MEDICAL COLLEGES OF NORTHERN PHILIPPINES

Alimannao Hills, Peñablanca Cagayan

HEALTH
EDUCATION
Midterms-Second Semester F.Y. 2022-2023

Glaiza P. Salvador, RN, MSN

Clinical Instructor
 MIDTERMS COVERAGE
LESSON 4: Hallmarks of Effective Teaching in Nursing
LESSON 5: Principles of Good Teaching Practice in Undergraduate Education
LESSON 6: Barrier to Education and Obstacles to Learning
LESSON 7: Applying Learning Theories to Health Care Practice
LESSON 8: Planning and Conducting Classes

PRELIMS COVERAGE
CHAPTER 1: HEALTH EDUCATION PERSPECTIVE
LESSON 1: Historical Development in Health Education
LESSON 2: Issues and Trends in Health Education
LESSON 3: Theories in Health Education

CHAPTER 2: PERSPECTIVE ON TEACHING AND LEARNING

LESSON 1: Overview of Education on Health Care
LESSON 2: Concepts of teaching, learning, education process vis-à-vis nursing process,
historical foundations for the teaching role of the nurse
LESSON 3: Role of the Nurse as a Health Educator

KEYTERMS
accretion
andragogy hallmarks of teaching
behaviorist long-term memory
cognitive pedagogy
condition of learning sensory memory
evaluative practices short-term memory
forgetting stage theory
good teaching teaching practices
 REFERENCES:
TEXTBOOK:
Bastable, S. B. (2019). Nurse as Educator: Principles of Teaching and Learning for Nursing
Practice.
De Young, S (2014). Teaching Strategies for Nurse Educators
Bastable (2018). Nurse as Educator

Other References:
1. Bastable (2017). Essentials of Patient Education Second edition
2. Iwasiw (2017)/ Curriculum Development in Nursing Education Third edition
3. Hahn (2012). Focus on Health by Hahn, Tenth edition
4. Payne (2012). Understanding your Health Seventh edition

Website:
1. www.amazon.ca/exec/obidos/ASIN/0071054804
2. www.harcourt-international.com/surgicalnursing
3. www.medicine.htm
4. www.nursingguide.htm
5. www.nursingscribd.com
6. www.healtheducationforteens.com
LESSON : HALLMARKS OF EFFECTIVE TEACHING IN
NURSING
1.PROFESSSIONAL COMPETENCE
-Enjoys nursing-shows genuine interest in patients and displays confidence

-Creative and stimulating; excite interest

-Demonstrate clinical skills with expertise

-Aims at excellence; know ledge of the subject matter; polishes skills throughout career

-Learners-trust their teachers- accurate; demonstrated correctly

-Positive role model for learners

2. INTERPERSONAL RELATIONSHIPS
-skillful in interpersonal relationships

-personal interest in learners, being sensitive, respect, alleviate anxiety, accessible, fair,
express
points of view, feel free to ask questions, a sense of warmth

-evaluate students or consider problems/needs

-concern: not counselors-may lead to taking advantage and leads to lack of self-
discipline

- good relationship enhances learning

- must set teacher-student and nurse-patient-boundaries

-students-worthwhile individuals who have something to offer the profession

Three approaches:
a. empathic listening
-listening – very important
-shows respect, care, understand
 b. acceptance
- accept students as they are
-enhance self-esteem and convinces them that you have faith in desire and ability to
learn
-rewarded by the student by living up to the expectation
c. honest communication
-teacher’s thoughts: topic, learners
-openness-relaxed environment; better to accept criticism
-identify learners’ responsibilities to succeed
•These are necessities – required for all interpersonal relationships (not only on nursing
education)
If students experience them in teacher-student relationship – may apply to their
patients

3. PERSONAL CHARACTERISTICS
-magnetism, enthusiasm, cheerfulness, self-control, patience, flexibility, sense of humor,
good speaking voice, self-confidence, willingness to admit errors, caring attitude

