2019-HEALTH-EDUCATION.pptx

Health education

1. HEALTH EDUCATION Perspective on Health Education, Teaching and Learning

2. Course Description This course deals with concepts, principles and theories and learning. It also focuses on the appropriate strategies of 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.

3. ( (OVERVIEW) Historical Foundations for the Teaching Role of Nurses Florence Nightingale, the founder of modern nursing, was the ultimate educator. -She also emphasized the importance of teaching patients of the need for adequate nutrition, fresh air, exercise, and personal hygiene to improve their well-being.

4. Historical Foundations for the Teaching Role of Nurses By the early 1900's, public health nurses in the country clearly understood the significance of the role of the nurse as teacher in preventing disease and in maintaining the health of society.

5. Historical Foundations for the Teaching Role of Nurses As early as 1918, the National League of Nursing Education (NLNE) in the United States (now the National League for Nursing [NLN]) observed the importance of health teaching as a function within the scope of nursing practice. Two decades later, this organization recognized nurses as agents for the promotion of health and prevention of illness in all settings in which they practiced (National League of Nursing Education, 1937).

6. Historical Foundations for the Teaching Role of Nurses By 1950, the NLNE had identified course content in nursing school curricula to prepare nurses to assume the role as teaching others. In addition, the International Council of Nurses (ICN) has long endorsed the nurse's role as educator to be an essential component of nursing care delivery. Today, all state nurse practice acts (NPA's) include teaching within the scope of nursing practice responsibilities.

7. Historical Foundations for the Teaching Role of Nurses as early as 1993 the Joint Commission (JC) formerly the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), established nursing standards for patient education These standards, known as mandates, describe the type and level of care, treatment, and services that must be provided by an agency or organization to receive accreditation.

8. Historical Foundations for the Teaching Role of Nurses In addition, the Patient's Bill of Rights , first developed in the 1970's by the American Hospital Association, has been adopted by hospitals nationwide.

9. Historical Foundations for the Teaching Role of Nurses Pew Health Professions Commission (1995), influenced by the dramatic changes surrounding health care, published a broad set of competencies it believed would mark the success of health professions in the 21st century.

10. Historical Foundations for the Teaching Role of Nurses In 2006, the Institute for Healthcare Improvement announced the 5 Million Lives campaign. The campaign's objective is to reduce the 15 million incidents of medical harm that occur in U.S. hospitals each year.

11. Historical Foundations for the Teaching Role of Nurses Another recent initiative was the formation of Sullivan Alliance to recruit and educate staff nurses to deliver culturally competent care to the public they serve. This organization's goal is to increase the racial and cultural mix of nursing faculty, students, and staff, who will be sensitive to the needs of clients of diverse backgrounds (Sullivan & Bristow, 2007)

12. Historical Foundations for the Teaching Role of Nurses Since the 1980's, the role of the nurse as educator has undergone a paradigm shift, evolving from what once was disease-oriented approach to a more prevention-oriented approach. -from Disease –Oriented Patient Education (DOPE) to Prevention-Oriented Patient Education (POPE)

13. Historical Foundations for the Teaching Role of Nurses The role of today's educator is one of training the trainer---that is, preparing nursing staff through continuing education, in-service programs, and staff development to maintain and improve their clinical skills and teaching abilities. - Another important role 0f the nurse as educator is serving as a clinical instructor for students in the practice settings

14. Concepts of teaching learning, education process vis-à-vis nursing process for the teaching role of the nurse Education process is a systematic, sequential. logical, scientifically based, planned course of action consisting two major interdependent operations, which are the teaching and learning. Forms a continuous cycle that also involves two interdependent players, the TEACHER AND THE STUDENT

15. Education process is a framework for a participatory, shared approach to teaching and learning. Education process has always been compared to nursing process

16. Education process parallels nursing process Nursing Process EDUCATION PROCESS Appraise physical and ASCERTAIN LERNING NEEDS, Readiness to psychosocial need to learn and learning styles Develop care plan based on develop teaching plan Mutual goal setting Carry out nursing care perform the act of teaching interventions Determine physical and determine behavior changes psychosocial outcomes ASSESSMENT PLANNING IMPLEMENTATION EVALUATION

17. Role of the nurse as educator - promote learning and provide for an environment conducive to learning Role of the nurse as teacher should stem from partnership philosophy Nurse act as a facilitator The new educational paradigm focuses on the learner learning that is the teacher becomes the guide on the side,

18. To increase comprehension recall, and application of information, clients must e actively involved in the learning experience Nurse serves as the coordinator of care assist colleagues in gaining knowledge and skills necessary for the delivery of professional nursing

19. LEARNING THEORIES

20. Learning Theories 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 -– behaviors closely observe responses and then manipulate the environment to bring about the intended change.

21. Cont. behaviorist theory -To modify people’s attitudes and response, behaviorists either alter the stimulus conditions in the environment or change what happens after a response occurs.

22. Behaviorist Theories 1.John Watson Theory - he define behavior as muscle movement - he postulated that behavior is a result of a series of conditioned reflexes, and all emotion and thoughts is a result of behavior learned through conditioning for example: fear of a hot stove is learned when a child’s curiosity leads him to touch a stove ( a stimulus followed by a response) and he feels pain ( another stimulus and response),Because of that innate fear of pain, the child now conditioned to avoid touching the stove even when its cold.

23. 2.Reinforcement Theory by Thorndike and Skinner -proposed that stimulus- response bonds are strengthened by reinforcements like reward or punishment example; same example of a child touching the stove. The child learns to avoid the stove because the pain was negative reinforcer for the behavior - a behavior that is rewarded is more likely to occur

24. 3.Operant Conditioning Model: Contingencies to increase and decrease the probability of an organism’s response I- To increase the probability of response A. Positive reinforcement- application of pleasant stimulus Reward Conditioning- a pleasant stimulus is applied following an organism’s response B. Negative Reinforcement- removal of an aversive or unpleasant stimulus Escape conditioning: as an aversive stimulus is anticipated by the organism, which makes a response to avoid the unpleasant event

25. II To decrease or extinguish the probability of a response: A. Non reinforcement : an organism’s conditioned response is not followed by any kind of reinforcement (positive, negative, or punishment) B. Punishment: Following a response, an aversive stimulus that the organism cannot escape or avoid is applied.

26. Cognitive Learning Theory B. Cognitive Learning Theory -While behaviorists generally ignore the internal dynamics of learning, cognitive learning theorists stress the importance of what goes on inside the learner. -The key to learning and charging is the individual’s condition (perception, thought, memory, and ways of processing and structuring information).

27. Cognitive learning, a highly active process largely directed by the individual, involves perceiving the information into new insights or understanding ( Bandura , 2001); Hunt Ellis, & Ellis 2004. -maintain that reward is not necessary for learning. More important are learner’s goals and expectations, which create disequilibrium, imbalance, and tension that motivate them to act.

28. Perspectives of Cognitive Learning Theories 1.Information Processing Model of Memory Functioning Stimuli: attention, then is the key to learning. Thus, if a client is not attending to what a nurse educator is saying, perhaps because the client is weary or distracted, it would be prudent to try the explanation at another tine when he is more receptive and attentive

29. In the second stage, the information is processed by the senses. Here it becomes important to consider the client’s preferred mode of sensory processing (visual, auditory, or motor manipulation) and t ascertain whether there are sensory deficits.

