her current mandatory learning needs are
related to her illness which is diabetes mellitus.

 METHODS IN ASSESSING LEARNING NEEDS

1. Informal conversations or interviews between the nurse and the patient and /or the
family members or other members of the health team by asking open-ended questions
where the learner may reveal information regarding their perceived learning needs.

2. Structured interviews where the nurse asks the patient some predetermined
questions to gather information regarding learning needs; the answers may reveal
uncertainties, anxieties, fear, unexpected problems and present knowledge base;
questions may include “what do think caused your problem?, “What does your
illness/health mean to you”; what are your strengths and weaknesses?’’
 3. Written pretest can be given to identify the knowledge level of the potential learner
and to help in evaluating whether learning has taken place by comparing pre-test with
the post test score.

4.Observation of health health behaviors over a period of different times may help
determine established patterns of behaviour like observing how a watcher does a
procedure more than once is an excellent way of assessing psychomotor need ;
questions like “are all the steps performed correctly?” or what additional learning or
instruction is needed to improve the performance?”

 Factors that will influence or determine if the learning process will be a success or
failure:
1. Assessing these needs will allow the nurse to design her teaching plan according to
what the client already knows, what he /she still needs to know, and to determine the
approach, the strategy, methods and device to be used.

2. Plan, introduce or even manipulate some factors in the learning environment or the
learner’s milieu so that the learner’s potentials are fully maximized and harnessed.
Questions can be asked like the following:
> What learning theory will best meet the needs of the learner as an empowered
individual or a critical thinker?
> What will enable him to apply the knowledge, attitudes, skills and values to
intelligently assess, analyze, plan and execute decisions or solutions to daily problems or
crisis situations?
> What will empower him to appropriately and wisely make informed cholesterol?
Learning is a relatively permanent change in mental processing, emotional
functioning and/or behaviour as a result of experience. It is a lifelong process that is
constantly evolving that takes place from the moment of concept up to death; in
Short , it is an ongoing process that is dynamic and constantly evolving “from womb to
tomb”.

B. READINESS TO LEARN
This the time when the client is “willing to learn” or is receptive to information.

> When is the most appropriate time to teach the learner?

> When the learner is ready – which is known as the “teachable moment” – that point in
time when the learner is most receptive to a teaching situation. (Havighurst, 1976).

When assessing readiness to learn the health educator must:

1. Determine what needs to be taught
2. Find out exactly when the learner is ready to learn.
3. Discover what the patient wants to learn
4. Identify what is required of the learner:
> what needs to be learned
> what the learning objectives should be
> find out in which domain of learning and at what level the lesson will be taught

Example: A procedure to be taught involves in the psychomotor domain and will use
strategies that will require the learner to make a return demonstration to show
acquisition of skills.
> Determine if the timing (the point at which the nurse will conduct teaching) is right or
Proper
> Find out if rapport or interpersonal relationship with the learner has been established
 >If the learner is showing signs of motivation
> If the plan for teaching for teaching matches the developmental level of the learner

FOUR TYPES OF READINESS TO LEARN (PEEK) (Lightenthal, 1990)

1. Physical Readiness
> Measures of ability – adequate strength, flexibility and endurance is needed to teach a
patient how to walk with crutches and for the client to be ready to learn while
measures requiring visual and auditory acuity of a patient also affect the learning
readiness especially if the senses of sight and hearing are impaired.

> Complexity of task – the difficulty level of the subject or the task to be mastered;
Psychomotor skills require varying degrees of manual dexterity and physical energy
output but once acquired or mastered, they are usually retained better and longer than
learning in the cognitive and affective domains.

> Environmental effects – refers to an environment that is conducive to learning, free

from noise and other distractions which may affect the physical readiness to learn.

> Health status – Is the patient in a state of good health or ill health? Does he still have
the energy or motivation to learn?

> Gender – studies show that men are less inclined to seek health consultation or
Intervention than women. Women are more conscious and receptive to medical care
and health promotion teaching.

2. Emotional Readiness
> Anxiety level – may or may not be a hindrance to learning. Some degree of anxiety may
motivate a person to learn but high or low degree of anxiety will interfere with readiness
to learn.

> A moderate level of anxiety contributes to successful learning and is the best time for
learning .

“While some anxiety contributes to learning, too much anxiety interferes with the
learning ability”.

Fear greatly contributes to anxiety and exerts negative effects on readiness to learn
whether it be in the cognitive effects, psychomotor or affective domains of learning or
even lead a patient to deny his or her illness.

