NUR.

3520 HEALTH EDUCATION

CLASS 1
 COURSE DESCRIPTION

This course provides students with the knowledge and skills

necessary to provide health information to clients across the
lifespan in a variety of settings in both planned and spontaneous
situations. Emphasis is placed on client assessment and the
appropriate use of existing health information resources.
[Link]
Why is health education important?
 WHAT IS HEALTH (PATIENT) EDUCATION?
Strategies/approaches for informing, educating, and involving patients. (Coulter & Ellins (2007). British Medical Journal, 335(7609), 24–27.]
To improve health literacy
To improve self care
 Provision of printed leaflets and health information
 Self-management education
packages
 Self-monitoring and self-administered treatment
 Provision of computer-based and internet health
 Self-help groups and peer support
information
 Patient access to personal medical information
 Targeted approaches to tackle low levels of health
literacy in disadvantaged groups  Patient-centred telecare

 Targeted mass media campaigns

To improve patient safety
 Information to help choose safe providers
To improve clinical decision making
 Patient involvement in infection control
 Patient decision aids
 Encouraging adherence to treatment regimens
 Training for clinicians in communication skills
 Checking records and care processes
 Coaching and question prompts for patients
 Patient reporting of adverse drug events
 HEALTH EDUCATION IS....

Purposeful, and has an intent of behaviour change

Nurses and other health care professionals (HCP), together with the
client and significant others:
 Assess needs, motivation, and abilities
 Assist in forming goals
 Plan educational activities
 Implement health teaching
 Evaluate outcomes toward goal attainment
 HEALTH EDUCATION IS......
A process
 Involves providing assistance to people in order for them to
learn health-related behaviors.
 Goal is to incorporate behaviours into day-to-day life.
 Informs, motivates, and assists people to a) adopt, and b)
maintain healthy behaviors/practices.

Carranti, B. (2017). Patient Education. In J. F. Giddens (Ed.). Concepts for nursing practice. Chapter
43, page 414
 SCOPE

Self-directed - - Formal classes - - 1:1 Patient-Nurse learning encounters

 PURPOSE, GOALS, AND BENEFITS OF
PATIENT EDUCATION

Purpose: To increase the competence and confidence of clients to

manage their own self-care, and of staff and students to deliver
high-quality care.
 PURPOSE, GOALS, AND BENEFITS (CONT’D)

Benefits of education to clients.....

Benefits of education to healthcare providers.....
We will use this scenario when describing the concept of health education

18-year-old Mia has

been diagnosed with a
Chlamydia infection.
Upon hearing the
diagnosis, she appears
to be withdrawn. After
the nurse reassures her
that the infection can be
treated, Mia engages
and asks questions that
indicate her desire to
learn about the
condition and its
Consider goals of interaction
treatment
Whose goals? How to prioritize?
[Link]
 PROCESS OF PATIENT EDUCATION
• Assess needs, motivation, • What do we know about Mia?
abilities • What might we ask?
• Assist in forming goals • What might the goal of education be?
• Plan educational activities • What kind of education activities
• Implement health teaching would we use?
• Evaluate outcomes toward goal • How would we implement health
attainment teaching?
• How will we know what she learned?
Image from Giddens (2017) textbook
 Client and Context Professional Foundations

 Adherence  Care coordination

 Caregiving  Caring: A relational process
 Community  Client safety
 Coping
 Clinical judgment
 Cultural safety
 Communication
 Determinants of health
 Critical reflection
 Ethical practice
 Family
 Evidence-informed practice
 Functional Ability  Inter-professional collaborative practice
 Grief  Health care quality
 Health care economics  Health education
 Human diversity  Leadership
 Health literacy  Legal practice
 Individual  Primary health care
 Interpersonal violence  Professionalism
 Motivation  Social justice
 Personhood  Supportive & palliative care
 Stress  Technology & informatics
Creative commons
HEALTH LITERACY IS THE ABILITY TO . . .

Understand
Access
Ability to understand
Ability to access the meaning of
health information health information
Health
Literacy
Evaluate Communicate
Ability to interpret & Ability to make
evaluate health informed decisions
information about health issues

In order to promote, maintain, & improve health in a variety of settings across the life-course
Canadian Expert Panel on Health Literacy, 2008 [Link]
 CLINICAL CONNECTION

[Link]
(6:10)
 MOTIVATION

 An internal state that arouses, directs, and sustains human behavior

(Glynn, Aultman & Ownes, 2005, p. 150). A willingness of the learner to embrace
learning with readiness as evidence of motivation (Redman, 2007).
 Motivation encompasses self-regulatory processes involving the
selection, activation, and sustained behavior toward certain goals
(Bandura, 1997, as cited in Giddens, 2013).
 Impacted by beliefs about the consequences of behaviour.
 ADHERENCE
 A concept related to human behavior, thus embraces complexity.
 Defined by the World Health Organization (WHO) as “the extent to
which a person’s behavior, e.g., taking medication, following a
diet, and/or executing lifestyles changes, corresponds with agreed
upon recommendations from a health care provider” (2003, p.3).
 The North American Nursing Diagnosis Association (NANDA) –
describes adherence behavior as a self-initiated action taken to
promote wellness, recovery, and rehabilitation.
 ADHERENCE - SCOPE

Non-adherence - - Partial adherence - - Total adherence

(intentional vs non-intentional)
 [Link]

Communication: Process of interaction between people in which symbols are

used to create, exchange, and interpret messages about ideas, emotions, and
mind states (Buchanan & Godfrey, 2017).
 WHAT IS COMMUNICATION?
Scope of Communication

Communication

Absence of
Effective Ineffective
Communication
Communication Communication
 HOW DO YOU RECOGNIZE
COMMUNICATION?

