Perspective on Teaching and Learning – OVERVIEW OF EDUCATION IN HEALTH CARE

Purposes, Goals and Benefits of Patient and Nursing Staff/Student Education

Patient Education

Purpose: To increase the competence and confidence of clients for self-management

Primary goal: To increase the responsibility and independence of clients for self-care

Nursing Staff/Student Education

Purpose: To increase the competence and confidence of nurses to function independently in providing
care to the consumer & to improve the quality of care delivered by nurses.

Primary aims: To nourish clients, mentor staff, and serve as teachers, clinical instructors, and preceptors
for nursing students & value their role in educating others and make it a priority for their patients, fellow
colleagues, and the future members of the profession.
Ultimate goal: To enhance the practice of Nursing

Benefits:
Increase consumer satisfaction
Improve quality of life
Ensure continuity of care
Decrease patient anxiety
Effectively reduce the complications of illness and the incidence of disease
Promote adherence to treatment plans.
Maximize independence in the performance of activities of daily living.
Energize and empower consumers to become actively involved in the planning of their care.

Historical Foundations for Patient Education in Health Care Teaching Role of Nurses
Benefits:
Increased job satisfaction
Enhanced patient–nurse autonomy
Increased accountability in practice
Opportunity to create change that really makes a difference in the lives of others
Also called association learning or classical/Pavlovian conditioning

Applying Learning Theories to Healthcare Practice PART 1 & 2

Learning
Is a relatively permanent change in mental processing, emotional functioning, and behavior as a result of
experience.

Learning Theory
Is a coherent framework of integrated constructs and principles that describe, explain, or predict how
people learn.

Contribution of Learning Theories

Provide information and techniques to guide teaching and learning.

Can be employed individually or in combination.
Can be applied in a variety of settings as well as for personal growth and interpersonal relations.

LEARNING THEORIES TO HEALTH EDUCATION

1. Behaviorist learning theories

2. Cognitive theory
3. Social theory
4. Psychodynamic theory
5. Humanistic theory

1. Behaviorist learning theory

Learning is the result of connections made between the stimulus conditions in the environment (S) and
the individual’s responses (R)—Sometimes termed S-R model of learning.

Approaches the study of learning by focusing on behaviors that can be observed , measured, and
changed.

To encourage people to learn new information or to change their attitudes and responses, behaviorists
recommend altering conditions in the environment and reinforcing positive behaviors after they occur.
Behaviorist learning theory

1- Respondent conditioning
Emphasizes the importance of stimulus conditions in the environment and the associations formed in the
learning process.

2- Operant conditioning
Focuses on the behavior of the individual and the reinforcement that occurs after the response.

Learning or conditioning is quite simple:

1- Respondent conditioning

Example:
someone without experience in hospital---(NS)
Visit sick pt. …..smell odors---(UCS)
that make him feel queasy (nauseous) and light headed---(UCR)
After his first visit, his subsequent visit to hospital—(CS) become associated with feeling anxious and
nauseated—(CR)
Especially if the visitor smells odors similar to those encountered during the first experience.
Principle of Respondent conditioning

May provide the basis for long-lasting attitudes toward medicine, healthcare facilities, and health
professionals.
Used to get rid of or extinguish (switch off) a previously learned response, which has been found to be
especially useful in teaching people to reduce their anxiety or break bad habits.
Teacher encourage the learner to build new associations for learning.
In health care, respondent conditioning has been used to treat addiction, phobias, and tension

2- Operant conditioning

To increase learning, is to apply positive reinforcement or rewards after the behavior occurs.

To decrease a bad habits, is accomplished by using either non reinforcement or punishment.

If non reinforcement does not work, then punishment may be employed as way to decrease responses.
There are a risks to use punishment—learner may become so emotionally upset (ashamed, sad, or
angry).
To be effective, it is necessary to assess what kinds of reinforcement are likely to increase or decrease
the behaviors to each individual.

Operant conditioning has been found to work well with nursing home and long-term care residents
and with patients who are not very verbal or do not engage in much thought or reflection
The success of operant conditioning partially depends on when the enforcement is applied. In early
stages learning needs to be reinforced every time it occurs
Learning occurs as the organism Responds to S- stimuli in the environment and is reinforced for making a
particular response.
A REINFORCER is applied after a Response strengthens the probability that the response will be
performed again under similar conditions.
Example of Positive Reinforcement (PR)

Nurse diligently go to work everyday because she gets a paycheck every month

SUMMARY of BEHAVIORIST LEARNING:

1- Focus on the learner’s drives, the external factors in the environment that influence a learner’s
associations, and on reinforcements that increase or decrease responses.

2- The teacher’s task is first to assess conditions in the environment that lead to specific responses.
3 - Then teachers must effectively manipulate conditions to build new associations, provide appropriate
reinforcement, and allow for practice to strengthen connections between stimuli in the environment and a
person’s responses or behavior.

2. The Cognitive Theory

Cognition is: The mental activities involved in thinking, knowing, & remembering

In contrast to behaviorist theory, cognitive theory focuses on what goes on “inside” the learner.

