Health Education and Patient Teaching

Education Process

• A planned action consisting of teaching and learning
• It is systematic, sequential, logical, scientifically based

Education

• An interactive process of sharing knowledge
• The goal is to achieve a positive judgement, well-developed wisdom, and behavior

Teaching (Instruction)

• Sharing of information and experience to meet intended learner outcomes
• Includes cognitive, affective, and psychomotor domains
• It is guided by an educational plan
• Formal or informal

Health Education

• The act of providing information and learning experiences
• Goal: behavior change for the betterment of the client's health

Patient Education (Patient Teaching)

• Assisting people to learn health-related behaviors
• Goal: optimal health and independence in self-care
• A basic function of nursing and a legal and moral requirement

Staff Education

• Influencing the behavior of nurses
• Goal: changes in knowledge, attitude, and skills
• Helps nurses maintain and improve competence for the delivery of patient care

ASSURE Model

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

Comparison: Nursing Process vs. Education Process

• Nursing Process
  • Assessment: Physical/Psychosocial
  • Planning: Develop care plan
  • Implementation: Carry out nursing interventions
  • Evaluation: Outcome
• Education Process
  • Assessment: Learning needs, readiness, styles
  • Planning: Teaching plan
  • Implementation: Perform teaching
  • Evaluation: Behavioral changes (SKA - Skills, Knowledge, and Attitude)

Concepts of Nursing Health Education

• Prepares students to play roles effectively as individuals and citizens
• Three phases:
  • Pre-nursing: Spread information to prospective nursing candidates
  • Nursing education: Educators focus on producing skilled nurses
  • Post-Nursing: Licensure, Registration

Learning

• A relatively permanent change in mental processing, emotional functioning, and/or behavior
• Result of exposure to different experiences
• A change in behavior (KSA) can be observed or measured
• Occurs at any time and place as a result of exposure to environmental stimuli

Learning Theory

• A coherent framework of integrated constructs and principles that describe, explain, or predict how people learn.

Importance of Learning Theories

• Provides information and techniques to guide teaching and learning
• Can be employed individually or in combination
• Applicable in various settings, including personal growth and interpersonal relations

Behaviorist Learning Theory

• Focuses on observable behaviors
• Product of stimulus conditions (S) and Responses (R)
• Association Theory – focus on the relationship between stimulus (S) and response (R) - Stimulus Response Theory
• Emphasizes the role of reinforcement

Applications of Behaviorist Learning Theory

• Closely observe responses to a situation and then manipulate the environment
• To modify people’s attitude and responses:
  • Alter the stimulus condition in the environment
  • Change what happens after the response occurs
• Useful in nursing practice especially in the delivery of health care
• Used to break or unlearn bad habits

Respondent Conditioning

• Classical/Reflex/Pavlovian
• Association learning
• Ivan P. Pavlov (1849-1936) - Russian physiologist
• Conducted experiments on dogs

Respondent Conditioning Concepts

• Emphasizes the importance of stimulus conditions and associations formed in the learning process
• Neutral stimulus (NS): Has no particular value or meaning to the learner
• Unconditioned stimulus (UCS): Naturally occurring
• Unconditioned Response (UCR): Naturally elicited by an unconditioned stimulus
• Highlights the importance of the environment and culture in healthcare affecting patients, staff, and visitors.

Principles of Respondent Conditioning

• Systematic Desensitization: Used to reduce fear and anxiety
• Stimulus Generalization: The tendency of initial learning experiences to be easily applied to other stimuli
• Spontaneous Recovery: Needs to be considered in relapse prevention programs
• Stimulus Discrimination: Easily recognize specific stimuli
• Extinction: Knowledge disappears if not used

Operant Conditioning

• By B.F. Skinner (1989)
• Focuses on the behavior of the organism occurring after the response
• A reinforcer is a stimulus or event applied after a response
• Experiment on Skinner box

Operant Conditioning Principles

• To increase response:
• Positive Reinforcement: Reward conditioning - Negative Reinforcement: Removal of aversive stimulus
• Types of Negative Reinforcement:
  • Escape Conditioning: Individual responds in a way to cause the uncomfortable stimulation to cease.
  • Avoidance Conditioning: Unpleasant stimulus is anticipated rather than directly applied.
• To decrease/extinguish response:
  • Non-reinforcement: An organism’s conditioned response is not followed by any reinforcement
  • Punishment: Punish the behavior, not the person. Punishment must be consistent, reasonable, and not prolonged.

