NCM 102

Course outline
I. HEALTH EDUCATION

 Historical Development in Health Education

 Issues & Trends
 Definition
 Theories in Health Education( Pender’s,
Bandura, Green and Health Belief)
 Process of Health Education
 Purpose/ Importance of Health Education
 Types
 Dimensions and Aspects of Health
Education
II. Concepts of Teaching and Learning

 The Education Process

 The Nursing Process
✓ Purpose
✓ Nature/ characteristics
✓ Steps
✓ Difference of Education & Nursing Process
III. Roles & Responsibilities of the Nurse as Health Educator

 Definition
 Roles & Functions
 Patient teaching definition
 Purpose
 Role of a nurse
 Factors that influence teaching
 Barriers to learning/ education
 Principles
IV. Communication
 Definition
 Role/ Purpose
 Types & Elements
 Therapeutic Communication
INTENDED LEARNING OUTCOMES:
At the end of this chapter, the student will be able to:

❖ Define what is Health Education.

❖ Explain the objectives and process of Health
Education
❖ Differentiate the types of Health Education
❖ Explain the importance and the various
dimensions of Health Education.
Early humans

❖ Earliest humans learned by trial and error to

distinguish those things that were good for them and
would enhance health from those that were harmful
and that would impair health.
❖ By observing animals they learned that bathing not
only cooled and refreshed his body, but helped
remove external parasites.
❖ They learned that application of mud assuaged insect
bites
❖ determining the actions of certain herbs, they learned
their various medicinal or poisonous characteristics
 Albularyos( local doctors, quack
doctors)
- They relied on indigenous ways and
materials
- They subscribed to superstitious beliefs
and practices

 Religious orders (sisters and priests-

1800s
✓ Awarding of nursing degrees in nursing
and medicine
ISSUES AND TRENDS
TRENDS…
 Integrated Learning Solutions
-web based learning environment
-supports the learner and group- centered
work

➢ Augmented Reality- ( Virtual)

➢ Professional Development of Teachers (
Webinars)
➢ Bite-sized Learning
➢ Formative Assessment Solution
ISSUES

 Technology
- cyberbullying, sexting and social networking

❖ Revising curriculum(colleges and universities)

❖ Unhealthy/ sedentary lifestyle
❖ Passive learning
 The act of providing information and learning experiences
for the purpose of behavior change and improved health
of the client.
 Totality of experiences which influences habits, attitudes
and knowledge relating to individual, community and
racial health ( Health education 2006)
 A process with intellectual, psychological and social
dimensions relating to activities that increase the abilities
of people to make informed decisions.
THEORIES IN Health EDUCATION

 Health Promotion Model

Major concepts of the Health Promotion

Model are:
❑ individual characteristics and
experiences,
❑ Behavior-specific cognitions & affect
❑ Behavioral outcome.
 Personal factors
(biological,
psychological
and socio-
cultural)

Perceived
Situational
benefits of
influences
action

Behavior outcome

Health-promoting
behavior
Interpersonal
Perceived influences
barriers to (families, peers,
action and healthcare
providers)

Perceived self-
efficacy
Bandura’s theory
 Social Learning theory
 Learning as a direct result of Conditioning,
Reinforcement and Punishment.
 He asserted that most human behavior is learned
through observation, imitation and modeling.
 In any form of observing and modelling: ARRM
ATTENTION
RETENTION
REPRODUCE
MOTIVATION
 Self-efficacy

- people with high self-efficacy—that is,

those who believe they can perform
well—are more likely to view difficult
tasks as something to be mastered
rather than something to be avoided.
 HEALTH BELIEF MODEL
 a psychological health behavior change model
developed to explain and predict health-related
behaviors, particularly in regard to the uptake of
health services.

CONCEPTS:
❖ Perceived severity- subjective assessment of the
severity of a health problem and its potential
consequences
-individuals who perceive a given health problem
as serious are more likely to engage in behaviors to
prevent the health problem from occurring.
❖ Perceived susceptibility

✓ subjective assessment of risk of developing a

health problem
✓ individuals who perceive that they are susceptible
to a particular health problem will engage in
behaviors to reduce their risk of developing the
health problem

❖ Perceived threat

✓ Combination of perceived severity and perceived

susceptibility
✓ higher perceived threat leads to a higher
likelihood of engagement in health-promoting
behaviors.
❖ Perceived benefits
✓ an individual's assessment of the value or efficacy of
engaging in a health-promoting behavior to
decrease risk of disease.
✓ If an individual believes that a particular action will
reduce susceptibility to a health problem or
decrease its seriousness, then he or she is likely to
engage in that behavior regardless of objective
facts regarding the effectiveness of the action

