KEY TERMS:

GOALS-broad statements of what a course intends to accomplish OBJECTIVES-are precise statements of what outcomes the learning instruction intends to accomplish. It also states where we want our learners or clients to go. ASSESSMENT-1st step in nursing process and includes the systematic collection, verification, organization, interpretation and documentation of client data. DIAGNOSIS-involves further analysis and synthesis of the data that have been collected. PLANNING-combines with outcome identification to compromise the third step in nursing process and includes both formulation of guidelines that establish the proposed course of nursing action in the resolution of nursing diagnosis and the development of the clients plan of care. IMPLEMENTATION-involves the execution of the nursing care plan derived from the planning phase. EVALUATION-involves determining whether the goals and objectives were met, partially met or none at all. The ultimate question of the Nurse Educator, whether in the clinical setting or in the academic setting -WHAT WILL I TEACH MY STUDENT/CLIENT? In the planning of lessons or what to teach students/clients, the nurse educator must put into consideration the client/student. It is noteworthy to bear in mind one of the basic precepts in the nursing profession. Nursing process

ASSESSMENT-observation, interview, interaction, examination, measurement. DIAGNOSIS-analysis (breaking down), synthesis (putting together), problem identification. PLANNING-setting of priorities, establishing goals and objectives, planning intervention, methods and procedures of delivering. IMPLEMENTATION-validating age/lesson plan, giving and documenting care/knowledge and information. EVALUATION-re-assessment comparison of clients/students status with the goals and objectives or expected outcome.

SUGGESTED STEPS IN THE PLANNING OF LESSONS

1. Develop a course outline or syllabus (in clients NCP) -A syllabus will help nurse educator in the planning of lessons because it gives the educator an idea of the topics that need to be discussed to the students, patients, health educators, etc. -In developing your syllabus, change your topics carefully according to perceived needs of the patients, students, health educators, community and the like. 2. Formulate Goals and Objectives -Goals and Objectives help the nurse Educator in describing behavioral changes in the learners or clients. bear in mind that goals are the generalized statements and the

objectives are the specific statements used in describing what the clients or learners ought to accomplish in the formulation of objectives, the following criteria is observed: a. MEASURABLE-is the standard of performance clearly defined in such that educators teaching the course agree on the standard and how the results would be interpreted. b. OBSERVABLE-can performance be detected by the senses of some measuring tool? c. RELEVANT-How useful are the objectives to the future tasks roles and responsibilities of the learner? d. TIME BOUND-Is there a timeframe in which the objectives should be attained? What is a reasonable amount of time? e. ATTAINABLE/ACHIEVABLECan the objectives be attained with the available resources and the abilities of the learners? f. LEARNER-ORIENTED-Is the objective stated in terms of what the learner should be able to do? Does the objective state expected learning outcomes instead of what the teacher will do? g. SPECIFIC-Is the objective stated in precise terms that describe the behavior? Does the objective state only one learning outcome? In summary, MORTALS.

In the formulation of Objectives, Bloom (1984) has postulated a taxonomy of objectives that will guide the educator in the planning of lessons. According to the taxonomy, the objectives shall be classified into: a. COGNITIVE DOMAIN (knowledge, comprehension, application, analysis, synthesis, evaluation) b. AFFECTIVE DOMAIN (receiving, responding, valuing, organization, characterization) c. PSYCHOMOTOR DOMAIN (reflexes, fundamental movements, perception, physical abilities, skilled movements, non-discursive) 3. Content Selection -In selecting the content of the course, the educator must consult the prescribed curriculum of the school, health agency of the Dept. of Health for which the educator works. 4. Organizing Content -Organize your lectures, content, plan of action, discussions, role playing, quizzes and tests, In short:ALL! 5. Make your learning activities -In every lesson, there should be an activity to enhance the skills of the learners in the particular subject or topic. 6. Choose resource materials -The educator must be prudent in choosing the appropriate materials for the subject matter or the specific lesson. 7. Evaluation -The educator should also prepare tools to measure the learning of the students. It may be in the form of tests, essays, etc.

PREREQUISITES TO LESSON PLANNING (LARDIZABAL, ET AL. 1997)

1. Knowledge of the subject matter -Knowledge of subject matter involves planning, learning activities or experiences that may be taken up in the classroom. 2. Knowing the learners -Good planning requires knowledge of what tot each as well as of who should be taught knowing the learner means understanding their traits and interests and planning for them. 3. Familiarity with different strategies -The health educator must know various ways of imparting learning in consonance with the learners nature and with the type of subject matter. 4. Materials -A teacher needs materials that will facilitate the teaching process. 5. Understanding of Objectives -This includes the aims of education especially of Philippine education, the aims of the course or subject and the aims of the specific lessons or intervention.