-make learning more interesting, fun, or pleasant

-teachers should maintain the standards because students will benefit from these
efforts

4. TEACHING PRACTICES
-mechanics, methods and skills in classroom and clinical teaching

-thorough knowledge of the subject matter and can present material in interesting,
clear, and organized manner

-Teaching subject matter in stimulating and inspiring way

-Factors: style, personality, interest, strategies

5. EVALUATION PRACTICES
-clearly communicating expectations, providing timely feedback on progress, correcting
students tactfully, fair, giving exams pertinent to subject matter

-expectations should be leveled at the beginning (teacher should let the students know:
read assignments, attendance, punctuality, deadlines, resources, assistance, breaks,
care plans-criteria should be available

-if not met, students should know it (whether well or not; it is not necessary to search
weaknesses)
 -fairness in evaluation is subjective

6. AVAILABILITY TO STUDENTS
-nursing students expect instructor to be available to them when needed

-In stressful clinical situations, physically helping students give nursing care, supervision,
answering questions, act as resource person

-Stressors for nurses/teachers is availability on precise time

-Teacher clarity: behaviors that teacher use ->topic-> intelligible, comprehensive, and
learnable

-logically organizes instruction, explains, use simple terms, constantly assesses

(understand/follow), uses examples, allows thinking, uses repetition and summarization

-positively correlated with students’ achievement/attitudes

a. View students as collaborators – students are respectful and supportive
b. Admitting weaknesses – being human
c. Recognized when their students were having difficulty and were able to figure
out what to do to help

-to be a good teacher you must really have the desire to be good
LESSON : PRINCIPLES OF GOOD TEACHING PRACTICE
IN THE UNDERGRADUATE EDUCATION
 Looking at the elements of good teaching is through this framework
 Written based on college settings, they apply to adult education settings.
 May be applied to nurse-patient interaction

1.Encourage student-faculty contact

-nurse-patient relationship, a professional one

2. Encourage cooperation among students

-patient and SO; collaborative learning. Study groups, group projects
-more on collaboration than competition

3. Encourage active learning

-based on experience; manipulate (talking, writing, outlining, applying,
asking questions, reflection)
4. Give prompt feedback
-assessment, observation, evaluation

5. Emphasize time on task

-time management; time to spend on studying
-take seriously, using time efficiently

6. Communicate high expectations

-challenge; expected to work hard,
-learners rise to the challenge

7. Respect diverse talents and ways of learning

 -traditions, belief, and practices

LESSON : BARRIER TO EDUCATION AND OBSTACLES

TO LEARNING
 Direct costs-fees, uniforms, books, exam fees, meals, transportation

 Opportunity costs-child needs to work to contribute to household income

 Illness and hunger-of child or someone in family requiring assistance

 Limited economic barriers-it may not be judged to be worth the time or

expense

 Low quality of schooling – classrooms, teaching materials, toilets,

electricity, class size, methods, curriculum, poor management

 Teacher inertia cause by-low wages, low morale, bad working environment,
irregular class

 Distance to school-boarding cots, transport costs, inaccessible to rainy

season, peace and order, lack of transportation
 LESSON : APPLYING LEARNING THEORIES TO
HEALTH CARE PRACTICE
 LEARNING THEORIES

I. BEHAVIORISTS THEORIES
-earliest formal theories of learning (20th century)
-thoughts and feelings

JOHN WATSON
-traditional to objective and practical
-defined as muscle movement
-behavior -> result of a series of conditioned reflexes, and all emotions and
thoughts are result of behavior learned through conditioning

GUTHRIE
-even skill like walking is learned through a series of conditioned responses

*Watson and Guthrie

-emphasized the contiguity of the stimulus and response, they are known as
contiguity theorists

Thorndike and Skinner

-stimulus and response bonds are strengthened by reinforcements
-reward and punishment

