Far Eastern University

Institute of Nursing

II. PERSPECTIVE ON TEACHING AND LEARNING

A. Overview of Education on Health Care
HEALTH
▪ The state of complete physical, mental, emotional and spiritual well-being and not merely the absence of disease or
infirmity (WHO)
▪ The expression of success experienced by the organism in its effort to respond adaptively to environmental changes
(Rene Dubois)
▪ a dynamic ecological resultant involving the interaction of many complex factors and conditions (Hoyman)

EDUCATION
▪ Deliberate and systematic influence exerted by the mature person upon the immature through instruction, discipline
and harmonious development of all powers of human being (physical, social, intellectual, aesthetic, and
spiritual) directed toward the final end.
▪ “Acquisition of the art of the utilization of knowledge” (Whitehead)

HEALTH EDUCATION
▪ Helping individuals and groups to better health through equipping every individual with desirable knowledge, attitude
and skills so that he can make the necessary adaptations in the face of the challenges of the ever changing
environment.
▪ Is a learning process which is concerned with changes in knowledge, feelings and behavior of people.
▪ It is an approach for teaching patients and their families to deal with past, present & future health problems.
▪ Is a process that informs, motivates, and helps people to adopt and maintain healthy practices and lifestyles,
advocates environmental changes as needed to facilitate this goal and conducts professional training.

A PROCESS
▪ Brings about changes in the knowledge and attitude of people and thereby affecting change in health practices.
▪ The sum of experiences which favorably influence habits, attitudes, knowledge relating to individuals, community and
racial health.
▪ Progressive course, series of measures or changes.

CONCEPTS OF HEALTH EDUCATION

A. Physicians point of view
▪ A means by which better understanding of the principles of healthful living is achieved.
▪ A learning process growing out of health needs, nourished by health knowledge and producing intelligent
constructive and healthful individual and community action.
▪ A means of creating opportunities for the people to participate and assume responsibility for the solution of
their own problems in cooperation with health specialists and educators.
▪ A cooperative task in which all people who are directly engaged in public health work could participate.
▪ It covers the combined, concerted efforts of the professional and lay persons to influence community health
habits and practices.
B. Nurses point of view
▪ Is a means of improving the health of people by employing various methods of scientific procedures to show
the most healthful ways of living.
▪ Consists of techniques that stimulate, arouse and guide people to live healthfully.
▪ The sum of activities in which health agencies engage to influence the thinking, motivation, judgment and
action of the people of the community.
C. Sanitary Engineers point of view
▪ Is a continuous process by which the public is made aware of facts and problems about health and of its
obligation individually and collectively in the attainment of physical, mental and social well-being.
D. School Administrators & Teachers point of view
▪ A cooperative task in which all engaged in public health should directly or indirectly participate for the
betterment of the health of the people.

Aims of Health Education

1. To help people understand that health is the most valuable community asset and to help them achieve health
by their own activities and efforts
2. To develop a sense of responsibility for improvement of their health as individual members of families and
communities
3. To develop scientific knowledge, attitude, and skills on health matters to enable people to develop correct habits
4. To develop ways and means of effecting favorable changes in health habits and attitudes of the people.
 5. To educate people for proper use of health services in whatever form it is made available to them by the
government
6. To alter behavior which may directly or indirectly influenced occurrence or spread of diseases in a given cultural
setting
7. To help people achieve health by their own actions and efforts.
8. To promote the greater possible fulfillment of inherited powers of the body and the mind, and happy adjustment
of an individual to society
9. To provide the person with appropriate knowledge to enjoy descent health and also the knowledge of the
occurrence and spread of diseases. Thus, enabling him to adopt relevant preventive measures
10. To create in the person an interest in his own health and well-being
11. To create in the person an interest for the health of other members of his family, as well as those living in his
surroundings
12. To create in the person a desire to support health education programs in his area