Especially learners’:
~Perception
~Thought
~Memory and
~Ways of processing and
~Structuring information

According to this perspective for individual to learn, they must change their perception and thoughts and
form a new understanding and insights.

Cognitive Learning Theory:

Cognitive theorists , unlike behaviorists, maintain that reward is not necessary for learning.
More important are learners’ goals and expectations, which create disequilibrium, imbalance, and tension
that motivate them to act and learn.
Learning involves perceiving the information, interpretation, and reorganizing information into new
insights.
Cognitive development is an interactive process in which a variety of new experiences must exist before
intellectual abilities can develop.
Cognitive Learning Theory Perspectives

Cognitive learning theory

Principles of cognitive learning theory:

Focus on internal factors within learners, such as their developmental stage of reasoning, perceptions,
thoughts, ways of processing and storing information in memory, and the influence of social factors on
attitudes, thoughts, and actions

The role of the teacher is to assess learner’s developmental stage, goal & expectations, preferred style,
then organize learning experience to be meaningful and keep learning simple and at appropriate level

3. Social Learning Theory

Learning is often a social process, and other individuals, especially “significant others,” provide
compelling examples or role models for how to think, feel, and act.
Social Learning Theory

Principles of social learning theory:

1- Focus on role model, the reinforcement that a model has received, the social environment since much
of the learning occurs by observation, watching others & learning what happens with them.

2- The role of the teacher is to act as a typical role model, to use effective role models in teaching that
are rewarded for their behavior, to assess the internal self-regulation of the learner, to provide feedback
for learner’s performance

Social learning theory focuses on the learning that occurs within a social context. It considers that people
learn from one another, including such concepts as observational learning, imitation, and modeling.

Bandura’s principles (1977)

Albert Bandura is considered the leading proponent of this theory.

There are four steps, which are internal processes that direct social learning

1. ATTENTION PHASE: attention to role models that are high status.

2. RETENTION PHASE: the storage and retrieval of what was observed.
3. REPRODUCTION PHASE: learner copies the observed behavior.
4. MOTIVATION PHASE: whether the learner is motivated to perform the learned behavior.

4. Psychodynamic theory

Principles of the Psychodynamic theory

1- Focus on learner’s personality development, significant childhood experiences, conscious and

unconscious motivations, id(social values and standards taught)-ego(self) –superego(integrity, morality)
conflicts and defensive behaviors

2- The teacher’s role is to listen, ask probing questions about motivations and wishes, assess emotional
barriers to learning, and make learning pleasurable while working to promote ego strength in learners
5. Humanistic theory

The assumptions that each individual is unique and that all individuals have a desire to grow in positive
way

According to humanistic, feeling and emotions are the keys to learning, communication, and
understanding.

Learning occurs on the basis of a person’s motivation, derived from needs, the desire to grow in positive
ways, self-concept, and subjective feelings.

Learning is facilitated by caring facilitators and a nurturing environment that encourage spontaneity,
creativity, emotional expression, and positive choices

One of the best-known humanistic theorist is Abraham Maslow

Humanistic theory

Principles of learning:
1- Focus on the learner’s desire for positive growth, subjective feelings, needs, self- concept, choices in
life, and interpersonal relationships

2- The teacher’s role is to assess and encourage changes in learner’s concept, and feelings by providing
support, freedom to choose, and opportunities for creativity

Experiences that affect learning

Educator must be knowledgeable

Learner’s past experience
Lack of clarity and meaningfulness on what is to be learned, neglect, poor role models, confusing
reinforcement, inappropriate materials for learner’s ability.
To ensure learning is permanent

-Organize the learning experience

-Make it meaningful
-Pace the presentations
-Practicing new information
-Reinforcement
-Assess and evaluate learning

Application of learning theories

Each theory emphasis certain aspects of learning

We can use one or a combination of more than one
Behaviorists focus on stimulus conditions and pay attention to reinforcement, manipulating environment,
Social learning theory stresses role models that would demonstrate the behavior use the theory according
the type of the learner, a passive learner might benefit more from a behaviorist approach.

GENERALIZATIONS ABOUT LEARNING

Learning is a function of physiological and neurological developmental changes.

Brain processing is different for each learner.
Learning is active, multifaceted, and complex.
Meaningful practice strengthens learning connections.
Stress can interfere with or stimulate learning.

Learning Hindrances

Ignoring common considerations may hinder learning. Other learning hindrances:

Inappropriate materials for learner’s ability, readiness to learn, or stage of development.

Detrimental socialization experiences.
Non stimulating environment.
Lack of goals or realistic expectations.

Lack of clarity and meaningfulness to what is being learned.

Fear, neglect, or harsh punishment.
Negative or ineffective role models.

Determinants of Learning

Numerous factors make the nurses

role challenging in meeting this information needs such as:

1. Short length of stay

2. Difference in educational levels
3. Time constraints
4. Varied staffing patterns
5. Part – time employment
6. Varied job functions
7. Age differences

EDUCATOR’S ROLE IN LEARNING

The role of educating others is one of the most essential interventions that a nurse performs.

The learner – not the teacher is the single most important person in the education process.