30. In the third stage, the information is transformed and incorporated (encoded) briefly into short-term memory, after which it is either disregarded and forgotten or stored in long-term memory -Long-term memory involves the organization of information by using a preferred strategy for storage ( e.g. , imagery, association, rehearsal, or breaking the information into units).

31. - The last storage involves the action or response that the individual makes on the basis of how information was processed and stored -In general, cognitive psychologists note that memory processing and the retrieval of information are enhanced by organizing information and making it meaningful.

32. Nine events in cognitive processes that active effective learning by Robert Gagne : Gain the learner’s attention (reception) Inform the learner of the objectives and expectations (expectancy) Stimulate the learner’s recall of prior learning (retrieval) Present information (selective preparation) Provide guidance to facilitate the learner’s understanding (semantic encoding) Have the learner demonstrate the information or skill (responding) Give feedback to the learner (reinforcement) Assess the learner’s performance (retrieval) Work to enhance retention and transfer through application and varied practice (generalization)

33. C. Social Learning Theory - proposed by Albert Bandura (1977) - later renamed to Social Cognitive Theory - first people learn as they are in constant reaction with other environment. Two concepts in Social Learning Theory 1. Role Modeling 2. Vicarious Reinforcement- involves determining whether role models are perceived as rewarded or punished for their behavior

34. Four Step Internal Process outline by Bandura -firstly, most learning occurs as a result of observing other people’s behavior and its consequences ( rolemodeling ) - second, attentional processes determine which modelled behaviors will be learned

35. Third. Retention processes refers to the ability retain modeled behaviors in permanent memory. for retention to occur, must retain a mental image of the modeled behavior ( e.g picturing skilled being carried out) or a verbal symbol that is easily recalled ( e.g an example is remembering a numbered list of activities involved in a skill)

36. - rehearsal is seen as a significant way of committing learned material to memory. - Bandura emphasizes that although observation starts the learning process, expertise is developed through practice with external and internal feedback

37. Motivation for learning will determine which modeled behaviors are enacted. A person is motivated when he sees the possibility of valued outcomes as opposed to unrewarding or punishing outcomes. ex. An example of valued outcome as a motivator is a situation in which a student always hands assignments in early because each time he receives praise from the teacher for doing so.

38. D.A Model of Adult Learning - proposed by Malcolm Knowles (1984) - crusaded for a model of education for adults that was different from the education of children - He adopted the term Andragogy – teaching of adult Pedagogy- teaching of children

39. Comparison Pedagogy to Andragogy according to Knowles PEDAGOGY ANDRAGOGY NEED TO KNOW Learn what the teacher wants them to learn Need to know why they need to learn something Self Concept Perception of being dependent on the teacher for learning Feel responsible for their own learning Role of Experience s Adults learn when they need to know Readiness to learn Must be ready when the teacher says they must or they will not be promoted Ready to learn when they feel the need to know Orientation to learning Subject centered orientation Li- fe centered or task centered orientation Motivation Externally motivated Primarily internally motivated, with some external motivation

40. PRINCIPLES OF TEACHING AND LEARNING

41. Hallmarks of effective teaching in nursing Six major categories in effective teaching 1.Professional Competence -maintains and expands his knowledge through reading, research, clinical practice, and continuing education 2. Interpersonal relationship with students - an effective teacher is skillful in interpersonal relationship

42. 3.Personal Characteristics -qualities such as magnetism, enthusiasm, cheerfulness, self-control, patience, flexibility, a sense of humour , a good speaking voice, self- confidence, willingness to admit errors, and caring attitude 4.Teaching Practices -is defined as mechanics, methods and skills in classroom and clinical teaching. 5.Evaluation Practices- 6.Availability to students

43. Principles of good teaching practice in undergraduate education . 1Encourage student- faculty contact 2.Encourage cooperation among students 3.Encourage active learning 4. Give prompt feedback 5. Emphasize time on task 6. Communicate high expectation 7. Respect diverse talents and ways of learning

44. Barriers to education and obstacles to learning 1.Lack of time to teach- greatest barrier 2.Many nurses and other healthcare personnel admit that they don’t feel competent with their teaching skills 3. personal characteristics of the nurse educator play an important role in determining the outcome of a teaching-learning interaction. 4.Low priority assigned to patient and staff education by administration and supervisory personnel

45. 5.Lack of privacy, noise and frequent interferences due to client treatment schedules and staff work 6.Absence of third- party reimbursements to support patient education 7. Some nurses and physician questions whether health education is effective 8.The type of documentation system used by healthcare agencies has an effect on the quality and quantity of patient teaching.

46. Factors impacting ability to learn 1.Lack of time due to rapid patient discharge from care 2.The stress of acute and chronic illness 3.Low literacy and functional health literacy 4.The negative influence of the hospital environment itself, resulting in loss of control, lack of privacy, and social isolation 5.Personal characteristics of the learner 6.Lack of support an lack of ongoing positive reinforcement from the nurse and significant others

47. 7 .Denial of learning needs, resentment of authority, and lack of willingness to take responsibility 8.The inconvenience, complexity, inaccessibility, fragmentation of healthcare system

48. Principles of learning Learning is defined in as relatively permanent change in mental processing, emotional functioning, and/or behavior as a result of experience. It is a lifelong, dynamic process by which individuals acquire new knowledge or skills and alter their thoughts, feelings, attitudes, and actions.

49. -Learning enables individuals to adapt to demands and changing circumstances and is crucial in health care - Learning theory- is a coherent framework of integrated constructs and principles that describe , explain, or predict how people learn

50. Patient Education- is a process of assisting people to learn health related behavior that can be incorporated into everyday life with the goal of optimal health and independence in self- care. Staff Education- is the process of influencing the behavior of nurses by producing changes in their knowledge, attitudes, and kills, to help nurses maintain and improve their competencies for the delivery of quality care to the consumer.

51. Types of Learning Gagne’s Condition of Learning( eight types of learning) 1.Stimulus -Response Learning- involves a voluntary response to a specific stimulus or combination of stimuli example; nursing student learning to monitor an intravenous solution. 2. Signal Learning or the conditioned response- the person develops a general diffuse reaction to a stimulus Example; a nursing aide student may feel fear every time the term skill test is mentioned because he fear whenever taking an actual skill test. Because of the association, just the term skill test is enough to evoke fear. The words have become the signal that elicits response

52. 3 . C haining- is the acquisition of a series of related conditioned responses or stimulus- response connections. Ex. The nursing student is told to monitor the IV line and fit he line is not dripping , first is open the clamp further. If the action is not successful, checking the line for a return back flow is in order.

53. 4.Verbal Association- is a type of chaining and is easily recognized in the process of learning medical terminology. 5. Discrimination Learning - a great deal can be learned through forming large numbers of stimulus- response or verbal response chains. However the, the more new chains that are learned, the easier is to forget previous chains. To learn and retain large numbers of chains , the person has to be able to discriminate among them.