> Support system – will give the patient increased sense of security and well-being while
a weak or absent support system elicits sense of insecurity, despair, frustration and a high
level of anxiety.

> Nurses who provide emotional support to the patient and family members go through
“what is termed as reachable moments” which allow for both nurse and client to
mutually share and discuss concerns and possible solutions or alternative to care. This
emotional support paves the way for the teachable moment when the client /family
become receptive to learning.

> Motivation – is strongly associated with emotional readiness or willingness to learn. A

telling cue is when the learner starts asking questions and interest in what the teacher is
doing or saying.
> Risk-taking behaviors – are activities that are undertaken without much thought to
what their negative consequences or effects might be. The role of the HE is to develop
awareness in the patient as to how this can shorten his lifespan; how to develop
strategies to minimize risk; to recognize the signs and symptoms of probable disease
state and what to do should this worst-case scenario develop.

> Frame of mind – depends on what the priorities of the learner are in terms of his needs
which will determine his readiness to learn. An important consideration is Maslow’s
hierarchy of needs as guide in identifying needs prioritization.

> Developmental Stage- determines the peak time for readiness to learn or “teachable
moment”.

3. Experiential readiness – refers to previous learning experiences which may positively

( if the experience is pleasant and appropriately reinforced ) or negatively (if the learning
experience has been unsatisfying, humiliating or frustrating) affect willingness to learn.

a. Level of aspiration – depends on the short term and long-term goals that the learner
has set which will influence his motivation to achieve.

b. Past coping mechanisms –refer to how the learner was able was able to cope with or
handle previous problems or situations and how effective were the strategies used. Will
these be applicable to the present learning situation?

c. Cultural background – is important to assess and know from the patient’s own cultural
perspective to determine readiness to learn.

> Awareness of the culture of the learner is of prime importance. Knowledge of the
concepts of transcultural nursing will be a great help.
> Find out also if the patient if the patient understands the language that is being used
to communicate with him.

d. Locus of control- refers to motivation to learn which may be;

> Internal locus of control or intrinsic ( within the individual as he/she is driven by
by the desire to know or learn)
> External locus of control or extrinsic (motivation to learn is influenced by others who
encourage the learner to learn).

e. Orientation – this refer’s to a persons’s point-of-view which may be;

>Parochial – close-minded thinking, conservative in their approach to new situations,
less willing to learn new materials and have great trust in the physician.
>Cosmopolitan orientation – is a more word ly perspective and more receptive to new
or innovative ideas like the current trends and perspectives in health education.

4. Knowledge Readiness
a. Present knowledge base –referred to as stock knowledge or how much one has already
knows about the subject matter from previous actual or vicarious learning.

The teacher must recognize that cognitive impairment due to mental retardation
requires special techniques to strategies of teaching and the cooperation of the family
must be enlisted especially in the self-care activities of the client.
Learning disabilities and low-level reading skills will need special approaches to
teaching to prevent discouragement and bolster readiness to learn.
C. LEARNING STYLES
> It is a characteristic of the cognitive, affective, and physiological behaviors that serve as
relatively stable indicators of how learners perceive, interact with, and respond to the
learning environment.
> Learning style also represents both inherited characteristics and environmental
influences. “As a result of our hereditary equipment, most people develop learning
styles t hat emphasize some learning abilities over others”.

 Motivation and Behavior of the Learner

> Motivation is a psychological force that moves a person to some kind of action
(Haggard, 1989).
> It is the willingness of the learner to embrace learning, with readiness as evidence of
motivation (Redman, 2001).
> Motivation has also been conceptualized in terms of moving forward to reach one’s
goal or meet a need. Ex. Maslow’s hierarchy of needs
> Motivation is related to learning behaviour or learning and behaviour. It is the force
that drives the learner to learn and to comply or apply the knowledge resulting to a
change in behaviour. It has been found that “motivation is significantly is significantly
related to measures of compliance with a medical regimen” (Becker, etal, 1974).

 Learning Assessment of Clients

a. Literacy and Readability
>Literacy is the ability of adults to read, understand and interpret information written at
the 8th grade level or above; the relative ability of persons to use printed and written
material commonly encountered in daily life. Medical/paramedical practitioners are
more concerned with health literacy.
>Health literacy refers to how well an individual can read, interpret and comprehend
health information for maintaining a high level of wellness.
One who is literate is an “educated person” or one who is “able to read and
write”(Webster’s Collegiate Dictionary, 1994). This poses a great deal of problems
because of the present trend for managed home care which requires patients to be
more responsible for self-care and recovery. Poor or low health literacy leads to inability
to read and understand instructions for medications, procedures, appointments for
follow-up care and patient health education programs.

b. 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; the confusion lies in “reading” as being able to
decode words fluently and “reading” as being able to comprehend or understand the
meaning of words.

