He handout (2)

ROOSEVELT COLLEGE SYSTEM
Institute of Nursing and Health Education
1
RESOURCE MATERIAL ON HEALTH EDUCATION
COURSE TITLE
HEALTH EDUCATION
NO. OF UNITS
CONTACT HOURS
3 units lecture
54 hours
VENUE Amphitheater 1 (Lecture)
PROFESSOR Rovie V. Gonzales, RN, MAN
DEGREE PROGRAM
TERM OFFERED
Bachelor of Science in Nursing
2nd
Year, Summer
COURSE DESCRIPTION The course includes discussions of concepts, principles,
theories and strategies of clinical and classroom teachings. It
provides critical thinking activities for students to apply
concepts of learning and teaching and appreciate the nurse's
role as a teacher in various settings. It further provides
experiences to develop beginning skills in designing and
applying a teaching plan using the nursing process as a
framework in the Related Learning Experience and classroom
settings.
PRE-REQUISITE None
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
A. HEALTH EDUCATION PERSPECTIVE
1. Historical Development
Mid 1800s
the responsibility for teaching has been recognized as an important role of nurses as
caregivers.
Florence Nightingale
the founder of modern nursing, was the ultimate educator.
Early 1900s
public health nurses, role of the nurse as teacher in preventing disease and in
maintaining the health of society.
1918
National League of Nursing Education (NLNE)/ National League for Nursing (NLN)
-observed the importance of health teaching as a function within the scope of
nursing practice.
- recognized nurses as agents for promotion of health and prevention of illness
in all settings.
1950

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identified course content in nursing school curricula to prepare nurses to assume the
role as teachers of others.
1993
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
- established nursing standards for patient education.
2001
teaching activities must be patient centered and family oriented.
2. Issues and Trends in Health Education
2.1 General Issues And Trends
•Politicians and healthcare administrators alike recognize the importance of health education
to accomplish the economic goal of reducing the high costs of health services.
•Healthcare professionals are increasingly concerned about malpractice claims and
disciplinary action for incompetence.
•Consumers are demanding increased knowledge and skills about how to care for themselves
and how to prevent disease.
•The aging of the population are requiring an emphasis to be placed on self-reliance and
maintenance of a healthy status over an extended lifespan.
•Major cause of morbidity and mortality are those disease that are lifestyle related and
preventable through educational intervention.
•The increase in chronic and incurable conditions requires individuals and families become
informed participants to manage their own illnesses.
•Client education improves compliance.
•The increase number of self-help groups exist to support clients in meeting their physical
and psychosocial needs.
2.2 Specific Issues And Trends
Current Mandates for Nurse as Educator
 To increase the quality and years of healthy life
 To eliminate health disparities among different segments of the population
 To use theory and evidenced based strategies to promote desirable health behavior
Trends affecting Health Care
 Social, economic, and political forces that affect a nurse‘s role in teaching:
 Growth of managed care
 Increased attention to health and well-being of everyone in society
 Cost containment measures to control healthcare expenses
 Concern for continuing education as vehicle to prevent malpractice and incompetence
 Expanding scope and depth of nurses‘ practice responsibilities
 Social, economic, and political forces that affect a nurse‘s role in teaching:
 Consumers demanding more knowledge and skills for self-care
 Demographic trends influencing type and amount of health care needed
 Recognition of lifestyle related diseases which are largely preventable
 Health literacy increasingly required
 Consumers demanding more knowledge and skills for self-care
 Demographic trends influencing type and amount of health care needed

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 Recognition of lifestyle related diseases which are largely preventable
 Health literacy increasingly required
 Advocacy for self-help groups
REMEMBER THIS: “NURSES, YES YOU! ARE IN A KEY POSITION TO CARRY
OUT HEALTH EDUCATION”
•Most continuous contact with clients.
•Most accessible source of information for the consumer.
•Most highly trusted of all health professionals.
3. THEORIES IN HEALTH EDUCATION
•A theory is a set of interrelated concepts, definitions and prepositions that presents a
systematic view of events or situations by specifying relations among variables in order to
explain and predict the events of the situation.
o Individual (Intrapersonal) Health Behavior Models/ Theories
o Interpersonal Health Behavior Theories
o Community Level Models/ Theories
o Individual (Intrapersonal) Health Behavior Models/ Theories
1.HEALTH BELIEF MODEL (Rodenstock, Becker, Kirscht, et. al) – 1950‘s
 Adopted behavioral sciences to examine health problems
 Help explain why people would or would not use available preventive services
(Xray=TB)
 Researchers assumed that people feared diseases and that the health actions of people
were motivated by the degree of fear (perceived threat) and the expected fear of
actions
2. TRANSTHEORETICAL MODEL/ Stages of Change Model (Prochaska and
DiClemente)- 1979
 Outlining the stages of an individual‘s readiness to change, or attempt to change,
toward healthy behaviors.
 Evolved from smoking cessation and also the treatment of drug and alcohol addiction,
lately is for dietary modifications/changes
 Behavior chagne is viewed as a process, not an event, with individuals at various
levels of motivation or ―readiness‖ to change
3. CONSUMER INFORMATION PROCESSING MODEL (Bettman, McGuire, et.al)
 Developed out of the study of human problem solving and information process
 Has many useful application in the area of health education
 INFORMATION is a necessary tool in H.E. just like KNOWLEDGE is necessary but
not sufficient for behavior change, INFORMATION is necessary but not sufficient for
knowledge= limits to any person‘s information processing capacity= limitations upon
individuals in the amount of informatino they can acquire, use and remember
4. THEORY OF REASONED ACTION (Fishbein and Ajzen)
 Based on the assumption that most behaviors of social elevance are under volitional
(willful) control
 A person‘s intention to perform (or not perform) the behavior is the immediate
determinant of that behavior