54. 6.Concept Learning- is learning how to classify stimuli into groups represented by a common concept. 7.Rule Learning - a rule can be considered a chain of concepts or a relationship between concepts. - rules generally expressed as “ if … then” relationships. 8. Problem solving- - to solve a problem the learner must have a clear idea of the problem or goal being sought and must be able to recall and apply previously learned rules that relate to situation.

55. Learning Styles of different age group Learning styles refers to the ways in which, and conditions under which, learners most efficiently and most effectively perceive, process, store, and recall what they are attempting to learn (James & Gardner, 1995) and how they prefer to approach different learning tasks .

56. Keefe (1979) defines learning styles as the way the learners learn, taking into account cognitive, affective, and physiological factors that affect how learners perceive, interact with, and respond to the learning environment.

57. Six Learning Style Principles 1.Both the style by which the educator prefers to teach and the style by which the learner prefers to learn can be identified. 2.Educators need to guard against relying on teaching methods and tools that match their own preferred learning styles. 3.Educators are most helpful when they assist learners in identifying and learning through their own style preferences. 4.Learners should have the opportunity to learn through their preferred style. 5.Learners should be encouraged to diversify their style preferences. 6.Educators can develop specific learning activities that reinforce each modality or style.  

58. Learning Style Models 1. Right-Brain/Left-Brain and Whole-Brain Thinking -The left hemisphere of the brain was found to be the coal and analytical side, which is used for verbalization and for reality-based and logical thinking. -The right hemisphere was found to be the emotional, visual-spatial, and nonverbal side, with thinking processes that are intuitive, subjective, relational, holistic, and time free.

59. 2. Field-Independent/Field-Dependent Perception -An extensive series of studies by Witkin , Olman , Raskin , and Karp (1971b) identified two styles of learning in the cognitive domain, which are based on the bipolar distribution of characteristic of how learners process and structure information in their environment

60. CHARACTERISTICS OF FIELD-INDEPENDENT AND FIELD-DEPENDENT LEARNERS A. Field-Independent Learners Are not affected by criticism Will not conform to peer pressure Are less influenced by external feedback Learn best by organizing their own material Have an impersonal orientation to the world Place emphasis on applying principles Are interested in new ideas or concepts for own sake Provide self-directed goals, objectives, and reinforcement Prefer lecture method

61. B. Field-Dependent Learners Are easily affected by criticism Will conform to peer pressure Are influenced by feedback (grades and evaluations) Learn best when material is organized Have a social orientation to the world Place emphasis on facts Prefer learning to be relevant to own experience Need external goals, objectives, and reinforcements Prefer discussion method

62. C .   Dunn and Dunn Learning Styles ( Rita and Kenneth Dunn ) - assist educators in identifying those characteristics that allow individuals to learn in different ways -The model includes motivational factors, social interaction, and physiological and environmental elements

63. Dunn and Dunn five basic stimuli that affect a person’s ability to learn; 1. Environmental elements (such as sound, light, temperature, and design), which are biological in nature. 2.Emotional elements (such as motivation, persistence, responsibility, and structure), which are developmental and emerge over time as an outgrowth of experiences that have happened at home, school, play, or work. 3.Sociological patterns (such as the desire to work alone or in groups or a combination of these two approaches), which are thought to be socio culturally based.

64. 4 .Physical elements (such as perceptual strength, intake, time of day, and mobility), which are also biological in nature and relate to the way learners function physically. 5.Psychological elements (such as the way learners process and react to information), which are also biological in nature.

65. Terms used in Dunn and Dunn model and its meaning 1.Sound Individuals react to sound in different ways some need complete silence, others are able to block out sounds around them, and still others require sound in their environment for learning. 2. Light some learners work best under bright lights, whereas others need dim or low lighting.

66. 3. Temperature some learners have difficulty thinking or concentrating if a room is too hot or, conversely, if it is too cold. 4.Design - when learners are seated on wooden, steel, or plastic chairs, 75% of the total body weight is supported on only four square inches of bone. This results in fatigue, discomfort, and the need for frequent body position changes -some learners are more relaxed and can learn better in an informal environment by being able to position themselves in a lounge chair, on the floor, on pillows, or on carpeting. Others cannot learn in an informal environment because it makes them drowsy.

67. THE EMOTIONAL ELEMENTS 1.Motivation - or the desire to achieve, increases when learning success increases. Unmotivated learners need short learning assignments that enhance their strengths. 2. Persistence Learners differ in their preference to complete tasks in one sitting or to take periodic breaks and return to the task at a later time.

68. 3. Responsibility -involves the desire to do what the learner thinks is expected. It is related to the concept of conformity or following through on what an educator asks or tells the leaner to do. 4. Structure -refers to either the preference for specific directions, guidance, or rules prior to carrying out an assignment or the preference for doing an assignment without structure in the learner’s own way.

69. THE SOCIOLOGICAL ELEMENTS 1.Learning Alone - Some learners prefer to study by themselves, whereas others refer to learn with a friend or colleague. 2.Presence of an Authority Figure - Some learners feel more comfortable when someone with authority or recognized expertise is present during learning. 3.Variety of Ways - Some learners are flexible and can learn as well alone as they can with authority figures and peer groups.

70. THE PHYSICAL ELEMENTS 1.Perceptual Strengths Four types of learners are distinguished in this category: a. Those with auditory preferences. b. Those with visual preferences c. Those with tactile preferences d. Those with kinesthetic preferences

71. INTAKE Time of Day  a. Early-morning learners b. Late-morning learners c. Afternoon learners d. Evening learners

72. Mobility Mobility refers to how still the learner can sit and for how long a period of time.  

73. THE PSYCHOLOGICAL ELEMENTS 1.Global Versus Analytic - some learners are global in their thinking and learn best by obtaining meaning from a broad, overall concept before focusing on the details in the surrounding environment.

74. 2. Hemispheric Preference - Learners who possess right-brain preference tend to learn best in environments that have low illumination, background music, casual seating, and tactile instructional resources.

75. 3. Impulsivity Versus Reflectivity -Impulsive learners prefer opportunities to participate verbally in groups and tend to answer questions spontaneously and without consciously processing their thinking. -Reflective learners seldom volunteer information unless they are asked to do so, prefer to contemplate information, and tend to be uncomfortable participating in group discussions.

76. The Educator’s Role in Learning The educator plays a crucial role in the learning process by: Assessing problems or deficits. Providing important information and presenting it in unique and appropriate ways. Identifying progress being made. Giving feedback and follow-up. Reinforcing learning in the acquisition of new knowledge, skills, and attitudes. Evaluating learners’ abilities.

77. Determinants of Learning 1.Assessment of the Learner Nursing assessment of learners’ needs, readiness, and styles of learning is the first and most important step in instructional design – but it is also the step most likely to be neglected.

78. Three determinants in the assessment of the learner 1. learning needs – what the learner needs and wants to learn. 2.Readiness to learn – when the learner is receptive to learning. 3.Learning style – how the learner best learns.

79. 2. Assessing Learning Needs Learning needs are defined as gaps in knowledge that exist between a desired level of performance and the actual level of performance A learning need is the gap between what someone knows and what someone needs or wants to know - Such gaps exist because of a lack of knowledge, attitude, or skill.