Motivation in line with nursing practice: Motivation is the desire to learn It greatly influences how quickly and how much a person learns It is generally greatest when a person recognizes a need and believes the need will be met through learning It is not enough for the need to be verbalized by the nurse; it must be experienced by the client The task: to help the client personally work through the problem and identify the need WHY? Clients sometimes need help identifying information relevant to their situation before they can see a need. Factors that may affect learning: 1. Readiness to learn 2. Active involvement 3. Relevance of the information 4. Feedback 5. Non-judgmental support 6. Simple to complex 7. Repetition 8. Timing 9. Environment 10. Emotions 11. Physiologic events 12. Cultural aspects 13. Psychomotor activity Barriers to learning: Acute illness-client requires all resources and energy to cope with illness. Pain-decreases ability to concentrate Prognosis-client can be preoccupied with illness and unable to concentrate on new information

MOTIVATION AND BEHAVIOR CHANGE (Things that a nurse should know in client teaching)
Definition of Terms: Drive, Motivation, Motive

Emotion-this requires energy, hence, can be a distraction to learning Language-client may not be fluent in the nurses language Age-attention span, physiologic change that comes with age Culture/religion-restrictions because of sets of beliefs Physical disability Mental disability

SOCIAL COGNITIVE THEORY (Baranowski, et al. 1997) -behavior is a result of an interaction among the person, the environment and the behavior itself. -based on RECIPROCAL DETERMINISM-a change in one will cause change with the rest. SELF-EFFICACY THEORY -behavior change occurs because of the expectations or expected result of the new behaviour and ones belief about his/her ability to perform a specific behaviour in a specific situation. -based on four principles: performance accomplishment, vicarious experience, verbal persuasion and physiologic state. STAGES OF CHANGE THEORY -people go through stages before a change in behaviour occurs -6 stages of change: 1. precontemplation stage 2. contemplation stage 3. preparation stage 4. action stage 5. maintenance stage 6. termination stage THEORY OF REASONED ACTION -proposes that adoption of new behaviour results from individual intention to change the behavior -behavior change will result if a person intends to change BEHAVIOR MODIFICATION THEORY (Skinner, 1938) -the never-ending law of reward and punishment -It is based on the premise that behaviour occurs because of its consequences -changing the consequences, reinforcements and rewards can change behavior

Learning principles used in motivating learners (Breckon, Harvey and Lancaster, 1998) 1. Use several senses 2. Actively involve the patients or clients in the learning process 3. Provide an environment conducive to learning 4. Assess the extent to which the learner is ready to learn 5. Determine the perceived relevance of the information 6. Repeat information 7. Generalize information 8. Make learning a pleasant experience 9. Begin with what is known; move toward what is unknown 10. Prevent information in an appropriate rate

MOTIVATION AND BEHAVIOR CHANGE THEORIES

HEALTH BELIEF MODEL (Elder, et al. 1999) -explains behavior and predicts whether behavior change will occur based on a set of beliefs or perceptions, which include perceived seriousness, susceptibility, benefits and barriers.

TRANSCULTURAL ASPECTS OF NURSING

WHAT IS CULTURE? -the non-physical traits, such as values, beliefs, attitudes and customs that are shared by a group of people and passed from one generation to the next (Spector, 2000) WHAT IS CULTURAL CARE NURSING? -it is a concept that describes the provision of nursing care across cultural boundaries that takes into account the context in which the client lives and the situations in which the clients health problems arise THINGS TO REMEMBER ABOUT CULTURE (Bonder et al, 2001) -Culture is learned and transmitted from one generation to another -Culture is localized and is created through specific interactions with specific individuals -Culture is patterned -Culture is evaluative -Culture has continuity with change CULTURAL COMPETENCE MODEL -Cultural competence (the ability to work effectively in cross-cultural situations) -Culturally competent nurse (implies that within the delivered care the nurse understands and attends to the total context of the clients situation and uses a complex combination of KSA. CULTURAL AWARENESS -the process whereby the nurse becomes respectful, appreciative

