1. N115 Health Education and Healthy Behaviors
Focus:
Health Education and Health Behavior
Learning Principles
Theories and Models
Health Literacy
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2. Health Education Health Behavior Learning Domains Health Literacy
Learning Principles
Learning opportunities designed to encourage or promote the adoption of healthy behaviors (Center for Disease Control & Prevention)
An action taken by an individual or group of individuals to change or maintain their health status or prevent illness or injury (Center for Disease Control & Prevention)
Type of learning:
Three Learning Domains:
Cognitive
Affective &
Psychomotor
Health literacy is an individual's ability to gain access to, understand and use health information for promoting and maintaining health. (WHO, 2009).
Learning depends on:
1.Learning environment
2. Ability to learn, a)Emotional capacity,
b) Intellectual capacity
c) Physical capacity & d).Developmental stage
3. Learning style & preference
4.Motivation to learn
The central concern of health education are positive informed changes in health behavior
Hint, Hint Hint!!!
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3. Goals Client Education
Promoting, protecting, maintaining and restoring health & helping clients cope with illness or altered health status.
Reducing health risk factors, increasing a persons level of wellness. Taking specific protective health measures, coping with diagnostic procedures and treatments, managing symptoms of illness, & optimizing health status
Prenatal classes- teach about fetal development, healthy food choices, exercise… greater knowledge can result in greater health
Involve family-
Helping to cope with permanent health alterations. i.e. learn a new way to communicate
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4. Nurse’s Role
Clients have a right to have sufficient knowledge to make an informed decision.
Present information in a clear and concise manner.
Anticipate the client’s needs for information based on physical condition and treatment
Clarify information
Carry out the nursing process i.e. assessment, nursing diagnosis, planning, implementation and evaluation
Clarify information from physicians or other health care professionals.
Teaching is a required competent skill for nursing practice.. Legal and professional responsibility.
Teach on issues for which clients have expressed needs and in a manner that is meaningful & relevant to them
Must do more than just pass on facts; determine what the client needs to know, find the appropriate time, when they are ready to learn and evaluate the impact of client education on client outcomes

5. LEARNING Consider … Without LEARNING, our ability to grow to change
to adapt to our environment
would not be possible.
Learning is the processing of information, which leads to change and/or an increase in our knowledge and abilities.
There are basic learning principles applicable to everyone
There are learning styles specific to individuals/ and developmental stages..
Clients have learning needs- desire or requirement to know something that is presently unknown by the learner.. May include new knowledge, learn a different skill or physical ability, new understanding about an issue, way to change ineffective behavior..
Cognitive activity that is represented by a change in behavior
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6. There are 3 Learning Domains/Taxonomies (ways to LEARN according to Bloom)
Cognitive: knowledge and development of intellectual skills.
Affective : growth in feelings/emotions (Attitude)
Psychomotor: motor skills
Cognitive (understanding)- includes all intellectual behaviors and requires thinking- knowing, comprehending and applying
Affective (Attitudes)- concerns expressions of feelings and acceptance of attitudes, opinions or values.
Psychomotor-(motor skills) acquiring skills that require the integration of mental and muscular activity such as walking.
Example: Client with diabetes must learn to control blood glucose (cognitive), use a glucometer (psychomotor) learn positive coping strategies and learn to accept chronic nature of the disease (affective)
Include cognitive and affective in all teaching plans and when teaching is a skill all 3 domains….i.e. irrigate a colostomy
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7. LEARNING DEPENDS UPON:
Learning Environment
Ability to Learn
Learning Style & Preference
Motivation to Learn
Remember
There must be opportunities for application
Active learning (interaction) leads to greater learner engagement, retention, and competence.
Adults
Are autonomous and self-directed
Have accumulated a foundation of life experiences & knowledge
Are goal oriented & relevancy- orientated (reason for doing, practical)
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8. The Learning Environment Should:
be characterized by :
physical comfort
mutual trust
respect
mutual helpfulness
freedom of expression
acceptance of difference
Also:
Well lit and well ventilated
Appropriate furniture and comfortable temperature.
Few distractions
Consider family involvement
Close cubicle curtains, be wary of family members in the room..
