THE NURSE AS AN EDUCATOR

INTRODUCTION The teaching-learning process primarily involves the teacher, the learner and the subject matter. The success of this process rests mainly on the shoulders of the teacher. POHL (1988) Says that teaching is an integral part of the nursing process and the nurse is teaching whether directly or indirectly, in every contact with potential learners. ROLES AND FUNCTIONS OF THE EDUCATOR ALEGADO (1996) The teacher should possess the necessary attitude and competencies to effectively create a productive atmosphere related to the teaching-learning process. He also said that good teachers know how to help people become conscious of their own values that are more satisfying to society. Based on these perspectives, one can conclude that aside from the usual goal of learning, which is the acquisition of the necessary knowledge, attitudes and skills, the incorporation of values in the curriculum is also a must. In todays healthcare practice, the scenario has shifted from hospital care to communitybased care which places its emphasis on health promotion and disease prevention. The nurse educator is not only a teacher but is also an advocate of tender loving care and she is mandated to incorporate this doctrine into the practice of her profession. PATRICIA BENNER Provided a model, from Novice to Expert, where she contends that as a nurse gains experience, clinical knowledge becomes a blend of practical and theoretical knowledge. FIVE LEVELS OF COMPETENCY IN NURSING PRACTICE : 1. 2. 3. 4. 5. novice advanced beginner competent proficient expert

This conceptualization concentrates on excellence. According to her, experienced-based skill acquisition is safer and quicker when it rests upon a sound educational base.

BARCELO (2001) According to him, nursing leaders have to decide whether at the entry level of professional practice, the need is for a generalist or a specialist and to come upwith an acceptable list of minimum competencies that a fresh graduate of BSN must possess. PARADIGM SHIFT IN THE CONCEPT OF HEALTH (WHO) 1995 The World Health Organization issued a policy statement which included a paradigm shift in the concept of health from being disease-centered to human development a change from physician-dependent cure and sustained health through people-empowered healthy options. The shift to promotion of health and illness has been more the concern of the community health nurse rather than the hospital staff nurse, but not anymore. THE LEGAL BASIS OF HEALTH EDUCATION IN THE PHILIPPINES The Philippine constitution of 1987, Art.11, Sec.15 states that: The state shall protect and promote the right to health of the people and instill health consciousness among them This goal of protecting and promoting the peoples birthright to health and instilling the knowledge, attitudes and practices (KAP) which will enable them to adopt a healthy behaviors and lifestyles can principally be achieved through health education. Art. XIII, Sec. 11 states that: The state shall adopt an integrated and comprehensive approach to health development which shall endeavor to make essential goods, health and other social services available to all people at affordable cost. There shall be priority for the needs of the under previleged sick, elderly, disabled, women and children. THE LEGAL BASIS OF HEALTH EDUCATION IN THE NURSING CURRICULUM The teaching function has always been viewed as an essential function of a nurse whether she is taking care of a well or an ill person, patients family members, nursing students, hospital or clinical staff nurses or a group of mothers in the community. One of the more important functions of the nurse is as a health educator and this is explicitly stated in The Duties of a Nurse in Rule IV, Art VI, Sec. 28 of the Philippine Nursing Act of 2002 also known as RA 9173, among which are to: 1. Provide health education to individuals, families and communities ; and

2. Teach, guide and supervise students in nursing education programs including the administration of nursing services in varied settings like hospitals and clinics. Specifically, it states that The nursing education program shall provide sound general and professional foundation for the practice of nursing taking into consideration the learning outcomes based on national and universal nursing core competencies. The learning experience shall adhere strictly to specific requirements embodied in the prescribed curriculum as promulgated by the Commission on Higher Educations policies and standards of nursing education. ROLE is defined as a function, responsibility, job, duty, task, position, or behavior that includes accountability and responsibility for the position that one holds. As a teacher, the nurse performs multiple roles as ,manager, facilitator, a source of motivation and inspiration, an agent for social change, role model, and resources person. HEIDGERKEN (1965) defined the role functions of the nurse educator as the: 1. instructional role, 2. faculty role, 3. individual role. Instructional roles are the central functions of a nurse educator as the: 1. Planning and Organizing course : a. selecting objectives, substantive content and teaching and learning activities (for classroom, laboratory, the clinical and community settings) b. correlating them with other courses in the curriculum. 2. Creating and Maintaining a Desirable group climate which will encourage and enhance learning that will eventually lead to the development of the learners selfdiscipline. 3. Adopting Teaching Methods and preparing instructional materials according to the varying interests, needs and abilities of the students. 4. Motivating and Challenging students to pursue and sustain learning activities which will lead them toward acceptance of responsibility for their own learning. 5. Teaching which consists of a complex role involving a series of activities: a. supplying information needed or telling the students where it may be obtained.

