Health Education

( Prelims)
Course Description:
The course includes discussions on health education concepts, principles, theories,
and strategies as they apply in the clinical and classroom situations

Course Objectives:
At the end of the course, given relevant situations/conditions, the student will be able to:
1. Apply principles, theories and strategies of health education in assisting clients to
promote and maintain their health
2. Develop an instructional design to meet the learning needs of clients
Learning Objective:

HEALTH
WHO : A state of complete physical, mental, and social well being and not merely the absence
of disease or infirmity. It encompasses the ability of the individual to perform tasks expected
even if some manifestations of illness are felt.

KOZIER : A sense of being physically fit, mentally stable and socially comfortable. It
encompasses more than the state of being free of disease.

PEPLAU; The process by which an individual strive for a stable equilibrium and a forward
movement of one’s personality.

ABDELLAH; A state when an individual has no unmet needs and no anticipated or actual
impairment of the body that is manifested.

EDUCATION
Accdg. To Kozier: It is an interactive process of imparting K through sharing, explaining,
clarifying and synthesizing the substantive content of the learning process in order to arrive at a
positive judgment and well-developed wisdom and behavior.

HEALTH EDUCATION
Refers to the act of providing information and learning experiences for purposes of behavior
change for health betterment of the client.

It is the totality of experiences which favorably influence habits, attitudes, and knowledge
relating to individual, community and racial health.

“ A truly educated person nowadays, needs broad general education and the opportunity to
study a small number of subjects in-depth”… Jacques Delors, UNESCO

CONCEPT
Refers to an idea or a mental image which makes reflective thinking possible. It is the building
block of theories through which knowledge is formed.
Concept can either be:
1. Abstract concepts- complex concepts that require more than one term to convey their
meaning. Ex. Man, nursing
2. Concrete concepts- simple and realistic concepts. It illustrates simplicity of a thing.
Ex. Joseph is a student
THEORY
A written description / an abstract explanation describing how several factors may relate
to and affect each other.
ex. 4 major components of nursing( person, health, environment, nursing) in Watson’s

PRINCIPLES
They are basic generalizations that are accepted as true and that can be used as a basis for
reasoning or conduct.

STRATEGY
It is an over-all plan of action for instruction that anticipates barriers and resources of the
learning experience to achieve goals.

LEARNING
. It is the acquisition of K of all kinds such as abilities, habits, attitudes, values, and skills
primarily to create change in an individual.
. It is a gradual, continuous process throughout life.

TEACHING
The process of providing learning materials, activities, situations and experiences that enable
the clients or learners to acquire K,S,A and values to facilitate self-reliant behavior.

It is a consequential process, where the teacher demonstrates, and the learner appreciates
what is shown and to internalize what is seen and heard.

PATIENT TEACHING
Basic function of nursing.

Perceived as a legal and moral requirement and function of a licensed nurse practitioner.
It is a system of activities intended to produce learning and change in client behaviour.

LEARNING NEED
- a desire to know something that is presently unknown to the learner. It may be a new
K,S, A, physical activity, or a new behavior.

MOTIVATION- stimulation of interest

COMPLIANCE-when the person recognizes and accepts the need to learn and follow
through with the appropriate behavior that will reflect learning.

ANDRAGOGY- the art and science of helping adults to learn.

PEDAGOGY- the art and science of helping children to learn

GERAGOGY- The art and science of stimulating and helping the elderlies to learn.

HISTORICAL DEVELOPMENT OF HEALTH EDUCATION

 Prior to the coming of the religious orders to the Phil., ‘arbularyos’ or local doctors had
been tending to the health needs of the community.

.....they were repositories of K of how to take care of one’s health.

With the coming of the religious orders, the more informed way of treating the sick had
been institutionalized with the awarding of degrees in nursing and medicine.

The religious sisters continued to be nurses until lay individuals were able to secure
nursing degrees in the 1800’s.

FLORENCE NIGHTINGALE- the founder of modern nursing, and the ultimate educator.

- developed the first school of nursing

- devoted a large portion of her career to teaching nurses, physicians

and health officials about the importance of proper conditions in
hospitals and homes to improve the health of people.

By the early 1900’s, public health nurses clearly understood the significance of the role
of the nurse as teacher in preventing disease and in maintaining the health of society.

As early as 1918, the National League of Nursing Education (in the US), now , the
National League for Nursing observed the importance of health teaching as a function within the
scope of nursing practice

By 1950, the NLN had identified course content in nursing school curricula to prepare
nurses to assume the role as teachers of others.

Most recently, the NLN developed the first certified nurse educator (CNE) exam to raise
“the visibility and status of the academic nurse educator role as an advanced professional
practice discipline with a defined practice setting” (2006)

Today, all Nurse Practice Acts (NPAs) include teaching within the scope of nursing
practice responsibilities. Nurses, by legal mandate of the NPAs , are expected to provide
instruction to consumers to assist them to maintain optimal levels of wellness and manage
illness.