*Thought process are the result of stimulus-response activities-very simple behavior

-drill, practice, memorization

II. COGNITIVE LEARNING

-since 1960’s, predominant approach to psychology

*Cognitive science - study of how our brains work in the process of perceiving, thinking,
remembering, and learning
*Information processing is used to describe this field of study
 -the focus is more on mental processes that are responsible for behavior and its
meaning

*Learning is an active process -> learner constructs meaning based on prior knowledge and
view of the world

*SUBSUMPTION THEORY OF MEANINGFUL VERBAL LEARNING (Ausabel,1963)

-new information is subsumed into exiting though and memory structures

Meaningful learning is thought to occur only if existing cognitive structures are organized and
differentiated.

-repetition of meaningful material and use in various contexts would enhance the
retention of the material

Rumelhart (1980)
“Schema/schemata”
-knowledge structures that are stored in memory
- “all knowledge is packaged into units” called schemata
-people remember patterns of facts or visual, auditory, or tactile cues
-schemata is like theories, in which it comprehends and predict events
-schema is not always accurate. It may be altered

THREE KINDS OF LEARNING ACCORDING TO SCHEMA THEORY

1.ACCRETION
-Learning of facts
-new information is learned and added to existing schemata
-No changes are made to existing knowledge

2. TUNING (Schema evolution)

-Existing schemata evolve or are refined throughout the life span as new
situations and issues are encountered

3. RESTRUCTURING (Schema creation)

-Development of new schemata by copying an old schema and adding new
elements that are different enough to warrant a new schema

STAGE THEORY
-information processing relates to memory activity
-information is both processed and stored in three stages

THREE STAGES:
1.SENSORY MEMORY
- fleeting
 - objects seen may last for only half a second
- things heard may last about three seconds
- if not attended to, may be forgotten

2. SHORT-TERM MEMORY
-sensation must be of some interest to the person or activate a known schema
-whatever we are thinking about or that which impinges on us from an external
stimulus at any given time
-may last about 20 seconds, unless repeated

3. LONG-TERM MEMORY
-Firmly tie things to an existing schema in the brain
-Mnemonics, relate name to other similar name, create mental association
picture
*Focus on making learning meaningful and interesting and tying it to students’
existing schemata
*Elaboration, application, analogies, questioning, organizing, summarizing

COMMON CONCEPTS OF COGNITIVE THEORIES

1.LEARNING
*Behaviorist – acquisition of knowledge and skills that changes a person’s behavior
*Cognitive- acquisition of knowledge than on the resulting behavior change
- More concerned with what the knowledge means to a person than they are with
whether the person’s behavior will change as a result
“The process whereby novices become more expert”
•Domain-specific learning
-The amount of knowledge and understanding you already possess on a subject will
have a tremendous influence on what and how you learn
-Easier for you to learn more->present schema

2. METACOGNITION
-Evolved from the study of information processing, thinking about one’s thinking
-Process learners use to gauge their thinking while reading, studying, trying to learn,
solving
-Some people are intelligent novices
-> they know what they know and what they don’t know, and they plan to get the info
and understanding they need

3. MEMORY
-consolidation function in the memory process
-items are stationed in memory
“The more we connect new information to old, the more we ruminate over new
information, and the more frequently we recall and think about it, the more long-lasting
it will be”
-the more we recall, the more danger there is that we will actually change those
memories
-we tend to construct rather than retrieve one
-We take fragment memories and construct new one

*Connectionistic Model
-Many theorists believe in memory retrieval rather than memory construction
-having the right cues to prompt us and if the item was stored well
-info that is meaningful to the person may be retained very well vs. meaningless,
forgotten
-studies show that a person can hold about seven times in short-term memory
before forgetting it, and to go beyond seven times, use mental strategy
-pure repetition serves only to extend duration

*Chunking
-very successful to go beyond seven times
-chunks are formed when info is clustered into patterns