Attributes of Communication

 It is a process of complementary exchange between people.

 Occurs in a context.

 A learned skill over time.

 COMMUNICATION
Process of Complementary Exchange
 COMMUNICATION & CARING-
RELATIONAL PRACTICE
Elements that characterize therapeutic
communication Non-verbal behaviors designed to facilitate active
Difference between "Therapeutic Relationship" vs. listening:
"Social Relationship."  
  S – Sit squarely facing the client (unless
 Developing an attitude of respect, dignity and ethnic/cultural background of client discourages
empowerment direct eye contact).
 Active listening O – Observe an open posture.

Being fully present L – Lean forward toward the client.
 Listening with the whole self E – Establish eye contact (unless ethnic/cultural
 Empathy background of client discourages direct eye contact).
 Communicating hope R – Relax

Developing trust
 Good direction -communicating with intention
INTERRELATED CONCEPTS
 CRNM
 Standards of Practice
 CNA

In nursing, patient education has long been a major component.

Florence Nightingale was the ultimate educator.
 ROLES OF THE NURSE AND HEALTH
EDUCATION (CRNM COMPETENCIES, 2019)
 Clinician - “Registered nurses are clinicians who provide safe, competent,
ethical, compassionate, and evidence-informed care across the lifespan in
response to client needs. Registered nurses integrate knowledge, skills,
judgment and professional values from nursing and other diverse sources into
their practice” (pp. 3-4).
 Communicator - “Registered nurses are communicators who use a variety of
strategies and relevant technologies to create and maintain professional
relationships, share information, and foster therapeutic environments” (p. 5).
 Collaborator - “Registered nurses are collaborators who play an integral role
in the health care team partnership” (p. 5).
 ROLES OF THE NURSE AND HEALTH EDUCATION, CONT’D

(CRNM COMPETENCIES, 2019)

 Coordinator - “Registered nurses coordinate point-of-care health service delivery with
clients, the health care team, and other sectors to ensure continuous, safe care” (p. 6).
 Advocate - “Registered nurses are advocates who support clients to voice their needs to
achieve optimal health outcomes. Registered nurses also support clients who cannot
advocate for themselves” (p. 7).
 Educator - “Registered nurses are educators who identify learning needs with clients and
apply a broad range of educational strategies towards achieving optimal health outcomes”
(p. 7).
 Scholar - “Registered nurses are scholars who demonstrate a lifelong commitment to
excellence in practice through critical inquiry, continuous learning, application of evidence
to practice, and support of research activities” (p. 8).
NURSING PROCESS AND EDUCATION PROCESS

According to Giddens (2017), “the educational process and the

nursing process are essentially the same and include learner
assessment, planning, implementation, evaluation, and
documentation” (p. 416).
 THE EDUCATION PROCESS
DEFINITION OF TERMS

Education Process: A systematic, sequential, and planned course of

action on the part of both the teacher and learner to achieve the
outcomes of teaching and learning.
Teaching/Instruction: A deliberate intervention that involves sharing
information and experiences to meet the intended learner outcomes.
Learning: A change in behavior (knowledge, attitudes, and/or skills)
that can be observed or measured; that can occur at any time or in any
place as a result of exposure to environmental stimuli.
 THE EDUCATION PROCESS
DEFINITION OF TERMS, CONT’D
Patient Education: The process of helping clients learn health-related
behaviors to achieve the goal of optimal health and independence in
self-care.
Staff Education: The process of helping nurses acquire knowledge,
attitudes, and skills to improve the delivery of quality care to the
consumer.
 TRENDS AFFECTING HEALTH CARE
Social, economic, and political forces that affect a nurse’s role in
teaching:
 Growth of managed care.

 Increased attention to health and well-being of everyone in

society.
 Cost-containment measures to control healthcare expenses.

 Concern for continuing education as vehicle to prevent

malpractice and incompetence.

 TRENDS (CONT’D)
 Expanding scope and depth of nurses’ practice responsibilities.
 Consumers demanding more knowledge and skills for self-care.
 Demographic trends influencing type and amount of health care
needed.
 Recognition of lifestyle related diseases which are largely
preventable.
 Increased prevalence of chronic conditions.
 TRENDS (CONT’D)

 Impacts of advanced technology.

