Health Education PDF

HEALTH EDUCATION This course deals with concepts, principles and theories in teaching and learning. It also focuses on the appropriate strategies of the health education, as they apply in various health care scenarios. The learners are expected to develop beginning skills in designing and im...

HEALTH EDUCATION This course deals with concepts, principles and theories in teaching and learning. It also focuses on the appropriate strategies of the health education, as they apply in various health care scenarios. The learners are expected to develop beginning skills in designing and implementing a teaching plan, using the nursing process as a framework. Introduction The World Health Organization (WHO) defined Health Education as consisting of "consciously constructed opportunities for learning involving some form of communication designed to improve health literacy, including improving knowledge, and developing life skills which are conducive to individual and community health." Health Education is any combination of learning experiences designed to help individuals and communities improve their health, by increasing their knowledge or inffluencing their attitudes.(WHO) Health education is a process aimed at encouraging people to want to be healthy, to know how to stay healthy, to do what they can individually and collectively to maintain health, and to seek help when needed, ( Alma Ata Declaration -1978) Aims: 1. To encourage people to adopt and sustain health promoting lifestyle and practices 2. To promote the proper use of the health services available to them 3. To arouse interest, to provide new knowledge, improve skilled and change attitudes in making rational decisions to solve their own problems 4. To stimulate individual and community self reliance and participation to achieve health development through individual and community involvement at every step from identifying problems to solving them.(WHO) Objectives: 1. Informing People : people are informed about the different diseases, their etiology and how to prevent them 2. Motivating People: concerned with clarifying/changing or forming attitudes, beliefs, values or opinions. After health information is given, it is necessary to motivate them after their lifestyles, so that it becomes favorable to promoting health and preventing disease. Motivation is defined as a combination of forces which initiate, direct, and sustain behavior.(WHO) UNIT I  PRINCIPLES AND THEORIES IN TEACHING AND LEARNING I. Overview Health education is an essential tool for a nurse to effectively channel the patient's role for his health management. Patient education requires patients/clients skill building and responsibility: patients need to know when, how, and why they need to make a lifestyle change. (https://nurseslabs.com) The end or purpose of nursing is the well-being of people …it is the moral end. That is, it involves the seeking of good , and it involves relationships with other human beings. The science learned and the technical skills developed are designed and shaped by this moral end. (Curtin and Flaherty, 1982,p.86). Education in health care today—both patient education and nursing staff/student education—is a topic of utmost interest in every setting in which nurses practice. The current trends in health care are making it imperative that patients and their families be prepared to assume responsibility for self-care management. Also, these trends make it essential that nurses in the workplace be accountable for the delivery of high-quality care. The focus is on outcomes— whether it be that the patient and his or her family have learned essential knowledge and skills for independent care or that staff nurses and nursing students have acquired the up-to-date knowledge and skills needed to competently and confidently render care to the consumer in a variety of settings. The need for nurses to teach others and to help others learn will continue to increase in this era of healthcare reform. With changes rapidly forthcoming in the system of health care, nurses will find themselves in increasingly demanding, constantly fluctuating, and highly complex positions (Jorgensen, 1994). It is necessary for nurses in the role of educators to understand the forces, both historical and present-day, that have influenced and continue to influence their responsibilities in practice, with teaching being a major aspect of the nurse’s professional role. II. Objectives ____________________________________________________________________ After completing this unit, the students will be able to: 1. Define what learning theory is. 2. Differentiate the basic approaches to learning for each of the five psychological learning theories.  3. Give an example of applying each psychological theory to changing the attitudes and behaviors of learners in a specific situation. 4. Identify the differences and similarities in the psychological learning theories specific to a. the basic procedures of learning, b. the assumptions made about the learning, c. the task of the educator, d. the sources of motivation, and e. the way in which the transfer of learning is facilitated. III. Learning Theories Related to Health Care Practice Learning is a relatively permanent change in mental processing, emotional functioning, skill, and/or behavior as a result of experience. It is the lifelong, dynamic process by which individuals acquire new knowledge or skills and alter their thoughts, feelings, attitudes, and actions. Learning enables individuals to adapt to demands and changing circumstances and is crucial in health care—whether for patients and families dealing with ways to improve their health and adjust to their medical conditions, for students acquiring the information and skills necessary to become a nurse, or for staff nurses devising more effective approaches to educating and treating patients and one another in