Forgetting
-the flip side of memory

Hypotheses of forgetting:
a. the connections(networks) are weakened (disuse, disease, interference with
new memories)
b. no right stimulus or cue
c. person’s intent to learn partly

4. TRANSFER
-ability to take information learned in one situation and apply it to another
-the transfer of learning is what teaching is all about

Factors:
1.The extent to which material was originally learned
2. The ability to retrieve information from memory
3. The way in which the material was taught and learned
-focus on the responsibility of the educator; should be made explicit to the
learner
-emphasizing concepts and principles than facts
*Positive transfer-present learning is enhanced by past learning
*Negative transfer- past learning interferes with the present learning
III. SOCIAL LEARNING THEORY (SOCIAL COGNITIVE THEORY)

Albert Bandura
*Key Components:
1.People learn as they are in constant interaction with their environment
- Most learning occurs as a result of observing other people’s behavior and its
consequences (modeling)

2. Attentional processes
– determine which modeled behaviors will be learned
-People perceive and attend only a certain number of modeled behaviors
-Characteristics, activities, and social interactions

3. Retention processes
-ability to retain modeled behavior in permanent memory
-people must retain a mental image of modeled behavior or verbal symbol that is easily
recalled
-rehearsal –significant way of retention
-motivation for learning will determine which modelled behaviors are enacted.
-motivation comes with possibility of valued outcomes as opposed to unrewarding or
punishing

TYPES OF LEARNING
PEDAGOGY VS ANDRAGOGY
Malcolm Knowles-proponent
ANDRAGOGY -teaching of adults
PEDAGOGY -teaching of children

DIFFERENCE BETWEEN PEDAGOGY AND ANDRAGOGY

AREAS PEDAGOGY ANDRAGOGY

Need to know Learn what the teacher wants them to learn Need to know why they
need to learn something
Self-concept Perception of being dependent on the teacher Feel responsible for their
for learning own learning
Role of experience The teacher’s experience, not the children’s is Adults learn from each
 what counts other’s experience
Readiness to learn Must be ready when the teacher says they Ready to learn when they
must or they will not be promoted feel the need to know
Orientation to learning Subject-centered orientation Life-centered or task-
centered
Motivation Externally motivated Primarily internally
motivated, with some
external motivation

Summary
1. Adults are motivated to learn info for which they understand the purpose and see
practical applications
2. Adults want to take some control of their learning process and be self-directed
3. Adults want their life experiences to be considered in the learning situation and want
to learn from others’ experiences

GAGNE’S CONDITIONS OF LEARNING

1.SIGNAL LEARNING (Classical conditioning)
-Conditioned response
-Person develops a general diffuse reaction to a stimulus
-ex. An infant smile at the sight of its mother.

2. STIMULUS-RESPONSE LEARNING (Operant conditioning)

- Developing a voluntary response to a specific stimulus or combination of stimuli
-ex. A child says papa at the sight of his father

3. CHAINING
-acquisition of a series of related conditioned responses or stimulus-response
connections
- it is the process whereby most complex psychomotor skills are learned.
-ex. Riding a bicycle or playing the piano

4. VERBAL ASSOCIATION
-a type of chaining and is easily recognized in the process of learning medical
terminology
-ex. when a child learns the equivalent of words or its meaning.

5. DISCRIMINATION LEARNING
-A great deal can be learned through forming large numbers of stimulus-response or
verbal chains
-However, the newer chains that are learned, the easier it is to forget previous chains
-To learn and retain large number of chains, the person must be able to discriminate
among them
 -ex. The child learns to distinguish between his mother and his aunt.

6. CONCEPT LEARNING
-Learning how to classify stimuli into groups represented by a common concept
-ex. The child learns the concept bird. He distinguishes a bird from a mammal.

