Health Educations progression to the forefront of Health Promotion is brought about by the mandate of Healthy People 2000, which

recognizes that although it is difficult to separate some health problems from social and environmental influences, many health goals are affected by individual lifestyle changes. Definitions Sum of activities every health care professional engage in to influence the thinking, motivation, judgment and action of the people in the community Is any combination of learning experiences designed to facilitate voluntary adaptations of behavior conducive to health Consists of techniques that stimulate, arouse and guide people. It includes three (3) concepts: a. Health education involves the use of teaching and learning strategies b. Learners maintain voluntary control over the decision to make changes in their actions. c. Health education focuses on behavioral changes that have been found to improve health status Aspects 1. Provision of Information imparting knowledge 2. Communication exchange of information 3. Education change in knowledge, attitude and skills Goals 1. Help individuals, families and communities achieve, through their own actions and initiative, optimal states of health. 2. Help facilitate an individuals ability to improve personal living conditions 3. Make informed decision about personal, family and community health practices. 4. Self-empowerment and self-responsibility for ones health Principles 1. Health education considers the health status of the people 2. Health education is learning. 3. It involves motivation, experience and change in conduct and thinking 4. It should be recognized as a basic function of all public health workers. 5. It takes place in the home, in the school, and the community.

6. It is a cooperative effort. 7. It meets the needs, interest and problems of the people affected 8. It is achieved by doing. 9. It is a slow, continuous process. 10. It makes use of supplementary IEC materials. 11. It utilizes community resources. 12. It is a creative process. 13. It helps people attain health through their own efforts 14. It makes careful evaluation of the planning, organization and implementation of all health education programs and activities. Steps 1. Creating awareness 2. Motivation 3. Decision-making action Methods and Strategies Interviewing Counseling Lecture-discussion Open Forum Workshop Case study Role Play Symposium Community Assembly IEC materials Use of Publications Use of Audio-visual aids Client Education It is a major aspect of nursing practice and an important independent nursing action. It is multi-faceted, involving protecting, promoting and maintaining health. It involves teaching about reducing health risk factors, increasing a persons level of wellness and providing information about specific protective health measures. According to Virginia Henderson, part of nurses role is to improve the patients level of understanding and therefore promote health. Any combination of learning experiences designed to facilitate voluntary adaptations of behavior conducive to health.

Purposes of Client Education 1. Promotion / Maintenance of Health Increasing a persons level of wellness Growth and Development topics Fertility Control Hygiene Nutrition Exercise Stress Management Lifestyle Modification Resources within the Community 2. Prevention of Illness or Injury Health Screening Reducing Health Risk Factors Specific Protective Health Measures Immunization Use of Contraceptives Use of Sunscreens Use of Medication Cord Care First Aid Safety 3. Restoration of Health Injured or ill clients need information and skills that will help them regain or maintain their levels of health. Information about test, diagnosis, treatment and medication Self-care skills or skills needed to care for family members Resources within health care setting and community 4. Coping with impaired functioning or adapting to altered health and function Adaptation in lifestyle Problem solving skills Adaptation to changing health status Strategies to deal with current problems Home IV skills Medications Diet Activity Limits Strategies to deal with future problems Fear of pain with terminal cancer Future surgeries and treatments Information about prognosis, treatment and the like Facilitation of strong self-image

 Grief and Bereavement counseling Health Educator one who improves the health of the people by utilizing different scientific methods/procedures to demonstrate healthful ways of living. Qualities: Knowledgeable Credible Good Listener Emphatic Flexible Patient Creative/Innovative Motivates learners to improve their level of performance Knows how to makes things simple and summarize them Encourages groups active participation Good sense of humor Provide quick feedback Develop and reinforce positive behaviors Allow opportunity to learn at individual and group levels. LETS BRUSH UP ON SOME NOTEWORTHY TOPICS ON GROWTH & DEVELOPMENT, AND LEARNING & COGNITION. Growth = measurable; quantitative = progressive increase and continuous advancement of the individual form birth to maturity. It involves both structural and physical changes, as well as functional changes which involve a slowing down of mental processes. Maturation = is the process of attaining a level of development at which some specified mental function or type of behavior ordinarily appears. It is the unfolding of traits potentially present in the individual because of heredity. It refers to a process of change of individual that occurs primarily as function of aging or time. It excludes the effects of practice and experience.

