Concepts of Health, Overview of Education in Health Care, and Change - PDF

**[MODULE 1: ]** **CONCEPTS OF HEALTH, OVERVIEW OF EDUCATION** **IN HEALTH CARE, AND CHANGE** **Unit 1: Concepts of Health, Illness, and Wellness** **A. The Dimensions of Health** The dimensions of health are composed of the: a. **societal health** which is the link between health and the way...

**[MODULE 1: ]** **CONCEPTS OF HEALTH, OVERVIEW OF EDUCATION** **IN HEALTH CARE, AND CHANGE** **Unit 1: Concepts of Health, Illness, and Wellness** **A. The Dimensions of Health** The dimensions of health are composed of the: a. **societal health** which is the link between health and the way a society is structured. This includes the basic infrastructure necessary for health (e.g. shelter, peace, food, income) and the degree of integration or division within the society; and b. **environmental health** which refers to the physical environment where people live; it involves housing, transport, sanitation, pollution and pure water facilities. Student Health and Counseling Services - Eight Dimensions of Wellness **Figure 1. Dimensions of Health** **B. Factors in the Ecosystem which Affect the Optimum Level of Functioning (OLOF)** **C. Concepts of Health, Illness, and Wellness, in Relation to Health Education** - **Some aspects of health** are determined by genes, age and other factors which may be beyond one\'s control. - **Whereas, wellness** is largely determined by the decisions you make about how to live your life. - **a state of mind** (awareness of the choices available for a healthy lifestyle), a way of life which involves options that an individual takes to enjoy a healthy life; - the **perception** that one is capable of achieving one\'s full potentials through the options one has in relation to being well. - the **integration of the mind, body and spirit,** the level of self-actualization where one feels that he has lived a full and accomplished life. **REFERENCES :** Estrada-Castro, C. (2011). *Health education for nursing and other allied professions (with teaching strategies and principles of teaching and learning)* (1st ed.). Educational Publishing House. **B. Overview of Education in Health Care\ ** **A. Health Education Defined** **[Health education]** - Refers to the **act of providing information and learning experiences for purposes of behavior change and improved for health of the client.** - The **acquisition of knowledge through exchange of information from the teacher and the learner** facilitates better understanding of the need for change. - Health education is the **totality of experiences** which favorably **influence habits, attitudes and knowledge relating to individual, community and racial health** (Health Education: 2006). - According to the *Joint Committee for Health Education (2005),* health education is **\"a process** with **intellectual, psychological, and social dimensions** relating to **activities that increase the abilities of people to make informed decisions affecting their personal, family and community wellbeing.** The process, **based on scientific principles, facilitates learning and behavioral change** in both health personnel and consumers, including children and youth.\" - The **[nurse, as health educator,]** **provide clients with basic information** geared to the **promotion and maintenance of health, the prevention of illness and the development of self-reliant behaviors.** **B. Process of Health Education** **Health education consists of learning experiences** that **promote behavior conducive to good health.** It provides the tools for **developing physical, emotional, spiritual and sound mental health.** - **Physical health -** learning experiences that helps ***promote the ability of the body to function accordingly.*** - **Emotional health -** the ability of an individual to ***cope with stress and strain as one faces the realities and challenges of life.*** - **Mental health -** the ability of an individual to ***make correct judgments or sound decisions to cope with situations or conditions affecting her daily activities.*** - **Social health -** the ability of an individual to ***relate well with others regardless of status or position.*** - **Spiritual health -** recognizes the ***supernatural aspect of divine healing and the individuals\' communion with his/her creator.*** Green and Ottoson (2012) posited that **health education is based on the assumption** that ***\"beneficial health in both children and adults results from the combination of planned, consistent, integrated learning opportunities.\"*** This assumption rests on direct evidence from the evaluation of health education programs in schools, worksites, medical setting, and the mass media. *\"The challenge for the educator is to find the most productive ways of influencing voluntary individual* *and community behavior without violating individual freedom.