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 GOAL = not only predict human behavior but also to understand it
5. SOCIAL LEARNING THEORY OR SOCIAL COGNITIVE THEORY (Rotter and
Bandura)
 Human behavior is explained in three-way reciprocal theory in which personal factors
(one‘s cognitive process), behavior, and environmental influences continually interact
in a process of reciprocal determinism or reciprocal causality.
 Person can shape the environment as well as the environment shaping the person
o INTERPERSONAL HEALTH BEHAVIOR THEORIES
1. SOCIAL NETWORKS/ SOCIAL SUPPORT THEORIES (Eng, Israel, et. al)
 Social network= kin, work groups, friends, neighbors
 Types of characteristics of SN:
 Structural = size (number of people) and density (how they really know each other)
 Interactional = reciprocity ( mutual sharing), durability (length) intensity (frequency
of interaction) and dispersion (ease with each other to contact one another)
 Functional = social support, connections to social contacts, maintenance of social
identity
o COMMUNITY LEVEL MODELS/ THEORIES
1. COMMUNITY ORGANIZATIONS
 Emerged from a specific field of activity within social work in the late 1800‘s into
broader process
 Involves working with people as they attempt to ―define their own goals, mobilize
resources, and develop action plans‖ = meet their needs that they identified
collectively
2. DIFFUSION OF INNOVATIONS THEORY (Rogers and Shoemaker)
 Provides an explanation for how new ideas, products and social practices diffuse or
spread within a society or from one society to another.
 Diffusion can be thought of as a special type of communication in which messages are
concerned about a new idea
3. ORGANIZATIONAL CHANGE THEORIES
 Organizations are complex and layered social systems.
 Change may be influenced at each other
4. ECOLOGICAL MODELS
 Focus attention on the individual and the social environmental factors as the targets
for any interventions
 LIFESTYLE & HEALTH BEHAVIOR = direct attention toward changing
individuals, rather than changing the social and physical environment which can serve
to reinforce unhealthy behaviors
B. PERSPECTIVE ON TEACHING AND LEARNING
1. Overview of Education in Health Care
•Purpose, Benefits, and Goals of Patient, Staff and Student Education
Purpose: to increase the competence and confidence of patients to manage their own self-
care and of staff and students to deliver high-quality care

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Benefits of education to patients:
- increases consumer satisfaction
- improves quality of life
- ensures continuity of care
- reduces incidence of illness complications
- increases compliance with treatment
- decreases anxiety
- maximizes independence
Benefits of education to staff:
- enhances job satisfaction
- improves therapeutic relationships
- increases autonomy in practice
- improves knowledge and skills
Benefits of preceptor education for nursing students:
- prepared clinical preceptors
- continuity of teaching/learning from classroom curriculum
- evaluation and improvement of student clinical skills
Goal:
 to increase self-care responsibility of clients and to improve the quality of care
delivered by nurses
2. Concepts of Teaching, Learning, Education process vis-à-vis Nursing Process,
Historical Foundations for the Teaching Role of the Nurse
THE EDUCATION PROCESS DEFINITION OF TERMS:
 Education Process: a systematic, sequential, planned course of action on the part of both
the teacher and learner to achieve the outcomes of teaching and learning
 Teaching/Instruction: a deliberate intervention that involves sharing information and
experiences to meet the intended learner outcomes
 Learning: a change in behavior (knowledge, skills, and attitudes) that can be observed and
measured, and can occur at any time or in any place as a result of exposure to
environmental stimuli
 Patient Education: the process of helping clients learn health-related behaviors to achieve
the goal of optimal health and independence in self-care
 Staff Education: the process of helping nurses acquire knowledge, attitudes, and skills to
improve the delivery of quality care to the consumer
ASSURE Model
A useful paradigm to assist nurses to organize and carry out the education process.
Analyze the learner
State objectives
Select instructional methods and materials
Use teaching materials
Require learner performance
Evaluate/revise the teaching/learning process

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Historical Foundations of The Nurse Educator Role
•Health education has long been considered a standard care-giving role of the nurse.
•Patient teaching is recognized as an independent nursing function.
•Nursing practice has expanded to include education in the broad concepts of health
and illness.
Organizations And Agencies Promulgating Standards And Mandates:
1. NLN
–first observed health teaching as an important function within the scope of
nursing practice
–responsible for identifying course content for curriculum on principles of teaching
and learning
2. ANA
- responsible for establishing standards and qualifications for practice, including
patient teaching
3. ICN
- endorses health education as an essential component of nursing care delivery
4. State Nurse Practice Acts
- universally includes teaching within the scope of nursing practice
5. JCAHO
- accreditation mandates require evidence of patient education to improve outcomes
6. AHA
- Patient‘s Bill of Rights ensures that clients receive complete and current information
7. Pew Health Professions Commission
- puts forth a set of health profession competencies for the 21st century; over one-half
of recommendations pertain to importance of patient and staff education
3. Role of The Nurse As A Health Educator
•With at least 3 yrs hospital stays, organizations expect that staff nurses will have to be
skilled teachers
•They will need to learn the basic principles of teaching and how to apply them
•Nurses who spend the majority of their time in the education role such as staff development
instructors or educators in collegiate settings have more formal preparation for the educator
role.
•Provide a holistic approach to care delivery.
•Act as facilitators.
•Clarify confusing information.
•Serves as a coordinator of care.
•Assist colleagues in gaining knowledge and skills necessary for the delivery of professional
nursing care.
CREATE A GROUP, DISCUSS AND ANSWER THE FOLLOWING (seatwork)
1.Is every nurse capable of taking appropriate action to revise the approach to educating the
client if the
information provided is not comprehended? How?
2.Can every nurse determine whether information given is received and understood? How?