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.

c. Clues manifested by patients with low literacy (De Young, 2003)

1. Not even attempting to read printed material
2. Asking to take PEMs (printed educational materials) to discuss with significant
others
3. Claiming that eyeglasses were left at home
4. Stating they can’t read something because they are too tired or don’t feel well
 5. Avoiding discussion of written material or not asking any questions about it
6. Mouthing words as they try to read

d. Two Test which is most often used to measure patient literacy related to the basic
reading skill of decoding words (recognizing letters that form words and the
pronouncing the words correctly But do not measure comprehension) and can be
administered in 2-3 minutes.
1. REALM (Rapid Estimate of Adult Literacy in Medicine) – requires patient to
pronounce common medical and anatomical words. It contains 66 words arranged 3
columns in ascending order of numbers of syllables and increasing difficulty. Based on
the number of words that were pronounced correctly, the raw score obtained by the
patient is given a corresponding grade range from 3rd grade and below up to 9th grade
and above.

2. WRAT (Wide Range Achievement Test) – the patient is asked to read aloud from a
list of 42 words of increasing difficulty. The examiner asks the patient to pronounce
each word and checks off each word that is pronounced incorrectly. When 10
consecutive words are mispronounced, the test is stopped. The conversion of the raw
score to a grade level is shown in the test administration manual.
In performing her health education function in relation to low literacy clients, the
nurse starts with assessing the reading ability of the patient and then plans an approach
to teaching that will best meet their learning needs.

 Teaching Strategies for Low Literate Patients

1. Establish a trusting relationship before beginning the teaching-learning process. It is
very important for the nurse to communicate her belief and trust in the patients’
ability to undertake self-care activities that could be effectively done by;
a. focusing on strengths
b. specifying what needs to be learned

2. Use the smallest amount of information possible by teaching only what the patient
needs to learn.
a. Prioritize behavioural objectives; limit presentation an discussion to one or two
concepts per session
b. Present context of the message first before giving any new information
c. Limit the teaching session to no more than 20-30 minutes

3. Make points of information as vivid and as explicit as possible

a. Explain information in simple term terms using examples that the patient can relate
to
b. Use visual aids, such as signs and pictorials and use explicit instructions like “Do not
Eat or Drink Anything” or “ instead of NPO or NOTHING BY MOUTH”, avoid using all
capital letters or abbreviations.
c. Use underlining, highlighting, color-coding, arrows and international symbols to give
directions or emphasize important information.

4. Teach one step at a time

a. By teaching in increments (starting from the simplest and gradually increasing in the
level of difficulty)
b. By organizing information into chunks to allow patients to understand each item first
before proceeding to the next block information or chunking also gives the patient a
sense of order, allows for questioning and assimilation of information.
c. To allow the nurse to evaluate progress and give positive reinforcements like words
of encouragement or praise.
 5. Use multiple teaching methods and tools requiring fewer literacy skills – aside from
repetition of concepts and information, supplement oral instructions with other forms
of media like simple lists, pictorials, videotapes which the patient can take home and
refer to from time to time. Interactive computer programs allow the patients to
proceed at their own pace and can be programmed developmentally to match the
patients’ literacy skills.

6. Allow patients to restate information in their own words and to demonstrate any
procedure that is being taught (Hands-on practice, role-playing real-life situations, etc)
to reveal gaps in knowledge or misconception of information.

Story-typing – a strategy used for low-level readers which is very useful inteaching
functional skills. While audio taping, the patients listen to the nurse’s oral instructions,
they repeat it in their own words and then the message (with corrections of version
using patient’s own words. Hence, the patient can read and repeatedly refer to the
message in familiar language which he fully understands.

7. Keep motivation high through constant reassurance, recognition of progress and

encouragement to keep on trying.

8. Build in coordination with procedures by using the principles of;

a. Tailoring – coordinating the patients’ regimens into their daily schedules rather than
forcing them to adjust their lifestyles to regimens imposed on them, it allows new tasks
to be associated with old behaviors. Tailoring also personalizes the message so that
instruction is individualized to meet the patients learning needs.

b. Cuing – focuses on the appropriate combination of time and situation using prompts
and reminders to get a person to perform a routine task.