\"* *- Green and Ottoson* The **process of health education** has certain **[key aspects:]** 1\. It is a **planned opportunity of learning** through **information about health guided by specific goals, objectives, activities and evaluation criteria.** 2\. It occurs in a **specific setting.** 3\. It is a **program of series or events** that **introduces concepts** at **appropriate learning levels.** 4\. It is **based on what was previously learned** in order to determine what is to be learned in the future. 5\. It comprehensively emphasizes how the **various aspects of health interrelate** and **how health affects the quality of life.** 6\. It includes **interaction between the qualified educator and learner.** *Effective health instruction hinges on two interrelated issues:* *\"what to teach and how to teach it."* *-Heidgerken* **Health educators plan and conduct health teachings for the following purposes, which is for clients to:** 1. Be **aware of the values of health;** 2. **Develop the skills** in the **promotion and maintenance of health;** 3. **Acquire and apply** concepts and information received; 4. **Develop and discuss** opinions regarding health; and 5. Formulate accurate and effective **decision-making.** **C. Purposes of Health Education** Health education aims at more than merely the dissemination of information regarding good health practices and disease treatment. It serves several vital purposes in society, such as the following (Creasia and Parker: 2007): **1. A Means of Propagating Health Promotion and Disease Prevention** - Health education **describes the interrelationship of the learner\'s mental, emotional, social, and physical health.** - It serves to **analyze how environment and personal health interrelate** in ways that **enhances health,** thereby **reducing client risks.** - Health education is also concerned with **how lifestyle, family history and other risk factors relate to the cause or prevention of diseases and other health problems.** - This **seeks support of family and peers** to **influence the personal health of an individual.** - The **nurse explains** the **relationship** between **positive health behavior and the prevention of injury, illness, disease, and premature death** (Breckon: 1994). - Health education analyzes **how prevention and control of health problems are influenced by education, research, and advances in technology in all health-care areas.** - It explains the **impact of personal health behaviors on the functioning of body systems.** - It is also concerned with the **analysis of how public health and social policies,** along with **government regulations, influence the health promotion and disease prevention of the individual, family and community.** **2. Used to Modify or Continue Health Behaviors as Necessary** - Health education **determines the role of an individual** to be **self-reliant and assume self-responsibility** for improvement of health and personal health assessment. - It also **determines strategies for health maintenance** and **risk reduction;** - **Identifies short and long-term consequences of various behaviors,** and - **Demonstrates strategies for improving and maintaining personal, family and community health.** - Health education **provides information on injury prevention** and **management strategies** for potential health problems to maintain personal, family, and community health. - Health education continues to **demonstrate ways of avoiding and reducing health threatening situations** (Quinn: 2014). **3. Provides Health Information and Services** - Health education **provides health information, products and services** in the **maintenance of good health.** - It also **demonstrates the ability to evaluate resources** from home, the school and the community that provide health information. - Health education, also, **demonstrates the roles and responsibilities of school and community health services to self and others.** - It is also used to **assess the cost and availability of health care services** and **analyze situations requiring professional health care.** *\"Patients look for something more in every nurse\... Beyond technical skill, conscientious performance and pleasing appearance is that intangible something that makes the truly successful nurse.\"* *- Dorothy Densing* **4. Emphasizes Good Health Habits and Practices as an Integral Aspect of Culture, Media and Technology** - Health education **evaluates the influence of culture on the health behaviors and care services** which people get from healthcare providers. - It **evaluates the effect of media, technology and other factors on personal, family, and community health.** - Health Education **analyzes information necessary in reaching out to people in the community** to **facilitate understanding and compliance** with what is being taught geared towards self-reliant behavior. **5. A Means to Communicate Vital Information to the Public** - Health education helps the family, peers, and others to **communicate their needs, wants and feelings effectively** to enable them to **resolve health conflicts and problems.