partnership. Despite the significance of learning to each individual’s development, functioning, health, and well-being, debate continues about how learning occurs, which kinds of experiences facilitate or hinder the learning process, and what ensures that learning becomes relatively permanent. Until the late 19th century, most of the discussions and debates about learning were grounded in philosophy, school administration, and conventional wisdom (Hilgard, 1996). Around the dawn of the 20th century, the new field of educational psychology emerged and became a defining force for the scientific study of learning, teaching, and assessment (Woolfolk, 2001). As a science, educational psychology rests on the systematic gathering of evidence or data to test theories and hypotheses about learning. A learning theory is a coherent framework of integrated constructs and principles that describe, explain, or predict how people learn. Psychological learning theories and motor learning are discussed in this unit, each of which has direct applicability to nursing practice. Rather than offering a single theory of learning, psychology provides alternative theories and perspectives on how learning occurs and what motivates people to learn and change (Hilgard & Bower, 1966; Ormrod, 2004; Snowman & Biehler, 2012). Motor learning evolved as a branch of experimental psychology and can be differentiated from “verbal” learning (Newell, 1991). By the middle of the 20th century, motor learning was established as a specialized area of study, and it has been influenced by behavioral theory, cybernetics, and information processing (VanSant, 2003). A. Behaviorist Learning Theory Focusing mainly on what is directly observable, behaviorists view learning as the product of the stimulus conditions (S) and the responses (R) that follow—sometimes termed the S-R model of learning. Whether dealing with animals or people, the learning process is relatively simple. Generally ignoring what goes on inside the individual—which, of course, is always difficult to ascertain—behaviorists closely observe responses and then manipulate the environment to bring about the intended change. Currently in educational and clinical psychology, behaviorist theories are more likely to be used in combination with other learning theories, especially cognitive theory (Bush, 2006; Dai & Sternberg, 2004). Behaviorist theory continues to be considered useful in nursing practice for the delivery of health care. To modify people’s attitudes and responses, behaviorists either alter the stimulus conditions in the environment or change what happens after a response occurs. Motivation is explained as the desire to reduce some drive (drive reduction); hence, satisfied, complacent, or satiated individuals have little motivation to learn and change. Getting behavior to transfer from the initial learning situation to other settings is largely a matter of practice (strengthening habits). Transfer is aided by a similarity in the stimuli and responses in the learning situation and those encountered in future situations where the response is to be performed. Much of behaviorist learning is based on respondent conditioning and operant conditioning procedures. 1. Respondent conditioning (also termed classical or Pavlovian conditioning) emphasizes the importance of stimulus conditions and the associations formed in the learning process (Ormrod, 2004).  In this basic model of learning, a neutral stimulus (NS)—a stimulus that has no particular value or meaning to the learner—is paired with a naturally occurring unconditioned or unlearned stimulus (UCS) and unconditioned response (UCR) After a few such pairings, the neutral stimulus alone (i.e., without the unconditioned stimulus) elicits the same unconditioned response. Thus, learning takes place when the newly conditioned stimulus (CS) becomes associated with the conditioned response (CR)—a process that may well occur without conscious thought or awareness. Consider an example from health care. Someone without much experience with hospitals (NS) may visit a relative who is ill. While in the relative’s room, the visitor may smell offensive odors (UCS) and feel queasy and light-headed (UCR). After this initial visit and later repeated visits, hospitals (now the CS) may become associated with feeling anxious and nauseated (CR), especially if the visitor smells odors similar to those encountered during the first experience. In health care, respondent conditioning highlights the importance of the healthcare facility’s atmosphere and its effects on staff morale. Often without thinking or reflection, patients and visitors formulate these associations as a result of their hospital experiences, providing the basis for long-lasting attitudes toward medicine, healthcare facilities, and health professionals. In addition to influencing the acquisition of new responses to environmental stimuli, principles of respondent conditioning may be used to extinguish a previously learned response. Responses decrease if the presentation of the conditioned stimulus is not accompanied by the unconditioned stimulus over time. Thus, if the visitor who became dizzy in one hospital subsequently goes to other hospitals to see relatives or friends without smelling offensive odors, then her discomfort and anxiety about hospitals may lessen after several such experiences. Certain respondent conditioning concepts are especially useful in the healthcare setting. a. Systematic desensitization is a technique based on respondent conditioning that is used by psychologists to reduce fear and anxiety in their clients (Wolpe, 1982). The assumption is that fear of a particular stimulus or situation is learned; thus it can also be unlearned or extinguished. With this approach, fearful individuals are first taught relaxation techniques. While they are in a state of relaxation, the fear-producing stimulus is gradually