See barriers to learning on pg 556 Kozier
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9. Ability To Learn
Emotional Capability- how does a person’s level of anxiety affect learning?
Intellectual Capability
Physical Capability-consider a persons’ size, energy, strength, coordination and sensory acuity, physical condition.
Developmental Stage: Consider learning in children vs. adult learning
1 mild anxiety can help a person focus, more intense levels of anxiety can be incapacitating (how can you alleviate the anxiety)
3. Physiological events (illness, apin, sensory deficits inhibit learning).. Drugs and Rx… psychomotor capability
Other issues to consider: readiness to learn, watch your timing (learning how to give an insulin injection), cultural barriers (values/beliefs around weight; western medicine differ from cultural healing beliefs and practice)
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10. Conditions for effective learning are enhanced if Adult Learners:
Feel a need to learn …
Perceive the goals of a learning experience to be their goals …
See that the learning process is related to, and makes use of, their experience
Principles of adult learning
As people mature, they move from dependence to independence
An adults previous experiences can be used as a resource for learning
Learning is related to an immediate need, problem or deficit
An adult is more oriented to learning when the material is useful immediately, not sometime in the future
Learning is reinforced by application and prompt feedback
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11. Learn To Do By Doing
“Tell me and I forget. Teach me and I remember. Involve me and I learn.”
Benjamin Franklin ( )  
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12. Learning Style and Preferences (Some Examples)
Visual learners understand new information best by seeing it in the form of pictures, demonstrations, diagrams, charts, films and so on.
Verbal learners understand new information best through written and spoken words.
Intuitive learners discover new relationships and can be innovative in their approach to problem solving.
Others learn best (Active learners) when they are able to manipulate tools and find out how they work.
Reflective learners prefer to think about new information before they act on it.
Sequential learners understand new information in linear steps where each step follows logically from the previous one.
May link to culture (strong oral tradition).. Ask clients how they like to learn
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13. Clients may be Motivated to Learn/Change if they
PERCEIVED SELF-EFFICACY-Perceived ability to successfully complete a task.
Perceive Disease as a Threat
PERCEIVE BENEFITS OF HEALTH PROMOTING BEHAVIOR
PERCEIVE Ways to overcome BARRIERS TO HEALTH PROMOTING BEHAVIOR
Cause and Effect
Motivation is the desire to learn.. Greatest when a person experiences a need and believes the need will be met through learning, may need to help the client personally work through a problem and identify the need to learn.
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14. Motivation:
Social Motives: Connection, Social Approval and Self Esteem
Task Mastery Motives: Driven by the desire for achievement.
Physical Motives: Desire to Maintain and Improve Health
Exercise linked to social aspects of the exercise activities
Learning how to manage diabetes on own before leaving for university
Someone who has undergone a leg amputation may be extremely motivated to learn assistive devices..
How do you increase motivation?
By relating the learning to something the client values and helping the client see the benefits of learning
Helping the client make the learning situation pleasant and nonthreatening
Encourage self direction and independence
Demonstrating a positive attitude about the clients ability to learn
Offering continuing support and encouragement
Creating a learning situation in which the client is likely to succeed.
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15. Definition of Teaching
Teaching - is an interactive process that promotes learning. Engagement in a set of activities that helps individuals to gain new knowledge that may lead to change.
Most effective when it responds to the learner’s needs.
System of activities intended to produce learning
Effective teaching depends upon:
-listen empathetically
-good observation
-speak clearly
-intrapersonal variable-attitudes, values, culture and emotions, and knowledge
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16. How Do The Nursing Process And Teaching Process Differ?)
Important
How Do The Nursing Process And Teaching Process Differ?)
Steps
Nursing Process
Teaching Process
(Teaching Plan)
Assessment
Collects all client data – physical, psychosocial, cultural, developmental & spiritual, test etc
Collects client data re learning needs, learning style, motivation, ability to learn available teaching resources
Diagnosis
Nsg diagnosis based on assessment findings
Id client learning needs based on one or more of the 3 learning domains: Cognitive, Affective & Psychomotor.. Educational diagnosis
Planning
Dev. individualized care plan; Set diagnostic priorities based on client needs; Collaborate with client
Establish learning objectives (outcomes), s, prioritized learning needs, select content and time frame, select teaching strategies, Collaborate with client
Implementation
Perform nursing & client Interventions
Include client/ family
Implement teaching methods
Actively involve client & others
Evaluation
Id success in meeting client goals & outcomes of nsg care
Alter interventions if goals not met
Evaluate client learning based on achieve of learning outcomes.