** - This is done to **communicate care, consideration and respect for themselves and others.** - It also helps **analyze possible causes of conflict** and in the **formulation of strategies for solving interpersonal conflicts without harming oneself or others.** **6. It is also a form of Advocacy** - Health education **evaluates the effectiveness of various methods of teaching to express health information and ideas correctly.** - It conveys **valid information** and **cites opinions about health-related issues** (Bastable: 2004). - Health education is a **means to work cooperatively with people** in advocating health to individuals, families, schools, and communities. - It is the **ability of the nurse to convey health messages** and **use effective communication techniques** to a particular group of people, influences these clients in making positive health choices, and make use of strategies to overcome barriers when discussing about information, ideas, feelings, and opinions on health issues. **D. 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, patient\'s family members, nursing students, hospital or clinical staff nurses or a group of mothers in the community.*** Some authors have argued that ***nurses may not be adequately prepared to assess the learner\'s needs or even implement the appropriate teaching strategies, approaches and use of learning materials.*** 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: a. \"provide health education to **individuals, families and communities;** b. \"teach, guide and supervise **students in nursing education;** c. **Implement 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 Education\'s policies and standards of nursing education."*** **E. Types of Health Education** a. **Biological.** - Information about human **biology and hygiene.** - The nurse provides **health information about the human body** and **how to take care of it.** b. **Health Resources.** - **Health services** which direct the individual regarding the **\"sensible\" use of health care resources.** c. **Society and Environment.** - An environment in which **health choices are made.** - This is concerned with **national, regional, and local education policies,** which are often pursued and implemented without considering health consequences. **F. Dimensions of the Health Education Process** Health education is a **complex process that requires eclectic knowledge, skills, and values** on the part of the educator. This needs a c**onceptual framework which envisions the totality of the learning process** and **all its dimensions.** It **begins with the formulation of objectives** and the **anticipated outcome for each particular subject area** which prepares the teacher and the learner to assume their roles and responsibilities during the process. **Heidgerken (1971) described the four (4) dimensions of the educative process, namely:** - substantive or curricular dimension - procedural or methodological dimension - environmental or social dimension - human relations or interactional dimension **1. Substantive or Curricular Dimension** - Substantive or curricular dimension refers to the **subject matter specific to nursing education** and is best embodied by the phrase with **\"what is taught and what is learned\"** - **Subject matter** is usually listed in the **course curriculum** which includes **all basic elements and learning activities** for a particular **planned purpose and directed by a faculty member** for a **specific group of students.** - Substantive or curricular dimension also refers to **providing opportunities for nursing students** to **acquire essential knowledge, skills and attitudes** that will prepare them for **professional duties and responsibilities in actual nursing practice.** **2. Procedural or Methodological Dimension** - Procedural or methodological dimension consists of **strategies or methods of teaching** which **motivate students to learn.** - These are **learner activities in teaching concepts** ranging from those **planned by the teacher** to those **self-initiated by the students** in their quest for knowledge. - Some of the **[more common challenges encountered by teachers in dealing with students in the course of the learning process]** are as follows: a. **Choice of the most appropriate methods** in helping the students learn; b. **Identification of the method** most likely to **lead and direct learners in their own learning**; and c. **Initiation of ways** that **continue the lifelong process of learning.** ***Note:*** *When the **learner shows resistance or difficulty in adapting to the learning process,** it is important to **understand her goals and motivation** toward achieving these goals, her **ability to effect change**, and her **previous knowledge and experiences.