The educator plays a crucial role in the learning process by:

Assessing problems or deficits

Providing information in unique ways
Identifying progress made
Giving feedback and follow-up
Reinforcing learning
Determining education effectiveness

Assessment of the Learner

Nurses are taught that any nursing intervention should be preceded by an assessment. This is the correct
approach.

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.

What makes assessment so significant and fundamental to the educational process?

As an initial step in the process it validates the need for learning and the approaches to be used in
designing learning experiences.

THREE DETERMINANTS OF LEARNING

Three (3) determinants of learning:

The needs of the learner

The state of readiness to learn

The preferred learning styles for processing information.

A. Learning Needs (WHAT the learner needs to learn)

Assessment of Learning Needs

Identify the learner.
Choose the right setting.
Collect data about, and from, the learner.

Methods to Assess Learning Needs

Informal conversations – day to day conversations

Structured interviews – set of questions

Focus groups – 4-12 learners

Questionnaires – checklists

Tests – written or online (pre/post tests)

Observations – used for patterns of behavior

Documentation – progress notes, NCPs, discharge plans or nurses’ notes

Assessing Learning Needs of Nursing Staff

Written job descriptions – what is required to carry out job responsibilities

Formal and informal requests – ideas and needs congruent with educational programs

Quality assurance reports – learning needs coming from safety violations or errors in procedures

Chart audits – help identify trends in practice (inconsistencies, errors in charting, new interventions
implemented

Rules and regulations – knowledge regarding SOPs of the hospital and any changes

Self-assessment – self-directed/self-awareness

Gap analysis – gap in knowledge needs

B. Determining Readiness to Learn (WHEN the learner is receptive to learning)

Educator must understand what needs to be taught, collect and validate information, assess learning
needs.

Timing is important: learner must be ready.

TYPES OF READINESS TO LEARN

P = Physical readiness
E = Emotional readiness
E = Experiential readiness
K = Knowledge readiness

C. Determining Learning Styles

Observation, interviews, and learning style instruments are usually used.

Assessment is best in the educational process.

Educators can then support instruction with materials that guide a variety of styles.

VARK Learning Styles

Four (4) preferences that reflect learning style experiences and preferences of students
Visual – see
Aural – hear
Read/write – written text
Kinesthetic – do
Ethical, Legal, and Economic Foundations of the Educational Process PART 1 & 2

INTRODUCTION

Ethico-moral and legal foundation of client education refers to the ideals that guide one’s behavior.

Refers to the behavioral norms or standards accepted by the society to which a person belongs.

Approximately 40 years ago, the fields of modern western bioethics arose in response to the increasing
complexity of medical care and decision making

A Differentiated View of Ethics, Morality, and the Law

What is Ethics?
It refers to the guiding principles of behavior and ETHICAL refers to norms and standard behavior

What is Moral?
Moral refers to an internal value system (the moral fabric of one’s being) and this value system,
defined as morality, is expressed externally through ethical behavior.

What is Legal?
Legal rights & obligations are laws that control behavior or conduct and are enforced through the
fear of punishment or consequence, such as fine, imprisonment or both.

MORALS refer to the individuals internal beliefs and values that guide their behavior and judgments of
right & wrong.
-Morals are often shaped by personal beliefs, cultural upbringing, religious teachings and individual
experiences.
-Morals are deeply ingrained and can vary from person to person.
ETHICS on the other hand, are broader and more systematic set of guidelines that govern the conduct
and interactions of individuals within a specific group, profession or society.
-Ethics provide a structured framework for evaluating behavior and making ethical decisions that align
with shared values and norms.
-Ethical principles often transcend personal beliefs and focus on universal concepts of fairness, justice,
honesty and respect.

MORALS are more subjective & individual oriented while ETHICS are more objective and are meant to
ensure consistent & responsible behavior within a group

Evolution of Ethical and Legal Principles in Health Care

Charitable immunity - legal doctrine stating that if an organization is deemed to be a charity it might NOT
BE HELD LIABLE for an injury caused by the negligence of an organization's employee.
PRACTICED ACTS

These are documents that define a profession, describes the profession’s scope of practice.
Provide guidelines for:
state professional board of nursing regarding standard for practice
entry to profession via licensure
disciplinary actions that can be taken if necessary

CODE OF ETHICS FOR NURSES

As early as 1950, the American Nurses Association (ANA) developed & adopted an ethical code for
professional practice, titled The Code of Ethics for Nurses. This code of ethics represents an articulation
of nine provisions for professional values and moral obligations with respect to the nurse-patient
relationship and with respect of the profession and its mission. Lachman (2009a, 2009b) outlines these
provisions and further clarifies the nursing role in each provision:

CODE OF ETHICS FOR NURSES:

1. Honor the human dignity of all patients and co workers.

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.
5. The nurse is responsible for maintaining competence, preserving integrity & safety & continuing
personal growth.
6. The nurse has 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 organization supports the development of social policy.

PATIENT’S BILL OF RIGHTS

A statement of the rights to which patients are entitled as recipients of medical care were created and has
been framed and posted in every health care facility

PATIENTS BILL OF RIGHTS:

1. Right to appropriate medical care and humane treatment

2. Right to informed consent
3. Right to privacy and confidentiality
4. Right to information
5. Right to choose Health care provider and facility
6. Right to self determination
7. Right to religious belief
8. Right to Medical Records
9. Right to leave
10. Right to refuse participation in medical research
11. Right to correspondence and to receive visitors
12. Right to express grievances
Right to be informed of His rights and obligations as a patient

LEGAL RIGHT & DUTIES

This refer to rules governing behavior or conduct that are enforceable under threat of punishment or
penalty, such as a fine or imprisonment or both.