80. 3.LEARNER’S CHARACTERISTCS Important steps in the assessment of learning needs: 1.Identify the learner. Who is the audience? 2.Choose the right setting. Establishing a trusting environment will help learners feel a sense of security in confiding information, believe their concerns are taken seriously and considered important, and feel respected. 3.Collect data about the learner. Once the learner is identified, the educator can determine characteristic needs of the population by exploring typical health problems or issues of interest to the population.

81. 4. Collect data from the learner. Learners are usually the most important source of needs assessment data about themselves. Allow the patient and/or family members to identify what is important to them, what they perceive their needs to be, what types of social support systems are available, and what assistance these supports can provide.

82. 5. Involve members of the healthcare team. Other healthcare professionals will likely have insight into patient of family needs or the educational needs of the nursing staff or students as a result of their frequent contacts with consumers as well as caregivers.

83. 6. Prioritize needs. A list of identified needs can become endless and seemingly impossible to accomplish. Maslow’s (1970) hierarchy of human needs may help the educator with prioritizing so that the learner’s basic needs are attended to first and foremost before higher needs can be met.

84. 7. Determine availability of educational resources. A need may be identified, but it may be useless to proceed with interventions if the proper educational resources are not available, are unrealistic to obtain, or do not match the learner’s needs.

85. 8.Assess demands of the organization. This assessment will yield information that reflects the climate of the organization. 9.Take time-management issues into account.

86. Learner’s Characteristics that influence a client’s ability, motivation, and desire to learn: 1.Culture 2.Literacy 3. Age 4.Education Level and Health status 5.Socioeconomic level

87. CRITERIA FOR PRIOPITIZING LEARNING NEEDS 1.Mandatory: Needs that must be learned for survival or situations in which the learner’s life of safety is threatened. Learning needs in this category must be met immediately. For example, a patient who has experienced a recent heart attack needs to know the signs and symptoms and when to get immediate help.

88. 2. Desirable Needs that are not life dependent but are related to well-being or the overall ability to provide quality care in situations involving changes in institutional procedure. For examples: It is important for patients who have cardiovascular disease to understand the effects of a high-fat diet on their condition .

89. 3. Possible: Needs for information that are nice to know but not essential or required or situations in which the learning need is not directly related to daily activities.  

90. Methods to Access Learning Needs 1. Informal Conversations Often learning needs will be discovered during impromptu conversations that take place with other healthcare team members involved in the cared of the client, and between the nurse and the patient or his or her family

91. 2. Structured Interviews The structured interview is perhaps the most common form of needs assessment to solicit the learner’s point of view. The nurse asks the learner direct and often predetermined questions to gather information about learning needs.

92. 3. Focus Groups Focus groups involve getting together a small number (4 to 12) of potential learners to determine areas of educational need by using group discussion to identify points of view or knowledge about a certain topic.

93. 4. Self-Administered Questionnaires The learner’s written responses to questions about learning needs can be obtained by survey instruments. Checklists are one of the most common forms of questionnaires.

94. 5.  Test Giving written pretests before teaching is planned can help identify the knowledge levels of potential learners regarding a particular subject and assist in identifying their specific learning needs.

95. 6. Observations Observing health behaviors in several different time periods can help to determine conclusions about established patterns of behavior that cannot and should not be drawn from a single observation

96. 7. Patient Charts Physicians’ progress notes, nursing care plans, nurses’ notes, and discharge planning forms can provide information on the learning needs of clients.

97. Readiness to Learn Once learning needs have been identified, the next step is to determine the learner’s readiness to receive information. Readiness to learn- can be defined as the time when the learner demonstrates an interest in learning the information necessary to maintain optimal health or to become more skillful in a job.

98. - Observations, conducting interviews, gathering information from the learner as well as other healthcare team members, and reviewing written data in charts. Timing—that is, the point at which teaching should take place—is very important.

99. Learning Styles of different age group Learning styles refers to the ways in which, and conditions under which, learners most efficiently and most effectively perceive, process, store, and recall what they are attempting to learn (James & Gardner, 1995) and how they prefer to approach different learning tasks .

100. Learning Styles of Different age groups Introduction When planning, designing, and implementing an educational programme, the nurse educator must consider the learners’ developmental stage in life. An individual’s developmental stage significantly influences the ability to learn. At each developmental period throughout the life, the educator must take into account the three major stage-range factors associated with the learner’s readiness – physical, cognitive, and psychosocial maturation. 100

101. When planning, designing, and implementing an educational programme, the nurse educator must consider the learners’ developmental stage in life. An individual’s developmental stage significantly influences the ability to learn. At each developmental period throughout the life, the educator must take into account the three major stage-range factors associated with the learner’s readiness – physical, cognitive, and psychosocial maturation. 101

102. Identify the physical, cognitive, and psychosocial characteristics of learners that influence learning at various stages of growth and development Recognise the role of the nurse as educator in assessing stage-specific learner needs according to maturational level

103. The Developmental Stages of Childhood Within childhood, there are four stages.: infancy- toddlerhood (0-3 years), preschooling (approx. 3-6 years), school-aged childhood (approx. 6-12), and adolescence (approx. 12-18). Pedagogy is the art and science of helping children to learn. Throughout childhood, learning is subject-centred. . 103

104. Teaching Strategies During Infancy and Toddlerhood Patient education need not be illness-related. Less time should be devoted to teaching parents about illness care. More attention should be given to teaching parents about normal development, safety, health promotion, and disease prevention. If the child is ill, assessment of the child’s and parents’ anxiety levels and helping them cope with their stress represent the first priority for teaching intervention. This is because anxiety negatively impacts on readiness to learn. Health teaching should take place at home or day-care centre. During hospitalisation, teaching should take place in safe and secure environment. 104

105. The following teaching strategies are suggested for short-term learning: Read simple stories from books with lots of pictures Use dolls to act out feelings and behaviours Use simple audiotapes with music and videotapes with cartoon characters Role-play to bring the child’s imagination closer to reality Perform procedures on a doll to help the child understand what an experience would be like Keep teaching sessions brief (5 minutes) and close together 105

106. Adolescent (ages 12-19) Marks the transition from childhood to adulthood. Are known to be among the nations' most at risk populations (American Association of Colleges of Nursing,1994)

107. P hysical, Cognitive & Psychosocial Development Adolescents vary greatly in their biological ,psychosocial, social, and cognitive development. They must adapt to rapid, dramatic, and significant bodily changes , which can temporarily results in clumsiness and poorly uncoordinated movements. Alterations in physical size, shape and function of other bodies , along with the appearance and development of secondary characteristics.

108. Bring about a significant preoccupation with their appearance and a strong desire to express sexual urges. (Santrock,2006; Vander Zanden et al., 2007) Piaget (1951,1952,1976) termed this stage of cognitive development as a period of formal operations. Adolescents are able to hypothesize and apply the principles of logic to situation never encountered before.

109. EGOCENTRISM With this capacity ,teenagers can become obsessed with what they think as well as what others are thinking, a characteristic known as adolescent egocentrism.