❖ Perceived barriers
✓ an individual's assessment of the obstacles to
behavior change.
✓ perceived benefits must outweigh the perceived
barriers in order for behavior change to occur.
❖ Modifying variables

✓ Demographic (age, sex, race, ethnicity, and

education)
✓ psychosocial (personality, social class, and peer
and reference group pressure)
✓ structural variables(knowledge about a given
disease and prior contact with the disease)

❖ Cues to action
✓ A.k.a. as a trigger necessary for prompting
engagement in health-promoting behaviors.
✓ can be internal or external
 Perceived benefits:
Demographics: If I eat healthy, I
age, race, status won’t get it

Self-efficacy:
Perceived
susceptibility Perceived threat: I know I can eat
Since diabetes runs in healthy and workout to
Diabetes runs in my reduce my chance of
family so maybe I’ll the family, I’m afraid
I’ll get it having the disease.
get it

Cues to action:
Seeing family members struggling to
deal with diabetes
 PRECEDE-PROCEED model
❑ a comprehensive structure for assessing health needs
for designing, implementing, and evaluating health
promotion and other public health programs to meet
those needs.

❑ PRECEDE stands for PREDISPOSING, REINFORCING &

ENABLING CONSTRUCTS IN EDUCATIONAL DIAGNOSIS
AND EVALUATION
 PRECEDE phases PROCEED phases

Phase 1 – Social Diagnosis Phase 5 – Implementation

Phase 2 – Epidemiological, Behavioral

Phase 6 – Process Evaluation
& Environmental Diagnosis

Phase 3 – Educational & Ecological

Phase 7 – Impact Evaluation
Diagnosis
Phase 4 – Administrative & Policy
Phase 8 – Outcome Evaluation
Diagnosis
PHASE 1-SOCIAL DIAGNOSIS

✓ identifying
and evaluating the social
problems that affect the quality of life of
a population of interest

✓ gainingan understanding of the social

problems that affect the quality of life of
the community and its members, their
strengths, weaknesses, and resources;
and their readiness to change.
PHASE 2- Epidemiological, Behavioral, and
Environmental Diagnosis

o Epidemiological diagnosis determining and

focusing on specific health issue(s) of the
community, and the behavioral and environmental
factors related to prioritized health needs of the
community.

o Epidemiological assessment may include secondary

data analysis or original data collection — examples
of epidemiological data include vital statistics, state
and national health surveys, medical and
administrative record
o Behavioral diagnosis — analysis of behavioral links to
the goals or problems that are identified in the social or
epidemiological diagnosis.
✓ behaviors that exemplify the severity of the disease
✓ through the behavior of the individuals who directly
affect the individual at risk
✓ through the actions of the decision-makers that affects
the environment of the individuals at risk

o Environmental diagnosis
✓ environmental factors beyond the control of the
individual are modified to influence the health
outcome
Phase 3 – Educational and Ecological Diagnosis

❑ Predisposing factors - are any characteristics of a

person or population that motivate behavior prior
to or during the occurrence of that behavior.
(individual's knowledge, beliefs, values, and
attitudes. )
❑ Enabling factors are those characteristics of the
environment that facilitate action and any skill or
resource required to attain specific behavior.
(programs, services, availability and accessibility of
resources, or new skills required to enable behavior
change)
❑ Reinforcing factors are rewards or punishments
following or anticipated as a consequence of a
behavior.(social support, peer support, etc. )
Phase 4 – Administrative and Policy Diagnosis

✓ administrative and organizational concerns that must

be addressed prior to program implementation

 Administrative diagnosis assesses policies, resources,

circumstances and prevailing organizational situations
that could hinder or facilitate the development of the
health program.

 Policy diagnosis assesses the compatibility of program

goals and objectives with those of the organization
and its administration. This evaluates whether program
goals fit into the mission statements, rules and
regulations that are needed for the implementation
and sustainability of the program.
Phase 5 – Implementation of the Program

Phase 6 – Process Evaluation

 used to evaluate the process by which the

program is being implemented. This phase
determines whether the program is being
implemented according to the protocol, and
determines whether the objectives of the
program are being met. It also helps identify
modifications that may be needed to improve
the program.
 Phase 7 – Impact Evaluation
This phase measures the effectiveness of the
program with regards to the intermediate
objectives as well as the changes in
predisposing, enabling, and reinforcing
factors.