b. explaining, classifying and interpreting c. demonstrating or explaining a procedure, a process or exhibiting materials. d. serving as a resource person for group projects to the individual students. e. supervising students performance in the classroom, laboratory and in any other setting where the student of nursing may be having learning experiences. f. evaluating all the planned learning and teaching activities and student outcomes related to the courses assigned to her to teach. Faculty role will depend on the size, control and complexity of the institution. The nurse educator can be: 1. chairwoman, secretary or member of one committee responsible for planning and coordinating the total educational offering for a particular program or other committee which engages in policy making or administration. 2. counselor or students in academic or non-academic matters 3. a researcher 4. resource person to groups outside of he institution 5. a representative to professional nursing organizations 6. a public relations agent where she will be able to interpret the objectives and the policies of her institution and helps in recruitment, among others. Individual role the teacher functions as a member of a family, church, community and as a citizen. As an individual, she brings her basic dignity and distinct personality everywhere she goes. PARADIGM SHIFT IN THE ROLE OF THE NURSE EDUCATOR The teacher used to be the omnipotent fountain of wisdom, the transmitter of information and knowledge, the all-knowing mentor and the student was likened to a sponge which soaks up whatever the teacher says or do. Today, a paradigm shift has occurred where the focus of the teaching-learning process has transferred from the teacher and the teaching endeavor to the learner and the learning process. Hence, the primary role of the nurse educator is not to teach or educate but to provide the opportunities for the learner to be actively involved in the learning process and to create an environment that will inspire or motivate the learner to apply the

knowledge and skills to assess, criticize, and select the best possible solutions to situations or problems. NURSING CORE COMPETENCIES The core competency standards will gauge the minimum knowledge, skills and attitudes that a graduate nurse possesses to be able to provide efficient and quality nursing care in her level as a beginning nurse practitioner. THE NURSING CORE COMPETENCY STANDARDS There are eleven nursing core competencies (araes of expertise fundamental or essential to a particular job or function) that are included in the Nurses Licensure Examination. These are: 1. Safe quality nursing care 2. management of resources and environment 3. Health education 4. Legal responsibility 5. Ethnic-moral responsibilities 6. Personal and professional development 7. Quality improvement 8. Research 9. Records management 10. Communication 11. Collaboration and teamwork CORE COMPETENCY 1 : Assesses the learning needs of the patient and family. INDICATORS: 1. Obtains learning information through interview, observation and validation 2. Defines relevant information 3. Completes assessment records appropriately 4. Identifies priority needs Authors Note: Needs assessment will serve as the starting point for the development of the program of health education and the formulation of specific action plans. It will determine the rationale, nature and scope of the program. How to conduct needs assessment. The health educator should: 1. Know how to locate and obtain valid sources of information pertaining to the target population which may be primary or secondary data

2. Know how to use the the family assessment guide or the community assessment guide, whichever the case may be, in identifying the health threats, health deficits, foreseeable crisis/ stress points and in priority setting or ranking 3. be able to analyze the data and prioritize the areas for health education planning 4. Utilize Maslows Hierarchy of Needs to determine the priorities for patient care

CORE COMPETENCY 2 : Develops health education plan based on assessed and anticipated needs. INDICATORS: 1. Considers the nature of the learner in relation to: social, cultural, political, economic, educational and religious factors. Authors notes: In developing the health education plan, the health educator must know and understand the nature of the target population or clientele: What is their level of understanding regarding the current problem/issue? Do they consider this a high level priority which needs immediate attention and intervention? Who or what elicit their active participation in the program? The health education plan should: 1. be based on the assessed health needs, problems and perceptions of the clientele which will be the basis of the goals and objectives of the teaching plan; 2. be evaluated according to the extent to which for goals and objectives have been met; 3. be a result of the active participation and cooperation of the interested stakeholders like the community leaders, sectoral or group representatives, opinion leaders and representatives of the target population 4. contain appropriate interventions to meet goals and objectives.

CORE COMPETENCY 3 : Develops learning materials for health education. INDICATORS: 1. Involves the patient, family, significant others and other resources 2. Formulates a comprehensive health education plan with the following components: objectives, content, time allotment, teaching-learning resources and evaluation parameters

3. Provides for feedback to finalize the plan Authors notes: In developing the learning materials for health education, the health educator: must be able to get the cooperation, pro-active involvement and commitment of the learners or target population to ensure the success of the program; must apply pertinent principles of teaching and learning: must be able to formulate a comprehensive teaching-lan (will be discussed after chapter 5) must have a wide array of teaching strategies like buzz sessions, brainstorming, role playing, socio-drama, forum lecture, use of audiovisual materials. CORE COMPETENCY 4 : Implements the health education plan. INDICATORS: 1. Provides for conductive learning situation in terms of time and place 2. Considers family and clients preparedness 3. Utilizes appropriate strategies 4. Provides reassuring presence through active listening, touch, facial expression and gestures 5. Monitors client and familys responses to health education Authors notes: The health educator must be able to: determine what strategies will be most effective in discussing the problem/issue identify, by consulting with the clients what would be the most convenient time, day and place to hold these discussions/brainstorming or lessons find out if they need financial assistance or childcare while attending the health education class monitor if there is a positive change or improvement in the clients knowledge, attitudes, skills and values as a result of the health teachings mainly through observation and interview. CORE COMPETENCY 5 : Evaluates the outcome of health education. INDICATORS: 1. Utilizes evaluation parameters 2. Documents outcome of care 3. Revises health education plan when possible