and sensitive to the values, beliefs, practices of other people -Ethnocentrism (a behavior in which a person is totally unaware of others cultural beliefs and values -Ethnorelativism (reflects an attitude of nurses who value, respect and integrate cultural differences into practice CULTURAL KNOWLEDGE -involves a process of seeking and obtaining factual information about different cultures (CapinaBacote, 1998) -components: 1. Unconscious incompetence 2. Conscious incompetence 3. Conscious competence 4. Unconscious competence CULTURAL ENCOUNTERS -is the process whereby a nurse engages directly in cross-cultural interactions, with clients from culturally diverse backgrounds CULTURAL SKILL -collecting relevant cultural data about a clients health history and accurately performing culturally specific physical assessment -Cultural assessment (a systematic appraisal or examination of individual, groups and communities as to their cultural beliefs, values and practices to determine explicit needs and intervention practices within the context of the people be evaluated-Geiger et al. 2000)

TRANSCULTURAL NURSING
DEFINITION OF NURSING -nursing is a learned humanistic and scientific profession and

discipline which is focused on human care phenomena and activities in order to assist, support, facilitate or enable individuturals or groups to maintain or regain their well-being in culturally meaningful and beneficial ways or to help people face handicaps and death KEY CONCEPT OF TRANSCULTURAL NURSING -Transcultural nursing as a learned subfield or branch of nursing which focuses upon the comparative study and analysis of cultures with respect to nursing health-illness caring practices, beliefs and values with the goal to provide meaningful and efficacious nursing care services to people according to their cultural values and healthillness context WHAT THE NURSE EDUCATOR SHOULD CONSIDER: 1. Become self-aware of your own cultural values, norms and beliefs and the influence they have on your view of life, family and relationships 2. Develop and maintain an attitude of respect for the broad range of cultural differences and their importance to individuals 3. Develop a strategy for continuing education about predominant cultures in a given community or institution 4. Explore the possibility of integrating the appropriate use of teaching strategies and communicators 5. Use resource persons to know about another culture ORGANIZING PHENOMENA OF CULTURE

CULTURAL FACTORS -Cultural factors determine the worth of behaviours, whether behaviors are acceptable and whether behaviors are incorporated to daily living -When these behavioral concepts are applied to health, they influence the individuals expectation of health care -The nurse must be sensitive to the clients cultural context in order to provide care that meets the individual needs WHAT ARE THE ORGANIZING PHENOMENA OF CULTURE? -Communication-the vehicle for transmitting and presenting culture (verbal/non-verbal) -Space-includes ones body, the surrounding environment and objects and people within that environment (proximal distance and touch) -Orientation to time-being focused on the past, the present or the future -Social organization-refers to ways in which groups determine rules of acceptable behaviour and roles of individual members -examples: 1. Family-whether nuclear, extended, incipient and blended 2. Familial PatternsLINEAR(extended and hereditary family, patriarchal), COLLATERAL(family first policy, children are highly valued, socialization around family groups), INDIVIDUALIST(individual first, elders are not as honoured, equal distribution of notes) 3.Religion-often a source of comfort during stressful life events and provide support during the healing process

4.Lifestyle-altenative lifestyle may include: homosexual couples and communal groups -Environmental context-the relationship between people and nature and to a persons perceived ability to control activities of nature, such as factors causing illness -Folk medicine-the concept of faith healers, hilots, mambabarangs etc. -Biologic variations-enzymatic differences and susceptibility to disease THE KLEINMANS EXPLANATORY MODEL WHAT IS THE EXPLANATORY MODEL? -It is a tool that helps a culturally different patient or client to explain his/her viewpoint or perspective on health and illness -It provides similarities and differences between the explanatory model and that of western biomedicine. Potential points of differences that may inhibit planning of care, hx of the clients self-care actions and use of resources PARTS OF THE E.M. -Etiology -Time of onset of symptoms -Pathophysiology -Course of Sickness -Treatment CULTURALLY SENSITIVE CLIENT TEACHING -When caring for clients with diverse cultures, the nurse should consider the following guidelines for client teaching: 1. Assess and incorporate family history of health care as to: -Fluency in the mothers tongue

-Extent of family support -Community resources -Level of education -Change of social status as a result of relocation 2. Affirm clients strengths and potential for growth 3. Recognize informal caregivers as an integral part of tx 4. Evaluate the clients current knowledge base by asking the client to state what he/she knows about a specific topic 5. To ascertain the clients perception of need, ask the client/family what the want/need to learn 6. Observe the interaction between the client and family to determine family roles and authority figures 7. Use language easily understood by the client 8. Clarify verbal/nonverbal messages with your client 9. Have the client repeat information taught. If feasible, have the client do a returned demonstration of material taught