Phase 8 – Outcome Evaluation

 This phase measures change in terms of
overall objectives as well as changes in
health and social benefits or quality of life.
 PROCESS OF HEALTH EDUCATION

❖ Consistsof learning experiences that

promote behavior conducive to health
❖ To develop:

✓ Physical health
✓ Emotional health
✓ Mental health
✓ Social health
✓ Spiritual health
Key aspects:
➢ It is a planned opportunity of learning through
information about health guided by specific
goals, objectives, activities and evaluation
criteria.
➢ It occurs in specific setting
➢ It is a program of series or events that introduces
concepts at appropriate learning levels.
➢ It is based on what was previously learned in order
to determine what is to be learned in the future.
➢ It comprehensively emphasizes how the various
aspects of health interrelate and how health
affects the quality of life
➢ Interaction between the qualified educator and
learner.
Health educators plan and conduct
health teachings to:
❑ Be aware of the values of health
❑ Develop the skills in the promotion &
maintenance of health
❑ Acquire and apply concepts and information
received.
❑ Develop and discuss opinions regarding health
❑ Formulate accurate and effective decision
making
PURPOSE OF HEALTH EDUCATION
❑a means of propagating health promotion and
disease prevention
❑ Used to modify or continue health behaviors as
necessary
❑ Provides health information and services
❑ Emphasizes good health habits and practices as an
integral aspect of culture, media and technology
❑A means of communicating vital information to the
public
❑A form of advocacy
TYPES OF HEALTH EDUCATION

❖ BIOLOGICAL

❖ HEALTH RESOURCES

❖ SOCIETY AND ENVIRONMENT

DIMENSIONS OF HEALTH EDUCATION

✓ Substantive/ Curricular dimension

• subject matter

✓ Procedural/ Methodological Dimension

• Strategies/ methods

✓ Environmental/ Social Dimension

• Physical & social factors

✓ Human relations dimension

 ASPECTS OF HEALTH EDUCATION

❑ Behavioral sciences
- (psychology, sociology and cultural
anthropology)
- Behavior change---- desired outcome of health
education

❑ Public Health

❑ Education
IMPORTANCE OF HEALTH EDUCATION

✓ Enhance knowledge awareness

✓ Promotes health, safety and security of the people
✓ Develop and improve community resources
✓ Increase productivity and strength of character
✓ Disease prevention
✓ Minimize cost
✓ Self-reliant behavior
Concepts of teaching and
learning
EDUCATION
❑ An interactive process of imparting
knowledge through sharing, explaining,
clarifying and synthesizing the substantive
content of the learning process in order to
arrive at a positive judgement and well-
developed wisdom and behavior ( Kozier
2004)
 A state of complete,
physical, mental and
social well-being
and not merely the
absence of disease
and infirmity (WHO)

❑ A sense of being
physically fit,
mentally stable and
socially comfortable
( Kozier, 2004)
LEARNING
❖ Acquisition of
knowledge of all
kinds such as
abilities, habits,
attitudes, values and
skills primarily to
create change in an
individual(Calderon
1998)
❖ Gradual, continuous
process throughout
life.
PATIENT TEACHING

➢ Basic function of
nursing
➢ A system of
activities intended
to produce
learning and
change in client
behavior.
➢ Dynamic
interaction
between the
nurse as a teacher
and the patient as
the learner
TEACHING

❑ is a process of
providing learning
materials, activities,
situations and
experiences that
enable the clients or
learners to acquire
knowledge, attitudes,
values and skills in
order to facilitate self-
reliant behavior
 EDUCATION PROCESS
 Systematic, sequential , logical, scientifically
based, planned course of action consisting of
teaching and learning ( Bastable 2007)
 Provides information
regarding learner’s
knowledge.
 Gathering of data (
demographic
profile, skills and
abilities
 Carefully
organized written
presentation of
what the learner
needs to learn
and how the
nurse educator
going to initiate
the learning
process.
 Procedures or
techniques and
strategies that the
teacher will use to best
implement the plan.
 Measurement of
the teaching-
learning
performance of
both the
teacher and the
learner.
 Input, process,
input
 Providesthe necessary tool to enable
the nurse to render quality nursing
care to patients.

 Scientific
and systematic problem
solving approach used to identify,
prevent and treat actual or potential
health problems and promote
wellness.
 Purpose of the nursing
process
✓ Provides a tool to enable the nurse to
render quality nursing care to clients
✓ Helps
identify the client’s health care
needs and determine priorities of care
and expected outcomes
✓ Establishes
nursing intervention to meet
client-centered goals
✓ Provides nursing interventions to meet
client’s needs
✓ Evaluatesthe effectiveness of nursing
care in achieving client’s goals

✓ Achieves scientifically- based,holistic,

individualized care

✓ Takesthe opportunity of working

collaboratively with clients and other
members of the health care team.
✓ Achieves continuity of care to the
clients
 NATURE OF
THE
NURSING PROCESS
❑ The nursing process is dynamic and
cyclic

❑ It is planned and goal-directed

❑ It is an intellectual process
CHARACTERISTICS:
 SYSTEMATIC
- Ordered sequence of precise and accurate
activities

➢ DYNAMIC
- Active interaction and integration among
activities

➢ INTERPERSONAL
- client-centered
 GOAL- DIRECTED
- Nurse and client work together in order to
identify specific goals.