Principles of Health Education

1. HE considers the health status of the people.
2. HE is learning.
3. HE involves motivation, experience and change in conduct and thinking.
4. HE should be recognized as a basic function of all health workers.
5. HE takes place in the home, in the school and the community.
6. HE is a cooperative effort.
7. HE meets the needs, interests and problems of the people affected.
8. HE is achieved by doing.
9. HE is a slow continuous process.
10. HE makes use of supplementary aids and devices.
11. HE utilizes community resources.
12. HE is a creative process.
13. HE helps people attain health through their own efforts.
14. HE makes careful evaluation of the planning, organization and implementation of all health education programs
and activities.
15. HE is an integral part of health programs.
16. Every member of the public health team has the responsibility in educating people.
17. It is not enough to impart information, what counts is what is done with the knowledge.

HEALTH EDUCATOR
♦ The facilitator or implementer of health education.
♦ Initiator of the process whereby people learn to improve their health attitude and habits to work together for
the improvement of health conditions of the family, community and the nation.

Traits / Qualities of a Health Educator

Efficient Good Communicator Good Listener
Creative / Resourceful Keen Observer Systematic
With sense of Humor Change Agent Tactful
Analytical Knowledgeable Open

EDUCATION PROCESS
Process
♦ progressive course, series of measures or changes.
♦ Is a systematic, sequential, logical, scientifically based, planned course of action.
♦ Consisting of two major interdependent operations:
1. Teaching
2. Learning
♦ Forms a continuous cycle
♦ involves 2 interdependent players:
1. Teacher
2. Learner
♦ mutually desired behavior changes
♦ Foster growth in the learner
♦ Growth in the teacher
Education Process Parallel Nursing Process
▪ Steps run parallel to nursing process but with different goals and objectives.
Nursing Process
▪ Planning and implementation of care based on assessment and diagnosis of the physical and psychosocial needs of
the patient.
Education process:
▪ Planning and implementation of teaching based on assessment and prioritization of the client’s learning needs,
readiness to learn and learning style
▪ A useful paradigm to assist nurses to organize and carry out the education process using the ASSURE model:
 o Analyze the learner
o State the objectives
o Select the instructional methods and materials
o Use instructional methods and materials
o Require learner performance
o Evaluate the teaching plan and revise as necessary

HISTORICAL FOUNDATION FOR THE TEACHING ROLE OF NURSES

♦ Patient Education has been considered a major component of standard care given by nurses

1950s
♦ The NLE identified the course content in nursing school curricula to prepare nurses to assume the role as teachers
of others.
♦ Developed the first certified nurse educator (CNE) exam
♦ American Nurses Association (ANA) set forth statements on the functions, standards, and qualifications for nursing
practice, of which patient teaching is a key element.
♦ International Council of Nurses (ICN) has long endorsed the nurse’s role as educator to be essential component of
nursing care delivery.
♦ TODAY, all state nurse practice acts (NPA) include teaching within the scope of nursing practice responsibilities.
Nurses, by legal mandate are expected to provide instruction to consumers to assist them to maintain optimal
levels of wellness and manage illness.

1970s
American Hospital Association
♦ Developed the Patient’s Bill of Rights and has been adopted by hospitals nationwide.
♦ Established the guidelines to ensure that patients receive complete and current information concerning their
diagnosis, treatment and prognosis in terms they can reasonably be expected to understand.

Mid – 1800
♦ Responsibility for teaching has been recognized as an important role of nurses as caregivers.
Focus of teaching:
1. Care of the sick and on promoting the health of the well public.
2. Educating other nurses for professional practice.

Florence Nightingale
♦ Founder of modern nursing, ultimate educator
♦ Developed the first school of nursing
♦ Devoted a large portion of her life to teaching nurses, physicians and health officials about the importance of
proper conditions in the hospitals and homes to improve the health of the people. She emphasized the
importance of teaching patients of the need for adequate nutrition, fresh air, exercise, and personal hygiene to
improve their well-being.