Development = qualitative; behavioral = capacity to function ex. skill or ability = series of changes that occur in an orderly, predictable manner as a result of maturation and experience. The goal of development is to enable the individual to adapt to the environment in which he lives. *Childhood is the foundation period of life. *Development results from maturation & learning The philosophical roots of developmental psychology were propounded by John Locke and Jean Jacques Rosseau. In 1960s, Locke suggested that what happens during childhood has a profound and permanent impact on the individual because the newborn infant is like a blank slate, or tabula rasa, jon which experience writes its story. On the other hand, Rosseau some 70 years later suggested that children are capable of discovering how the world operates without adult teaching, such that they should be allowed to grow as nature dictates, with little guidance or pressure from parents. Hence, he believed that children should be valued fro what they are, rather than for what they will become. Swiss psychologist John Piaget (1896 1980) suggested that the influences of both nature and nurture are inseparable and interactive, and that heredity as much as environment contribute to development. He also postulated the four stages of cognitive development, each of which has certain characteristics that are peculiar to that stage: Sensorimotor Stage A. Reflexive (Birth 1month) Reflexes B. Primary Circular Reaction (1 4 months) Perceptions centered on body Need gratification **RN keeps routines (feeding, bathing) as consistent as possible C. Secondary Circular Reaction (4 8 months) Acknowledges external envt Learns that he is separate fr envt A. Coordination (8 12 months) Distinguishes goal from means (rituals)

B. Tertiary Circular Reaction (12 18months)

Discovers new goals

C. Invention of new ideas Mental Images (18 24months) **A scheme is a basic unit of knowledge, which may be a pattern of action, a mental image of an object, or a complex idea. Two processes guide the development of schemes: organization, which is the ocmbination and integration of separate schemes into more complex patterns; and adaptation, which consists of assimilation and accommodation. Assimilation is the taking in of new information about objects by trying out existing schmes on objects that fit those schemes. In accommodation, schemes are modified as the infant tries out familiar schemes on objects that do not fit them. Pre-conceptual / Pre-operational (Toddler) (2 4 years old) Explores environment Language development REPRESENTATION = creative, symbolic play *RN teaches procedures using picture books for childs hospital stories or dolls for procedures. Rationale: child associates words w/ objects ** Thoughts & language are EGOCENTRIC ** Children become able to represent something w/ something else, acquire language and play games of pretend. Intelligence at this stage is said to be intuitive, because they cannot make general, logical statements. During this stage, children do not exhibit the ability to conserve number or amount, or to recognize that important properties of substance remain constant despite changes in shape, length or position Intuitive Thought (Preschool) (4 7 years old) Includes others thoughts expressed in words Determines individuals have roles (-) Ability to conserve # or amount or recognize that important properties of a substance remain constant despite changes in shape, length or position.

Role play / imitation *RN encourages questions and offers explanations Pictures & Short stories re: hygiene Concrete Operations (7 12 years old) It is when children can understand logical principles that apply to concrete external objects and apply and exhibit the concept of conservation. They can also appreciate the perspective of another, and think about two concepts, such as longer and shorter, at the same time. Formal Operations (12 15 years old) It is when adolescents and adults can think logically about abstractions, can speculate, and can consider what might or what ought to be. At this stage, individuals can work in probabilities and possibilities, and can imagine other worlds, especially ideal ones. They can reason about purely verbal and logical statements, and can relate any element or statement to any other, as well as manipulate variable in a scientific experiment and deal with proportions and analogies. They reflect on their own activity of thinking.

DEVELOPMENTAL CAPACITIES FOR LEARNING LEARNING CAPACITY Infant (sensorimotor) Relies on parents for basic needs Learns to trust adults when they convey love and compassion Explores environment through senses TEACHING METHODS Keep routines consistent Hold infant firmly ad speaking softly to convey sense of trust

Toddler (pre-operational) Learns to understand words and express feelings Learns by associating words with objects Likes to explore environment through play

Preschooler (intuitive) Vocabulary grows Uses language w/o comprehending meaning of words, especially concepts (right or left, time) During play, child expresses feelings more through actions than words Asks questions and imitates adult School-age Child (concrete) Interacts w/ adults and peers outside immediate family Begins to acquire ability to relate series of events and actions to mental representations that can be expressed verbally and symbolically Is able to make judgment Play becomes more formal and imaginative Is inquisitive, asking many questions about health

