Patient’s Education Hx

Mid 1800’s – 1900’s

- Florence Nightingale – founder of modern nursing and also known as the ultimate
nurse educator
- Developed the 1st NSG school ( St. Thomas Nursing School)
- Developed the environment theory
- Through the process of patient’s education. Florence taught her px and staff to
imbibe her environmental theory in their life
- Role of Nurse during this time is about disease prevention
- Patient teaching was recognized as an independent nursing interaction
1918
- Rise of National League of Nursing Educator (presently known as the National
League of Nursing)
- Nurse is an agent for the promotion of health and prevention of illness all settings
in which they practice
1950
- Subjects with relation to becoming a nurse educator were included in the Nursing
curricula
- Certified Nurse Educator Exam
- Nurses should provide instruction to consumer to assist them to maintain optimum
levels of wellness and manage illness, through cost effective, safe and high quality
care
1993
- Joint Commission on Accreditation of Health Care Organizations (JCAHO)
established nursing standards for patient education
- According to these standards, types of level of care, treatment and services should
receive accreditation and that Nurse teaching should be patient-centered and
family-oriented
- Patients and relative are now part of the decision making process and should
understand what they have been taught (Patient’s Bill of Rights)
1995-2002
- The Pew health Professions Commissions recommendations in nursing:
> Provide clinically competent and coordinated care to the public
> Involve patient and families in decision making regarding interventions
> Provide clients with education and counseling in ethical issues
> Expand public access to effective care
> Ensure cost effective and appropriate care for the consumer
> Prevention of illness and promotion of healthy lifestyle
2006
- Institute for health care improvement announced the 5 million lives campaign
- Sullivan alliance-increase understanding of patients by increasing diverse society
of nurses
PATIENTS EDUCATION
Purpose-increase competence and self-confidence of clients for self management
Goal-increase responsibility and independence of clients for self care

Effective teaching results to:

> Increase consumer satisfaction
> Improve quality of life
> Ensure continuity of care
> Decrease client anxiety
> Reduce complications of illness
> Promote treatment plans
> Maximizes independent ADL
>Empower consumers to become active in the planning of care

PATIENT EDUCATION PROCESS

Assessment
Planning
Implementation
Evaluation

OR

Analyze the learner

State the objectives
Select instructional materials and methods
Require learner performance
Evaluate teaching plan and revise as necessary

ROLE OF NURSE EDUCATOR

- Not primarily to teach but to provide an environment conducive to learning (…
create the environment.. don’t wait for it…)
- Process designer

Barriers in teaching
- lack of time to teach
- Nurses do not feel competent or confident with their teaching skills
- Personal characteristics of the nurse educator
- Low budget allocations for the adoption of innovations and time saving strategies
and techniques
- Not conducive environment
- Some nurses and physicians question whether patient education is effective
- Type of documentation system

Obstacles to learning
- Lack of time
- Stress of acute or chronic illness
- Low literacy and functional health literacy
- Hospital environment
- Personal characteristics of the learner
- Extent of changes needed
- Lack of support and reinforcement
- Denial of learning needs

PLANNING AND CONDUCTING A CLASS

The Planning Sequence
- before entering the classroom, planning should have been done
- evaluation of learning should also have been done
- a good planning should be done steps ahead of the learner, not just an hour or so.
(this is for the own sake of the lecturer and the learner)
- objectives, content and evaluation tool

Developing a Course Outline or a Syllabus

- in all settings, a course should always be accompanied by a syllabus
- a course outline should include the name of the course, the name of the instructor,
one paragraph course description and a list of course objectives
- changes may also be stated in the outline or syllabus to notify the students about
the changes that may happen

Formulating Objectives
Objectives – reflects what learner is supposed to learn from what is taught to them

The Values Objectives

- why do we need objectives?
1. It guides teacher in handling and selecting of teaching materials
2. Helps determine whether people in class have learned what you tried to teach
(learning outcome)
3. Provides the learner what to expect in a discussion

Cognitive Domain
-Knowledge: Define, Delineate, Describe, Identify, List, Name, State
-Comprehension: Classify, Discuss, Estimate, Explain, Summarize
-Application: Adjust, Apply, Compute, Demonstrate, Generate, Prove
-Analysis: Analyze, Compare, Contrast, Critique, Defend, Differentiate
-Synthesis: Create, Develop, Propose, Suggest, Write
-Evaluation: Assess, Choose, Conclude, Defend, Evaluate, Judge
Psychomotor Domain
-Arrange: Assemble, Calibrate, Combine, Copy, Correct, Create, Demonstrate,
Execute, Handle, Manipulate, Operate, Organize, Position, Produce, Remove, Revise,
Show, Solve

Affective Domain
Accept, Agree, Choose, Comply, Commit, Defend, Explain, Influence, Integrate,
Recommend, Resolve, Volunteer

Wording the Objectives (contents of an objective)

Intended Learner
Behavior to be performed
Degree of attainment of specific goal
Condition under which goals are to be performed

Individual class session objectives are usually few ( only 3-5 per class) – may be just
read or presented through a transparency

SELECTING CONTENT –it is in the instructor’s discretion what to teach

>first consideration is the time frame
>second is the background of the students have
>third is the textbook
-cramming is the pitfall of teachers
-give time for discussion of meaningless of the subject
-consider active participation
-rehearse orally in front of the mirror
-avoid quick pacing (weakness of beginner)

Organizing Content
-make the discussion fun, enjoyable and smooth running
-follow a sequence
-guide the students on what are you doing
-you can have a critic sit in front of you
-move from generalizations to specifications
-you can start the class with a review