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4. Hallmarks of Effective Teaching In Nursing
I.Professional Competence:
a. Through knowledge and subject matter
b. Polishes skills throughout her career
c. Maintains and expands her knowledge in reading, research, clinical practice
and continuing education
d. Portrays excellent clinical skills and judgment become a positive role model
for learner.
II.Interpersonal Relationship with Students
a. Taking personal interest in learners
b. Being sensitive to their feelings and problems, conveying respect for them.
c. Alleviating their anxieties
d. Being accessible for conferences
e. Being fair, permitting learners to express differing points of view
III. Teaching Practices
•Defined the mechanics, methods, and skills in classroom and clinical teaching.
IV.Personal Characteristics
•Qualities such as personal magnetism, enthusiasm, cheerfulness, self-control,
patience, flexibility, a sense of humor, a good speaking voice, self-confidence,
willingness to admit errors, and a caring attitude are all desirable characteristic
teachers.
V. Evaluation Practices
•Valued by students include clearly communicating expectations, providing timely
feedback on student progress, correcting students tactfully, being fair in the evaluation
process, and giving test that are pertinent to the subject matter.
VI. Availability to students
•This may take the form for educators of being there in stressful
classroom and clinical situations, physically helping students give nursing
care, giving appropriate amounts of supervision, freely answering
questions and acting as a resource person during clinical learning experiences.
5. 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
6. Barriers to Teaching and Obstacles to Learning
 Barriers to Teaching – Factors that impede the nurse‘s ability to deliver
educational services.
 Obstacles to Learning – Factors that negatively affect the ability of the learner to
pay attention to and process information.
Barriers to Teaching
1. Lack of time.
2. Do not feel confident or competent with their teaching skills.

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3. Personal characteristics of the nurse educator plays an important role in determining the
outcome of a teaching-learning interaction.
4. Low priority was often assigned to patient and staff education by administration and
supervisory personnel.
5. The environment in the various settings where nurses are expected to teach is not always to
carrying out the teaching-learning process.
6. An absence of third-party reimbursement to support patient education relegates teaching
and learning to less than high priority status.
7. Some nurses and physicians question whether patient education is effective as a means to
improve health outcomes.
8. The type of documentation system used by healthcare agencies has an effect on the quality
and quantity of patient teaching.
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.
5.Personal characteristic of the learner.
6.The extent of behavioral changes needed.
7. Lack of support and lack of ongoing positive reinforcement from the nurse and significant
others.
8. Denial of learning needs, resentment of authority, and lack of willingness to take
responsibility.
9. The inconvenience, complexity, inacessiblity, fragmentation and dehumanization of the
healthcare system.
7. Applying Learning Theories To Health Education Practices
a. Principles of Learning
Different principles vary and apply to different aspects of learning and teaching.
1.Use of general senses – learning is more likely to occur if clients are allowed to practice
what they are being taught.
2.Actively involve the patients or clients in the valuing process – relates to teaching method;
include lecture, videos, print materials or methods that engage the participants, as discussion,
role-playing, small group discussion, question and answer.
3.Provide an environment conducive to learning – should have good lightning and
temperature control and comfortable seating with enough space between students.
4.Assess the extent to which the learning is ready to learn – Assessment data can be obtained
directly from the client or families or it can be gathered for a variety of other sources such as
charts or reports.
5.Determine the perceived relevance of information – Willing to learn what they perceive as
being important
6.Repeat Information – Repetition enhances learning. When new information is presented, it
be presented several times, in a variety of ways.

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7.Generalize information – Using variety of examples . and applying the information to
specific situations in the client‘s life promotes learning and contributes to a better chance of
compliance
8.Make learning a pleasant experience – can be accomplished through the frequent
encouragement and positive feedback.
9.Begin with what is known, move toward what is known – It should begin with the basics or
general information that is known and move toward new information that which is unknown.
10.Present information as in appropriate rate – The rate of information is taught must be
suitable to the client, depending on the client‘s knowledge level, a faster or slower phase may
be necessary.
b. Learning Theories
1. Behaviorist Theories – is a result of a series of conditioned reflexes, and all
emotion and through a result of behavior learned through conditioning
2. Cognitive Theories – An active process in which the learner constructs memory
base on own knowledge and view of the world.
3. Social Learning Theory – A person is motivated when she sees the possibility of
valued outcomes or opposed to rewarding or punishing outcomes.
c. Types Of Learning
1.Signal Learning – or the conditioned response, the person develops a general diffuse
reaction to a stimulus.
2.Stimulus-Response Learning – Involves developing a voluntary response to a
specific stimulus or combination of stimuli.
3.Chaining – is the acquisition of the series of related conditioned responses or S-R
connections.
4.Verbal Association – A type of chaining that easily recognized in the process of
learning medical terminology.
5.Discrimination Learning – To learn and retain large numbers of chains, the person
has to be able to discriminate among them.
6.Concept Learning – Learning how to classify stimuli into groups represented by a
common concept.
7.Rule Learning – chain of concepts or a relation of between concepts.
8.Problem Solving – Must be able to recall and apply previously learned rules that
relate to the situation.
d. Learning Styles
As the habitual manner in which the learner receive and perceive information, process it,
understand it, value it, store it, and recall it.
A. Learning Style Models – People who have a habitual verbal approach to learning
represent, in their brains, information they read, see or hear in terms of words or
verbal association.
B.Cognitive Styles Model – The perception and ordering of knowledge affects how
the person learns.
C.Field Independence Style – In which items are perceived relatively independently
of their surrounding field.
D.Matching Learning Styles – To instruction- the effectiveness of matching teaching
style to learning styles; and student shown more satisfaction when the teacher matches
the student‘s learning style.