Use play to teach procedure or activity (handling examination equipment, applying bandage to a doll) Offer picture books that describe story of children in hospital or clinic Use simple words such as cut instead of laceration to promote understanding Use of role playing, imitation and play to make it fun for them to learn Encourage questions and offer explanations. Use simple explanation & demonstrations

Teach psychomotor skills needed to maintain health. (Complicated skills, such as using a syringe, may take considerable practice)

Adolescent (formal operational) Struggles between childlike feelings of dependence and independence of adults Wants to be in control but, during illness, fears loss of selfconcept or body image Is able to solve abstract problems Learns best when immediate benefit is gained Young/Middle Adult (maturity) Complies w/ health teaching because he fears the result, is trying to gain approval, is responding to nurses attitude, or knows it is in best interest Learning occurs when adult values information being taught Older Adult [67 & above] Often, there is a decline in visual & auditory acuity, which impairs perception of stimuli Sensory alterations, mobility limitations, and physical coordination problems affect capacity to learn He takes pride in being independent and caring for self There is no decline in intelligence w/ age

Help adolescent learn about feelings and need for selfexpression Using teaching as collaborative activity Allow them to make decisions about health and health promotion (safety, sex education, substance abuse) Use problem-solving to help adolescents make choices Encourage independent learning Offer information so that adult can understand effects of health problem

Teach when client is alert and rested Involve adult in discussion or activity Focus on wellness and persons strength Use approaches that enhance sensorially impaired client

SPHERES / DOMAINS OF LEARNING Taxonomy of Cognitive Domain by Benjamin Bloom Capacity to think Intellectual Evaluation formulation of judgment

Synthesis production of unique relationship

Analysis identification of element & relationship

Application use of rules or principles in concrete situations

Comprehension translation & interpretation

Knowledge recall of facts, sequences and/or classification Taxonomy of Affective Domain by David Krathwohl Emotions; feelings Values; attitude Internalizing directs way of life automatically

Conceptualization integrates into value system

Valuing appreciates / exhibits commitment

Responding willingness to react to phenomenon Receiving awareness & sensitivity in a phenomenon

Taxonomy of Psychomotor Domain by Elizabeth Sympson Activities; Behavior Doing acting

Organizing creates new movt/patterns to suit a particular problem Adaptation performs skills and adapts them to special circumstances Complex Overt Response performs a motor skill competently, accurately & smoothly

Mechanism performs a learned activity w/ confidence& proficiency

Guided Response performs an act under the guidance of a nurse

Set readiness to take immediate action: mental, physical & emotional

Perception uses the senses to obtain cues to guide motor activity TYPES OF LEARNING ACCORDING TO R. GAGNE Problem Solving having a clear idea of the problem or goal being sought and being able to recall and apply previously learned rules that relate to the situation. Rule Learning establishing a chain of concepts or a relationship between concepts expressed as Ifthen relationships. Concept Learning learning how to classify stimuli into groups represented by a common concept Discriminative Learning forming large numbers of stimulusresponse or verbal chains and distinguishing or differentiating them Verbal Association relates words to their meanings Chaining the acquisition of a series of related conditioned responses / stimulus-response connections Stimulus-Response Learning a voluntary response to a specific stimulus or combination of stimulus Signal Learning a general diffuse reaction to a stimulus (a conditioned response) LEARNING, MEMORY AND COGNITION 1. There are three types of memory: sensory memory, short-term memory. Sensory memory, also known as iconic memory, refers to the sensory registration of an event. Short-term memory, sometimes called working memory, retains information for a very short period of time and prepares such information so it can be transferred to long-term memory. Long-term memory is the part of the memory system that stores information that has