Authors notes: As in all undertakings, an evaluation process must be undertaken to determine the strengths and weaknesses of the program, the areas that need to be modified, revised or eliminated. formulate goals and objectives that are simple, measurable, attainable, realistic and time-bound (SMART) find out if the goals and objectives have been met by comparing these with results; develop an evaluation plan which involves - developing and administering evaluation tests - conducting surveys - observing behavior - other methods of data collection for evaluation analyze and interpret the data collected and property document the results of the evaluation use the results of the evaluation to modify, improve, revise or even change the existing or future programs. ROLES AND RESPONSIBILITIES OF HEALTH EDUCATORS The Responsibilities and competencies for Entry-level Health Educators are embodied in A Competency-Based Framework for Professional Development of Certified health Education Specialists, NCHEC, New York, 1996 (Cottrell, Girvan Mckenzie, 2001) Among the responsibilities of a health educator are: 1. assessing individual and community needs for health education 2. planning effective health education programs 3. implementing health education programs 4. evaluating effectiveness of health education programs 5. coordinating provisions of health services 6. acting as a resource person in health education 7. communicating health and health education needs, concerns and resources. IN THE CODE OF ETHICS ( Unabridged Version ) Society for public health education, Inc., Article IV deals with the Responsibility in Employing Educational Strategies and methods and states that, In designing strategies and methods, the health educator should be aware of his/her possible impact on the community and other health professionals and must not place the burden of change solely on the target population but must involve other appropriate groups to bring about effective changes. Obligation to two principles:

1. the people have a right to make decisions affecting their lives 2. there is moral imperative to provide people with all relevant information and resources possible to make their choices freely and intelligently (Cottrell, Girvan, & Mckenzie, 2001)

ETHICO-LEGAL BASIS OF HEALTH EDUCATION The right of the patient to accurate and adequate information regarding his or her health condition, medications or treatments and the possible risks or adverse reactions and alternative treatments available are all spelled out in the Patients Bill of Rights (American Health Association, 1975). Professional nurses are mandated to provide patient education by organizational policy including federal and state regulations and failure to comply may be penalized by a fine and/or a citation by the Department of Health in many states in the USA especially in healthcare facilities with Medicaid and Medicare funding. Ethico- Legal Considerations Among the ethico-legal aspects of care which involve the teaching skills of the nurse is the right of the patient to adequate information related to his/her medical condition, treatments and medications, and the pertinent risks and hazards involved as well as alternative modes of treatment. This is in relation also to the doctrine of informed consent which is specifically stated in the Patients Bill of Rights (AHA, 1975)

ECONOMIC CONSIDERATONS Todays realities point to the logic of shorter stay of the patient in the hospital and the emphasis on satellite types of ambulatory and home care services considering the enormity of the cost of human and material resources and at the same time, the growing scarcity of nursing manpower and personnel. IMPORTANCE OF DOCUMENTATION For a hospital to be able to qualify for Medicaid and Medicare reimbursement, it has to show proof that patient health education has been part of the care given to its patients and/or their family members which should be properly documented in the patient record (Boyd, et. al., 1998)

This protects the health personnel as well as the institution from the presumption that what you did not chart, you did not do or what was not written was not done. An interdisciplinary method of documenting patient educaton was proposed by Snyder in 1996 using a flow sheet containing: 1. an assessment of the education needs of the client and/or his family which includes: a. the clients readiness to learn b. barriers to learning due to language, poor hearing c. referrals to a patient advocate or another health personnel. 2. a space for documenting the: a. name of the recipient of health education b. what was taught like insulin injection c. when was it taught d. how the client responded to instruction CASEY (1995) stated that documentation of patient teaching is probably, the most undocumented skill service because nurses do not realize the scope and depth of the teaching they do. BASTABLE (2003) also said that lack of time may be a barrier for the nurse to provide sufficient information for self-care, and illness acuity level interferes with the patients ability to process information necessary to meet his/her physical and emotional needs. The importance of health teachings is very crucial in the post discharge planning and care of the patient whether in the home or in an ambulatory or community care setting. Clearly, the primary end-users of the governments health and social services are the depressed, oppressed, powerless and exploited members of the society and the primary tool for setting these programs on the right direction is through health education.