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8. Planning and Conducting Classes
a. Developing a course outline/syllabus
The course outline should include the name of the course, name of instructor, a one-
paragraph course description and a list of course objectives, topical outline, teaching method
used, the textbook or other readings and methods of evaluation. It helps the learner to gauge
first ‗what is to be learned‘ and ‗what is expected of them.‘
b. Formulating Objectives
To write objectives that have meaning not just for you but also for the learners. It
should reflect what the learner is supposed to do with what is taught.
c. Selecting Content
The best way to determine how long it will take you to teach the content is to plan it
out and then rehearse it orally, (preferably in front of a mirror). Build in time for questions
and any active learning techniques you plan to use.
d. Selecting Teaching Methods
Factors affecting choice of method:
-Selection of method depend on the objectives and type of learning you are trying to
achieve.
-Course content also dictates methodology to some extent. A class on isolation
technique may be taught by demonstration, computer simulation or hands-on practice.
-Choice of teaching strategy also depends on the abilities and interest of the teacher.
-Compatibility between teacher and teaching methods is important, but so
compatibility between learners and teaching methods.
-Factors that influences the selection of teaching methods is the number of people in
the class
e. Choosing a textbook/references
Considerations should guide you when choosing a textbook, suggest evaluating the
content scope and quality, credibility of authorship, format, and issues like cost, permanency,
gravity of point.
f. Conducting the classes
Begin by introducing yourself, Tell a class little about yourself. First session is the
best time to communicate your expectations for the course. Review the course syllabus or
outline and have time to answer portions about content, methods and assignment. A positive
way to end the introductory portion of the course is to try to stimulate the learner‘s appetites
for what is to come.
C. CHARACTERISTICS OF THE LEARNER
1. Determinants of Learning
a. Learner‘s Characteristics
-Includes among other culture/ethinicity, literacy, age, health status, educational level, and
socio economic status.
1.Culture
Defined as invisible patterns that form the normal ways of acting, feeling,
judging, perceiving and organizing the world.
2.Literacy
The client ability to read and understand what is being read is and essential
component of learning. Establishing the reading level and using materials that are
consistent with the client‘s ability.
3.Age

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Older adults tend to learn best when the information is relevant to them and
has a practical application. Teaching the older adult student present some challenges,
although none are irresponsible.
4.Education Level and Status
It has been well documented that education level is significantly associated
with health status (more educated, more healthier). The more educated the client is the
one who seeks treatment earlier in the disease process and the less educated is sicker.
5.Socioeconomic Level
The impact of socio-economic level on learning has more to do with being
able to use the information being taught rather than the process of learning.
b. Assessment of the Learner
•To assess the learners to determine their background and how much they already
know about the content of the course. Assessment can be done formally by giving
pretests or short questionnaire or more informal by asking questions during class.
c. Assessing Learning Needs
•Assessment aims to provide information about what client wants to know and want
to learn. Their beliefs, family dynamics, housing situation, skills, educational levels,
fear or concerns about their condition.
2. Motivation and Behavior of The Learner
a. Learning Principles
1.Use of general senses – learning is more likely to occur if clients are allowed to practice
what they are being taught.
2.Actively involve the patients or clients in the valuing process – relates to teaching method;
include lecture, videos, print materials or methods that engage the participants, as discussion,
role-playing, small group discussion, question and answer.
3.Provide an environment conducive to learning – should have good lightning and
temperature control and comfortable seating with enough space between students.
4.Assess the extent to which the learning is ready to learn – Assessment data can be obtained
directly from the client or families or it can be gathered for a variety of other sources such as
charts or reports.
5.Determine the perceived relevance of information – Willing to learn what they perceive as
being important
6.Repeat Information – Repetition enhances learning. When new information is presented, it
be presented several times, in a variety of ways.
7.Generalize information – Using variety of examples . and applying the information to
specific situations in the client‘s life promotes learning and contributes to a better chance of
compliance
8.Make learning a pleasant experience – can be accomplished through the frequent
encouragement and positive feedback.
9.Begin with what is known, move toward what is known – It should begin with the basics or
general information that is known and move toward new information that which is unknown.

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10.Present information as in appropriate rate – The rate of information is taught must be
suitable to the client, depending on the client‘s knowledge level, a faster or slower phase may
be necessary.
3. Literacy and Readability
a. Reading Levels of Clients
• Many factors that contribute to reading difficulty of PEMS (Printed Educational
Materials), factors are readability formulas, long sentence and fully syllabus words.
b. Assessing Literacy
•People with low literacy often inadvertently give us clues that lead to realization that
may have reading comprehension problem.
–Not even attempting to read printed materials
–Asking to take PEMs at home to discuss with a significant other
–Claiming eyeglasses were left at home
–Stating that they can‘t read anything, because they‘re too tired or don‘t feel well
–Avoiding discussion of written material or asking no questions about it.
–Mouthing words as they try to read.
c. Teaching Strategies for Low Literate Clients
1. Important to set osbjectives that are realistic for the people‘s level of
understanding.
2. Choose the information that will meet the objectives
3. Overload must be avoided when teaching people with low literacy
4. Keep instructions simple by breaking them down into smaller units.
5. Evaluation should take place so you know how the person has learned.
6. Be creative in the way you evaluate learning.
d. Developing Educational Printed Materials
Whether you are developing a brochure, a pamphlet, or an instruction sheet, the guidelines
for maintaining a low readability level and attractiveness for the low literate person are the
same.
 Organizational Factors
1.Include a short but descriptive title
2.Use brief headings and subheadings
3.Incorporate only one idea per paragraph, and be sure the first sentence is the topic
sentence
4. Divide complex instructions into small steps
5. Consider using a question/answer format
6. Address no more than three or four main points
7. Reinforce main points with summary at the end
 Linguistic Factors
1.Keep the reading level at grade 5 or 6 to make the material understandable to most low
literate persons
2.Use mostly one or two syllable words or short sentences
3.Use a personal and conversational style. For example, ―You should weigh yourself
everyday‖, is preferable to ―The person with congestive heart failure should measure
body weight everyday.‖
4.Define technical terms if they must be used.
5. Use words consistently throughout the text. For example, stay with the word pill rather
than switching between pill and medicine.
6. Avoid the use of idioms that might mean different things to different people. For
example, the term junk food may not be clear to all people.