By Early 1900s
♦ Public health nurses in the Philippines, clearly understood the significance of the role of the nurse as teacher in
preventing disease and in maintaining the health of the society. or decades, patient teaching has been an
independent nursing function.
♦ As early as 1918, the National League of Nursing Education (NLNE) in the US (now the National League for Nursing
(NLN) observed the importance of health teaching as a function within the scope of nursing practice.
♦ Two decades later, this organization recognized nurses as agents for the promotion of health and the prevention of
illness in all settings in which they practiced.

As Early as 1993
Joint Commission formerly Joint Commission on Accreditation of Healthcare Organizations (JCAHO):
♦ Recognized the importance of patient education by nurses
♦ Established nursing standards for patient education.
♦ Those standards known as mandates described 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
expectation to include an interdisciplinary team approach in the provision of patient education as well as
evidence, that patient and their significant others participate in care and decision making and understand what
they have been taught. Hence, the following must be considered by the health care providers during the
education process:
Literacy level Language skills
Educational background Culture of every client

1995
♦ PEW HEALTH PROFESSION COMMISSION (PHPC) published a broad set of competencies it believed would mark
the success of the health profession in the 21st century. In 1998, it released a fourth report on the follow-up on
 health professional practice in the new millennium.

Recommendations proposed by the PHPC:

1. Provide clinically competent and coordinated care to the public
2. Involve patients and their families in the decision making process regarding health interventions
3. Provide clients with education and counseling on ethical issues
4. Expand public access to effective care
5. Ensure cost-effective and appropriate care for the consumer
6. Provide for prevention of illness and promotion of healthy lifestyle

According to Grueninger (1995) :

The transition toward wellness has entailed a progression:
“from disease-oriented patient education (DOPE)
prevention-oriented patient education (POPE)
health-oriented patient education (HOPE).”
This new approach has changed the role of the nurse:
a. From one of wise healer to expert advisor or teacher to facilitator of change.
b. Emphasis is now on empowering patients to use their potentials, abilities, and resources to the fullest
c. Another role of today’s educator is training the trainer – preparing the nursing staff through continuing
education, in-service programs, and staff development to maintain and improve their clinical skills
and teaching abilities. The key to success of the nursing profession is for the nurses to teach other
nurses.
d. Another very important role of the nurse as educator is serving as a clinical instructor for the students in the
practice setting. Staff nurses function as clinical preceptors and mentors to ensure that nursing
students meet their expected learning outcomes.

2006
♦ Institute of Healthcare Management was organized.
♦ Objective: To reduce the 15 million incidents of medical harm in US hospitals each year.
♦ Major implications: Teaching patients and their families as well as nursing staff and students ways how they can
improve care to reduce injuries, save lives, and decrease cost of health care

2007 - SULLIVAN ALLIANCE

Objective: To recruit and educate staff nurses to deliver culturally competent care to the public they serve. Effective
health care and health education of patients and their families depends on a sound scientific base and
cultural awareness in an increasingly diverse society.
Goal: To increase the racial and cultural mix of nursing faculty, students, and staff, who will be sensitive to the needs of
clients of diverse backgrounds.
♦ Since 1980s, the role of the nurse as educator has undergone a paradigm shift, evolving from what once
was a disease-oriented approach to a more prevention-oriented approach.
♦ Focus in teaching: Teaching for the promotion and maintenance of health. Education has become a part of
the discharge plan at the end of hospitalization, and has expanded to become a part of
comprehensive plan of care that occurs across the continuum for the healthcare delivery process

C. ROLES OF THE NURSE AS A HEALTH EDUCATOR

♦ The role of educator has shifted from traditional position of being the giver of information to that of a process designer
or coordinator.
♦ Shift from Traditional teacher-centered to learner-centered approach which requires:
a. Skill in needs assessment
b. Ability to involve learners in planning
c. Link teachers to learning resources
d. Encourage learner initiative.