110. IMAGINARY AUDIENCE ELKIND (1984) labeled this belief as the imaginary audience, a type of social thinking that has considerable influence over an adolescents behavior.

111. Adolescents are able to understand the concept of health illness , the multiple causes of disease ,the influence of variables on health status ,and the ideas associated with health promotion and health prevention. They can also identify health behaviors but may reject practicing them or begin to engage in risk-taking behaviors because of the social pressures they receive from peers as well as their feelings of invincibility.

112. PERSONAL FABLE The personal fable leads adolescents to believe that they are vulnerable—other people grow old and die , but not them; other people may not realize their personal ambitions ,but they will.

113. Erikson (1968) has identified the psychosocial dilemma adolescents face as one of identity versus role confusion. Teenagers have a strong need for belonging to a group ,friendship peer acceptance and peer support.

114. TEACHING STRATEGIES An estimated number of 20% of the united states teenagers have at least 1 serious health problem such as asthma, learning disabilities, eating disorder ( e.g., obesity, anorexia, or bulimia) diabetes, a range of disabilities as a result of injury ,or psychological problems as a result of depression or physical and/ or emotional maltreatment.

115. Accident- 50% are results from motor vehicles. Homicide Suicide

116. T-TERM LEARNING Use one on one instruction to ensure confidentiality of sensitive information. Choose peer group discussion sessions as an effective approach to deal with health topics as smoking, alcohol and drug use, safety measures, teenage sexuality. Use face to face or computer group discussion, role-playing, and gaming as methods to clarify values and problem solve, which feed into the teenager’s need to belong and to be actively involved.

117. Employ adjunct instructional tools, such as complex models, diagrams, and specific, detailed written materials, which can be used competently, by many adolescents. Clarify any scientific terminology and medical jargon used. Share decisions making whenever possible because control is an important issue for adolescent. Include them in formulating teaching plans related to teaching strategies, expected outcomes, and determining what to be learned and how it can best be achieve d to meet their needs for autonomy.

118. Suggest options so that they feel they have a choice about courses of action. Give rationale for all that it is said and done to help adolescents feel a sense of control. Approach them with respect, tact, openness, and flexibility to elicit their attention and encourage their responsiveness to teaching-learning situation. Expect negative responses, which are common when their self-image and self integrity are threatened.

119. Avoid confrontation and acting like an authority figure.

120. LONG-TERM LEARNING Accept adolescents personal fable and imaginary audience as valid, rather than challenging their feelings of uniqueness and invincibility. Acknowledge that their feelings are very real because denying them their opinions simply will not work. Allow them the opportunity to test their own convictions.

121. ADULT Young adult stage (20-40 Years of Age) Middle-aged adult stage (40-64 Years of age) Older adult stage (65 Years of Age and above) Andragogy – is the art and science of teaching adults.

122. Adult learn best when: Learning is related to an immediate need, problem, or deficit. Learning is voluntary and self-initiated. Learning is person centered and problem centered. Learning is self-controlled and self-directed. The role of the teacher is one of facilitator. Information and assignments are pertinent.

123. New materials draws on past experiences and is related to something the learner already knows. The threat to self is reduced to a minimum in the educational situation. The learner is able to participate actively in the learning process. The learner is able to learn in a group. The nature of the learning activity changes frequently. Learning is reinforced by application and prompt feedback.

124. Young Adulthood(20-40 Years of Age) Physical, Cognitive, and Psychosocial Development Physical – During this this period, physical abilities for most young adults are at their peak, and the body is at its optimal functioning capacity. Cognitive – the cognitive capacity of young adults is fully developed, but with maturation, they continue to accumulate new knowledge and skills from expanding reservoir of formal and informal experiences. Psychosocial – Erikson describes the young adult’s stage of psychosocial development as the period of intimacy versus isolation.

125. Teaching Strategies The nurse as educator must find a way of reaching and communicating with this audience about health promotion and disease prevention measures. It is important for the nurse as educator to allow them the opportunity for mutual collaboration in health education decision making. They should be encouraged to select what to learn, how they want material to be presented and which indicators will be used to determine the achievement of learning goals.

126. It is important to draw on their experiences to make learning relevant, useful, and motivating. Making them aware of health issues and learning opportunities can occur in a variety of settings, such as physicians’ offices, community clinics, outpatient departments, or hospitals.

127. Group discussion is an attractive method for teaching and learning because it provides young adults with the opportunity to interact with others with similar age and situation.

128. Middle-Aged Adults ( 41-64 yrs. old)

129. Middle-Aged Adults It is the years of stability and consolidation It is the time when children have grown and moved away from home. They have time to share their talents, serves as mentors for others and pursue new interests. It is the time wherein they are mature enough to assume responsibility in a realistic manner and make decisions for themselves.

130. Physical development During this stage of maturation, a number of physiological changes begin and others affect middle-aged adults self-image, ability to learn, and motivation for learning about health promotion, disease prevention and maintenance of health. The menopausal period

131. Menopause refers to the so-called change of life in women Andropause (climacteric) denote the change in sexual response in men

132. Psychosocial development Generativity versus Stagnation (Erikson, 1963) Developing all the factors that may cause them to become aware of their own mortality. The later years are the phase in which productivity and contributions to society are valued. It is also the years of retirement

133. Cognitive development Formal operations Piaget maintained that cognitive development stopped with this stage that was achieved during adolescence. Postformal operations the adult thought processes go beyond logical problem solving.

134. Dialectical thinking I t is the ability to search for complex and changing understanding to find a variety of solutions to any given situation or problem.

135. Teaching Strategies for Middle-Aged Adults

136. Midlife crisis issues : Menopause Physical changes in their bodies Own parents declining health status How finite their life really is

137. OLDER ADULTHHOOD (65 Years of Age and Oder)

138. PHYSICAL, COGNITIVE, AND PSYCHOSOCIAL DEVELOPMENT Physiological Changes The senses of sight, hearing, touch, taste and smell are usually the first areas of decreased functioning noticed by adults. The perceptive abilities that relate most closely to learning capacity are visual and auditory changes. Physiological changes affect organ functioning and result in decreased cardiac output, lung performance and metabolic rate.

139. Cognitive changes Two kinds of intellectual ability Crystallized intelligence Fluid intelligence Psychosocial Changes Erikson (1963) labeled the major psychosocial developmental task at this stage in life as ego integrity versus despair.

140. Teaching strategies : Physical Needs 1. To compensate for visual changes , teaching should be done in an environment that is brightly lit but without glare. Visual aids should include large print, well-spaced letters, and the use of primary colors. Use white or off-white, flat matte paper and black print for posters, diagrams, and other written materials.

141. Because of older persons’ difficulty in discriminating certain shades of color, avoid blue, blue-green and violet hues. Additional accommodations should be made to meet physical needs, such as arranging seats so that the learner is reasonably close to the instructor and to any visual aids that may be used. For patients who wear glasses, be sure they are readily accessible, lenses are clean, and frames are properly fitted.

142. 2. To compensate for hearing losses , eliminate extra noise, avoid covering your mouth when speaking, directly face the learner and speak slowly. Female instructors should wear bright lipstick, and male teachers can wear lip gloss. Low –pitched voices are heard best, but do not drop your voice at the end of your words or phrases. When addressing a group, microphones are useful aids. Ask for feedback from the learner to determine whether you are speaking too softly, too fast or not distinctly enough.