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17. Teaching Processes First step Assessment of learning needs
Determining what information is critical to teach and best ways to teach it…in consideration of the principles of learning (learning environment, ability to learn, learning style, motivation)
Comprehensive assessment of learning needs incorporates data from the nursing history and physical assessment and addresses the clients support systems.. Consider readiness to learn, motivation, reading and comprehension level (literacy)..assess for stage of change.. Learning needs can change as health status changes.
Nursing history components:age ( see chart 559 for special teaching considerations), clients understanding of health problems, health beliefs and cultural practices, economic factors, learning style, supports)
Physical exam (mental status, energy, nutritional status, physical capacity to learn, ability to perform self care activities)
Readiness- (physical, emotional, cognitive)

18. Health Literacy Health literacy is the ability to: Access
Know
Health literacy is the ability to:
Access
Understand and
Act on information for health.
Health professionals, who provide clear, reliable, understandable information, are essential to helping people manage their health.
Reading prescription labels, nutrition labels, interpreting appt slips, completing health insurance forms, following instructions for diagnostic tests..
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19. …Literacy Levels of Canadian Adults
22% of adult Canadians fall in the lowest literacy, level 1. Ex: unable to read the medicine label to determine the amount to administer
26% of adults read at a level 2. They can only deal with material that is simple and familiar to them.
33% of adults can read well enough to get along from day to day.
20% of adults can read complex reading material
Health literacy is the ability to access, understand and act on information for health.
Accessing health information and services can be difficult, especially for someone feeling ill, anxious or in pain. Being able to access and understand information makes a difference to health and well-being.
Health professionals who provide clear, reliable information are essential to helping people manage their health.

20. Why is Health Literacy Important?
Literacy facilitates access to information, and enables individuals to make informed health decisions, to influence events, and to exert greater control over their lives.
People who are not literate tend to be poor, live & work in less healthy environments, & more at risk at many levels & less likely to engage in health promotion & disease prevention since survival is their priority.
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21. Clues to Problems Client’s Health Literacy
Behaviour:
Failing to complete written forms
Frequently missing appointments
Non-adherence with medication prescriptions
Inability to name medications, explain their purpose, or the timing of their administration
Comments related to forgetting glasses or taking written instructions home for family members to read.
Healthy people (2010)
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22. Communication Strategies to Consider
Present information that clients can easily understand, multiple teaching methods
Use simple terminology
Keep session short
Repetition
Relate example to personal life experiences, actively involve
Frequently ask if clients understand what is being communicated, obtain feedback
Keep reading level at or below grade 6
Write abbreviations out in full
Active voice
Use common words
Use 14 to 16 point font
Short sentences
Priority information first
Bold for emphasis, simple pictures, plenty of white space
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23. Planning Creating learning goals and outcomes Timing
identify the expected outcomes for clients and establish learning priorities.
Timing
Organizing teaching material
Maintaining learning attentions and participation
Building on existing knowledge
Selecting teaching methods and resources
setting priorities- timing, organizing teaching material, maintaining attention and building on existing knowledge, selecting teaching methods, selecting resources, writing teaching plans
Learning outcomes- written in the same way as client outcomes
Choosing content- accurate and current, based on learning outcomes, adjust for age, developmental level, culture, time to spend, resources available.
Strategies (pg. 565) description, answering questions, demonstration, group discussion, practice, role playing
Tools- flip charts, photos, handouts, audio, computer
Organizing the learning experience- start with something the learner is concerned about, known to unknown, address things early that cause anxiety, schedule time for review…

24. Intervention and Evaluation
Implementing teaching approaches
e.g. one-on-one discussions, demonstrations, role playing
Evaluating teaching-learning
Evaluating outcomes and interventions – client and nursing perspectives
Establish rapport before teaching, Pay attention to learning barriers, illiteracy and learning disabilities, sensory alterations, language, cultural diversity, needs to clients with severe illness, use teaching aids that help to focus attention, repetition….