 Health literacy increasingly required.
 Research findings that client education improves compliance.
 Advocacy for self-help groups.
 Increased use of on-line technologies.
 Screenings occasioned by advances in genetics and genomics.
 BARRIERS TO TEACHING

Barriers to teaching are those factors impeding the nurse’s

ability to optimally deliver educational services.
 MAJOR BARRIERS TO TEACHING
 Lack of time
 Environments not conducive to the teaching–learning process.
 Inadequate documentation system to allow for efficiency and ease of recording the
quality and quantity of teaching efforts.
 Budget cuts; funding.
 Inadequate preparation of nurses to assume the role of educator with confidence and
competence
 Personal characteristics, e.g., lack of motivation.
 Low-priority status given to teaching
 Some question the benefits of education with respect to improved health outcomes.
 MAJOR OBSTACLES TO LEARNING

Obstacles to learning are those factors that have a

negative impact on the learner’s ability to attend to,
and process information.
 MAJOR OBSTACLES
 Limited time due to rapid discharge from care.
 Stress of acute and chronic illness, anxiety, sensory deficits, and low literacy.
 Loss of control, lack of privacy, and social isolation of hospital environment.
 Situational and personal variations in readiness to learn, motivation and compliance,
and learning styles.
 Extent of behavioral changes (in number and complexity) required.
 Lack of support and positive reinforcement from providers and/or significant others.
 Denial of learning needs, resentment of authority, and locus of control issues.
 Complexity, inaccessibility, fragmentation, and dehumanization of the healthcare
system.
 QUESTIONS ABOUT TEACHING AND
LEARNING
The following questions can be posed about the elements of the
education process, the role of the nurse as educator, and the
principles of teaching and learning:
 How can healthcare team work together more effectively to
coordinate educational efforts?
 What are the ethical, legal, and economic issues involved?
Health education in clinical situations, and the role of the
nurse.
 Clinical Connection

[Link]
(8:46)

Intervention teach-back patient education method

[Link]
(4:08)
 QUESTIONS (CONT’D)
 What assessment methods and tools can be used to determine
learning needs, readiness, and styles?
 Which learner attributes positively and negatively influence
education efforts?
 What can be done about the inequities in the delivery of
education services?
 Which elements need to be taken into account when developing
and implementing teaching plans?
 QUESTIONS (CONT’D)

 Which instructional methods and materials are available to

support teaching efforts?
 Under which conditions should certain teaching methods and
tools be used?
 How can teaching be tailored to meet the needs of specific
patients/populations?
 What is the best way to evaluate the effectiveness of teaching and
learning?
 8 MOST COMMON PATIENT
EDUCATION MISTAKES

[Link]
(16:53)
 Nurses have many opportunities to carry out health education.
They are the healthcare providers who have the most continuous
contact with patients and their families, are usually the most
accessible source of information for the consumer, and are the
most highly trusted of all health professionals.
 APPLYING LEARNING
THEORIES TO
HEALTHCARE PRACTICE

Bastable, 2017
REVIEW HOW THE BRAIN FUNCTIONS

[Link]
kLeTu2XcQ2oIrLAJAn8iWA:1663620129913&source=lnms&tbm=isch&sa=X&ved=2ahUKEwiRwon326H6AhX8lIkEHVY2Ao4Q_AUoAnoECAIQBA&biw=1266&bih=601&dpr=1.5#imgrc=SfjvSUCyJKbDpM
 LEARNING

Learning: a relatively permanent change in

mental processing, emotional functioning, and
behavior as a result of experience

Learning Theory: 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
APPLICATION QUESTIONS TO KEEP IN MIND

 How does learning occur?

 What kinds of experiences help or hinder
the learning process?
 What helps ensure that learning becomes
relatively permanent?
 BEHAVIORIST LEARNING THEORY

 Concepts: stimulus conditions, reinforcement,

response, drive

 To change behavior, change the stimulus

conditions in the environment and the
reinforcement after a response.
 RESPONDENT CONDITIONING

 Learning occurs as the person responds to

stimulus conditions and forms associations.

 A neutral stimulus is paired with an

unconditioned stimulus–unconditioned
response connection until the neutral stimulus
becomes a conditioned stimulus that elicits the
conditioned response.
 OPERANT CONDITIONING

 Learning occurs as the person responds to

stimuli in the environment and is reinforced
for making a particular response.

 A reinforcer is applied after a response,

strengthening the probability that the
response will be performed again under
similar conditions.
 CHANGING BEHAVIOR USING
OPERANT CONDITIONING
 To increase behavior
 Positive reinforcement
 Negative reinforcement (escape or
avoidance conditioning)
 To decrease behavior
 Nonreinforcement
 Punishment
COGNITIVE LEARNING THEORY
 Concepts: includes several well-known
perspectives, e.g. gestalt, information
processing, cognitive development, and social
cognition theory.

 To change behavior, work with the

developmental stage and change cognitions,
goals, expectations, equilibrium, and ways of
processing information.
 GESTALT PERSPECTIVE

Perception and the patterning of stimuli

(gestalt) are the keys to learning, with each
learner perceiving, interpreting, and
reorganizing experiences in her/his own way.

Learning occurs through the reorganization of

elements to form new insights and
understanding.
 INFORMATION PROCESSING

The way individuals perceive, process, store,

and retrieve information from experiences
determines how learning occurs and what is
learned.