7. RULE LEARNING
- the acquiring of knowledge and understanding of a relationship between concepts.
- “If … then” relationships
-A learner should learn and comprehend a lot of rules in a certain field to have no
difficulty with the highest level of learning, which is problem solving
-ex. A child learns the principle- “Metals expanding on heating”
8. PROBLEM SOLVING
-this is the highest stage in the hierarchy of learning process
-the learner must have a clear idea of the problem or goal
-recall and apply previously learned rules that relate to the situation
-process of formulating and testing hypotheses
-define the problem or goal
-recall the necessary rules related
-ex. A boy proves theorems in geometry

LEARNING STYLES
People learn in uniquely different ways. The student can be a learner who is analytic,
memory, visual, auditory, reflective, can learn better independent or in a group
-formerly cognitive style-> learning involves more than just cognitive
-physiologic, affective, cognitive
-habitual manner in which learners receive and perceive info, process it, understand it,
value it, store it, and recall it

BASIC CONCEPTS:
Holistic/global thinkers
->want to get the whole picture quickly, or the gist of things
->broad categories before details
-> process information simultaneously than step-by-step manner
->see how new info connect to old ones and value
->retain overall info

Analytic thinkers
->process details of a picture
->outline component parts in logical way
->sees info in objective manner
-> do not connect info to personal values or experiences

Verbal approach
 -> represent, in their brains, information they read, see, or hear in terms of words or
verbal association

Visual approach
->experience information they read, see, or hear in terms of mental pictures or images

KOLB’S THEORY OF EXPERIENTIAL LEARNING

FOUR STAGES OF LEARNING CYCLE

1.Concrete experience (CE)
-learn from actual experience

2. Reflective observation (RO)

-learning by observing others

3. Abstract conceptualization (AC)

-creating theories to explain what is seen

4. Active experimentation (AE)

-using theories to solve problem

-These four abilities /modes of learning occur on two continuums:

>AC to CE – thinking vs feeling
>AE to RO - external vs internal

FOUR POSSIBLE LEARNING STYLES:

1.CONVERGER
-AC and AE
-good decision-making and problem solving
-technical work rather than interpersonal relationships

2. DIVERGER
-CE and RO
-imagination and awareness of meaning
-feeling oriented, people oriented, working in groups

3. ACCOMODATOR
 -CE and AE
-actively accomplish things, trial, and error method to solve problems
-impatient
-acts on intuition, risk takers

4. ASSIMILATOR
-AC and RO
-inductive reasoning, creating theoretical models, integrating ideas
-more concerned with ideas than people

GREGORC COGNITIVE STYLE MODEL

-the mind has the mediation abilities of perception and ordering
-everyone processes info in all four dimensions, but they have a preference

1.CONCRETE SEQUENTIAL (CS)

-Highly structured, quiet learning environment and do not like being interrupted
-Concrete learning materials, visual, literal

2. CONCRETE RANDOM (CR)

-intuitive, trial-and-error, look for alternatives
-order new information mentally

3. ABSTARCT SEQUENTIAL (AS)

-holistic, seeks understanding of new info
-needs consistency, doesn’t like interruptions
-good verbal skills, logical, rational

4. ABSTRACT RANDOM (AR)

-holistic, visual
-busy, unstructured learning environment
-focused on personal relationships

FIELD INDEPENDENCE/DEPENDENCE MODEL

-Proponent: Herman Witkin

a. Field-independent style
-items are perceived independent from their surrounding field
-analytical (parts more than the whole)

b. Field-dependent style
-person has a difficulty perceiving items aside from their surroundings
 -global (whole more than the parts)

FIELD INDEPENDENT FIELD DEPENDENT

Mathematical reasoning is strong
Analyzes the elements of a situation
Recognizes and recalls details
Task oriented
Forms attitudes independently
More pronounced self-identity
Difficulty with mathematical reasoning
Analyzes the whole picture, than elements
Does not perceive details
People oriented
Attitudes guided by authority or peer group
See themselves as others see them

The end for midterms . . .