Ethics terminology, such as informed consent, confidentiality, non maleficence, and justice, can be found
within the language of the legal system.

6 ETHICAL PRINCIPLES

1. Autonomy – right to self-determination or “self-governance”

2. Veracity – truth telling

3. Confidentiality - refers to personal information that is entrusted and protected as privileged

information via a social contact, healthcare standard or code, or legal covenant.

4. Non-maleficence – “do not harm”.

Negligence

Malpractice

Duty

5. Beneficence – “doing good” for the benefit of others.

6. Justice – fairness and equal distribution of goods and services.

THE ETHICS OF EDUCATION IN CLASSROOM AND PRACTICE SETTINGS

TWO TYPES OF RELATIONSHIP:

1. Student-Teacher Relationship (novice and expert)

2. Patient-Provider Relationship (respect, trust, and caring; professional-personal boundaries)

LEGAL AND FINANCIAL IMPLICATIONS OF DOCUMENTATION

Why is DOCUMENTATION important?

According to Comprehensive Health Planning Act in 1965, Public Law 89-97, 1965 (US) “a hospital has to
show evidence that patient education has been a part of patient care” .

Proper documentation provides written testimony that patient education has indeed occurred.
Documentation is REQUIRED by:

Joint Commission - The Joint Commission is the nation's oldest and largest standards-setting and
accrediting body in health care.

Third-party reimbursement - Insurance companies (or other payers) need detailed documentation of the
care provided to approve and pay claims.

Respondeat superior* - It holds employers responsible for the actions of their employees. Proper
documentation protects both the nurse and the employer in case issues.

Informed consent - shows that the patient was properly informed about a procedure or treatment and
agreed to it. It’s essential for legal and ethical reasons.

Documentation - EMR/EHR - (Electronic Medical Record/Electronic Health Record):

These digital systems are used to store and share patient information securely. Proper documentation in
EMRs/EHRs improves communication among healthcare providers and supports quality care.

Challenge for healthcare providers:

• EFFICIENT AND COST-EFFECTIVE PATIENT EDUCATION.

Balancing comprehensive information delivery with resource constraints.
Time Constraints, Resource Limitations, Diverse Learning Needs

• LEGAL RESPONSIBILITY OF ALL NURSES.

Nurses are ethically and legally required to educate patients about their health conditions,
treatment plans, medications, and self-care strategies.

• LITTLE PREPARATION ON PRE-LICENSURE LEVEL.

sig Teaching skills during nursing education. Many pre-licensure programs focus on clinical and technical
competencies, with less attention given to communication and education strategies.
THERAPEUTIC COMMUNICATION
Therapeutic communication in nursing consists of an exchange between patient and nurse using verbal
and non-verbal cues.
It’s a process in which the healthcare professional consciously uses specific techniques to help patients
better understand their condition or situation.

Therapeutic Communication Techniques

Are specific responses that encourage the expression of feelings and ideas and convey acceptance and
respect.

1. Active Listening
Means being attentive to what a patient is saying both verbally and non-verbally.

SOLER (Townsend 2012)

S - Sit facing the patient

This posture conveys the message that you are there to listen and are interested in what the patient is
saying.

O - Open position (i.e. keep arms and legs uncrossed)

This position suggests that you are "open" to what the patient says. A "closed" position such as crossing
arms conveys a defensive attitude, possibly provoking a similar response in the patient.

L - Lean toward the patient. Conveys that you are involved and interested in the interaction.

E - Eye Contact - Establish and maintain intermittent eye contact to convey your involvement in and
willingness to listen to what the patient is saying.

R - Relax - It is important to communicate a sense of being relaxed and comfortable with the patient.
Restlessness communicates a lack of interest and a feeling of discomfort to the patient.

2. Sharing Observations
Stating observations often helps a patient communicate, without the need for extensive questioning,
focusing or clarification.
Example: "I see you haven't eaten anything." or "You look tired"

3. Sharing Empathy
Empathy - is the ability to understand and accept another person's reality, accurately perceive feelings,
and communicate this understanding to the other. Statements reflecting empathy are highly effective
because they tell a person that you heard both the emotional and the factual content of the
communication.
Example: "It must be frustrating to not be able to do what you want." - A nurse says to an angry patient
who has low mobility after a stroke.

4. Sharing Hope
Nurses recognize that hope is essential for healing and learn to communicate a "sense of possibility" to
others. Appropriate encouragement and positive feedback are important in fostering hope and
self-confidence and for helping people achieve their potential and reach their goals. You give hope by
commenting on the positive aspects of the other person's behavior, performance or response.
Example: "I believe that you'll find a way to face your situation because I've seen your courage
and creativity" - A nurse says to a patient discouraged about a poor prognosis.