Organizing information and making it

meaningful aids the attention and storage
process; learning occurs through guidance,
feedback, and assessing and correcting errors.
 COGNITIVE DEVELOPMENT
 PERSPECTIVE
Learning depends on the stage of cognitive
functioning, with qualitative, sequential
changes in perception, language, and thought
occurring as children and adults interact with
the environment.

 Recognize the developmental stage and

provide appropriate experiences to encourage
discovery.
 SOCIAL COGNITION
An individual’s perceptions, beliefs, and
social judgments are affected strongly by
social interaction, communication, groups,
and the social situation.

Individuals formulate causal explanations to

account for behavior that have significant
consequences for their attitudes and actions
(attribution theory).
 SOCIAL LEARNING THEORY

 Concepts: role modeling, vicarious

reinforcement, self-system, self-regulation.

 To change behavior, utilize effective role

models who are perceived to be rewarded,
and work with the social situation and the
learner’s internal self-regulating
mechanisms.
 PSYCHODYNAMIC LEARNING
THEORY
 Concepts: stage of personality development,
conscious and unconscious motivations, ego-
strength, emotional conflicts, defense
mechanisms

 To change behavior, work to make

unconscious motivations conscious, build ego-
strength, and resolve emotional conflicts.
HUMANISTIC LEARNING THEORY
 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.
 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.
 MOTOR LEARNING
 Motor learning is useful in addition to
theories of psychological learning.

 Examples of skills taught:

 Walking

 Putting on a colostomy bag

 Operating sophisticated medical equipment

STAGES OF MOTOR LEARNING
Cognitive stage
Learner works to develop cognitive map
Associative stage
More consistent performance, slower gains,
fewer errors
Autonomous stage
Automatic stage, achieving advanced level
MOTOR LEARNING VARIABLES
 Pre-practice
 Motivation, attention, goal setting,

modeling, demonstrations

 Practice
 Massed vs. distributed, variability, whole

vs. part, random vs. blocked, guidance vs.

discovery learning
MOTOR LEARNING VARIABLES
(CONT’D)
 Feedback
 Intrinsic (inherent) feedback

 Sensory and perceptual information that

arises when a movement is produced

 Extrinsic (augmented or enhanced

feedback)
 Provided to learner from outside source

(nurse, biofeedback)
 COMMON PRINCIPLES OF LEARNING

Promoting change
 Relate to what learner knows and is familiar with
 Keep experiences simple, organized, and meaningful
 Motivate learner
 May need incentives and rewards, but not always
 Experiences must be at the appropriate developmental
level
 Make learning pleasurable, not painful
 Demonstrate by guidance and attractive role models
 COMMON PRINCIPLES OF
LEARNING (CONT’D)
Making learning relatively permanent
 Relate experiences to learner

 Reinforce behavior

 Rehearse and practice in variety of settings

 Have learner perform and give constructive feedback

 Make sure interference does not occur before, during,

or after learning
 Promote transfer

 Have learner mediate and act on experience in some

way (visualize, memory devices, discuss, talk,

discuss, write, motor movement)
 QUESTIONS TO CONSIDER

 In what ways do the learning theories

differ?
 In what ways are they similar?
 How can the learning theories be used in
combination to change behavior and
enhance learning?
 Why are some theories more effective with
certain individuals than with others?
NURS3520 – HEALTH EDUCATION
EXPLORING THE PEMAT
 PEMS –BENEFITS

 Promote learning and increase knowledge

 Promote patient engagement and self-management
 Enhance the patient experience
 Provide consistent information
 Save health care providers’ time
 Reduce health care utilization and costs
 Can you think of other benefits?
 Promote Learning and Increase Knowledge
 Exposure to well-designed PEM increases patients’ knowledge (You, Wolff, Bailey & Grobman,
2012).
 PEM help people remember important messages.
 Patients receive information from many different people. Studies examining patients’ memory report that
40 to 80% of the information provided by health care practitioners is forgotten immediately, and half of the
information patients remember is actually recalled incorrectly (Kessels, 2003).
 Patients have more control over learning.
 They can read materials at their own pace and refer to them as often as needed. Reviewing printed
materials after interaction with health care providers can promote long-term retention of new information
(Wilson et al., 2010).
 Patients may find it very difficult to learn at the hospital.
 The environment can be noisy and distracting. Patients may feel anxious or tired or be in pain. This
interferes with their concentration and memory. Patients can review PEM at home, where privacy and
comfort makes the setting more conducive to learning.
 PEM provide accurate information to family members who were not present during teaching.
Wizowski . L., Harper , T., & Hutchings, T. (2014).
 Promote Patient Engagement and Self-Management
 Providing quality health information (accurate, accessible, and actionable) enables patients to better
manage their health and wellbeing and make fully informed decisions about their treatment and care
(Patient Information Forum, 2013; Coulter, 2012; Johnson, Sandford & Tyndall, 2008).

 With interactive features such as questions, journals, and charts, patients can use PEM as tools for
monitoring health behaviours and outcomes.