introduced at a nonthreatening level so that anxiety and emotions are not aroused. After repeated pairings of the stimulus under relaxed, nonfrightening conditions, the individual learns that no harm will come to him from the once fear-inducing stimulus. Finally, the client is able to confront the stimulus without being anxious and afraid. In healthcare research, respondent conditioning has been used to extinguish chemotherapy patients’ anticipatory nausea and vomiting (Lotfi-Jam et al., 2008; Stockhurst, Steingrueber, Enck, & Kloster-halfen, 2006), while systematic desensitization has been used to treat drug addiction (Piane, 2000), phobias (McCullough & Andrews, 2001), and tension headaches (Deyl & Kaliappan, 1997), and to teach children with attention-deficit/hyperactivity disorder (ADHD) or autism to swallow pills (Beck, Cataldo, Slifer, Pulbrook, & Guhman, 2005). b. Stimulus generalization is the tendency of initial learning experiences to be easily applied to other similar stimuli. For example, when listening to friends and relatives describe a hospital experience, it becomes apparent that a highly positive or negative personal encounter may color patients’ evaluations of their hospital stays as well as their subsequent feelings about having to be hospitalized again. With more and varied experiences, individuals learn to differentiate among similar stimuli, at which point discrimination learning is said to have occurred. As an illustration, patients who have been hospitalized a number of times often have learned a lot about hospitalization. (what are the possible and simple things that people learn when they are always admitted in the hospital?). As a result of their experiences, they make sophisticated distinctions and can discriminate among stimuli (e.g., what the various noises mean and what the various health professionals do) that novice patients cannot. Much of professional education and clinical practice involves moving from being able to make generalizations to discrimination learning.  c. Spontaneous recovery is a useful respondent conditioning concept that needs to be given careful consideration in relapse prevention programs. The underlying principle operates as follows: Although a response may appear to be extinguished, it may recover and reappear at any time (even years later), especially when stimulus conditions are similar to those in the initial learning experience. Spontaneous recovery helps us understand why it is so difficult to completely eliminate unhealthy habits and addictive behaviors such as smoking, alcoholism, and drug abuse. 2. Operant conditioning, which was developed largely by B. F. Skinner (1974, 1989), focuses on the behavior of the organism and the reinforcement that occurs after the response. A reinforcer is a stimulus or event applied after a response that strengthens the probability that the response will be performed again. When specific responses are reinforced on the proper schedule, behaviors can be either increased or decreased.  Two methods to increase the probability of a response are to apply positive or negative reinforcement after a response occurs. a. According to Skinner (1974), giving positive reinforcement (i.e., reward) greatly enhances the likelihood that a response will be repeated in similar circumstances. As an illustration, although a patient moans and groans as he attempts to get up and walk for the first time after an operation, praise and encouragement (reward) for his efforts at walking (response) will improve the chances that he will continue struggling toward independence. b. A second way to increase a behavior is by applying negative reinforcement after a response is made. This form of reinforcement involves the removal of an unpleasant stimulus through either escape conditioning or avoidance conditioning. The difference between the two types of negative reinforcement relates to timing. 1) In escape conditioning, as an unpleasant stimulus is being applied, the individual responds in some way that causes the uncomfortable stimulation to cease. Suppose, for example, that when a member of the healthcare team is being chastised in front of the group for being late and missing meetings, she says something humorous. The head of the team stops criticizing her and laughs. Because the use of humor has allowed the team member to escape an unpleasant situation, chances are that she will employ humor again to alleviate a stressful encounter and thereby deflect attention from her problem behavior. 2) In avoidance conditioning, the unpleasant stimulus is anticipated rather than being applied directly. Avoidance conditioning has been used to explain some people’s tendency to become ill so as to avoid doing something they do not want to do. For example, a child fearing a teacher or test may tell his mother that he has a stomachache. If allowed to stay home from school, the child increasingly may complain of sickness to avoid unpleasant situations. Thus, when fearful events are anticipated, sickness, in this case, is the behavior that has been increased through negative reinforcement. According to operant conditioning principles, behaviors also may be decreased through either non reinforcement or punishment. Skinner (1974) maintained that the simplest way to extinguish a response is not to provide any kind of reinforcement for some action. For example, offensive jokes in the workplace may be handled by showing no reaction; after several such experiences, the joke teller, who more than likely wants attention—and negative attention is preferable to no attention—may curtail his or her use of offensive humor. Keep in mind, too, that desirable behavior that is ignored may lessen as well if its reinforcement is withheld. If non reinforcement proves ineffective, then punishment may be employed as a way to decrease responses, although this approach carries many risks. Under punishment conditions, the