** This helps **determine the kind of learning activities** an individual needs that will be **most effective in overcoming the difficulty of imparting the knowledge needed or desired by the learner.*** **3. Environmental or Social Dimension** - Environmental or social dimension refers to **physical and social factors in the teaching-learning situation.** - It also refers to **extrinsic factors that capture the interest of the learner.** - In turn, it **makes students adapt to varying changes** in order to see the difference between what is ideal from what is real. **[Physical factors] refer to the actual setting where learning takes place,** including the following: a. **The classroom,** equipped with audio-visual materials; b. **Laboratory settings,** such as skills laboratory, RLE laboratory commensurate with the number of students and consistent with the standards of nursing education; c. **Home-based and modern or traditional hospital set-ups;** and d. **Community health agencies.** ***Note:*** *The crucial aspect of the environmental dimension of learning is the **human or social factor,** because **relationship between teacher and learner(s) determines the quality of the learning climate that prevails.*** When the **teacher and learner(s) congregate, each brings a definite personality pattern** such as aims, values and social habits among others, all of which have to **fuse together in order for effective learning to take place.**  **Figure 3: Heidgerken\'s Conceptual Model of the Total Educational Process for Nursing.** **4. Human Relations Dimension** - The human relations dimension takes into account the **relationship of the nurse educator with individuals involved** **in nursing care practice,** which **influence the effectiveness of the teaching and learning process.** It includes the following: a. The learners who are the recipients of knowledge. b. The teacher as the source of knowledge. c. Administrator, who are the resource allocator. d. Group of learners, who use the holistic knowledge in a discipline. e. Patient, as end-users of nurses teaching and learning experiences. f. Nursing Service Personnel knowledge of and training support for students. g. Allied health personnel and their group interaction. **G. Aspects of Health Education** **1. Behavioral Sciences** - The behavioral sciences which **incorporate psychology, sociology and cultural anthropology,** are concerned with **how people behave and why they behave in a particular way** (Feldman: 2006). They define the **[primary determinants of behavior as follows:]** a. Psychological predispositions: such as attitudes, knowledge, beliefs, skills, and experiences; b. Environmental reinforcement: family, friends, authority figures, and associates; and c. Socio-cultural context: sustained societal norms such as attitudes and behavior. **Behavior change** is a **desired outcome of health education;** hence primary behavioral determinants are crucial to the practice of a nurse as health educator and clients as recipients of health care. **2. Public Health** - Health promotion is a **common function in public health agencies.** **Health education relies on public health and health statistics for epidemiologic information.** - **[Determinants of health problems]** include the **environment, medical care, personal lifestyle** which are often **discovered in the public health realm.** - Other issues, such as **population dynamics, epidemiology, and biomedical science are deeply rooted in public health.** **3. Education** - Education refers to the **study and practice of teaching and learning** which plays a **vital role in the development of health education.** - **Learning theory, educational psychology, human development, pedagogy, andragogy, curriculum development, measurement, and testing are all rooted in the education literature.** **H. Importance of Health Education** Health education is a **system of teaching and learning process.** It **facilitates common understanding among people in a social structure** to **modify behaviors, make decisions and change** **social conditions** in ways that are **health enriching**. Among its many are the following (Breckon: 1994): **1. Enhance knowledge awareness.** Provides guidance and instruction to all individuals or group of individuals maintain to all that will a high level of wellness. **2. Promotes health, safety, and security of the people.** Promotes personal hygiene, environmental sanitation, and maintenance of a hazard-free environment for one to avoid illnesses, accidents and reduce mortality rate. **3. Develop and improve community resources.** Help individuals gain knowledge, and understanding of the different community health agencies who can provide health care services. Likewise develop habits, attitudes, and ideals that will help them live as healthy individuals and members of the community and share the task of community building and health care. **4. Increase productivity and strength of character.