 PEM Enhance the Patient Experience

 Providing verbal and written information at discharge from hospital improves patient satisfaction (Johnson,
Sanford & Tyndall, 2008).

 PEM can help patients know what to expect before, during, and after a procedure, treatment, or surgery.
 This can reduce their anxiety and increase satisfaction with their care and their care providers; (↓
uncertainty)
 Providing high quality and accessible health information promotes patient engagement and helps to
enhance patients’ experience of care (Patient Information Forum, 2013).
 Promote Consistent Information
 The content of PEM reflects what the health care team decides are the main messages. This promotes
consistency in patient and family education.

PEM Save Health Care Providers’ Time

 PEM reinforce information, so health care providers may not need to repeat teaching as often as they might
otherwise be required.
 PEM can help patients understand information and follow instructions. As a result, they may have fewer
questions and less need for follow-up teaching, visits, and phone calls.

PEM Reduce Health Care Utilization and Costs

 Providing patients with quality health information is the key to patient engagement and self-management of
long-term conditions. This has a positive impact on services use and costs. (Patient Information Forum, 2013; Mitic & Rootman,
2012; Jack et al, 2009; Goudreau et al, 2008).

Wizowski . L., Harper , T., & Hutchings, T. (2014).

 DOES THIS HAVE
THE POTENTIAL
TO IMPROVE
PATIENT SAFETY
& WELLBEING?

[Link]
 PEMS . . .
“… are effective only when
used as a part of an overall
patient education strategy.”
(Agency for Healthcare Research and Quality, 2010, p. 53)

[Link]
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BASED ON YOUR ASSESSMENT OF THE PATIENT’S
NEEDS AND PREFERENCES . . .
PEMs selected for patients should be:
 Accurate – Reflect current practice and reinforce what you teach.
 Match the organization’s philosophy and policies.
 Accessible –
 Easy to read and understand, which enables more people to use the information.
 Actionable –
 Encourage patients and families to take an active part in their health care.
 Focus on what patients need to know and do.
 Provide action steps with concrete examples.
 “HANDOUTS DON’T TEACH. PEOPLE TEACH.” (LONDON, 2009, P. 91)

1. Don’t rely on handouts to educate.

Simply giving a patient a handout is not enough to promote understanding or behaviour
change.
2. PEM should be used to support and reinforce verbal messages.
They can facilitate discussion, not replace it.
3. Review the material with the patient.
Emphasize important information (such as warning signs and who to call for help) by circling
or highlighting it in the material.
• This can help the patient find this information easily when they get home.
4. Endorse/contextualize the information.
Tell the patient why the information is important for them.
Discuss how the key points relate to their care.
5. Invite questions and encourage the patient to tell you if something is unclear.
Ask for/elicit feedback.
 INDIVIDUALIZE THE INFORMATION

 Personalize materials by adding the patient’s name, notes, and specific

instructions.

 Involve the patient and family/significant others as appropriate.

 For example: As you review discharge instructions, ask the patient how they
will do each step at home.
 From a list of recommended foods, ask the patient to circle those that they eat
regularly or might like to try.
 Elicit ongoing feedback. Everyone’s understanding of how the human body
works is different. And everyone has their own ideas and experiences, which
may or may not fit with the information you are providing.
Wizowski . L., Harper , T., & Hutchings, T. (2014).
CHECK/EVALUATE COMPREHENSION &
UNDERSTANDING
 “Check in” during process to find out ‘where they’re at’.
 Confirm that the patient has learned a skill by asking him or her to demonstrate the
skill.
 Give feedback and allow time for extra practice as needed.
 Confirm that the patient understands verbal and written instruction by using the
“teach back” method (Schillinger et al., 2003). Use open-ended questions.
 Ask the patient to restate the information or instructions in his or her own words.
 Make it clear that you are checking the effectiveness of your teaching, not testing the
patient. (we can all suffer from performance anxiety and shut down as a result).
 Clarify or re-teach as needed.
 NURSES (AND OTHER HEALTH
PROFESSIONALS) SHOULD . . .
Maintain a collection of
Select or develop the
patient education Be familiar with the
materials themselves to
materials on the topics content of the materials
ensure readability,
most relevant to their they use.
accuracy, and quality.
unit/practice.

Materials should be easily available to staff –

Ensure that materials are whether they are printed copies or electronic
integrated into the versions to be downloaded from a central
patient’s plan of care. database or internal website.
 PEMAT

1 2
Is a standardized and Focuses on short resources
systematic tool developed, and their actionability and
based on evidence, to assist understandability
health professionals (YOU!) to
evaluate/appraise resources.

Agency for Healthcare Research and Quality, Rockville, MD. [Link]

 THERE ARE TWO VERSIONS OF THE PEMAT
1. PEMAT-P for printable materials (e.g., brochures, pamphlets, PDFs), consisting
of 17 items measuring understandability and 7 items measuring actionability.

2. PEMAT-A/V for audiovisual materials (e.g., videos, multimedia materials),

consisting of 13 items measuring understandability and 4 items measuring
actionability.