Roles of the Nurse as a Health Educator in Health Promotion

1. Facilitator of Change
Goal: To promote health
The following are effective in facilitating change in the learning situation:
Analyzing Demonstrating Asking questions
Explaining Practicing Providing closure
Dividing complex skills
2. Contractor
♦ Stating mutual goals to be accomplished
♦ Devising an agreed-upon plan for action
♦ Evaluating the plan
♦ Deriving alternatives
 ♦ A contract involves trusting relationship
3. Organizer
♦ Manipulation of materials and space, sequential organization of content from simple to complex,
♦ Determining priority of subject matter
4. Evaluator
♦ Evaluative processes are integral part of all learning.
♦ Self-evaluation, learner evaluation, organization evaluation, peer evaluation
5. Coordinator of care.
♦ By ensuring consistency of information, nurses can support their clients in their efforts to achieve the goal of optimal
health.
♦ They also can assist their colleagues in gaining knowledge and skills necessary for the delivery of professional
nursing care.
6. Trainor of trainers

Elements of an ideal relationship:

1. Both parties have trust and respect.
2. The teacher assumes the student can learn and is sensitive to individual needs.
3. Both feel free to learn and make mistakes.

D. HALLMARKS OF EFFECTIVE TEACHING IN NURSING

Students have different opinions on the qualities of a good teacher based on their:
a. Individual learning styles
b. Goals
c. Personal needs

Six Major Categories of Effective Teaching (Jacobson, 1966)

1. Professional Competence
a. Shows genuine interest in patients and displays confidence in his/her professional abilities
b. Creative and stimulating, can excite student’s interest in nursing.
c. Polishes skills throughout his/her career through reading, research, clinical practice and continuing
education
d. Portrays excellent clinical skills and judgment becomes a positive role model for learners
e. Demonstrate clinical skills with expertise
f. A teacher who aims at excellence develops a thorough knowledge of subject matter.

2. Interpersonal relationships with students

a. taking a personal interest in learners f. being fair
b. being sensitive to their feelings and problems g. permitting learners to express differing points of view
c. conveying respect for them h. conveying a sense of warmth
d. alleviating their anxieties i. being accessible for conferences
e. creating an atmosphere in which they feel free to ask questions.

Disadvantages:
a. Maintaining a professional distance necessary when time comes to evaluate the student
b. Leads to lack of discipline in the classroom, with students taking advantage of their relationship with the
teacher.
Ways how educators help learners maintain self-esteem and minimize anxieties:
a. Empathic listening
b. Acceptance
c. Honest communication

3. Personal Characteristics
a. Personal magnetism g. Sense of humor
b. Enthusiasm h. Good speaking voice
c. Cheerfulness i. Self-confidence
d. Self-control j. Willingness to admit errors
e. Patience k. Caring attitude
f. Flexibility

4. Teaching Practice
♦ mechanics, methods, and skills in classroom and clinical teaching.
♦ Teaching subject matter in a stimulating way and inspiring learner interest depend on several factors:
a. Teacher’s style
b. Personality
 c. Personal interest in the subject
d. Use of a variety of teaching strategies.

5. Evaluation Practices valued by students:

a. clearly communicating expectations
b. providing timely feedback on student’s progress
c. correcting students tactfully
d. being fair in the evaluation process
e. giving tests that are pertinent to the subject matter

6. Availability to the students

a. giving guidance during stressful clinical situations
b. physically helping students give nursing care
c. giving appropriate amount of supervision
d. freely answering questions
e. acting as a resource person during clinical learning experiences

E. PRINCIPLES OF GOOD TEACHING PRACTICE IN UNDERGRADUATE EDUCATION

1. Encourage student-faculty contact.
2. Encourage cooperation among students.
3. Encourage active learning.
4. Give prompt feedback.
5. Emphasize time on task.
6. Communicate high expectations.
7. Respect diverse talents and ways of learning.

One important fact when evaluating teaching effectiveness

THERE IS NO ONE STYLE, TECHNIQUE, OR SKILL THAT IS EFFECTIVE FOR ALL LEARNERS AND ALL
TEACHING SITUATIONS.

F. BARRIERS TO EDUCATION AND OBSTACLES TO LEARNING

Barriers to Teaching
♦ Those factors that impede the nurse’s ability to deliver educational services.
Obstacle to Learning
♦ Those factors that negatively affect the ability of the learner to pay attention to and process information.