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7.Use graphics and language that are culturally and age relevant for the intended audience
8.Use active rather than passive voice; for example, ―Take one pill every morning‖ rather
than ―A pill should be taken every morning.‖
9.Incorporate examples and simple analogies to illustrate concepts
 Appearance Factors
1.Avoid a cluttered appearance by including enough white space.
2.Include simple diagrams or graphics that are well labeled
3.Use upper- and lowercase letters. All capitals are difficult for everyone to read.
4.Use 10-14 point type in a plain font (serif is preferred).
5.Place emphasized words in bold or underline them, but do not use capitals because they
are difficult to read.
6.Use lists when appropriate
7.Try to limit line length to no more than 50 of 60 characters.
D. TEACHING STRATEGIES AND METHODOLOGIES FOR TEACHING AND
LEARNING
1. Traditional Teaching Strategies
a. Lecturing
means of conveying facts, information and ideas that could not readily be obtained
elsewhere. A great deal of information can be communicated in an one hour lecture.
b. Discussion
a.Formal Discussion – the topic is answered in advance and the class is asked to
prepare to take part in the discussion by reading certain materials or watching a
videotape.
b.Informal Discussion – May take place spontaneously at any point during the class
including at the end of a lecture when the teacher asks ―are there any questions?‖
c. Questioning
To assess learner‘s comprehension but don‘t give much thought to using questioning
as a teaching strategy. A teacher asks some questions that are designed to wake the
students aware of their ignorance.
d.Using audiovisuals
Audiovisuals simply become time filled and entertaining, serving no real purpose. A
range of traditional audiovisuals can be used effectively, from picture and charts to
overhead transparencies, slides and videotapes.
e. Interactive Lecture
The technique of lecture, discussion, questioning and audiovisuals can be effectively
blended together into an interaction, illustrated lecture, utilizing the advantages of all the
methods and reducing their disadvantages.
2. Activity Based Strategies
a.Cooperative Learning
Is based on the premise that learners work together and are responsible for not only
their own learning but also for the learning of other group members.
b. Simulation
They are exercises that learners engage in to learning about the real world without the
risks of the real world.
 FOUR TYPES OF SIMULATION
–Simulation Exercise – A controlled representation of a piece of reality that
learners can manipulate to better understand the corresponding real situation.

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–Simulation Game – A game that represents real-life situations in which learners
compete according to a set of rules in order to win or achieve an objective.
–Role-playing – A form of drama in which learners spontaneously act out roles in
an interaction involving problems or challenges in human relations.
–Case study – An analysis of an incident or situation in which characters and
relationships are described, factual or hypothetical events transpire, and problems
need to be resolved or solved.
c. Problem-based learning
is an approach to learning that involves confronting students with real-life
problems that provide a stimulus for critical thinking and self-taught content.
d.Self-learning Modules
also called self-directed learning modules, self-paced learning modules, self-
learning packets, and individualized learning activity packages.
–Component of Self-learning Modules:
a.Introduction and instructions
b.Behavioral Objectives
c. Pretest
d. Learning Activities
e. Self-Evaluation
f. Post-test
3. Computer Teaching Strategies
a. Computer-assisted instruction
there can be very effective in the hands of a nurse educator, to be effective, it requires
that the program be aimed toward instructional objectives and be on high quality, that
learners have sufficient access to computer that there is sufficient technological support
and the computer is judged to be the best way to teach the given content.
b.Internet
a massive complex of computer connections across continents, connecting million of
computers. With internet node or a modem, potentially anyone can connect to the internet.
c.Virtual reality
a computer-based simulated three dimensional environment in which the participant
interacts with a virtual world. Advantages of virtual reality simulation over paper and pencil
or other computers are many. The ability to practice invasive procedure in a life-like scenario
is an extraordinary advantage over previous stimulation format.
4. Distance Learning
a.Interactive TV classes
learning site to be visible and heard and to allow maximum interaction between
teacher and students; and between students and students. Each remote site is similarly
equipped, so transmission can occur from any site.
b.Via Internet
Classes delivered via the internet an online or web-based classes. Such courses are
expanding exponentially as academia, business and health care organization are all getting
into the business of distance learning and believe that online courses can be cost effective.
5. Teaching Psychomotor Skills
a. Approaches to Teaching Skills
Teaching psychomotor skills in a college or hospital laboratory can be done in variety
of ways. Factors include the type of program, the number of educators available, nature of the