5. Sharing Humor
Humor is an important but often underused resource in nursing interaction. It is a coping strategy that can
reduce anxiety and promote positive feelings (Rose et al., 2013). It is a perception and attitude in which a
person can experience joy even when facing difficult times. It provides emotional support to patients and
professional colleagues and humanizes the illness experience.

6. Sharing Feelings
Emotions are subjected feelings that result from one's thoughts and perceptions. Feelings are not right,
wrong, good or bad, although they are pleasant or unpleasant. Sharing emotion makes nurses seem
more human and brings people closer. It is appropriate to share feelings of caring or even cry with others,
as long as you are in control of the expression of these feelings and express them in a way that does not
burden the patient or break confidentiality.

7. Using Touch
Touch is one of the most potent and personal forms of communication. It expresses concern or caring to
establish a feeling of connection and promote healing (Stuart, 2013). Touch conveys many messages
such as affection, emotional support, encouragement, tenderness, and personal attention.

8. Using Silence
Most people have a natural tendency to fill empty spaces with words, but sometimes these spaces really
allow time for a nurse and patient to observe one another, sort out feelings, think about how to say things,
and consider what has been communicated.

9. Providing Information
Providing relevant information tells other people what they need or want to know so they are able to make
decisions, experience less anxiety, and feel safe and secure. Patients have a right to know about their
health status and what is happening in their environment. Information of a distressing nature needs to be
communicated with sensitivity, at a pace appropriate to a patient’s ability to absorb it.
Example: “John your heart sounds have changed from earlier today, and so has your blood
pressure> I’ll let your doctor know”

10. Clarifying
To check whether you understand a message accurately, restate an unclear or ambiguous message to
clarify the sender’s meaning.
Example: “I’m not sure I understand what you mean by ‘sicker than usual.’ What is different
now?”

11. Focusing
Involves centering a conversation on key elements or concepts of a message. If conversation is vague or
rambling or patients begin to repeat themselves, focusing is a useful technique.
Example: We’ve talked a lot about your medications; now let’s look more closely at the trouble
you’re having in taking them on time.”
12. Paraphrasing
Paraphrasing is restating another’s message more briefly using one’s own words. Through paraphrasing
you send feedback that lets a patient know that he or she is actively involved in the search for
understanding.
Example: The patient says, “I’ve been overweight all my life and never had any problems, I can’t
understand why I need to be on a diet.” Paraphrasing is this statement by saying, “You’re not
convinced that you need a diet because you’ve stayed healthy.”

13. Validation
This is a technique that nurses use to recognize and acknowledge a patient’s thoughts, feelings, and
needs. Patients and families know they are being heard and taken seriously when the caregiver
addresses their issues (Harvey and Ahmann, 2014)
Example: “Tell me if I understand your concerns regarding your surgery. You’re worried that you
will not be able to return to your usual way of life.”

14. Asking Relevant Questions

Nurses ask relevant questions to seek information needed for decision making. Ask only one question at
a time and fully explore one topic before moving to another area. Open- ended questions allow patients to
take the conversational lead and introduce pertinent information about a topic.
Example: What’s your biggest problem at the moment? Or “How has your pain affected your life at
home?”

15. Summarizing
Is a concise review of key aspects of an interaction. It brings a sense of satisfaction and closure to an
individual conversation and is especially helpful during the termination phase of a nurse-patient
relationship. It also clarifies expectations.
Example: “You’ve told me a lot of things about why you don’t like this job and how unhappy
you’ve been. We’ve also come up with some possible ways to make things better, and you’ve
agreed to try some of them and let me know if any has helped.”

16. Self Disclosure

Are subjectively true personal experiences about the self that are intentionally revealed to another person.
This is not therapy for a nurse, rather it shows a patient that the nurse understands his experiences and
that they are not unique. Self disclosures need to be relevant and appropriate and made to benefit the
patient rather than yourself.

17. Confrontation
When you confront someone in a therapeutic way, you help the other person become more aware of
inconsistencies in his or her feelings, attitudes, beliefs, and behaviors (Stuart, 2013). Use confrontation
only after you have established trust, and helps him or her recognize growth and deal with important
issues.
ELEMENTS OF THE COMMUNICATION PROCESS
Communication is an ongoing and continuously changing process. Nursing situations have many unique
aspects that influence the nature of communication and interpersonal relationships. As a professional you
will use critical thinking to focus on each aspect of communication so your interactions are purposeful and
effective.

CIRCULAR TRANSACTIONAL MODEL

The Circular transactional model includes several elements; the referent, sender and receiver, message,
channels, context or environment in which the communication process occurs, feedback, and
interpersonal variables. In this model, each person in the communication interaction is both a speaker and
a listener and can be simultaneously sending and receiving messages.
Referent
The referent motivates one person to communicate with another. In a health care setting sights, sounds,
sensations, perceptions, and ideas are examples of cues that initiate the communication process.
Knowing a stimulus or referent that initiates communication allows you to develop and organize
messages more efficiently.
Example: A patient request for help prompted by his difficulty breathing causes a different response than
a patient request resulting from hunger.

Sender and Receiver

The sender is the person who encodes and delivers a message, and the receiver is the person who
receives and decodes the message. The sender puts the message into verbal and nonverbal symbols
that the receiver can understand (Arnold and Boggs, 2011). The sender’s message acts as a referent for
the receiver.