Barriers to Teaching:
1. Lack of time to teach
2. Nurses do not feel competent or confident with their teaching skills.
3. Personal characteristics of the nurse educator
4. Low priority assigned to patient and staff education by administration and supervisory personnel
5. Environment
6. Absence of 3rd party reimbursement to support patient education
7. Some nurses and physicians question whether patient education is effective as means to improve health
outcomes.
8. The type of documentation system used by healthcare agencies.

Obstacles to Learning:
1. Lack of time to learn
2. The stress of acute and chronic illness, anxiety, and sensory deficits in patients
3. Low literacy and functional health illiteracy
4. Negative influence of the hospital environment resulting in:
a. Loss of control
b. Lack of privacy
c. Social isolation
5. Personal characteristics of the learner that influence the success of educational endeavors:
a. Readiness to learn
b. Motivation and compliance
c. Developmental-stage characteristics and compliance
d. Learning style
6. Extent of behavioral changes needed both in number and in complexity, can overwhelm the learners and
dissuade them from attending to and accomplishing learning objectives and goals.
7. Lack of support and lack of ongoing positive reinforcements from the nurse and significant others.
8. Denial of learning needs, resentment of authority, and lack of willingness to take responsibility.
9. Inconvenience, complexity, inaccessibility, fragmentation, and dehumanization of the health care system result in
frustration and abandonment of efforts to participate and comply with goals and objectives of learning.
G. APPLYING LEARNING THEORIES TO HEALTH CARE PRACTICE
1. Principles of Learning (Thorndike’s)
1. The Principle of readiness
 implies the degree of preparedness and eagerness to learn.
 Individuals learn best when they are physically, mentally, and emotionally ready to learn, and do not learn
well if they see no reason for learning, are exhausted or in ill health , if they are distracted by outside
responsibilities, interests, or worries, have overcrowded schedules or other unresolved issues
 Instructor’s responsibility: Getting students ready to learn, creating interest by showing the value of the
subject matter, and providing continuous mental or physical challenge
2. The Principle of exercise
 things that are most often repeated are best remembered.
 It is the basis of drill and practice; students learn best and retain information longer when they have
meaningful practice and repetition.
 Instructor’s responsibility: Repeat important items of subject matter at reasonable intervals, and provide
opportunities for students to practice while making sure that this process is directed toward a goal
3. The Principle of effect
 based on the emotional reaction and motivation of the student.
 Learning is strengthened with pleasant or satisfying feeling
 It has a direct relationship to motivation
 Instructor’s responsibility:

a. Positive reinforcement; instructor should recognize and commend improvement

b. Instructors should be cautious about using punishment in the classroom
c. To set up the learning situation in such a manner that each trainee will be able to see evidence of
progress and achieve some degree of success
4. The Principle of Primacy
 Things learned first create a strong impression in the mind that is difficult to erase
 learning should be done correctly for the first time since it is difficult to “unlearn” or change an incorrectly
learned material.
 Instructor’s responsibility: What is taught must be right the first time; It must be procedurally correct and
applied the very first time. The instructor must present subject matter in a logical order, step by step,
making sure the students have already learned the preceding step
5. The Principle of Recency
 Things that are most recently learned are often best remembered
 Instructor’s responsibility:
a. Summarize a lesson or learning situation.
b. Repeat, restate, or reemphasize important points at the end of a lesson to help the student
remember them.
6. The Principle of intensity
 the more intense something is taught, the more likely it will be retained.
 a student will learn more from the real thing than from a substitute
 a student is likely to gain greater understanding of tasks by performing them rather than merely reading
about them.
 Instructor’s responsibility:
a. Use imagination in approaching reality as closely as possible.
b. Use a wide variety of instructional aids, demonstrations, skits, and role playing, analogies, and
personal experiences, to improve realism, motivate learning, and challenge students.
c. Emphasize important points of instruction with gestures, showmanship, and voice.
d. Make full use of the senses
7. The Principle of Requirement
 states that "we must have something to obtain or do something."
 It can be ability, skill, instrument or anything that may help us to learn or gain something.
 if you want to draw a person, you need to have the materials with which to draw, and you must know how to
draw a point, a line, a figure and so on until you reach your goal, which is to draw a person.
8. The Principle of Freedom
 states that things freely learned are best learned. Conversely, the further a student is coerced, the more
difficult it is for him to learn, assimilate and implement what is learned.
 Since learning is an active process, students must have the three great freedoms that constitute personal
responsibility:
a. freedom of choice
b. freedom of action
c. freedom to bear the results of action
 If no freedom is granted, students may have little interest in learning.