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been processed by short-term memory so that it can be retrieved and used when needed. Some methods of preparing material for transfer from shortterm memory to long-term memory are rehearsal, coding, chunking and mnemonics. Rehearsal is the process of repeating words, either aloud or silently, as a means of holding something in short-term memory and preparing it for long-term memory. Coding is a process of assigning a meaningful label or symbol to a stimulus or event as a means of remembering it. Chunking is a process of grouping or clustering more than one stimuli ins some meaningful way in an effort to remember more. Mnemonics are devices such as rules, gimmicks, rhymes, or other tricks intended to aid memory. There are three stages of memory: encoding, storage and retrieval. Encoding refers to the transformation of physical information into the kind of code that memory accepts; storage is the retention of the encoded information; and retrieval refers to the process by which information is recovered from memory when it is needed. Depth of processing refers tot eh thoroughness with which new information is studied and related to previously stored information. When these two things are done thoroughly, the chances are that the new information will be securely anchored in long-term memory. As applied to the school setting, most psychologists agree that how the teacher leads or guides students to information will greatly affect what and how they choose to process. The tow factors that increase the chances of successful retrieval are: (1) organizing the information in storage and (2) ensuring that the context in which we retrieve information is similar to the context in which we encoded it. The factors that decrease retrieval are: (1) interference and (2) emotional factors. Long-term memory can be improved by utilizing the principles of imagery and elaboration. Tow mnemonic systems which make use of imagery are the (1) method of loci and (2) the keyword method. The more we elaborate items, the more we will remember them; that is, if you want to remember something, you must expand on its meaning. Retrieval can be improved through context, organization and practice. Some well-known techniques for improving memory are based on theses three principles of memory. The PQ4R method is one of the best techniques for improving memory. This method takes its name from the first letters of its six stages: Preview, Questions, Read, Reflect, Recite, and Review.

8. The dual-memory theory is one of several theories that have been advanced regarding the relation between short-term and long-term memory. This theory assumes that information we have attended to enter short-term memory, where it can be either maintained by rehearsal or lost by displacement. This also provides a way for classifying severe memory disturbances. People who suffer from retrograde amnesia, caused by a concussion or severe injury to the head, have no memory for the events that immediately preceded the injury. Another kind of memory symptom is anterograde amnesia, which occurs \in patients who have undergone surgery for relief of epileptic seizures as a result of which they seem incapable of learning new material. 9. As alternative approach to the dual-memory theory is depth-ofprocessing. The general idea of this approach is that an item entering the memory system is analyzed in stages. The early stages analyze perceptual properties (visual/acoustic) of the item. Later stages analyze its meaning, including the categories it fits into and its connections to other items in memory. The deeper the level of processing, the stronger the residue and the more durable the memory. 10. Memory for complex, meaningful materials such as sentences, stories and textbook chapters is governed by certain principles, the most important of which is that memory is constructive. Construction is done, for example, by adding simple inferences to the material provide or by fitting the material into stereotypes and other kinds of schemata.*** 11. Individuals adapt to changes in the environment through the process of learning, which is defined as any relatively permanent change in the organism that results from past experience 12. In one form of learning that is called classical conditioning, a neutral stimulus is pared with an unconditioned that elicits an unconditioned response. After repeated pairings, the neutral stimulus alone comes to elicit the response, and it is then called a conditioned stimulus and the response is called a conditioned response. This process is referred to as acquisition. 13. Classical conditioning, therefore, involves the forming of an association between two units in the environment and tying them to an involuntary response. In humans, classical conditioning is often involved in learning emotional responses and attitudes. 14. Extinction is the weakening of a learned response. In classical conditioning, extinction is accomplished by repeatedly

presenting the conditioned stimulus without the unconditioned stimulus. Sometimes an extinguished response suddenly reappears and is called spontaneous recovery. Generalization is responding in the same way to more than one stimulus with similar characteristics. Discrimination involves responding to one stimulus while not responding to a very similar stimulus. 15. In operant conditioning (or instrumental conditioning) animals or humans will produce behaviors if they learn that those behaviors will be followed by reinforcement, and that they will stop producing behaviors that they learn will be followed by punishment. 16. In positive reinforcement, the representation of a stimulus (usually something pleasant), following a response that strengthens the response. In negative reinforcement, the response is strengthened by the removal of a stimulus (usually something unpleasant) following the response. 17. The consequences of behavior are classified according to the kinds of effect they have on subsequent behavior. Consequences that lead to an increase in the frequency of behavior is called reinforcement. Consequences that lead to the suppression or decrease in the frequency of behavior are called punishment. In positive reinforcement, the enforcer is anything that strengthens the response that lead to the enforcers removal. Punishment is anything that weakens the response. 18. Shaping behaviors involves rewarding responses that are closer and cl7oser to the desired behavior until the desired behavior is produced. The systematic use of rewards and punishment to achieve alteration in behavior is known as behavior modification. 19. Aversive conditioning is a method of controlling behavior that involves the use of unpleasant or aversive stimuli. It relies on negative reinforcement and punishment. It is used in some programs of behavior modification. 20. Not all learning is of a stimulus-response, conditioned nature. Cognitive learning involves acquiring and organizing information about ones environment making sense out of things rather than just responding. Cognitive learning is illustrated in the formation of cognitive maps of our surroundings. 21. Social learning theory us an approach to learning that combines traditional learning theory with a concern for human thought processes. This theory postulates that learning is not simply a matter of reacting to stimuli; instead, people apply cognitive processes to the stimuli they encounter, selecting, organizing, and transforming them. It is peoples interpretation of stimuli