** Help develop productive individuals who can adjust successfully and live happily with social groups to which they belong. Health education further enhances coping patterns that minimize the effects of stress on individuals and family. **5. Disease prevention.** Promotes individual and public health awareness on prevention of disease using various health care strategies and for the state to be the home of healthy and productive citizens. **6. Minimize cost.** Health education enables the government to attain health objectives at least cost. Knowledge and awareness of the people regarding health promotion and disease prevention minimize health care cost. **7. Self-reliant behavior.** Health education provides information and services necessary in fostering independent behaviors or self-care attitude conducive to health. **I. The Teaching of Health Education** In the United States some forty states require the teaching of health education. A **comprehensive health education curriculum consists of planned learning experiences** which will **help students achieve desirable attitudes and practices related to critical health issues.** Some of these are: **J. Issues and Trends in Health Education** **1. Social -** demographic trends like aging of the population requires emphasis on self-reliance and maintenance of a healthy life status over an extended lifespan particularly dealing with degenerative diseases and disabilities; Lifestyle-related diseases which are the major causes of morbidity and mortality are highly preventable and will need more intensive health education efforts. **2. Economic** - the shifts in payer coverage emphasizes on managed care and earlier hospital discharge, and the issue on reimbursement for health services provided require more intensive patient education to allow the patient and his family a more independent, compliant and confident management of care. **3. Political** - the federal government has formulated national goals and objectives directed towards the development of effective health education programs which will create awareness of health risks and encourage the adoption of healthy lifestyles. The role of health education in promotion of health and prevention of illness in containing the cost of hospitalization and healthcare expenses has already been recognized by politicians and heaithcare administrators. **a. Health Issues: Biological, Psychological, and Sociological Aspects of Health and Disease** **2. psychological** (perceptions, thoughts, emotions, attitudes and behaviors) **b. Emerging Trends in Health Care** In the United States of America, patients are being discharged quicker due to the: **1) New \"healthcare economics\"** **2) Advances in medical technology** **c. Future Directions for Patient Care** **K. Theories in Health Education** One of the **[most common mistakes and sources of frustration of a health educator]** is to **[\"tell\" the client what they need to know and expect them to obey and go through an attitude and behavior change.]** More often than not, ***this produces negative results*** because the **[health educator failed to conduct an assessment of the learning needs of that particular person or group]** which could **[provide a sound basis for the teaching-learning activities.]** In **[planning health education content, approaches, strategies and activities,]** there are **[models or theories]** which ***explain human behavior in relation to health education***. **[These theories can be classified on the basis of being directed at the level of:]** a. Individual (Intrapersonal); b. Interpersonal; or c. Community. **[The four most commonly used health theories are:]** a. Pender\'s Health Promotion Theory b. Bandura\'s self-efficacy theory c. Becker\'s Health Belief Model d. Green\'s Precede-Proceed Model **a. Pender's Health Promotional Theory (Revised)** Nola Pender: Health Promotion Model (Theory Guide) - Nurseslabs **Nola Pender** This model was developed in 1987 and revised by Pender in 1996 **[\"to increase the utility of its predictions and interventions.\"]** It is **[widely used in the field of nursing.]** 1. This model emphasizes **[\"actualizing health potential and increasing the level of well-being using approach behaviors rather than avoidance of disease]** that is why it has been **[classified as a health promotion model rather than a disease prevention model."]** 2. **[The components and their variables (revised model) are:]** A. **individual characteristics and experiences** B. **behavior-specific cognitions and affect** C. **behavioral outcome** D. **activity-related affect** E. **commitment to a plan of action**  **Figure 4. Health Promotion Model** In a nursing study (Johnson, etal, 1993), results showed that the **[modifying factors of age, income, education and selected biological characteristic of body mass had indirect effects on health-promoting lifestyles as proposed by the model.]