143. 3. to compensate for musculoskeletal problems, decreased efficiency of the cardiovascular systems, and reduced kidney functions. Keep sessions short, schedule frequent breaks to allow for use of bathroom facilities. Allow time for stretching to relieve painful, stiff joints and to stimulate circulation. Also provide comfort seating.

144. Cognitive needs 1. to compensate for a decrease in fluid intelligence, provide older persons with more opportunity to process and react to information and to see relationships between concepts. Wait for a response before introducing a new concept or word definition. For decrease short-term memory, coaching and repetition are very useful strategies that assist with recall.

145. 2 . be aware of the effects of medications and energy levels on concentration, alertness and coordination. 3. be certain to ask what an individual already knows about a healthcare issue or technique before explaining it. 4. Find out about older persons’ health habits and beliefs before trying to change their ways or teach something new.

146. Psychosocial needs 1. assess the family relationships to determine how dependent the older person is on other members for financial and emotional support. With permission to the patient, include the family members in teaching sessions enlist their support. 2. determine availability of resources. 3. encourage active involvement of older adults to improve their self-esteem and to stimulate them both mentally and socially.

147. Developing a Course Outline or syllabus A course outline or syllabus is considered a contract between the teacher and the learner. Follow what’s in the outline To protect you legally, you may include in the statement at the end of the outline that state changes in course material or evaluation may b necessary at times. But the learners will be notified in writing of changes

148. General guidelines in formulating course outline Course outline should include the : 1.Course 2.Name of the Instructor 3.A one- paragraph course description 4.And a list of objectives 5.Topical outline 6.Teaching methods to be used 7.textbook or other readings 8. Methods of evaluation 9.Classroom policy if necessary

149. Developing of Teaching Plans Teaching plan –it is a blueprint to achieve the goal and the objectives that have been developed.

150. Developing a teaching plan: 1.Elements 2. Objectives 3.Strategies and Methodologies 4.Resources 5.Evaluation

151. The following example of consistency among the first three elements of teaching plan: Purpose: To provide mothers of male newborns with the information necessary to perform post circumcision care . Goal : The mother will independently manage post circumcision care for her baby boy. Objective : Following a 20 minutes teaching session, the mother will be able to demonstrate the procedure for post circumcision

152. Taxonomy of Objectives by Bloom (1984) 1.Cognitive (knowing) - you can measure knowledge, comprehension,, application, analysis, synthesis, and evaluation by written or oral test 2.Psychomotor (doing) - you can observe what the learners are actually doing when they perform a skill - learners can demonstrate what they’ve learned and you can rate their performance 3.Affective ( feeling,valuing )- not easy to measure

153. Eight Basic Elements of Teaching Plan: Purpose (the why of the educational session) Statement of the overall goal List of Objectives An outline of the content to be covered in the teaching session Instructional Method (s) used for teaching related content Time allotted for the teaching of each objective Instructional resources (materials, tools and equipment)needed Method (s) used to evaluate learning

154. Formulating Objectives Write objective that the meaning is not just for you but also for the learners Objectives should reflect what the learner is supposed to do with what is taught

155. The value of objectives 1.You need to guide you in your selection and handling of course materials 2.Need objectives to help you determine whether people in the class have learned what you have tried to teach 3.Objectives are essential from the learners perspective.

156. Wording of the objective Should contain the following 1.Intended learner 2.The behavior to be performed 3. The conditions under which it is performed 4. And the expected degree of attainment of specific standards Ex. The nurse will list and explain, with 95 percent accuracy, the parameters by which effective hemodialysis is measured

157. Behavioral Verbs Useful for Writing Objectives Cognitive domain Knowledge: define, delineate, describe, identify, list, name, state Comprehension; Classify, discuss, estimate, explain, rephrase, summarize Application; Adjust, apply, compute, demonstrate, generate, prove Analysis: Analyze, compare, contrast, critique, defend, differentiate

158. Synthesis; create, develop, propose, suggest, write, Evaluation: assess, choose, conclude, defend, evaluate, judge Psychomotor domain : Arrange, assemble, calibrate, copy, correct, create, demonstrate, execute, show, sole, position Affective ; Accept, agree, choose, comply, defend, explain, influence integrate, recommend, resolve, volunteer

159. Selecting content The general guidelines for course content are usually prescribed by the curriculum of the school, health agency or proprietary agency -it is generally left to instructors discretion to determine exactly what to include on Particular topic and what can safely be skipped

160. Guidelines in selecting content 1.How much information you should include and into how much detail you should go - how much time you can devote to the topic - kind of background the students have 2.Plan the it out and then rehearse it orally

161. Selecting teaching Methods Selection of teaching methods is one of the most complex parts of teaching yet it receives the least attention in instructional planning

162. Factors affecting Choice of Method 1.Selection of methods depends on the objectives and type of learning you are trying to achieve 2.Course content also dictates methodology to some extent 3.Choice of teaching strategy depends on the abilities and interests of the teacher 4.Compatibility between teachers and teaching methods is important 5.Number of people in the class 6.Educators instructional options are limited to resources of the institution

163. Teaching Strategies and Methodologies 1.Traditional Teaching Strategies A. lecturing a. traditional oral essay b. participatory lecture c. lecture with uncompleted handouts d. the feedback lecture e. mediated lecture B. Discussion – formal or informal C. Questioning D. Using Audiovisuals- handouts, chalkboards/whiteboards, overhead transparencies, slides, videotapes, E. Interactive Lecture- combination of above strategies

164. 2.Activity –Based Learning Strategies a. cooperative learning-.learners work together and are responsible for not only their own learning but also for the learning of other group members. b. Simulations - controlled representations of reality. They are exercises that learners engage n to learn the real world without the risks of the real world. b.1 Simulation Exercises- : A controlled presentation of a piece of reality that learners can manipulate to better understand the corresponding real situation

165. b. 2 Simulation Game: A game that represents real-life situations in which learners compete according to set of rules in order to win or achieve an object. b.3 Case study- An analysis of an incident or situation in which characters and relationships are described , factual, or hypothetical events transpire, and problems need to b resolved or solved. b.4 role playing- it is a form of drama in which learners spontaneously act out roles in an interaction involving problems or challenges in human relations

166. b.5 Demonstration and Return Demonstration – Demonstration by educator ,return demonstration by the learner C. Team Based Learning- -offers educators a structured, student centered learning environment.it meant to enrich the student’s learning experience through active learning strategies. D. Seminars E. One –to-one- Instruction- (formal or non formal) involves face to face delivery of information specifically designed to meet the needs of an individual learner.