25. Nurses are Change Agents
Nurses Need To Know When Change is Most Likely to Occur
How & When to Influence/Motivate
What has worked in the past for client
We use behavior change
models to help encourage positive change
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26. Behavior Change Models
Behavior Change models attempt to change an individual’s or a specific target population’s behavior toward a more healthy lifestyle.
The majority of these models focus on modifying diet, exercise, smoking, addictions, sexual practices, drinking and driving and the use of seat belts
The Trans-theoretical Model (change theory) is a good example of a
Behavior Change Model
Quiz!
Describe how behavior can be changed and influenced
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27. Transtheoretical Model of Change
Application Of Theories And Models For Health-promoting Behavioral Outcomes
Nurses need to use Motivation & Social Learning Theories & Models when helping people to change behaviour, attitudes & values associated with their state of health.
Examples:
Pender’s Health Promotion Model-considers motivational source for behavioral change that is based on how the client perceives the benefits of changing the given health behavior.
Transtheoretical Model of Change
5 stages: Precontemplation, Contemplation, Preparation, Action, Maintenance (Kozier ,pg. 148)
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28. Transtheoretical Model Change Is A Process Involving Progress
Through Five (Six) Stages
Termination
By identifying the clients stage of change and focusing learning activities to match the clients stage, you facilitate the learners motivation to change and his or her transition from one stage to the next
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29. Transtheoretical Model Change Is A "Process Involving Progress Through Six Stages (Kozier p.149)
Precontemplation – does not intend to take action
Contemplation – acknowledges having a problem, intends to change, not ready to commit to action
Preparation – plans to take action in the immediate future, has taken steps to begin the behavioral change
Action – people/client have made specific overt modifications in their life styles
Maintenance – people/client are working to prevent relapse," a stage which is estimated to last "from 6 months to about 5 years“, integrates new behavior into lifestyle
Termination – people/client have zero temptation and 100% self-efficacy... they are sure they will not return to their old behaviour/habit
Relapse or recycle- an opportunity to learn from the experience and renew efforts to change..
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30. A question waiting for a place to happen?
Explain why theories on health promotion and human behavior are important for nurses to understand and use?
Why doesn’t one model fit all?
Also see tools/strategies for promoting behavioral change.
Different theories are best suited to different units of practice such as individuals groups and organizations, should begin with identifying the problem, goal and units of practice
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31. The Idea Behind Most Behaviour Change Models Is That:
Behavior change does not happen in one step
People tend to progress through different stages on their way to successful change
Each of us tend to progress through the stages at our own rate
Since in most cases the goal of education is behavioral change, the understanding of behavior provided by behavioral change theories provides insight into the formulation of effective teaching methods.
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32. Health Promotion: Successful Change
Above all else, change depends on the individual’s belief that he/she can and will succeed.
Self-efficacy and optimism
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33. Health Promotion: Behavior Change
Change isn’t easy!
Knowledge alone is not enough for most people to change their behavior
Knowledge combined with positive attitudes, beliefs, values, perceptions , support, and motivation is mighty!
Nurses self care
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34. Socio-Ecological Models
The most successful approaches to behavior change are the ones that take into consideration multiple factors that influence behavior and health. These successful approaches have been defined as socio-ecological as behavior is determined by a number of factors that include interpersonal and intrapersonal processes, institutional and community factors and public policy (McLeroy et. al., 1988)
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35. Retrieved from: http://www. balancedweightmanagement
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36. Each of these environments influence a persons health.
Individuals do not live in vacuums, they are embedded within complex and multilevel environments. Part of families, work at worksites, learn in schools, live in neighborhoods and are influenced by polices in each of these sectors.
Each of these environments influence a persons health.
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37. Case Example: Clark (pg. 51)
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38. A Summary Health Education and Health Behavior Learning
Nurse’s Role
Learning
Principles
Domains
Application of Theories and Models
Health Literacy
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