Active listening is important to accurately decode and understand a message. The more the sender and
receiver have in common and the closer the relationship, the more likely they will accurately perceive one
another’s meaning and respond accordingly. Establishing a rapport with a patient ensures effective
communication.

Message
The message is the context of the communication. It contains verbal and nonverbal expressions of
thoughts and feelings. As a nurse, you send effective messages by expressing clearly, directly and in a
manner familiar to a patient. Communication is difficult when participants have different levels of
education and experience.
Example: Statements such as “ Your incision is well approximated without purulent drainage” means the
same as “Your wound edges are close together, and there are no signs of infection”

Channels
Communication channels are means of sending and receiving messages through visual, auditory and
tactile senses.

Feedback
Feedback is the message a receiver receives from the sender. It indicates whether the receiver
understood the meaning of the sender’s message.

Interpersonal Variables
Interpersonal variables are factors within both the sender and receiver that influence communication.
Perception provides a uniquely personal view of reality formed by an individual’s culture, expectations,
and experiences. Each person senses, interprets, and understands events differently. Interpersonal
variables associated with illness such as pain, anxiety, and medication effects also affect nurse patient
communication.

Environment
The environment is the setting for sender- receiver interaction. An effective communication setting
provides participants with physical, emotional comfort and safety. Noise, temperature extremes,
distractions, and lack of privacy or space create confusion, tension and discomfort. Environmental
distractions are common in health care settings and interfere with messages sent between people. You
control the environment as much as possible to create favorable conditions for effective communication.
NURSE - PATIENT RELATIONSHIP
Caring relationships are the foundation of clinical nursing practice. In such relationships you assume the
role of a professional who cares about each patient and his or her unique health needs, human responses
and patterns of living. Therapeutic relationships promote a psychological climate that facilitates positive
change and growth. Therapeutic communication between you and your patients allows the attainment of
health related goals (Arnold and Boggs, 2011). The goals of a therapeutic relationship focus on a patient
achieving optimal personal growth related to personal identity, ability to form relationships, and ability to
satisfy needs and achieve personal goals (Stuart, 2013)
Motivational Interviewing
Is a technique that holds promise for encouraging patients to share their thoughts, beliefs, fears, and
concerns with the aim of changing their behavior. MI provides a way of working with patients who may not
seem ready to make behavior changes that are considered necessary by their health practitioners. When
using MI, a nurse tries to understand a patient’s motivations and values using an empathic and active
listening approach.
COMPLIANCE, MOTIVATION AND HEALTH
BEHAVIORS OF THE LEARNERS
Compliance, motivation, and health behaviors are interconnected concepts that play a significant role in
shaping the attitudes and actions of learners, particularly in educational and health-related contexts. Let's
break down these three aspects and their relationship:

1. Compliance

Compliance refers to the degree to which learners follow prescribed rules, guidelines, or instructions. In
the context of health behaviors, compliance often involves adherence to health-related practices such as:

● Following medical advice (e.g., taking medication, attending appointments)

● Adhering to health-related rules (e.g., school nutrition policies, physical activity guidelines)
● Complying with preventive measures (e.g., vaccinations, wearing masks)

Learners' compliance can be influenced by:

● Perceived relevance: If learners believe the health behaviors are beneficial, they are more likely
to comply.
● External factors: This can include parental influence, teacher authority, or institutional mandates.
● Incentives: Positive reinforcement like rewards or praise can enhance compliance.
● Autonomy: Learners are more likely to comply when they feel they have a sense of control over
their decisions.

2. Motivation

Motivation is a crucial factor that drives learners to engage in specific behaviors, including health-related
actions. Motivation can be intrinsic (coming from within, like a desire to be healthy) or extrinsic (driven
by external rewards or pressures, like avoiding illness or receiving praise).

Health behaviors can be motivated by:

● Personal goals: Learners may be motivated by the desire to improve their fitness, diet, or overall
well-being.
● Social influence: The desire to conform to peer behaviors, family expectations, or societal
norms.
● Educational initiatives: Schools and other educational settings can foster motivation through
curriculum, health education programs, and engagement in healthy lifestyle choices.
● Self-determination: Learners who feel they have the autonomy to choose their health behaviors
are more likely to maintain motivation and act consistently.

3. Health Behaviors of Learners

Health behaviors encompass actions that directly or indirectly influence a learner's physical or mental
well-being. These behaviors can be categorized as:
 ● Preventive behaviors: Regular exercise, healthy eating, adequate sleep, and stress
management practices.
● Intervention behaviors: Seeking medical care when ill, following treatment plans, and engaging
in rehabilitation activities.
● Health-risk behaviors: Smoking, excessive alcohol consumption, and unhealthy eating habits.

The health behaviors of learners are shaped by:

● Educational interventions: Schools and universities that incorporate health education programs
can improve health-related behaviors. Programs that emphasize the importance of balanced
nutrition, physical activity, and mental health can positively influence learners.
● Social and peer influence: Peer groups and social media can play a significant role in shaping
health behaviors. Positive peer influence can encourage healthy choices, while negative
influences might lead to risky behaviors.
● Support systems: Family, mentors, and teachers can encourage and support learners in
adopting healthy behaviors.