167. 3.Self –Learning Modules or Self Directed learning Modules, Self –paced learning modules – a self contained

168. Choosing A textbook -texts should provide a stable and uniform source of information for students to use in their individual study When choosing a textbook evaluate the content scope and quality, credibility of authorship, format, and issues like cost, permanency, quality of print, and the like Examine book’s appearance Consider in which the book will be used. Consider the use of the textbooks

169. Conducting the class -Introduce yourself Tell the class about yourself Establish a pleasant environment by welcoming the class, reading names and getting correct pronunciation Make sure that everyone gets the handout and commiserating about the early or late hour, the weather the parking A little humor is helpful

170. The first session is the best time to communicate your expectations for the course Review the course syllabus or the course content and take time to answer questions about content, methods, and assignments - give the class general idea of workload and your expectations in terms of preparation for class and in terms of learning outcomes -cover general classroom rules - communicate your enthusiasm for the subject by the end of the first class

171. Subsequent classes Begin by controlling the attention of the learners before you start to teach (whistle or a look) Walk around the periphery of the room instead of standing behind the desk or lectern - Assess the learners to determine backgrounds and how much they already know about the content course -

172. Techniques to enhance the effectiveness of verbal presentations: 1.Present Information enthusiastically 2.Include Humor 3. Exhibit Risk-Taking Behavior 4.Serve as a Role Model 5.Use Anecdotes and Examples 6. Use technology

173. General Principles for Teaching Across Methodologies: 1.Give positive reinforcement 2. Project an attitude of acceptance and sensitivity 3.Be organized and give direction 4.Elicit and give feedback 5.Use Questions 6.Use the teach –back or tell-back strategy 7.Know the audience 8.Use repetition and pacing- pacing refers to the speed at which information is presented 9.Summarize important points

174. 4.Resources or instructional materials- the tools used in educational lessons, which includes active learning and assessment. Basically, any resource a teacher uses to help him teach his students is an instructional material.

175. Three major variables in selecting instructional materials (LMAT) 1.Charactersitics of the learner 2.Characteristics of the medium 3.Characteristics of the task

176. Types of Instructional Materials 1.Written Materials- handouts such as leaflets, books, pamphlets, and instruction sheets 2.Commercially Prepared Materials- br0chures,posters, pamphlets, 3.Self-Composed Materials -

177. Evaluation - summative - formative Documentation

178. Ethico -Moral and Legal Foundations of Client Education Definition of Terms Ethics- refers to the guiding principles of behavior - it is the area of philosophic study that examines values, actions and choices to determine right and wrong. - It is defined as a system or valued behaviors and beliefs that governed conduct appropriate for all members of a group to ensure the rights of an individual. Ethical – refers to norms or standards of behaviours accepted by the society to which a person belongs

179. Moral Values- refer to internal belief system Ethical dilemmas – specific type of moral conflict in which two or more ethical principles apply but mutually inconsistent course of action

180. Legal Rights and Duties – refer to rules governing behaviors or conduct that are that are enforceable by law under threat of punishment or penalty, such as a fine, imprisonment or both. Practice Acts- are documents that define a profession, describe that a profession’s scope of practice, described that profession’s scope of practice and provide guidelines for state professional boards of nursing regrading standards for practice, entry into a profession via licensure, and disciplinary actions that can be taken when necessary.

181. Code of Ethics for Nurses 1.Honorthe human dignity of all patients and coworkers 2.Establish appropriate nurse- patient boundaries, and focus on interdisciplinary collaboration 3. The nurse-patient relationship is grounded in privacy and confidentiality 4. The nurse is accountable for the personal actions and the behaviors of those persons to whom the nurse has delegated responsibilities

182. 5.The nurse is responsible of maintaining competence ,preserving integrity and safety, and continuing personal growth 6. The nurse has a responsibility to deliver high quality care to patients 7.The nurse contributes to the advancement of the profession 8.The nurse participates in global efforts for both health promotion and disease prevention 9.Involvement in professional nursing organizations supports the development of social policy.

183. In order to provide universality on the practice of code of ethics, the Internal Council of Nurses made a code of ethics that served as the basis of standard of practice of nurses worldwide. This was first adopted in 1953 and recently revised in 2006.

184. The Code of Ethics for Filipino Nurses was made after a consultation on October 23, 2013 at Iloilo City after accredited professional organizations decided to adopt a new Code of Ethics under the RA 9173.

185. Application of Ethical Principles to Patient Education Six major Ethical Principles : Autonomy – refers to right of self determination -it the personAL choice control that an individual has as he goes through life (even death) - greek word auto “self” - nomos “law Laws: 1.Patient Self- Determination Act (PSDA) which was passed by Congress in 1991- this law require that, either at the time of the hospital admission or prior to the initiation of care or treatment in a community health setting

186. in PSDA LAW ,every individual receiving health care be informed in writing of the right under state law to make decisions about his or her health care, including the right to refuse medical and surgical and the right to initiate advance directives.

187. Key components of autonomy include; An intention to choose actions Understanding of the choices Action without interference or control The principle of autonomy is demonstrated by the use of informed consent

188. Certain situations may limit autonomy: 1. When the rights of one person interfere with the rights of another 2. When there’s a high probability that a person may injure himself or others.

189. 2. Veracity or truth telling – is closely linked to informed decision making and informed consent. - role of the nurse is expert witness - the nurse must always tell the truth and the patient is always entitled to the truth.

190. Four elements of Informed Consent 1.Competence- which refers to the capacity of the patient to make a reasonable action 2. Disclosure of Information, which requires that sufficient information regarding risks and alternative treatments- including no treatment at all- be provided to the patient to be enable him or her to make a rational decision

191. 3. Comprehension, which speaks to the individual’s ability to understand or grasp intellectually the information being provided. 4. Voluntariness, which indicates that the patient can make a decision without coercion or force from others.

192. 3. Confidentiality- refers to personal information that is entrusted and protected as privileged information via a social contract, healthcare standard or code or legal covenant. - health providers may not disclose any information of the patient without consent of the patient - exceptions, when a patient has been the victim or subject of a crime to which the nurse or doctor is a witness, when nurses or other health professionals suspect or are aware of child or elder abuse, narcotic use, legally reported communicable diseases, gunshot or knife wounds or the threat of violence towards someone.

193. 4.Non Maleficence- is defined as “do no harm” - this refers to the obligation to inflict no harm to others, it involves intention or unintentional - this refers to the ethics of legal determinations involving negligence and/or malpractice Negligence is defined as conduct which falls below the standard established by law for the protection of others against unreasonable risk of harm. - it involves the conduct of professionals that falls below professional standard of due care

194. For a negligence to exist there must be; A duty between the injured party and the person whose actions (or nonactions ) cause the injury A BREACH OF THAT DUTY must have occurred, it must have been t he immediate cause of the injury, The injured party must have experienced damaged from the injury

195. Malpractice – refers to a limited class of negligent activities committed within the scope of performance by those pursuing a particular profession involving highly skilled and technical services.

196. Most common causes of malpractice; Failure to follow standards of care Failure to use equipment in a responsible manner Failure to communicate Failure to document Failure to assess and monitor Failure to act as patient advocate Failure to delegate tasks properly

197. 5. Beneficence – is defined as “doing good” for the benefit of others - It is a concept that is legalized through properly carrying out critical tasks and duties contained in a job description; in policies, procedures, and protocols set forth by the healthcare facilities; and in standards and codes of ethical behaviors established by professional nursing organizations.