15
student body or number of practicing nurses to be taught, availability of technology and
philosophy of the program.
b. Assessment of Psychomotor Skills Learning
Skill performance checklist are common means of organizing skill learning and
assessment. Every nurse is familiar with skills checklist because they have been using it.
Checklist contain a rating scale with description such as Adequate, Good and Excellent or
Poor, Fair and Good or it may be numbered of scale that is added to give a total score.
6. Clinical Teaching
a. Purpose of Clinical Laboratory
A.It is in the clinical laboratory that many skills are perfected, complex psychomotor
skills may be practiced initially in a skills laboratory, but to be mastered. They often require a
live rather than simulated situation.
B.In the clinical laboratory, the opportunity for observation is an essential element of
clinical learning. The skill of observation can be taught in simulated situations.
C.Problem-Solving and decision making skills are also referred at the CL. Students
should learn the basis of these skills prior to entering the clinical setting.
D.Learners also gain organization and time management skills in clinical settings, It is
a real clinical practice with the help of the instructor, that learners find how to organize all the
data that bombards them. All the intellectual and psychomotor tasks the must perform.
E.Cultural Competence – is a skill that can be learned well in the CL. Learners may
know a lot of things about how to approach clients from different countries, but they become
comfortable and more expert with cross-cultural care when they care for culturally diverse
clients.
F.Learners of nursing becomes socialized in the CL. They learn which behavior and
values are professionally acceptable and learn about professional responsibility.
b. Models Of Clinical Teaching
Some models of clinical education have been used with some success. A model that
relies on keeping nursing students in a skill laboratory until they are proficient with skills.
They are sent to the clinical area and are assigned to practice psychomotor and other skills.
c. Preparation: Clinical Instruction
•Arrangements have been made for clinical units, the educator should set up a
meeting with the agency staff that will be involved with the education process. That may
include a staff development educator, unit manager, or head nurse. At that meeting, the
expectations of both parties can be discussed and actual implementation of the learning
experience can be worked out. This is the appropriate time to share clinical learning
objectives with the manager or the head nurse. If the staff are familiar with the learning
objectives, they can assist learners in meeting them.
•After these arrangements have been made, the educator can proceed with the final
preparation for clinical. This last step involves making specific assignments for learners on a
weekly or daily basis. (if the learners are not working with preceptors).
•Staff input can be invaluable in planning assignments. Staff members usually know
the patients and families better than the educator does. If the staff are aware of the learning
objectives, they can direct the instructor to suitable assignments.
•Educators and learners together may choose assignments. In some cases, especially
with students who are nearing completion of their educational program, students may choose
their own assignments.
d. Conducting A Clinical Laboratory Session

16
•Preconferences
During the preconference, planning of patient care continues. Learners usually share
some of the results of their research from the previous day. Tentative nursing diagnoses are
discussed, and the assigned learner can discuss possible nursing interventions with the other
learners and the instructor.
•The Practice Session
Combinations of strategies like demonstration with explanations, asking and
answering questions, and coaching techniques can be used. Questioning can be used to assist
learners in developing problem-solving and decision making skills. Coaching strategies can
be used to help learners set goals for themselves, to guide learners through psychomotor
skills, and to help them refine their thinking processes.
•Observation assignments
Learners may be assigned to observe nurses or other professionals performing various
aspects of health care that learners usually cannot perform. Learners might be placed, for
instance, in an endoscopy room or cardiac catheterization lab for few hours of observation.
Given some guidelines to channel their observations, they usually find this a valuable
experience. If they can be paired off with nurses whom they can both observe and question,
the learning experience may be even better.
•Nursing Rounds
The purpose of nursing rounds is to expose learners to additional nursing situations
and to encourage them to consult each other in planning and evaluating care. Nursing rounds
provide many opportunities to apply classroom theory to patient situations and to compare
and contrast patient care.
•Shift Report
Identify shift report as a unique time for learning. Whether the shift report is live or
taped, it is a way for students to learn the uniqueness of nursing communication and is a
means of professional socialization.
•Learning Contracts
Defined as written agreement between instructor (or supervisor) and learner spelling
out the learner‘s outcome objectives. The learning objectives, the learning resources needed
to achieve them, the learning experiences planned, a timeline, and an evaluation plan are
included.
•Written Assignments
The individualized nursing care plan is a standard teaching device. Care plans help
learners think like a nurse, in that they use problem-solving techniques to address patient
problems, and they use their knowledge of the interdisciplinary health care team as a
resource.
•Postconferences
Postconference time is ideal opportunity for pointing out applications of theory to
practice, for analyzing the outcome of hypothesis testing, for group problem solving and for
evaluating nursing care.
E. ASSESSMENT AND EVALUATION
a.Learning Assessment of Clients
Patient Assessment Skills
- Standard I. Assessment
In an assessment the nurse must use all of his or her senses. These include hearing,
touching, visual, and therapeutic communication. The cephalocaudal approach is most always
used. In other words, assessing a patient from head to toe. The nurse must self aware to be

17
able to conduct a thorough assessment. Data collection forms the basis for the next step in
standards of care which is diagnosis.
- Standard II. Diagnosis
A nursing diagnosis is a formal statement that relates to how a client reacts to a real or
perceived illness. In making a diagnosis the nurse attempts to formulate steps to assist the
client in alleviating and or mediating how they respond to real or perceived illness.
-Standard III. Outcome Identification
In this process the nurses uses the assessment and diagnosis to set goals for the patient
to achieve to attain a greater level of wellness. Such goals may simply be that the patient now
comprehends the regime of testing their blood sugar, or perhaps a new mother gleans a sense
of security now that she has been instructed in the correct method of breast feeding.
•Standard IV. Planning
The planning standard is designed around the clients activities while in the hospital
environment. Therefore the nurse must plan to teach and demonstrate tasks when the patient
is free to learn.
•Standard V. Implementation
This standard requires that the nurse put to the test the methods and steps designed to
help the client achieve their goals. In implementation, the nurse performs the actions
necessary for the client‘s plan. If teaching is one of the goals then the nurse would document
the time, place, method and information taught.
•Standard VI. Evaluation
- Evaluation is the final standard. In this step the nurse makes the determination whether or
not the goals originally set for the client have been met. If the nurse concludes that the
goal or goals have not been met, then the plan has to be revised and documented as such
b.Methods of Evaluation
Evaluation of Health Education Programs:
There should be continuous evaluation.
• Evaluation should not be left to the end but should be done from time to time for
purpose of making modifications to achieve better results.
1. Questionnaires
Questionnaires are simple and effective tools for collecting information from a large
number of people. Compared with other ways of collecting information, questionnaires are
relatively inexpensive to administer. They can be used to gather information about the
community-building process itself (process evaluation) or the results it produced (outcome
evaluation).
2. Focus Groups
Group interviews are another way to collect information from many people. Most
people are familiar with focus groups. A focus group is a small-group gathering conducted
specifically to collect information from the group members. During a focus group discussion,
between 6 and 12 people, who are similar in one or more ways, are guided through a
facilitated discussion on a clearly defined topic (Krueger and Casey, 2000).
3. Interviewing
Interviews should be structured, yet conversational. Begin by making the key
informant comfortable. Maintain a neutral attitude throughout the interview. Don‘t try to
defend your community-building project or argue with the key informant‘s assessment of a
situation. Be prepared to probe or use follow-up questions to gather additional information
that might clarify why the key informant sees the situation as he or she does. Be sure to take
detailed notes—they are essential to accurate analysis.