Thorndike’s Major Laws

• Law of Effect: Strengthens the connection between the stimulus and behavior, whereas annoying states weaken the connection. People repeat what has been satisfying and avoid what has been dissatisfying
• Law of Exercise: Repetition increases the probability of a correct response
• Law of Readiness: When a person is ready to respond or act, giving the response is satisfying

John B. Watson

• John B. Watson (1878-1958) - Graduated from psychology at the University of Chicago
• Trained on the skills of animal experiments
• Experiment about Baby Albert:
• "Mind could not be seen, it could be measured.”
• Influenced by Pavlov

John B. Watson’s View

• Surroundings are important in determining personalities.
• Behavior is shaped/learned rather than inherited.
• Behavior can be controlled.
• Reward for good behavior; punishment for bad deeds
• Child is a blank slate upon which anything can be written.

Conclusion: Behavioral Learning Theory

• All behaviors are learned and can be shaped through reinforcement and punishment.
• Role of Faculty:
  • Dominate the highly structured learning environment.
  • Act as authority and dispense knowledge.
  • Exercise control over learning experiences.
  • Set a positive learning climate by responding to student success with positive reinforcements to shape behavior

Cognitive Learning Theory

• Perception, thought, memory, and ways of processing and structuring information.
• A highly active process directed by the person
• The learner perceives, interprets, and then reorganizes information into new insights.
• Rewards are not necessary; the learner’s goals and expectations are important
• Educators must recognize diverse experiences, perceptions, and ways of incorporating information

Cognitive Learning Theory Applications

• Consider diverse aspirations, expectations, and social inferences that affect learning situations.
• Metacognition: Understanding one’s own way of learning.
• To promote transfer of learning, the learner must mediate or act on the information in some way

Gestalt Perspective

• Configuration or patterned organization
• “The whole is greater than the sum of its parts.”
• Each person perceives, interprets, and responds to any situation in their own way
• Important: What goes inside the learner
• Perception: Important in the learning process (W. Kohler)

Laws of Gestalt Psychology

• Law of Continuity
• Law of Closure
• Law of Proximity
• Law of Similarity
• Law of Pragnanz

Basic Principles of Gestalt Perspective

• Simplicity, Equilibrium, and Regularity: Consider patients who are listening to a complex, detailed explanation.
• Perception is selective: Only what is interesting is remembered.

Factors Influencing Perception

• Past experiences
• Needs
• Personal motives
• Attitudes
• Reference groups
• Situations

Information Processing Theory

• Explains how individuals perceive, process, store, and retrieve information from experiences.
• Determines how learning occurs and what is learned.
• Helpful in assessing problems in acquiring, remembering, and recalling information.

Information Processing Stages

• Stage 1: External: Orienting Stimuli
• Stage 2: Internal: Attention, Sensory Memory (Fleeting, less than 1 second)
• Stage 3: Internal: Processing, Encoding, Working Memory (Brief, less than 30 seconds)
• Stage 4: Internal: Memory Storage:
  • Short-term Memory: (Enduring, but retrieval problems)
  • Long-term Memory: (Enduring, but retrieval problems)
• Stage 5: Response: Action

Information Processing Strategies

• Get in touch with a learner’s way of processing information and thinking.
• Break material down into chunks of information or use mnemonic devices.

Information Processing Strategies for Educators

• Learner will indicate how they believe they learn (metacognition)
• Ask learners to describe what they are thinking as they are learning.
• Evaluate learner’s mistakes.
• Give close attention to their inability to remember or demonstrate information.

Robert Gagne’s Learning Theory

• Behaviorist - Focus on the outcome of behavior
• Problem-based learning/Conditions learning
• Uses the information processing model
• Problem: Find out what students need to know to solve a problem.