198. 6.. Justice – speaks to fairness and the equitable distribution of goods and services. - fairness or the obligation to be fair to all people. - THE LAW IS THE JUSTICE SYSTEM - the focus of the law is the protection of the society - the focus of health law is the protection of the consumer

199. Criteria in Decision making for the fair distribution of resources: 1.To each, an equal share 2.To each, according to need 3.To each, according to effort 4.To each according to contribution 5.To each, according to merit 6.To each, according to the ability to pay

200. Laws ; REPUBLIC ACT NO. 8344, OTHERWISE KNOWN AS "AN ACT PENALIZING THE REFUSAL OF HOSPITALS AND MEDICAL CLINICS TO ADMINISTER APPROPRIATE INITIAL MEDICAL TREATMENT AND SUPPORT IN EMERGENCY OR SERIOUS CASES, AMENDING FOR THE PURPOSE BATAS PAMBANSA BILANG 702, OTHERWISE KNOWN AS AN ACT PROHIBITING THE DEMAND OF DEPOSITS OR ADVANCE PAYMENTS FOR THE CONFINEMENT OR TREATMENT OF PATIENTS IN HOSPITALS AND MEDICAL CLINICS IN CERTAIN CASES"

201. The Patient's Bill of Rights - was first adopted by the American Hospital Association (AHA) in 1973 and revised in October 1992 -were developed with the expectation that hospitals and health care institutions would support these rights in the interest of delivering effective patient care -AHA encourages institutions to translate and/or simplify the bill of rights to meet the needs of their specific patient populations and to make patient rights and responsibilities understandable to patients and their families.

202. - a patient's rights can be exercised on this or her behalf by a designated surrogate or proxy decision-maker if the patient lacks decision-making capacity, is legally incompetent, or is a minor.

203. Bill of Rights 1.The patient has the right to considerate and respectful care. 2.The patient has the right and is encouraged to obtain from physicians and other direct caregivers relevant, current, and understandable information about his or her diagnosis, treatment, and prognosis.

204. 3.Except in emergencies when the patient lacks the ability to make decisions and the need for treatment is urgent, the patient is entitled to a chance to discuss and request information related to the specific procedures and/or treatments available, the risks involved, the possible length of recovery, and the medically reasonable alternatives to existing treatments along with their accompanying risks and benefits.

205. 4.The patient has the right to know the identity of physicians, nurses, and others involved in his or her care, as well as when those involved are students, residents, or other trainees. The patient also has the right to know the immediate and long-term financial significance of treatment choices insofar as they are known.

206. 5. The patient has the right to make decisions about the plan of care before and during the course of treatment and to refuse a recommended treatment or plan of care if it is permitted by law and hospital policy. The patient also has the right to be informed of the medical consequences of this action. In case of such refusal, the patient is still entitled to appropriate care and services that the hospital provides or to be transferred to another hospital. The hospital should notify patients of any policy at the other hospital that might affect patient choice

207. 6. The patient has the right to have an advance directive (such as a living will, health care proxy, or durable power of attorney for health care) concerning treatment or designating a surrogate decision-maker and to expect that the hospital will honor that directive as permitted by law and hospital policy .

208. 7. Health care institutions must advise the patient of his or her rights under state law and hospital policy to make informed medical choices, must ask if the patient has an advance directive, and must include that information in patient records. The patient has the right to know about any hospital policy that may keep it from carrying out a legally valid advance directive.

209. 8. The patient has the right to privacy. Case discussion, consultation, examination, and treatment should be conducted to protect each patient's privacy. 9.The patient has the right to expect that all communications and records pertaining to his/her care will be treated confidentially by the hospital, except in cases such as suspected abuse and public health hazards when reporting is permitted or required by law. The patient has the right to expect that the hospital will emphasize confidentiality of this information when it releases it to any other parties entitled to review information in these records.

210. 10.The patient has the right to review his or her medical records and to have the information explained or interpreted as necessary, except when restricted by law. 11.The patient has the right to expect that, within its capacity and policies, a hospital will make reasonable response to the request of a patient for appropriate and medically indicated care and services. The hospital must provide evaluation, service, and/or referral as indicated by the urgency of the case. When medically appropriate and legally permissible, or when a patient has so requested, a patient may be transferred to another facility. The institution to which the patient is to be transferred must first have accepted the patient for transfer. The patient also must have the benefit of complete information and explanation concerning the need for, risks, benefits, and alternatives to such a transfer.

211. 12.The patient has the right to ask and be told of the existence of any business relationship among the hospital, educational institutions, other health care providers, and/or payers that may influence the patient's treatment and care.

212. 13.The patient has the right to consent to or decline to participate in proposed research studies or human experimentation or to have those studies fully explained before they consent. A patient who declines to participate in research or experimentation is still entitled to the most effective care that the hospital can otherwise provide.

213. 14.The patient has the right to expect reasonable continuity of care and to be informed by physicians and other caregivers of available and realistic patient care options when hospital care is no longer appropriate.

214. 15.The patient has the right to be informed of hospital policies and practices that relate to patient care treatment, and responsibilities. The patient has the right to be informed of available resources for resolving disputes, grievances, and conflicts, such as ethics committees, patient representatives, or other mechanisms available in the institution. The patient has the right to be informed of the hospital's charges for services and available payment methods.

215. The effectiveness of care and patient satisfaction with the course of treatment depends, in part, on the patient's fulfilling certain responsibilities; 1. Patients are responsible for providing information about past illnesses, hospitalizations, medications, and other health-related matters. . 2.Patients must take responsibility for requesting additional information or clarification about their health status or treatment when they do not fully understand the current information or instructions.

216. 4.Patients are responsible for making sure that the health care institution has a copy of their written advance directive if they have one. 5.Patients are responsible for informing their physicians and other caregivers if they anticipate problems in following prescribed treatment.

217. 6.Patients also should be aware that the hospital has to be reasonably efficient and equitable in providing care to other patients and the community. The hospital's rules and regulations are designed to help the hospital meet this obligation. 7.Patients and their families are responsible for being considerate of and making reasonable accommodations to the needs of the hospital, other patients, medical staff, and hospital employees.

218. 8.Patients are responsible for providing necessary information for insurance claims and for working with the hospital as needed to make payment arrangements. 9.A patient's health depends on much more than health care services. Patients are responsible for recognizing the impact of their lifestyles on their personal health.

219. Role of the Nurse as Health Educator 1.Giver of information 2.Facilitator of learning 3.Coordinator of teaching 4.Advocate for the client

220. Role of the other members of the health team

221. Role of the Family in Health Education - is considered one of the key variables influencing positive patient care outcomes - primary motives in patient education for involving family members in the care delivery and decision making process are to decease the stress of hospitalization, reduce costs of care, increase satisfaction with care, reduce hospital re admissions and effectively prepare the patient for self care management outside the healthcare setting

222. Family role enhancement and increased knowledge on the part of the family have positive benefits for the learners as well as the teachers, - patients derive increased satisfaction and greater independence in self- care, and nurses experience increased job satisfaction and personal gratification in helping patients to reach their potential and achieve successful outcomes

223. - the family is the educator’s greatest ally in preparing the patient for discharge and in helping the patient for discharge and in helping the patient to become independent in self- care.