In recognition of the importance of patient education, by nurses, the Joint

Commission(JC) formerly the JCAHO, established nursing standards for patient education as
early as 1993. These standards known as mandates, describe the type and level of care,
treatment and services that must be provided by an agency or organization to receive
accreditation.
 More recently, the JC has expanded its expectations to include an interdisciplinary team
approach in the provision of patient education as well as evidence that patients and their
significant others participate in care and decision making and understand what they have been
taught.

The Patient’s Bill of Rights, first developed in the 1970’s by the American Hospital
Association, established the guidelines to ensure that patients receive complete and current
information concerning their diagnosis, treatment and prognosis in terms they can understand

The Pew Health Professions Commission (1995) published a broad set of competencies
st
it believed would mark the success of the health profession in the 21 century. More that half of
them pertain to the importance of patient and staff education and to the role of the nurse as
educator.

Since the 1980’s,the role of the nurse as educator has undergone a paradigm shift.
DOPE (Disease-oriented patient education)

POPE(Prevention-oriented pt educ’n)

HOPE ( Health-oriented pt educ’n)

*** Instead of the traditional aim of imparting info,the emphasis is now on empowering
pts to use their potentials, abilities and resources to the fullest.

Another important role of the nurse as educator is serving as a clinical instructor for
students in the practice setting. Many staff nurses function as clinical preceptors and mentors to
ensure that nsg students meet their expected learning outcomes.

Evidence indicates that nurses in the clinical and academic settings feel inadequate as
mentors and preceptors due to poor preparation for their role as teachers. The challenge of
relating theory learned in the classroom to the practice environment requires nurses not only to
be up to date with clinical skills and innovations in practice, but to possess the K and S of the
principles of teaching and learning.

The following are some of the significant forces that influence nursing practice in
particular and the healthcare system in general:
1. the Federal gov’t has published Healthy People 2010: Understanding and Improving
Health, a document that put forth national health goals and objectives for
the future., including the development of effective health educ’n programs to
assist indivs to:
 Recognize and change risk behaviors
 Adopt or maintain healthy practices
 Make appropriate use of available services for health care
.... Achieving these national priorities would definitely cut the costs of health care,
prevent the premature onset of disease and disability, and help all Americans lead
healthier and productive lives

2. The growth of managed care has resulted in shifts in reimbursement for healthcare
services
 3. Health providers are recognizing the economic and social values of reaching out to
communities, schools and workplaces to provide education for disease prevention and
health promotion

4. Healthcare professionals are increasingly concerned about malpractice claims and

disciplinary action for incompetence.

5. Nurses continue to define their professional role, body of K, scope of practice , and
expertise with client education as central to the practice of nursing.

PURPOSES OF PATIENT TEACHING

1. Increase client’s awareness and knowledge of their health status
2. Increase client satisfaction
3. Improve quality of life
4. Ensure continuity of care
5. Decrease patient anxiety
6. Increase self-reliant behavior
7. Reduce the incidence of complications of illness
8. Promote adherence to health care treatment plans
9. Maximize independence in the performance of ADL
10. Empower clients to be active to plan their own care

THE EDUCATION PROCESS

- a systematic, sequential, logical, scientifically based, planned course of action
consisting of 2 major interdependent operations: teaching and learning; and involves 2
independent players: the teacher and the learner

COMPARISON OF THE EDUCATION PROCESS AND THE NURSING PROCESS

Education Process
1. Collect data; analyze client’s learning strengths and deficits
2. Make educational diagnosis
3. Prepare teaching plan:
Write learning outcomes
Select content and time frame
Select teaching strategies
4. Implement teaching plan
5. Evaluate client learning

Nursing Process
1. Collect data, analyze client’s strengths and deficits
2. Make nursing diagnosis
3. Plan nursing goals\ desired outcomes and select interventions
4. Implement NCP
5. Evaluate client outcome

TEACHING-LEARNING PROCESS
A systematic, sequential, logical, scientifically based planned course of action. It is a
cycle that involves a teacher and a learner. It occurs before the lesson begins and continues
after the last lesson ends.
STEPS IN THE TEACHING-LEARNING PROCESS:
1. Assessment.
Gathering of data about the learner’s demographic profile, skills, and abilities needed
in identifying the most appropriate teaching strategy for a particular
learner
2. Planning.
A carefully organized written presentation of what the learner needs to learn and
how the nurse educator is going to provide the teaching
3. Implementation and Application of the Teaching Plan.
The point where theoretical and practical aspects of the teaching-learning process
meet as the teacher applies the plan to the learners.
4. Evaluation. The measurement of teaching-learning performance of both teacher and
learners.

THE PROCESS OF HEALTH EDUCATION

Health education consists of learning experiences that promote behavior conducive to
good health. It provides the tools for developing the ff.
1. Physical health. Activities or lng experiences that help promote the ability of the body to
function effectively
2. Emotional health. Activities that enable an indiv to cope with stress and strain of daily
life.
3. Mental health. Measures or strategies that enable an indiv to make correct judgments.
4. Social health. Ways in which an indiv can relate well with others regardless of status or
position.
5. Spiritual health. Activities that will help an indiv recognize and accept the supernatural
aspect of divine healing.