Once PEM is selected,

reviewed, and scored, Sometimes PEM are re-
consider how the PEM worked - tailored to
might be adapted to meet particular learners.
the needs of specific
learners.
Agency for Healthcare Research and Quality, Rockville, MD. [Link]
 PEMAT - LIMITATIONS
 Not for evaluating podcasts or websites
 The PEMAT does not assess accuracy or comprehensiveness, or perform
readability tests.
 Recommended that a readability assessment for print materials be completed
in conjunction with using the PEMAT


 Using only a readability formula, however, is not a substitute for using the
PEMAT. Readability formulas ignore many of the factors that contribute
to comprehension and can be misleading.
 “TAILORING” - DEFINITION
 The making or adapting of something to suit a particular
purpose/person.
 The notion that “one size does not fit all”.
 Tailoring PEMs is beneficial.

[Link]
 SUMMARY
 Challenges to literacy and health literacy are very common.
 People do not remember all we say and they might not understand instructions and other
information.
 Many tools required by health professionals.
 A universal approach and plain language competency are important strategies to support
understanding.
 Patient education materials are also an important resource to use along with other patient
education initiatives.
 Not all patient education materials are suited to all individuals or circumstances.
 Appraisal and tailoring of PEM can increase the opportunity to individualize them.
 PEMAT is one validated strategy for assessing the actionability and understandability of
PEMs.
 Limitation – does not assess either accuracy of information or readability.
HEALTH EDUCATION
LEARNER
ASSESSMENT
 Health Education Map of Competencies
Relational
Learner Assessment Planning Teaching
practice
Together with the client,
family, & health care team:
Identify learning needs. Collaborate with the client (&
family) in developing an
individualized plan of care. Teach the client and their
CarIng
family how to meet health
goals.
-spontaneous vs. planned
interactions.
Resources -
Appraisal Use & Motivation Adherence
Differentiation
Use resources to support client’s Assess motivation.
health education. Adapt teaching Motivate client to improve
strategies to specific client needs. &/or maintain health. Assess factors affecting
adherence.
Promote client adherence to
health plan and goals.

Concepts
Evaluate client learning &
Evaluation
Relational
Revise plan accordingly. Documentation 
Communication
Health Education
practice
Document client  Health Literacy
education.  Motivation
 Adherence
 ASSESSMENT Assessment
• First step in the process of patient education is assessing the
patient’s learning needs, preferred learning style, and readiness to
learn.
• This vital phase is often the most neglected or ignored aspect
when preparing for patient teaching.
• Assessment includes:
• **Finding out what patients already know & believe,
• What they want and need to learn,
• What they are capable of learning
• Attention: Factors affecting one’s ability to concentrate and
focus.
• Memory and recall: challenges.
ASSESSMENT CONT’D
• Situational psychological
states such as anxiety,
depression, fear, and
acceptance or denial of illness
are some of the factors that
influence capacity and
motivation to learn.

[Link]
Assessment of Learning Needs
• Identify the learner’(s)’
‘target’.
• **Assess prior
learning/what do they
know, understand, and
believe.
• Choose the right setting
in which to conduct the
assessment.
• Prioritize needs.
[Link]

Kitchie, S. , Ch. #4, in Bastable

CRITERIA FOR PRIORITIZING LEARNING
NEEDS
(BASTABLE P. 84 TABLE 4-1)

Mandatory: Needs that must be learned for

survival when the learner’s life or safety
is threatened.
Desirable: Needs that are not life-dependent
but are related to well-being.
Possible: Needs for information that are
“nice to know” but not essential or
required (e.g. because need might not be
directly related to daily activities or the
particular situation of the learner).

The nurse and the healthcare team, by virtue of experience, knowledge, and
skill, collaborate with the patient and family to prioritize needs.
COLLABORATION, E.G.
NURSE TEACHES A CHILD
TO USE AN EPI-PEN PRIOR
TO DISCHARGE FROM
PEDIATRIC UNIT.

Health care team

knowledge, skill, and
experience.

Patient’s, (family &

significant other’s)
perspectives & preferences,
knowledge, understanding,
beliefs, skills, & experience.

[Link]
 ASSESSMENT: CONSIDER THREE
DETERMINANTS OF LEARNING

**Effective assessment can decrease anxiety & stress,

and increase learning.
1. Learning Needs
• WHAT the learner needs to learn
2. Readiness to Learn
• WHEN the learner is receptive to learning
3. Learning Style
• HOW the learner learns best
METHODS TO ASSESS LEARNING NEEDS

• Informal conversations
• Structured interviews
• Questionnaires
• Observations
• Documentations/consults

Kitchie, S. , Ch. #4, in Bastable

 Readiness to Learn - PEEK Assessment
Bastable, p. 88 Table 4 - 2

P = Physical Readiness E = Experiential Readiness

measures of ability level of aspiration
complexity of task past coping mechanisms
environmental effects
cultural background
health status
gender locus of control
E = Emotional Readiness orientation
anxiety level
support system K = Knowledge Readiness
motivation present knowledge base
risk-taking behavior cognitive ability
frame of mind
learning disabilities
developmental stage
learning styles
Learning Style
• Can be determined through
observation, interviews, and the
LEARNING STYLE
use of tools or instruments.
• Some controversy about
learning styles (Newton & Miah,
2017).