18
4. Observation
The aim of observation is to document behavior through watching and listening.
Through observation it is possible to see what people are doing, when they do it, where they
do it, and how they are doing it. You can use observation to gather information about the
community-building process itself (i.e., process evaluation) or the results it produced (i.e.,
outcome evaluation).
c. Qualities of Good Measurement
A test's usefulness, according to Bachman and Palmer (2000), can be determined by
considering the following measurements qualities of the test: reliability, construct validity,
authenticity, interactivity, impact, and practicality. These qualities can easily describe a good
language test's usefulness.
1. Test Reliability:
The term reliability refers to consistency of measurement. Elaborately, they go on to say that
a reliable test score is consistent across different characteristics of the testing situation.
Moreover, if test scores are inconsistent, they provide no information about the ability being
measured.
2. Construct Validity:
The test's reliability and validity are strongly correlated. Any valid test is considered a
reliable test; however, not all reliable tests can be can be considered valid (Alderson, 2000).
Recently, according to Alderson (2000), ―the term construct validity is used to refer to the
general, overarching notion of validity‖. Therefore, the main focus of discussing the test's
validity is construct validity, in addition to some issues regarding this test's content validity.
According to Bachman and Palmer (2000), the term construct validity refers to the extent to
which people can interpret a given test score as an indicator of the abilities or constructs that
people want to measure. However, no test is entirely valid because validation is an ongoing
process (Weir, 2005).
3. Authenticity:
Bachman (1991) defines authenticity as the appropriateness of a language user‘s response to
language as communication. However, this definition was too general. Therefore, Bachman
and Palmer (2000) divided this idea into two parts. The first relates to the target language's
use, which they refer to as authenticity; and they define the second according to its relation to
the learners involved in the test. Below is a detailed explanation of authenticity and its
implications for the current test. Authenticity relates a test's task to the domain of
generalization to which we want our scores' interpretations to be generalized. It potentially
affects test takers' perceptions of the test and their performance (Bachman, 2000).
4. Interactiveness:
Interactiveness, according to Bachman and Palmer (2000), is ―the extent and type of
involvement of the test taker‘s individual characteristics in accomplishing a test task‖ (p. 25).
Does the test motivate students? Is the language used in the test's questions and instructions

19
appropriate for the students' level? Do the test's items represent the language used in the
classroom, as well as the target language? All these questions represent the crucial elements
that affect a test's interactiveness. Many recent views consider this notion the core of
language teaching and learning.
5. Impact:
According to Bachman and Palmer (2000), impact can be defined broadly in terms of the
various ways a test's use affects society, an educational system, and the individuals within
them. In general terms, a test operates at the macro level of a societal educational system
while corresponding to individuals, i.e., test takers, at the micro level. According to the test's
developer , society, educational systems, and individuals correlate strongly to this test.
6. Practicality:
―Practicality is the relationship between the resources that will be required in design,
development, and use of the test and the resources that will be available for these activities‖
(Bachman and Palmer,2000). They illustrated that this quality is unlike the others because it
focuses on how the test is conducted. Moreover, they classified the addressed resources into
three types: human resources, material resources, and time.
Based on this definition, practicality can be measured by the availability of the resources
required to develop and conduct the test. Therefore, our judgment of the language test is
whether it is practical or impractical.
d. Interaction Process Analysis/ Process Recording
Why should a student do a process recording?
Process recordings allow students to:
 enhance their ability to attend to a conversation with a client and remember it without
relying on recording devices
 converge listening skills and self-awareness
 review the conversation in detail and therefore possibly identify patterns
 to write clearly and coherently about the complex thoughts, actions and feelings that
comprise their human services practice
 reflect on their work, integrating theoretical concepts, skills and values that are being
taught in the curriculum
Example:
PROCESS RECORDING ACTIVITY
Observation of Setting Analysis and Recommendations
(Identify what facilitated the exchange, what were barriers,
and positive and negative aspects of the exchange)
The student had introduced herself and stated
the purpose of the interview to the patient the
evening prior to this process recording.
Facilitators:
Introduced self the night before and stated purpose
Curtains drawn between beds
Client relaxed and verbalized excitement about
talking with student

20
This communication exchange took place at
about 9 o‘clock in the morning. The patient,
Mrs. M., was in a semi-private room in bed
number one which is the bed closest to the door.
As a consequence, the room was quite noisy
during the exchange since there were other
health care workers coming in and out of the
room to attend to the other patient. The curtain
was drawn between the beds to minimize the
noise. Mrs. M., however, requested that the
door be left open in case someone wanted to
come in and visit. Mrs. M. appeared rather
relaxed and verbalized that she was excited to
be able to talk with a nursing student. The
television was on when the student entered the
room but was turned off, with permission,
before the process recording began. The room
itself was rather cluttered and cramped making
it difficult for the student to maneuver in the
room. Mrs. M. also had balloons, flowers, and
cards that added to the overall atmosphere of the
room. Those items made the hospital room look
warmer and more comfortable.
Turned TV off
Room had personal touches
Barriers:
Semi-private room with roommate present
Room entered by care providers for bed 2
Noisy and cramped space
Door open—Mrs. M. looking for visitors could
prevent her full participation in interaction
Interviewer:
(Student)
Interviewee: (Mrs.
M.)
Identify Communication
Technique
Analysis of Interaction
(was technique effective, why
or why not? Was there
anything else that could have
been explored?)
―Good morning Mrs.
M. We‘re going to go
ahead and start the
short interview that we
talked about
yesterday, if that‘s
―Sure, come on in.
You can just go ahead
and do anything you
want, honey.‖
(smiling)
Providing Information Telling Mrs. M. what she was
doing would put her at ease and
make her feel safe and secure.