Interactions Between Compliance, Motivation, and Health Behaviors:

● Intrinsic motivation can drive compliance with health behaviors. For example, a learner who
values fitness for personal satisfaction is more likely to regularly engage in physical activity,
making their behavior more sustainable in the long term.
● Extrinsic motivation, such as rewards or social pressure, can also lead to compliance, but the
motivation may not be as durable if the external incentives are removed.
● Health behavior modification often requires changes in both motivation and compliance. If
learners are motivated to improve their health but lack the compliance to follow through with
necessary actions, interventions may be needed to improve adherence.
● Feedback and reinforcement are important in maintaining motivation. When learners see
positive outcomes from their health behaviors (e.g., improved fitness, better mood), they are more
likely to continue engaging in them. Likewise, non-compliance can be addressed by providing
constructive feedback and reinforcing positive behaviors.

Strategies for Enhancing Compliance, Motivation, and Health Behaviors:

● Goal setting: Help learners set realistic and attainable health goals. These goals should be
specific, measurable, and personally meaningful.
● Behavioral interventions: Provide structured interventions that promote consistent health
behaviors, such as regular physical activity or nutritious eating.
● Social support: Encourage peer support networks or family involvement to reinforce positive
health behaviors.
● Positive reinforcement: Recognize and reward learners for maintaining healthy behaviors,
which can boost motivation and compliance.
● Self-reflection: Encourage learners to reflect on their health behaviors and the reasons behind
their choices. This can help increase intrinsic motivation and improve overall adherence to
health-related practices
●

.
BEHAVIORAL OBJECTIVES AND TEACHING PLANS (PART 1)

Behavioral objectives and teaching plans are essential components of the educational process. They help
define clear goals for what students should learn and provide a roadmap for achieving those goals.

Goal: the final outcome to be achieved at the end of the teaching and learning process

Objective: a specific, single, concrete, one-dimensional behavior that should be achieved at the end
of one or a few teaching sessions

Both goals and objectives are needed in order to accomplish something.

o Objectives must be achieved before goal can be reached.
o Objectives must be observable, measurable.
o Objectives must be consistent with, related to the goal.

Goals and Objectives: Establishment

o Must be a mutual decision between the teacher and the learner
o Both parties must participate in the decision-making process and “buy into” the immediate
objectives and ultimate goals.
o Blending what the learner wants to learn and what the teacher has assessed the learner
needs to know provide for a mutually accountable, respectful, and fulfilling educational
experience.
o Must be clearly written, realistic, learner centered
o Must be directed to what learner is expected to be able to do

The Importance of Using Behavioral Objectives

o Keeps teaching learner-centered
o Communicates plan to others
o Helps learners stay on track
o Organizes educational approach
o Ensures that process is deliberate
o Tailors teaching to learner’s needs
o Creates guides for teacher evaluation
o Focuses attention on learner
o Orients teacher and learner to outcomes
o Helps learner visualize skills
o Other advantages to writing clear objectives
o Provides basis for selection or design of instructional content, methods, and materials
o Provides learner with ways to organize efforts to reach their goals
o Helps determine whether an objective has been met

Writing Behavioral Objectives and Goals

Three important characteristics:
o Performance: describes what the learner is expected to be able to do
o Condition: describes the situation under which the expected behavior will be observed
o Criterion: describes how well or with what accuracy the learner must be able to perform to be
competent

Writing Behavioral Objectives and Goals: The ABCD Rule

o A—Audience (who)
o B—Behavior (what)
o C—Condition (under which circumstances)
o D—Degree (how well, to what extent, within what time frame)
 Writing Behavioral Objectives and Goals: The Four-Part Method
1. Identify the circumstance or testing situation (condition).
2. Identify who the learner is (audience).
3. State what the learner will perform (behavior).
4. State what the criterion reflecting quality or quantity of mastery is (degree).

Common Mistakes When Writing Objectives

o Describing what the instructor will do rather than what the learner will do
o Including multiple behaviors per objective
o Forgetting to include all four components of condition, performance, criterion, and who the
learner is
o Using terms for performance that have many interpretations, are not action-oriented, and are
difficult to measure
o Writing an unattainable, unrealistic objective
o Writing objectives unrelated to stated goal
o Cluttering an objective with unnecessary information
o Making an objective too general so that the outcome is not clear
o Writing SMART objectives
o Specific about what is to be achieved
o Measurable by quantifying or qualifying objectives
o Achievable, attainable objectives
o Realistic by considering available resources
o Timely by stating when the objectives will be achieved

BEHAVIORAL OBJECTIVES AND TEACHING PLANS (PART 2)

Taxonomy of Objectives According to Learning Domains

Behavior is defined according to type (domain category) and level of complexity (simple
to complex). o Three Types of Learning Domains (interdependent)
1. Cognitive—the “thinking” domain
2. Affective—the “feeling” domain
3. Psychomotor—the “doing/skills” domain

Complexity of Domain Levels

Hierarchy from low (most simple), to medium (moderately difficult), and to high (most complex) levels of
behavior

Cognitive Levels
Knowledge Evaluation

Affective Levels
Listening Displaying commitment and
willingness to revise judgment

Psychomotor
Perception Origination

Bloom’s Taxonomy
Taxonomy of Educational Objectives.
Familiarly known as Bloom’s Taxonomy, this framework has been applied by generations of K-12
teachers and college instructors in their teaching.
 The framework elaborated by Bloom and his collaborators consisted of six major categories:
Knowledge, Comprehension, Application, Analysis, Synthesis, and Evaluation.