PURPOSES OF HEALTH EDUCATION

1. A means of propagating health promotion and disease prevention
2. Used to modify or continue health behaviors if necessary
3. Provides health information and services
4. Emphasizes on good health habits
5. A means to communicate vital information to the public
6. A form of advocacy

DIMENSIONS OF THE HEALTH EDUCATION PROCESS

1. Substantive Dimension- what is taught and what is learned
2. Procedural Dimension- the teaching method and learner activities used
3. Environmental Dimension- the physical and social factors in the teaching-learning
situation
4. Human relations dimension- persons involved in the nursing care practice that influence
the effectiveness of the teaching and learning process.

STRATEGIES IN MANAGING CHANGE

a. Empirical-rational strategy. Assumes that learners are rational beings with mental
faculties, and behave acdg to their personal beliefs, interests and motivations
b. Normative or Re-educative strategy. Assumes that learners act consistently with their
socio-cultural norms.
c. Power-coercive strategy. Learners are coerced to comply with instructions.
FACTORS AFFECTING CHANGE
1. Culture. Beliefs and values important to the learner
2. Demographics. Learner’s age, gender, heredity and environment which may determine
level of response to change.
3. Socioeconomic Conditions and Environmental Circumstances. Learner’s adaptability,
flexibility, and capabilities in creating change.
4. State of wellness and development

BARRIERS TO TEACHING AND OBSTACLES TO LEARNING

Barriers to Teaching- defined as those factors that impede the nurse’s ability to deliver
educational services.
The ff are the major barriers interfering with the ability of nurses to carry out their roles
as educators:
1. Lack of time to teach.
- Early discharge from inpatient and outpatient results in fleeting contact with
one another.
- Schedules and responsibilities of nurses are very demanding.

*** Adopt an abbreviated, efficient and effective approach to client and staff
education

2. Many nurses and healthcare personnel admit that they do not feel competent or
confident with their teaching skills.

3. Personal characteristics of the nurse educator play an important role in determining the
outcome of a teaching-learning interaction.
- Motivation to teach and skill in teaching are prime factors in determining the
success of any educational endeavor.

4. Low priority was often assigned to patient and staff education by administration and
supervisory personnel.
- The level of attention paid to the educational needs of consumers has changed
due to mandate of the JC. However, budget allocations for educational programs remain
tight and can interfere with the adoption of innovative and time-saving teaching
strategies and techniques.

5. The environment in the various settings where nurses are expected to teach is not always
conducive in carrying out the teaching-learning process. Lack of space, lack of privacy,
noise and frequent interferences due to client treatment schedules and staff work
demands are some of the factors that negatively affect the nurse’s ability to concentrate
and to effectively interact with the learners.

6. Some nurses and physicians question whether patient education is effective as a

means to improve health outcomes when patients do not display interest in changing
behavior, when they demonstrate an unwillingness to learn, or when their ability to learn
is in question.
 7. Both formal and informal teaching are often done but not written down because if
insufficient time, inattention to detail, and inadequate forms on which to record
the extent of teaching activities.
- many of the forms used for documentation of teaching are designed to simply
check off the areas addressed rather than allow for elaboration of what was actually
accomplished

OBSTACLES TO LEARNING. Those factors that negatively affect the ability of the learner
to pay attention to and process information.

Factors Impacting the Ability to Learn:

1. Lack of time to learn due to rapid pt discharge from care and the amount of info a
client is expected to learn can discourage and frustrate the learner,
impending the ability and willingness to learn.
. 2. The stress of acute and chronic illness , anxiety and sensory deficits in patients are
just a few problems that can diminish learner motivation and interfere with
the process of learning.

3. Low literacy and functional health illiteracy has been found to be a significant factor in
the ability of clients to make use of the written and verbal instructions given to
them by providers.

4. The negative influence of the hospital environment itself, resulting in loss of control,
lack of privacy, and social isolation can interfere with the patient’s active
role in health decision making and involvement in the teaching- learning
process.

5. Personal characteristics of the learner have major effects on the degree to which
behavioral outcomes are achieved. Readiness to learn, motivation and
compliance, developmental-stage characteristics, and learning
styles are some of the prime factors influencing the success of educational
endeavors.

6.The extent of behavioral changes needed, both in number and complexity, can
overwhelm learners and dissuade them from attending to and accomplishing
learning objectives and goals.

7.Lack of support and lack of positive reinforcement from the nurse and S.O. serve to
block the potential for learning.

8.Denial of learning needs, resentment of authority, and lack of willingness to take

responsibility are some psychological obstacles to accomplishing behavioral
change.

9. The inconvenience, complexity, inaccessibility, fragmentation and dehumanization of

the healthcare system often result in frustration and abandonment of
efforts by the learner to participate in and comply with the goals and
objectives for learning.