** **b. Bandura's Self-efficacy Theory** Albert Bandura Interview: The Greatest Living Psychologist on Trump\'s "Atrocious Statements" and Humanity\'s "Pervasive Moral Paradox" -- Smashing Interviews Magazine **Albert Bandura** **Social Learning Theory** is the result of separate research by Rotter (1954) and Bandura (1977). **[Bandura renamed the theory as Social Cognitive Theory]** to ***emphasize the cognitive aspect of learning*** which ***explains human behavior by citing three factors which are in continuous interaction*** resulting in a **[process of reciprocal determinism or triadic reciprocal causality namely:]** 1. personal factors in the form of cognition, affect, and biological events, 2. behavior, and 3. environmental influences. These are very **dynamic relationships** where the **[person can shape the environment as well as the environment shaping the person.]** ***Change is two-way or bi-directional.*** **[Social Cognitive Theory emphasizes]** that ***cognition plays a critical role in people\'s capability to construct reality, self-regulate, encode information, and perform behaviors.*** In 1977, he introduced the concept of self-efficacy into the theory (Pajares, 2002). **[Self-efficacy]** is the ***single most important aspect of the sense of self*** that ***determines one\'s effort to change behavior*** according to Bandura. It is ***equated with self-confidence in one\'s ability to successfully perform a specific type of action.*** **[A person can increase self-efficacy through:]** a. personal mastery of a task; b. observing the performance of others (vicarious experience); c. verbal persuasion, such as receiving suggestions from others; d. arousal of her/his emotional state. In the construct of emotional coping responses, a person must be able to deal with any sources of anxiety surrounding that behavior in order to learn. There are ***several constructs in Social Learning Theory (SLT) which help to explain learning.*** One of these is the **[value expectancy theory:]** **[According to SLT, reinforcement can be accomplished in one of three ways:]** 1. **[direct reinforcement]** - ***supplied directly to the person being reinforced*** 2. **[vicarious]** - the ***participant observes someone else*** for behaving in an appropriate or inappropriate manner. This has also been called ***social modeling or observational learning.*** 3. **[through self-management]** - involves ***record-keeping by the participant of her/his own behavior.*** When the ***behavior is performed correctly,*** the ***person would reinforce or reward herself/himself.*** The ***[construct of self-control applies]*** to this type of reinforcement since it reflects the idea that ***individuals may gain control of their own behavior by monitoring it***.  **Figure 5. Self-Efficacy Theory** **[There are several other constructs which may be applicable to learning situations in health education.]** 1. **[Behavioral capability]** refers to the ***knowledge and skills necessary to do a behavior which influences actions.*** a. If ***individuals are to be able to perform specific behaviors,*** they must ***first know what the behaviors are and how to perform them.*** b. Therefore, ***clear instructions and/or training may be needed.*** 2. **[Expectations]** refers to the ***ability of humans to think*** and, therefore, to ***expect certain results in certain situations.*** 3. **[Expectancies]** are the ***values that people place on an expected outcome.*** c. The ***more highly valued the expected outcome,*** the ***more likely the person will perform the needed behavior*** to ***yield that outcome.*** 4. **[Efficacy expectations]** - are ***feelings of competency.*** 5. **[Outcome expectations]** - if a ***person believes that the outcome of the behavior (reinforcement) is not great or good enough in terms of benefits,*** ***he/she may not attempt the behavior inspite of the feeling of competency or efficacy expectations.*** **c. Becker's Health Belief Model** 1. **[perceived susceptibility]** - a ***person\'s opinion of the chances of getting a certain condition;*** 2. **[perceived severity]** - a ***person\'s opinion of how serious the condition is;*** 3. **[perceived benefits,]** a ***person\'s opinion of the effectiveness of some advised action to reduce the risk or seriousness of the impact;*** 4. **[perceived barriers,]** a ***person\'s opinion of the concrete and psychological costs of this advised action.*** - Even though the ***HBM was originally developed to help explain certain health related behaviors,*** it has also helped to ***guide the search for \"why\" these behaviors occur*** and - ***to identify points for possible change*** and - ***to design change strategies like developing messages that are likely to persuade an individual to make a healthy decision.