The categories after Knowledge were presented as “skills and abilities,” with the understanding that
knowledge was the necessary precondition for putting these skills and abilities into practice.

Teaching Guidelines:

Cognitive Domain
Learning involves acquisition of information based on the learner’s intellectual
abilities, mental capacities, understanding, and thinking processes.
Six levels of objectives
Methods most often used to stimulate learning in the cognitive domain include:
1. Lecture
2. Group discussion
3. One-to-one instruction
4. Self instruction (e.g., computer-assisted)
Cognitive-domain learning is the traditional focus of most teaching.
Cognitive knowledge is an essential prerequisite for learning affective and psychomotor skills.

Teaching Guidelines: Affective Domain

o Learning involves an increasing internalization or commitment to feelings expressed as
emotions, interests, beliefs, attitudes, values, and appreciations.
o Affective learning involves the degree of a person’s depth of emotional responses.
o Methods most often used:
o Group discussion
o Role-playing
o Role-modeling
o Questioning
 o Methods (cont’d)
o Simulation
o Gaming
o Case studies
o Three domain levels, five objective categories
o Nurse educators are encouraged to attend to the needs of the whole person by
recognizing that learning is subjective and value driven.
o More teaching time needs to focus on learner feelings, emotions, attitudes.

Teaching Guidelines: Psychomotor Domain

o Learning involves acquiring fine and gross motor abilities with increasing complexity
of neuromuscular coordination.
o Must integrate cognitive and affective skills
o Seven objective categories, five learning levels
o Methods most often used:
o Demonstration and instructional materials
o Return demonstration
o Simulation
o Self-instruction
o Psychomotor skill development is very egocentric and requires learner concentration.
o Asking questions that demand a cognitive or affective response during psychomotor
learning interferes with psychomotor performance.
o The ability to perform a skill is not equivalent to learning a skill.
o Repetition leads to behavior perfection and reinforcement.

Factors Influencing Psychomotor Skill Acquisition

1. Readiness to learn
2. Past experience
3. Health status
4. Environmental stimuli
5. Anxiety level
6. Developmental stage
7. Practice session length

Psychomotor Skills Practice

o Motor skills should be practiced first in the laboratory (safe and nonthreatening).
o Mental imaging (mental practice) is a helpful alternative.
o Feedback given to learners
o Intrinsic (within the learner)
o Augmented (external to learner)
o Immediacy of feedback plus performance checklists can serve as guides
o Mistakes are expected.

Development of Teaching Plans

o Teaching plan: blueprint to achieve goals and objectives
o Indicates purpose, content, methods, tools, timing, evaluation of instruction
o Mutually agreed upon goals and objectives clarify what the learner is to learn and what the
teacher is to teach.
o Reasons teaching plans are created
o Ensures a logical approach to teaching and keeps instruction on target
 o Communicates in writing an action plan for the learner, teacher, and other providers
o Serves as a legal document that indicates a plan is in place and the extent of
progress toward implementation

Basic Elements of a Teaching Plan

1. Purpose
2. Goal statement
3. Objectives list
4. Content outline
5. Methods of teaching
6. Time allotment
7. Resources for instruction
8. Learning evaluation methods

Judging a Teaching Plan

o Internal consistency exists when you can answer “yes” to the following questions:
o Does the plan facilitate a relationship between its parts?
o Are all eight elements of the plan related to one another?

Use of Learning Contracts

o Learning Contract: a written (formal) or verbal (informal) agreement between the teacher
and the learner that specifies teaching and learning activities that are to occur within a
certain time frame
o Purpose of a Learning Contract
o To encourage learner’s active participation at all stages of the teaching-learning process
o To improve teacher–client communication
o Learning contracts:
o Are an increasingly popular approach to teaching and learning
o Include a reward for upholding the terms of the contract
o Serve as an alternative and innovative technique of presenting information to the learner
o Shift the control and emphasis to learner centered

Components of the Learning Contract

1. Content—specifies precise behavioral objectives
2. Performance expectations—specify conditions by which learning will be facilitated
3. Evaluation—specifies criteria by which competencies will be judged
4. Time frame—specifies length of time needed for successful achievement of objectives

The Concept of Learning Curve

o Definition: a graphic depiction of changes in psychomotor performance at different stages of
practice during a specified time period
o Six stages of the theoretical learning curve
o The irregularity of individual learning curves
State of the Evidence
o Educational literature has plenty of evidence establishing the value and utility of
behavioral objectives. o Taxonomic hierarchy for categorizing behaviors has also been
established.
o Body of evidence on teaching plans is available.
o Educational literature has new research on learning contracts, psychomotor skill
acquisition, learning curve concept.