• Preferences, rather than

definitive style.
• Consider developmental stage,
contexts of individual’s life.

[Link]
 • Carl Jung (Psychologist 1921-
1971)
• “Types” – Patterns & preferences.
• Thinking vs Feeling;
Introversion vs Extroversion
THEORIES –
• . . . Myers-Briggs (1987) Type
PERSONALITY,
Indicator – added judgment-
LEARNING TYPES, perception
INTELLIGENCES
• 16 personality types (Bastable p.
101-103)
• Kolb (1984) Experiential
• Gardner’s Eight Types of
Intelligence (106-108)
In a study of a self-management educational strategy for individuals newly diagnosed or
living with diabetes, less educator talk in a session was found to lead to greater change
LISTENING
in participants’ beliefs about their diabetes.
FOR
• First session involved assessment:
MEANING
1) The ‘Patient Story’, involves each patient exploring how they discovered they had
diabetes and what they already know or believe about the condition.
2) Then the ‘Professional Story’ - Focused around helping individuals understand their
diabetes and its complications.

• Skinner, T.C., et al. (2008). ‘Educator talk’ and patient change: some insights from the DESMOND (Diabetes Education and Self Management for Ongoing and Newly Diagnosed) randomized
controlled trial. Diabetic Medicine, 25, 1117-1120. doi: 0.1111/j.1464-5491.2008.02492.x
 EXAMPLE QUESTIONS
• What are you most concerned about, or what worries you?
• How has your condition affected your life?
• What do you know about your condition, or illness?
• Who are the people in your life who assist you most?
• What would you like to know about your condition/illness?
• What are your goals for learning how to take care of yourself?
• What do you feel you need to know to achieve your goals?
• What specific problems are you having?
• What are you most interested in learning about?
• How will you manage your care at home?
What time of day do you learn best?

Do you like to read? If so, what types of books or magazines do you enjoy
reading?

EXAMP
If you have received prior health education, what worked well for you and
what did not work well?

Do you have access to a computer? Do you use a cellLEphone? If so, do you

QUESTI
access information over the internet on your computer or phone?

Would you describe your interest in receiving information by video, on the

computer, or phone? ONS
CONT’D
Would you prefer to read something first, or would you rather have me
explain information to you?

Do you learn something better if you read it, hear it, or do it hands on
yourself?

How do you feel about making the changes we’ve

discussed?
QUESTIONS CONT’D

WHAT CHANGES WOULD ARE THERE ANY PROBLEMS

YOU LIKE TO WORK ON THAT WOULD PREVENT
NOW? YOU FROM LEARNING
RIGHT NOW?
 Your 70 year old patient, Mr. Rosenfeld, has been
diagnosed with heart failure. He is on high potency
diuretic therapy and a 1L fluid restriction.

[Link]
[Link]
cCegQIABAA&oq=patient+learning&gs_lcp=CgNpbWcQAzICCAAyAggAMgIIADIGCAAQCBAeMgQIABAYMgQIABAYMgQIABAYMgQIABAYMgQIABAYMgQIABAYUMa0AViEuQFgw7oBaABwAHgAgAGeAYgB1QiSAQMwLjiYAQCgAQGqAQtnd3Mtd2l6LWltZ8A
BAQ&sclient=img&ei=NatmX6_-D4L-swXUt4X4DQ&bih=482&biw=1088&rlz=1C1GCEU_enCA821CA821#imgrc=e3fZqcVhBDxigM
 Motivation

FILLING UP THE HEALTH ED. TOOLBOX – THEORIES & MODELS

NURS3520 – 2019 Winn Briscoe RN MN/Revised /S. Barbeau (2020)

 Health Education Map
of Competencies
Relational Learner Teaching
Planning
practice Assessment
Together with the client,
family & health care team:
Identify learning needs Collaborate with the client (&
family) in developing an
individualized plan of care Teach the client and their family how
CarIng

to meet health goals.

-spontaneous vs. planned interactions

Resources -
Appraisal Use & Motivation Adherence
Differentiation
Use resources to support client’s
health education. Adapt teaching Assess motivation.
strategies to specific client needs Motivate client to improve Assess factors affecting
&/or maintain health adherence.
Promote client adherence to
health plan and goals
Relational
practice Concepts
Evaluation
Evaluate client learning &
Revise plan accordingly Documentation Communication
Document client education  Health Education
 Health Literacy
 Motivation
 Adherence
HEALTH EDUCATION - MOTIVATION

Presentation primarily sourced from Zulkosky & Huse, Chapter 5 in Giddens text

NURS3520 – 2018 Winn Briscoe RN MN Revised/S. Barbeau 2020

 BACKGROUND

 Consider your understanding of the dimensions and effects of health literacy on the individual, family, community etc.
 Consider your understanding of the many factors that affect adherence.
 Recognize that health education is targeted to supporting behaviour change to maintain and promote optimal health.
 Human beings are unique and their motivation for behavior change is affected by many factors.
 Human behaviour is dynamic and multi-faceted and influencing motivation is a process, which is made all the more
complex when one’s health is involved.
 Accordingly, nurses (and nursing students) who work with clients and the healthcare team in providing health education
should acquire understanding of motivation and behavior change.
 MOTIVATION (BASTABLE TXT. P. 160)