*** Health belief model - Wikipedia **Figure 6. The Health Belief Model** **d. Greene's Precede-Proceed Model** - **[Precede:]** - ***Predisposing, Reinforcing,*** and ***Enabling Constructs in Educational Diagnosis and Evaluation.*** - This was developed by Greene, et al. in 1980. - **[Proceed:]** - ***Policy, Regulatory,*** and ***Organizational Constructs in Education and Environmental Development.*** - This component was added in 1999 by Green and Kreuter. 1. Social diagnosis -begins with population self-study/ assessment relative to the quality of life 2. Epidemiologic diagnosis 3. Behavior and Environmental diagnosis 4. Educational & Organizational diagnosis - addresses issues dealing with education 5. Administrative & Policy diagnosis - addresses issues dealing with education 6. Implementation 7. Process evaluation 8. Impact evaluation 9. Outcome evaluation  **Figure 7. Greene's Precede-Proceed Model** **REFERENCES :** Estrada-Castro, C. (2011). *Health education for nursing and other allied professions (with teaching strategies and principles of teaching and learning)* (1st ed.). Educational Publishing House. Reynolds, M. (2014, March 16). *Teddy Stallard story: MakeADifferenceMovie.com* \[Video\]. YouTube.  Tan, C. B. (2017). *The nurse as health educator: Concepts, principles and strategies in teaching text and workbook* (2nd ed.). APD Educational Publishing House. **IMAGES :** Community Tool Box. (n.d.). *Chapter 2. Other models for promoting community health and development \| Section 2. Precede/Proceed \| Main section \| Community tool box*.  Gonzalo, A. (2021, March 5). *NOLA Pender: Health promotion model (Nursing theory guide)*. Nurseslabs.  *Health belief model*. (2022, December 12). Wikipedia, the free encyclopedia. Retrieved February 2, 2023, from  Lippke, S. (2020). Self-Efficacy Theory. In: Zeigler-Hill, V., Shackelford, T.K. (eds) Encyclopedia of Personality and Individual Differences. Springer, Cham. https://doi.org/10.1007/978-3-319-24612-3\_1167 Parker, M., & Parker, M. B. (2016, October 20). *Albert Bandura interview: The greatest living psychologist on Trump\'s \"Atrocious statements\" and humanity\'s \"Pervasive moral paradox\"*. Smashing Interviews Magazine.  PMHEALTH. (2022, January 4). *NOLA Pender health promotion model*. PSYCH-MENTAL HEALTH HUB.  **C. Change\ ** **A. The Change Process** The following guidelines may help affect change in learners: **1. Perceive the need for change** - **[Teachers and students]** must be able to ***assess their own need for change.*** - **[Progress]** requires ***modification, improvement or replacement of obsolete knowledge through re-education and training.*** - **[Change]** is a ***necessary ingredient*** to ***modify or improve teaching and learning to attain progress.*** - This can be ***done through identification and discussions*** with a ***specific group of people and areas that need change.*** **2. Initiate group interaction** The **[teacher]** must ***initiate and motivate students*** to ***think critically of nursing situations*** which will ***help them build a framework for problem-solving processes,*** which **[calls for the following responses:]** a. Identify external and internal forces for change; b. State the problem; c. Identify constraints; d. List change strategies or possible approaches to problem-solving; e. Select the best change strategy; f. Formulate the plan for implementation; and g. Develop or select tools for evaluating change. **3. Implement the change one step at a time.** - **[Change must be done gradually,]** ***one at a time*** in order to have an ***orderly and systematic process of change*** and to ***safeguard undesirable adverse effects of change.*** - **[Abrupt change]** can ***create further resistance or fear of change.*** **4. Evaluate the overall results of the change process and make further adjustments** - **[Change]** ***helps students identify strengths and weaknesses*** so as to ***provide remedial measures*** and ***allow the gradual process of change to occur*** with ***less problems or difficulty on the part of the teacher and the learners.*** **B. Managing Change** Considering how far-reaching the effects of change can be, it important to identify a particular management strategy for change (Jones: 2007). **1. Thinking-Practice Strategy** This is a strategy which assumes that learners are rational beings with mental faculties and behave according to their personal beliefs, interests and motivation. **2. Interest and Commitment Strategy** *\"Learners are eager to change if it is explained to them how they can* *benefit from the change process.