9. Repitition to reinforce information – repetition, in the form of saying the same thing
in different ways, is one of the most powerful tools to help patients understand their
problems and learn self-care.

 DEVELOPING PRINTED EDUCATIONAL MATERIALS

Whether it is a brochure, pamphlet or instruction sheet the following factors are
considered for maintaining a low readability level and attractiveness of the learning
materials to the low literate patient.
1. Organizational factors:
a. Include a short but descriptive title
b. Use brief headings and subheadings
c. Incorporate only one idea per paragraph and be sure the first sentence is the topic
sentence
d. Divide complex instructions into small steps
e. Consider using question /answer format
f. Address no more than three or four main points
g. Reinforce main points with a summary at the end.

2. Linguistic factors
a. Keep the reading level at grade 5 or 6 to make the material understandable to most
low literate patients.
b. Use mostly one or two syllable words and short sentences.
c. Use a personal and conventional style. “You should weigh yourself everyday” is
preferable to “Patients with congestive heart failure should measure body weight
 everyday”.
d. Define technical terms if they must be used.
e. Use words consistently throughout the text. Ex. start with the word pill instead of
switching between pill and medicine.
f. avoid the use of idioms which may mean different things to different people. Ex. junk
food may not be clear to all people.
g. Use graphics and language that are culturally acceptable and age relevant for the
intended audience.
h. Use active rather passive voice; Ex. “Take one pill every morning” instead of “A pill
should be taken every morning”.
i. Incorporate examples and simple analogies to illustrate concepts

3. Appearance factors
a. Avoid cluttered appearance by including enough white space.
b. Include simple diagrams or graphics that are well labelled
c. Use upper and lower-case letters. All capital letters are difficult for everyone to read.
d. Use lists when appropriate
e. Try to limit line length to not more than 50 to 60 characters.

Summary
Having been equipped with the necessary educational theories and principles , the
health educator is now ready to go through the planning session, hopefully, with the client and
or the family members , if not with the group of participants in the communities.

Post assessment

Modified True or False. Write True if the statement is correct and if the statement is False underline
the word/s that make the statement wrong.
________1. The nurse prescribe the learning needs of the learner.
________2. Confidential information can be shared anytime in any setting.
________3. Learning needs to be attended immediately are the health promotive activities.
________4, The client is receptive to learn when in pain.
________5. The client asks questions to the nurse is a sign of readiness to learn.
________6. Motivation drives the learner to learn.
________7. Instruct low literate clients with technical terms.
________8. Cognitive ability includes remembering oo memorizing of concepts.
________9. Story typing is used for high- level readers in teaching functional skills.
________10. In Maslow’s hierarchy of need s securing one’s safety is a basic physiologic need.

Learning Evaluation
I. Matching Type. Match Column A to Column B. Write the Letter of the correct answer on the
blank provided before the number.

A B
_______1. Mandatory needs A. motivation to learn
_______2. Locus of control B. how the learner best learn
_______3. Readiness C. factors that influence learning
_______4. Learning style D. gaps in knowledge
_______5. Motivation E. nice-to-know learning needs
_______6. Determinants of learning F. learning needs that must be met immediately
_______7. Readiness to learn G. the force that compels a man to action
_______8. Possible needs H. how the learner best learn
_______9. Desirable needs I. learning needs that are not life dependent
_______10. Learning needs J. moment when learner is receptive to information
II. Answer the questions properly.

1. Situation: Mr. John Dela Pena, 65 years old, a fisherman from Sta. Ana, Cagayan with a
positive swab test for COVID 19 but asymptomatic. His blood pressure is 120/80 mmHg,
respiratory rate is 80/min, body temperature is 36.90C.

a. Give your teaching strategies for low-literate patients that you will apply to give health
teachings to Mr. John Dela Pena. ( 5 pts)

b. As a student how would you protect yourself and your family from COVID 19. (5 pts)

Tell me and I’ll forget. Show me, and I may not remember. Involve me, and I’ll understand”

-Native American Proverb

Asperas, Carlito M. Strategies of Health Education, Is ted., Manila. Eductional Publishing

House,2005
Bastable, Susan B. Nurse Educator: Principles of Teaching and Learning for Nursing Practice, 2 nd
ed, Boston: Jones and Barlett Pub. 20
Castro, Cecilia. Health Education for Nursing and Other Allied Professions, Is ted, Educational
Publishing House,2011
www.cdc.gov> 2019-ncov >faq