individual cannot escape or avoid an unpleasant stimulus. Suppose, for example, a nursing student is continually late for class and noisily disrupts the class when she finally arrives, annoying both other students and the instructor. The instructor discovers there is no valid reason for the student’s lateness—the student says she overslept and did not allow sufficient time to find a parking place, and cites other factors she should have more control over. The instructor tries praising the student the few times she comes to class on time (positive reinforcement) and tries not paying attention to her when student arrives late (nonreinforcement), but the student continues to be late to class more often than she is on time. The student appears to enjoy the attention she receives. As a last resort, the instructor may try punishment, which involves applying a negative reinforcerment and removing a positive reinforcer. The positive reinforcers to be removed are the attention the student receives and the fact that she really does not need to change her behavior to conform to classroom expectations. The instructor might tell the student that if she is late, she must come in the back door and sit in back of the class, making sure not to disturb anyone (removal of the positive reinforcer of attention). Each time the student is late, the instructor will make note in her grade book (negative reinforcer of not doing well in the course). The problem with using punishment as a technique for teaching is that the learner may become highly emotional and may well divert attention away from the behavior that needs to be changed. Some people who are being punished become so emotional (sad or angry) that they do not remember the behavior for which they are being punished. One of the cardinal rules of operant conditioning is to “punish the behavior, not the person.” In the preceding example, the instructor must make it clear that she is punishing the student for being late and disrupting class rather than convey that she does not like the student. If punishment is employed, it should be administered immediately after the response with no distractions or means of escape. Punishment must also be consistent and at the highest reasonable level (e.g., nurses who apologize and smile as they admonish the behavior of a staff member or client are sending mixed messages and are not likely to be taken seriously or to decrease the behavior they intend). Moreover, punishment should not be prolonged (bringing up old grievances or complaining about a misbehavior at every opportunity), but there should be a time-out following punishment to eliminate the opportunity for positive reinforcement. The purpose of punishment is not to do harm or to serve as a release for anger; rather, the goal is to decrease a specific behavior and to instill self-discipline. Operant conditioning and discussions of punishment were more popular during the mid- 20th century than they are currently. However, it is important for nurses to be aware of the many cautions about punishment because punishment continues to be used more than it should in the healthcare setting, and all too often in damaging ways. Operant conditioning techniques provide relatively quick and effective ways to change behavior. Carefully planned programs using behavior modification procedures can readily be applied to health care. For example, computerized instruction and tutorials for patients and staff rely heavily on operant conditioning principles in structuring learning programs. In the clinical setting, the families of patients with chronic back pain have been taught to minimize their attention to the patients whenever they complain and behave in dependent, helpless ways, but to pay a lot of attention when the patients attempt to function independently, express a positive attitude, and try to live as normal a life as possible. Some patients respond so well to operant conditioning that they report experiencing less pain as they become more active and involved. A systematic review of physiotherapist-provided operant conditioning (POC) found moderate-level evidence showing that POC is more effective than a placebo intervention in reducing short-term pain in patients with subacute low back pain (Bunzli, Gillham, & Esterman, 2011). Operant conditioning and behavior modification techniques also have been found to work well with some nursing home and long-term care residents, especially those who are losing their cognitive skills (Proctor, Burns, Powell, & Tarrier, 1999). The behaviorist theory is simple and easy to use, and it encourages clear, objective analysis of observable environmental stimulus conditions, learner responses, and the effects of reinforcements on people’s actions. There are, however, some criticisms and cautions to consider when relying on this theory. First, behaviorist theory is a teacher-centered model in which learners are assumed to be relatively passive and easily manipulated, which raises a crucial ethical question: Who is to decide what the desirable behavior should be? Too often the desired response is conformity and cooperation to make someone’s job easier or more profitable. Second, the theory’s emphasis on extrinsic rewards and external incentives reinforces and promotes materialism rather than self-initiative, a love of learning, and intrinsic satisfaction. Third, research evidence supporting behaviorist theory is often based on animal studies, the results of which may not be applicable to human behavior. Fourth shortcoming of behavior modification programs is that clients’ changed behavior may deteriorate over time, especially once they return to their former environment—an environment with a system of rewards and punishments that may have fostered their problems in the first place. The next section moves from focusing on responses and behavior to considering the role of mental processes in learning.