\"* *-De Young* This strategy assumes that learners always act consistently with their desire to change and commitment to socio-cultural norms of behavior. They are therefore willing to change for purposes of acceptance and recognition. It is a self-made process and the extent of learning depends on the learners\' prospective goals of behavior change. *Example: In a re-educative milieu the teacher strives to foster development of students through counseling, training, small groups and experiential learning, and encourage individuals to participate in his or her own re-education process.* **3. Power and Self Discipline Strategy** This is a strategy which makes learners comply with instructions given by the teacher as an authoritative figure in order to bring about change. It is more traditional in style as it often demotivates students and could make teaching and learning processes offensive (Bradshaw and Lowenstein: 2007). **C. Factors affecting Change** Change is part of learning desired by both the teacher and the learner. However, constraints and difficulties are often encountered as the learner undergoes the process of change. **[Following are barriers to change:]** **1. Culture** Culture determines the beliefs and values important to the Learner that may delineate her potential development for change. Some cultures compete with change, other welcome change while some resist change. Thus, the socio-cultural background and tie learners\' personal characteristics influence the process of change. **2. Demographics** This pertains to the learner\'s age, gender, heredity, and environment which may determine innate qualities and potentials as well as tendencies and level of response of the learners to a learning stimulus. **3. Socio-economic Conditions and Environmental Circumstances** This may involve the learners\' adaptability, flexibility, and capabilities in creating change that may influence the quality and quantity of response to the change process. The learners\' position in the community, social interactions and economic status greatly affects much of the learners\' response to change. **4. State of wellness and development** The learners\' state of well-being and development relates to his physical, emotional, intellectual and spiritual health. This affects the instinctive qualities of the learners\' response to a stimuli and capability of coping with stress related situations. **D. Change and its Effect on the Filipino Health Value System** Based on a list of change barriers, the Philippines is a classic example of how large scale change can influence the state of the health care system. **[Following are some medical health remedies used by Filipinos:]** **1. Home Remedies** One remedy is the use of oils or ointments, often Chinese in origin, which serve as \"cure-alls\" for relaxing, heating, and comforting the muscles or providing relief for dizziness, colds, headaches, and sore. throats, among others. These include simple touch, adequate rest, light massage or effleurage, salt gargle, increased water intake, and ventilated rooms, among others. **2. Traditional Healing Techniques** The use of herbal medicinal leaves such as \"lagundi," \"banaba,\" \"pito-pito" and other sources like the bark of trees and stem of plants which provide relief. These can be used in the treatment of various diseases and disorders in the absence of western medical intervention or medical equipment. **3. Supernatural Healing or the Use of Faith Healers** Supernatural healing is a holistic and uniform approach to healing, which incorporates belief in the concurrent physical, emotional, and spiritual state of the patient. *Example:* *Faith healing uses techniques which include blessing of the body with holy water, prayers and devotions, laying hands on the patient\'s body, and anointing with oil, flagellation, or isolation. In the laying of hands, it appears as if the healer is transferring the healing energy from his or her hands to the patient\'s afflicted body part. Typically the patient attests to the energy that seems to enter the body and provides instant well-being.* **4. Regulated Drugs or Medicines** These are research-based drugs commonly referred to as regulated \"prescription drugs\". They require prescription from doctors due to expected adverse effects. These are mostly produced and manufactured by pharmaceutical companies. **5. Over-the-Counter Drugs** These are non-prescription drugs or medicine mostly produced and manufactured by multinational pharmaceutical companies. They can be bought by a patient from the counter without prescription from the physician. Examples of these are analgesics or antipyretics, paracetamol, ibuprofen, antacids, and laxatives, among others. *\"Healing which is the foremost function of therapeutic touch, could be called a humanization* *of energy in the interest of helping or healing others or oneself."* *-Dolores Krieger* **REFERENCES :** Tan, C. B. (2017). *The nurse as health educator: Concepts, principles and strategies in teaching text and workbook* (2nd ed.). APD Educational Publishing House.