Three Major Schools of Learning

1. Behavioral Theory - Learning takes place when there is a change in behavior
 2. Observational learning, imitation and modeling
3. Cognitive Theory - Learning by thinking, reasoning and transferring

2. Learning Theories
a. Contiguity Theory
▪ Watson and Guthrie emphasized the contiguity of the S and R
John Watson
▪ postulated that behavior is a series of conditioned reflexes, and all emotions and thought is a result of behavior
learned after conditioning.
▪ Ex: Child’s curiosity -----touch stove----- hot----pain----won’t touch the stove anymore even if it is cold.
b. Reinforcement Theory
▪ Thorndike and Skinner proposed that S-R bonds are strengthened by reinforcements such as Rewards and
Punishment
▪ Ex. The child learns to avoid the stove because the pain was a negative reinforcer.
c. Behaviorist Theory
▪ Environmental stimulus, conditions and reinforcement promote changes in response. To change behavior, change
the environment
Transfer of Learning: Practice similarity in stimulus conditions and responses between learning and new
situation
d. Cognitive Theory
▪ Internal perception and thought processing within the context of human development promote learning and change.
▪ To change behavior change cognition
e. Social Learning Theory
▪ External role models and their perceived reinforcement along with learner’s internal influences.
▪ To change behavior, change role models, perceived reinforcement, and the learner’s self-regulating mechanism
f. Psychodynamic Theory
▪ Internal forces such as development stage, childhood experiences, emotional conflicts, and ego strength influence
learning and change.
▪ To change behavior, change interpretations and make unconscious motivations conscious.
g. Humanistic Theory
▪ Internal feelings about self, ability to make wise choices, and needs affect learning and change.
▪ To change behavior, change feelings, self –concept, and needs

3. Types of Learning
3.1. Signal Learning
▪ Conditioned response
▪ Simplest level of learning
▪ The words are enough to evoke fear because she has felt fear whenever taking an actual skill test
3.2. Stimulus-Response Learning
▪ Involves developing a voluntary response to a specific stimulus or a combination of stimulus.
3.3. Chaining
▪ Acquisition of a series of related conditioned responses or stimulus-response connections
3.4. Verbal Association
▪ Type of chaining and is easily recognized in the process of learning medical terminology.
Thermal - hyperthermia
3.5. Discrimination Learning
▪ To learn and retain large number of chains, the person has to be able to discriminate among them.
3.6. Concept Learning
▪ People learn many concepts as they go through life
▪ Learning new concepts when a person has a wound- learn the meaning of wound, inflammation, asepsis, the signs
and symptoms
3.7. Rule Learning
▪ Can be considered a chain of concepts or a relationship between concepts.
▪ If… then relationship: IF you leave your patient in one position for a long period, then, the pressure on a body part
will cause ulceration.
3.8. Problem Solving
▪ To solve problem, learner must have a clear idea of the problem or goal being sought and must be able to recall and
apply previously learned rules that relate to the situation.
▪ A break in aspetic technique can lead to Infection. The rule… “IF ….THEN”
A break in aseptic technique can lead to infection; a break in closed sterile system can lead to entry of pathogens;
and raising the urine bag above the bladder can cause backflow of urine and therefore infection”
▪ Combination of these rules will lead to a higher order learning