Selecting Teaching Methods

-selecting the teaching method is the most complex part of teaching but receives
little attention
Factors affecting choice of method
1. Depends on the objectives and type of learning you are trying to achieve
- Facts-handouts
- Molding attitudes-role playing, discussion, case studies
- Motivating learners-gaming
- Encouraging creativity and problem solving- problem based learning or
individual projects
2. Course content
3. Abilities and interests of the teacher – method should be compatible to the
teaching style
4. Compatibility with teaching methods and the teacher. But compatibility with
learners is more important
5. Number of people in the class
a. for large groups – acetate, microphone, modules, computer programs,
audiovisuals
b. small groups – discussions, role playing, cooperative learning
6. Classroom setting – size, furniture, lighting, available technology, equipments
LECTURING
Purposes
- introduce topics(pure information)
-Integrate and synthesize a large body of knowledge to learners

Advantages
-economical
-effective to 200 as long as there is microphone
-great deal of info can be introduced in span of an hour
-important information can be taken from book and shortened
-topics form books can be brought to life
-imagination and creativity is unleashed in students
-develops learning abilities of students

Good lecturers should be:

1. has good speaking voice
2. good timing
3. dramatic gestures
4. sense of humor
5. good memory

Disadvantages
-students become passive listeners like sponge
- no students can listen for as very long time no matter how active are they from
the beginning
-not all students go to school to listen(students job is only to study)
- because students cannot be continuously stimulated, many objectives are not met
-bad lecture methods are inherited by student making them poor lecturers when
they grow up
-little emphasis on problem solving, decision making, analysis, and thinking (surface
learning)
-learning through lecture is more on memorization
-lecturing brings problem of limited attention span on the part of learners (15 min-
20min)

Organizing a Lecture
o Hierarchal or classical- information is subdivided and outlined. Simplest structure
and easy to follow
o Problem centered-problems are posed and solutions are developed
o Comparative-done if objectives are different between two entities
o Thesis format- discussed in some point of view (morality or ethics)

Note: All lectures should have “advance organizers” (the bridge of lectures)
Delivering the lecture
>Control anxiety
-imaging or seeing yourself in front of the audience before lecturing
>Spontaneity
-A spontaneous lecture always starts with preparedness and mastery
-never forget the order of your lecture
>Voice Quality
-use of microphone for clearer speaking in a large group
-never use a soft voice
-(IF YOUR VOICE IS NATURALLY SOFT, TRY OBSERVING OTHERS TECHNIQUES)
>Body Language
-move from one side to another
-never show signs of nervousness because audience will tend to watch those signs
-“uh”, “okay”, and “so forth” are the common words spoken by nervous people
- maintain eye contact, move your eyes around the class
>Speed Delivery
-pacing affects the learner’s comprehension (Too slow= boredom: Too
fast=struggle)
-have pauses now and then to allow students to think and catch up and form
questions
>Getting on the right foot
-be an attention getter
-provocative question
-startling statement
` -powerful quote
-mention a recent event
>Clarifying the lecture
-give examples to make clearer and more vivid picture of the topic you are lecturing
-tackle the imagination because mental images are retained more in a learner
Facilitating retrieval from the memory
-repetition (do not overdo repetitions or else it will be cause confusion instead of
retention)
-elaboration
-Imagery-info are formed either words or mental pictures (mental images are
better)

TYPES OF LECTURES-use different lectures from time to time

1. Traditional or oral essay-orator is the only speaker
2. Participatory Lecture
3. Lecture with uncompleted handouts
4. Feed Back lecture-10 min group discussions around a structured questions
5. Mediated lecture-use of media and films
DISCUSSION

Advantages
- Gives learners the opportunity to learn while applying concepts, topics and
theories
- Aims for clarification of information and concepts
- Class discussions can become group discussion then be divided to subgroups
discussion
- Lessens anxiety of learners to question unclear topics
- Participants get practice of their critical thinking skills
- Attitudes can also be changed through discussion because learners hear various
viewpoints

Disadvantages
-draws a lot of time
-inefficient way of communicating information
-only effective in small groups making it expensive
-teachers cannot become moderators and facilitators at the same time
-not all participates

Discussion techniques
1. make expectations clear before starting the discussion
2. set the ground rules (time limits, interruptions, limit the number of times a
person may speak to allow others to voice out)
3. arrange the physical space (circle formation is the best for group discussion, eye
contact maintained)
4. plan a discussion starter
5. facilitate, don’t discuss
6. encourage quiet group members
7. don’t allow monopolies
8. direct the discussion among group members
9. keep the discussion on the track
10. clarify when confusion reigns
11. tolerate some silence
12. Summarize when appropriate
QUESTIONING- is designed to bring fundamental truth to an issue

Functions
-places learners in an active role
-never sets a student in a daydream
-assess baseline knowledge
-review content of previous lesson
-increases motivation to learners

Levels of questions
>Convergent
-require the learner to integrate info that has already been learned
-needs low level of cognitivity
>Divergent
-requires higher level of cognitivity because it uses analysis
-generate new ideas, draw implications, and formulate new perspective

>Low-order questions
-from what has been memorized or have been read
>Higher order questions
-critically analyze and comprehend

QUESTIONING TECHNIQUES
1. Prepare questions ahead of time
2. State questions clearly and specifically
3. Tolerate some silence
4. Listen carefully to responses
5. Use the beam focus build technique
6. Provide feedback
7. Handle wrong answers carefully

*the different ways of delivering a question to a class (open-ended question, close-

ended question, factual questions, probing questions….etc.)

*Audio visuals