➢ UNIVERSALLY APPLICABLE
- sick, young, old, regardless of race, creed or
religion and any practice setting
 STEPS IN
THE
NURSING PROCESS
❖ ASSESSMENT
- Interview, physical examination,
research and review of records

❖ DIAGNOSIS
-typology of nursing problems by
Maglaya
- Readiness for wellness
- Health threat
- Health deficit
- Foreseeable crisis
❖ PLANNING
- Nurse works with the client to set goals, objectives and
predict outcomes

❖ IMPLEMENTATION
- Actual performance of the plan

❖ EVALUATION
-collection of pertinent reliable data about the process
and outcome of care.

❖ DOCUMENTATION
- Written record of the assessment, the care provided
and the patient’s response
Education vs nursing
process
ROLES OF A NURSE
EDUCATOR
❑ Primary
source of
knowledge
❑ The primary catalyst
for the learning
process
❑A role model
❑ An active facilitator
❑A source of health
care information and
care to clients
❑ diligent
FUNCTIONS
OF A HEALTH
EDUCATOR
 Practitioner
professionally prepared
in the field of health
education

 Demonstrates
competence in both
theory and practice

 Accepts responsibility in
advancing the aims of
the health education
process
✓ Collaborates with health specialists and
civic groups
✓ Formulates operational plans and
policies
✓ Conducts and coordinates health needs
assessment and other public health
surveys
✓ Designs and conducts evaluation and
diagnostic studies
✓ Plans and implements health education
and promotion programs
✓ Prepares and distributes health
education materials
✓ Provides guidance to agencies and
organizations
✓ Promotes and maintain cooperative
working relationship
✓ Provides and maintain health education
libraries
✓ Formulates, prepares and coordinates
grant applications and grant-related
activities
✓ Documents activities and records
informations
✓ Maintains databases, mailing list and
telephone networks etc.
 Process of influencing patient
behavior and producing
changes in K, S, A necessary
in maintaining/improving
health.

 Holistic process

 Assisting the patient in

interpreting, integrating and
applying the information
given.

 Patient teaching ends with

an evaluation of patient
learning
Purpose of client teaching

❑ Increase clients’ awareness and

knowledge
❑ Increase client satisfaction
❑ Improve quality of life
❑ Ensure continuity of care
❑ Decrease patient anxiety
❑ Increase self-reliant behavior
❑ Reduceeffectively the incidence of
complication of illness
❑ Promoteadherence to healthcare
treatment plans
❑ Maximize
independence in the
performance of ADL’s
❑ Energize and empower consumers
 THE ROLE
OF THE NURSE IN CT

✓ Health teaching
✓ Caring- during diagnostic
procedures, surgery
✓ Health information to clients
and families
✓ Application of the principles
of teaching and learning
✓ Motivation of clients
❖ FACTORSTHAT
INFLUENCE
CLIENT
TEACHING
❑Stage of development
❑Cultural values
❑Language used
❑Physical environment
❑Previous experiences
❑Knowledge and skill of the
teacher
PRINCIPLES OF
CLIENTTEACHING
AND LEARNING
❖ Assess teaching needs of the client
❖ Assess readiness of the client to learn and
relevance of the content
❖ Assess what the client knows
❖ Consider language barriers, literacy, ethnic or
cultural background, age, emotional status
❖ Interactive discussions
❖ Demonstrate tasks
❖ Praises and positive feedback
❖ Role modeling
❖ Conflicts and frustrations impede learning
❖ Structured teaching and presentation
❖ Variety of teaching methods- Posters, videos,
models and online and printed materials
❖ Present information in small segments over a
period of time
DOCUMENTATION
OF CLIENT
TEACHING
 CHARACTERISTICS OF DOCUMENTATION
IN CLIENT TEACHING

o Covers all aspects of patient care

o Critical for communication among team
members
o Provides a legal record
o Supports quality assurance efforts
o Promotes continuity of care
o Facilitates reinforcement
Good documentation reflects the
following:

➢ Initialassessment and reassessment

➢ Nursing diagnoses and client learning
needs
➢ Interventions provided
➢ Client’s response and outcomes
➢ Discharge plan of care
➢ Ability of the client and family to
manage needs after discharge
 COMPONENTS OF THE
DOCUMENTATION SYSTEM