An internal state that arouses, directs, and sustains human behavior

(Glynn, Aultman & Ownes, 2005, p. 150). A willingness of the learner to
embrace learning with readiness as evidence of motivation (Redman,
2007).
 Movement in a direction to meet a goal.
 Affected by both internal and external factors.
 SCOPE OF MOTIVATION
FIGURE 5-1 GIDDENS, 2013

Autonomy

Extrinsically Extrinsically
motivated motivated Intrinsically
Amotivated
without self- with self- motivated
determination determination
 CATEGORIES OF MOTIVATION
Affiliative
*Define

Power Avoidance
 Define  Define
 
Self-determination
 Desire

Compelled
 Aspiration

Preference for challenge

Energizing force
 Persistence

Internal dispositions

ATTRIBUTES
 MOTIVATIONAL FACTORS
 Consider domains affecting learning


Cognitive

Psychomotor

Affective
 Notion of factors potentially being a facilitator versus a blocker
 Personal attributes

Environmental influences
 Learner relationship systems
 DOMAINS OF LEARNING
- THREE MAIN TYPES

1. Cognitive—the “thinking” domain - knowledge, information, ‘facts’, standards, etc.

2. Affective—the “feeling” domain - emotions, values, attitudes etc.

3. Psychomotor—the “skills” domain - the “doing”, application.

AXIOMS THAT SET THE STAGE FOR GOAL SETTING: BASTABLE P. 163.
The state of optimal anxiety

Learner readiness

Realistic goal setting

Learner satisfaction/success

Uncertainty reducing or uncertainty maintaining dialogue

 
Set of concepts, definitions, and propositions
 Systematic view of events or situations

Allows explanation of events or situations

Explains and/or predicts

WHAT IS A
THEORY?
 HOW MIGHT THE NURSE INFLUENCE
MOTIVATION??
 Being familiar with models and theory can assist the nurse in applying what others have learned about
motivation/behavior change and learning in health education.

 Repertoire of “tools” in toolkit.

 Not all theories pertinent to all situations.

 Assessment & addressing deterrents and optimizing facilitators.

 HOW DO NEEDS MOTIVATE PEOPLE?

All needs theories of motivation propose a similar idea: individuals have needs that, when unsatisfied, will
result in motivation
MASLOW’S HIERARCHY OF NEEDS
Self-fulfillment needs

Consider Relevance to Nursing?

Psychological needs

Basic needs
Self Efficacy – people’s judgments of their capabilities to organize
and execute courses of action required to attain designated types of
performance. It is concerned not with the skills one has but with
judgments of what one can do with whatever skill one possesses

BANDURA (1986)-SOCIAL COGNITIVE THEORY

 “The patient will never care how much you
know, until they know how much you care.” 

Learner relationship systems

Affective domain.
Caring-Relational practice

(Terry Canale in his American Academy of Orthopedic Surgeons Vice Presidential Address)
 Cognitive variables Environmental Variables
Capacity to learn • Appropriateness of physical environment
• Readiness to learn • Social support systems
• Family, group, work, community resources
• Expressed self-determination
Educator-Learner Relationship System
• Constructive attitude
• Prediction of positive relationship
• Expressed desire & curiosity
• Willingness to contract for behavioral outcomes
• Facilitating beliefs
Affective Variables Comprehensive
• Expressions of constructive emotional state Parameters
• Moderate level of anxiety for Motivational
Physiological Variables Assessment
• Capacity to perform behavior of the Learner
Experiential Variables Table 6-1 Bastable, p. 165

• Previous successful experiences

LOCUS OF CONTROL MODEL (ROTTER, 1996, AS CITED
IN SYX, 2008, P.52)

Where does
your patient
Internal place her/his External
locus of
control?

Belief – One has control over Belief - Health is controlled

health outcomes. Health is a by factors outside of
consequence of one’s actions. one’s control; unrelated to
behaviour.
 Consider the concept of Motivation and Potentially Applicable Theories and
Models . . . Exemplar – Mr. Winston
• Mr. Winston is 64 years of age and he is post–op day three following surgical repair
of a ruptured abdominal aortic aneurysm.
• He continued to bleed following his initial surgery and was taken back to surgery to
repair an arterial bleed.
• He dangled at the bedside last evening and had a lot of abdominal pain.
• He is receiving patient controlled analgesia (PCA) morphine.
• His wife returned to check on the farm & will be back tomorrow.
• He is sleepy today and refused physio assistance to ambulate this morning.
• The physio has enlisted your support to help motivate Mr. Winston to ambulate
today
How could you incorporate the “Health Education Map of
Competencies” into this situation/exemplar. Think about what you could
do to help Mr. Winston to move forward in his recovery process. As his
nurse, how could you help motivate Mr. Winston?