and not the stimuli themselves that control behavior. According to this theory, much of what we learn is the result of learning by observation, or modeling. 22. Studies of social learning indicate that: a. Both classical and instrumental conditioning occur in the natural social environment b. Both classical and instrumental learning can occur vicariously. c. Humans often engage in observational learning, in which they learn by watching others, even though they are not directly reinforced. 23. It is possible to view associative learning and cognitive leaning as complementary. Neither in itself provides a complete explanation, but each helps to explain some aspects of learning that other neglects or does not explain adequately. 24. Words can provide powerful and efficient ways of teaching and learning new behaviors. 25. Studies have shown that when people are given feedback information about how well one is doing that performance generally improves. 26. Cognition is a process of knowing, which encompasses thinking, problem solving, decision-making, reasoning, judging and imagining. All these higher mental processes depend on learning and memory. 27. In problem solving, an individual is prevented by a barrier, either physical or psychological from reaching some goal, and an effort must be made to circumvent or surmount that barrier. Problems vary in their complexity and in the effort needed to solve the. 28. The direct application of previous knowledge to a problem is called reproductive thinking. Sometimes this does not work and creative thinking is needed, wherein new rules based on other stores of information are generated. 29. Whether a problem requires reproductive or creative thinking, the problem-solving process uses various strategies which include hypothesis testing, the use of algorithms and heuristics, and computer simulation. 30. Blocks to problem solving include difficulty in isolating the problem, a tendency to delimit the problem area too closely, inability to see the problem from various viewpoints, a tendency to see what you expect to see, saturation, and failure to use all sensory inputs.

31. Social cognition encompasses our understanding of people and social situations. Metacognition refers to our capacity to critically evaluate our cognitive processes. PROCESS Has the ff: a. Goal/s b. Steps c. feedback NURSING PROCESS TEACHING PROCESS - promotes health, prvent illness, restores health, alleviates suffering, and safe environment a. Assessment a. Assessment - data gathering - learning need - classifying (subj/obj) (cognitive, - validating psychomotor/ - clustering affective) - interpreting/analyzing b. Nsg dx (NANDA-based) b. Nsg dx (NANDA) - Diagnostic label r/t etiology - same as manifested by: (defining characteristics) c. Planning c. Teaching Plan - Long-term goal * Objective - SMART objective * Content * Resources * Parameters d. Implementation - independent nsg - dependent - interdependent of nsg e. Evaluation d. Implementation - teaching strategies - may also use the said 3 types measures e. Evaluation

THE NURSING PROCESS IN TEACHING AND LEARNING Assessment Client learning needs Sources: - Client Ask pertinent questions Seek out needed info some other way - Clients behavior - Health care professional Know anticipatory learning need

 Relevant client data a. Readiness to learn - reflects clients willingness and ability to learn - the behavior that reflects motivation at any specific time - the client may search out info by: Asking questions Reading books or articles Talking to others; showing interest b. (-) readiness to learn - avoids subject or information - hopes or believes that someone else will take care of the problem - may change the subject - may have somatic symptoms (headache, upset stomach etc.) - emotional readiness (extreme anxiety, depression, grieving) - cognitive readiness (can think clearly) - facilitate readiness to learn Tactfully call attention to a learned need Point out an opportunity to learn c. Motivation (whether the client wants to learn) - usually greatest when the client is ready; learning need is recognized; content is meaningful to the client - can be increased by: Relating the learning to something the client values Helping the client make the learning situation pleasant and non-threatening - encouraging self-direction and independence - offering continuing support and encouragement - creating a learning situation where the client is likely to succeed d. Ability to learn - physical and cognitive capabilities to learn physical strength, movement and coordination sensory deficits reading level developmental level cognitive function e. Socio-economic - knows how the practices and values held by clients impinge on their learning needs - avoid stereotyping - consider financial status

f. Learning Style - use a variety of teaching techniques and activities g. Age - provide info on clients developmental status - influence health teaching content and teaching approaches h. Health beliefs and practices - helps predict preventive health behaviors

Prepared by: Julius U. Tepora, R.N.