▪ Admission assessment

- Patient and profile history

- Functional ability
- Ways of individualizing teaching
- Design assessment forms
▪ PROBLEM LIST
- List of actual and potential health
problems
- Medical and nursing diagnoses

▪ CARE PLAN
- Individualized care plan
- ADPIE
▪ FLOW SHEETS
- Observations and lists of patients name and data
- Findings or patient responses

▪ PROGRESS NOTES
- shows the patient progress perceived by HCP’s
involved in patient care.
- Patient teaching
- Outcome of care

▪ DISCHARGE SUMMARY
- reports written at the time of discharge
- Transfer of patient in another facility
➢ Anything that conveys a message
➢ Interacting with one another
➢ Ability to understand and find
meaning into the message sent for
appropriate response
➢ Effective communication requires
knowledge of the subject matter,
theories and stimuli
 Communication embodies the
instructional process
 Instructional materials gives shape
and substance to the curriculum.
 Through communication------
development and effective
instructional materials
 MODES OF
COMMUNICATION
TRADITIONAL
❑ Print supplemented by motion pictures
❑ Slides/ films
❑ Radio and disk recordings

MODERN
❑ Television, radio
❑ Programmed machine teaching
❑ Language laboratories
❑ Computers, internet, social media, powerpoint
presentations
❑ blackboard
 ACTIVE COMUNICATION
- Enables the teacher to present facts,
design concepts and guide students
- Works with individual students and gain
attention
- Directs learning
- Uses machine
- Points out further references
- Asks critical questions
- Encourage students
 ELEMENTS OF
COMMUNICATION
❑ SOURCE
- Teacher
- Originating or perceiving an idea or
purpose which she wants to
communicate in order to produce a
particular response in the learner
- Directly encode message through
perceiving, thinking, reasoning, judging,
speaking, writing, drawing, gesturing
and demonstrating
 FACTORS INFLUENCING EFFECTIVE
COMMUNICATION
✓ Communication skills
✓ Knowledge
✓ Attitudes
✓ Social status

❑ A teacher who lacks self-confidence, does not

respect students or is bored with the subject
matter----- blocks the communication process +
negative impact
 THE MESSAGE
- goal, intent or purpose to be
communicated by the teacher
- Physical form of words
- Translation of ideas, purpose and
intentions of the teacher
- Selective inattention that leads to
arc of distortion
 THE CHANNEL

- To encode the purpose of the source

into a message
- Face to face communication- the
encoding function is channeled directly
by the intellectual, the sensory and the
motor skills of the source
- Ex: chalkboard, vocal mechanism, social
media
 THE RECEIVER

- The student for whom the message is

intended.
- The student is the receiver- interprets the
message by listening attentively,
reading, logical reasoning and judging
 TYPES OF COMMUNICATION

✓ Verbal or Oral communication- interaction between

individuals
Ex: internet, live chat, telephone

✓ Nonverbal- does not use words but rather more of actions

Ex: signs, facial expression & body language
Utilizes the 5 senses:
➢ Sight
➢ Auditory
➢ Gustation
➢ Olfactory
➢ Touch
 SIGHT
-visual observation communicates many
information
- Ex: during patient rounds

➢ AUDITION
-Ex: rotation and tilting of the head; distinguish
certain sounds

➢ GUSTATION
-sense of taste
Ex: serving of food or use of utensils
 OLFACTORY
- Sense of smell
- Distance receptor

➢ TOUCH
-close receptor using hand and body contact
that conveys warmth, feelings, desires,
intentions, quality of expression, gratitude,
sympathy to another person
- Positive means of contact and
communication
- Signifies meaning and candor
  BARRIERS TO EFFECTIVE COMMUNICATION

✓ Giving an opinion
✓ Offering false reassurances
✓ Being defensive
✓ Showing approval/ disapproval
✓ Stereotyping
✓ Changing the subject matter
inappropriately
 PHASES OF
COMMUNICATION/
INTERVIEW
✓ Toneand guidelines for the relationship
are established.

✓ Interviewerand interviewee meet and

learn to identify each other by name

✓ Agreement of contract about the goals

of the relation, location of interview,
frequency and length of contacts and
duration of the relationship and duration
of the relationship
WORKING PHASE
✓ Longest phase

✓ Interaction- essence of this phase

✓ Purposeful-ensure achievement of
mutually agreed upon goals and
objectives.
TERMINATION PHASE
 Occurs when the conclusion of the
initial agreement is acknowledged.

 Examinegoals of the relationship for

attainment and evidence of progress