21
okay with you.‖
(using direct eye
contact and a friendly
tone of voice)
Student pulls up a
chair and sits near the
head of the bed at
patient‘s eye level)
―Well, let‘s go ahead
and get started. (using
direct eye contact).
―Why don‘t you tell
me how you feel about
going home today?‖
―Um-huh. (nodding
head, using good
posture)
Student continues to
nod intermittently as
well as saying ―um-
huh‖ or ―yes‖
―Well (Mrs. M. sighs)
I have mixed feelings
you see because I
really would like to
get home so I can
work on my
geneology records
I‘ve been doing. But
(pauses) I don‘t want
to go home until I‘m
completely better.
You see, I was in here
before and I got this
disease from the lady I
was sharing the room
with. I just know I
got it from sitting in
the same armchair as
her. Then, (sighs and
frowns), when I got
home I was sick. I
started coughing and
vomiting. I ended up
right back here again
(puts emphasis on
again).
Student positioned herself
for active listening
(SOLER)
Asking relevant questions
Continued use of active
listening
Enhances trust
Facilitates
communication
Conveys interest and
involvement
Eye contact conveys
sincerity, interest, and
professionalism
To seek information
To allow client to take
the lead in the
conversation and give
pertinent information
Using positive non-
verbal messages lets
client know student is
interested
Use of paraphrasing or
clarifying may have
been helpful here
―So, you really aren‘t
sure you want to go
home yet.‖
―I (um) Oh, I don‘t
know. (puzzled tone
of voice and puzzled
look on face) You see
my daughter, she lives
in Springfield, and
takes care of my
Reflecting and Focusing Trying to keep
conversation focused
May have needed to
use a close-ended
question here to zero in
on only one area.

22
―Has your daughter
been in to visit you
since you‘ve been in
the hospital?‖
―I see you‘ve gotten
balloons and flowers
all over there. But no
one has been in to
visit?‖
husband who has
Alzheimer‘s Disease.
She thinks that I ought
to stay in here for a
while longer to be
sure I am better before
I go home. She takes
care of my husband in
a home, you know, so
she knows a lot about
hospitals and stuff like
that.
―Mary?‖ (Mrs. M.
pauses) No. But I
have one son and
three daughters you
know. They‘re spread
out all across the
United States. My
son just got out of the
hospital with some
prostate problems so
he couldn‘t be here.
He‘s a lawyer too so
he‘s very busy. And
then there are the
twins (chuckling).
Well, they aren‘t
really twins. They are
9 years apart but they
look just alike.‖
―My son called me
this morning. He is
doing pretty good. He
just got discharged
yesterday. But my
neighbor came to see
me yesterday.‖
Probing
(Interpreting Information
and attempting refocusing
Trying to keep
conversation on track
An effective way to get
more information but
sometimes you get
more information than
you need
Focusing could have
been helpful here
Would be interesting to
know what prompted
this question. If
wanting to know why
daughter wanted her to
remain in the hospital,
a more direct question
may have worked
better.
Conversation was
becoming idle, needed
to ask something like
―How do you plan to
manage when you go
home?‖ or asking
about the neighbor
could be used to focus
the conversation.

23
was intent of the student)
Changing the subject
―Well good. It sounds
like you‘ve been
keeping pretty busy in
here, then.‖
―Well my time is up.
Thank you for
allowing me to talk
with you. (direct eye
contact) I hope all
goes well for you at
home.‖
―Oh yes. And I am so
glad. It is boring in
here, you know.‖
―Oh you‘re welcome
honey. (smiles)
Always glad to help a
student. I hope I
won‘t have to come
back here for a long
time.‖
Summarizing
Terminating interaction
Used to let Mrs. M.
know the conversation
was near the end.
Did not really
summarize key points
Brought closure but
was somewhat abrupt
EVALUATION
(What is your overall impression of this communication exchange? Was the goal of the interview achieved?
Were there any recurring themes in the exchange? What were the interviewers strengths or weaknesses? What
was the social value of this exchange?)
This process recording conveyed that the student was comfortable talking with Mrs. M. It did convey some
difficulty staying focused on the particular issue of concern. Mrs. M. shared a lot of information that was not
really relevant to what the student wanted to know. Being comfortable and proficient with the use of
paraphrasing, clarifying, and focusing may have helped the student gather the pertinent data needed with the
client getting off the subject. Active and attentive listening can give cues to what is really important to a client.
In this interaction the client‘s family was very important to her.
All in all the interaction was therapeutic, although the primary objective of finding out how she felt about going
home was never really met. Follow-up questions were needed to guide the conversation back to that focus and
get the information that was sought. The social interaction would have been beneficial to the client regardless of
whether the main objective was realized or not.
My goals for further communication growth would be:
1. Learn to use additional techniques such as paraphrasing, clarifying, and focusing redirect conversation
so I can achieve the intended information.
2. Learn to use a variety of techniques naturally without having to think about them.
"The most important practical lesson that can be given to nurses is to teach them what
to observe.“
Florence Nightingale

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