Far Eastern University

Institute of Nursing

Day 9

I. PLANNING AND CONDUCTING CLASSES

1. Developing a Course Outline/ Syllabus
♦ Course outline or syllabus should always accompany a course.
♦ A course outline helps the learners to gauge just what is to be learned and what is expected of them.
Course Outline/ Syllabus Includes:
a. Name of the course e. Topical outline
b. Name of the instructor f. Teaching methods to be used
c. One paragraph course description g. Textbooks or other readings
d. List of course objectives h. Methods of evaluation

Syllabus - a plan of the entire course, a course outline and a program of study that an educator prepares
before actual health education.
- more extensive and detailed than a teaching plan

• it should contain the following:

Course code: NUR1203
Course title: Strategies of Health Education
Credits: 3 units
Course description:
- designed to enlighten student nurses on their roles as health educators and to equip them with the skills and
competencies in choosing the approaches, strategies and methodologies that they can employ in the conduct of health
education among their client in the community and other health care settings as well as discharge planning and
documentation.

Course requirements:
1. Major exam, quizzes, graded recitations
2. Other requirements- group presentation, demonstrations

Methodologies:
Lecture
Audio-video presentation
Graded group presentation

Course objectives:
- upon completion of the course, the students will be able to:
1. Apply the knowledge, attitudes and skills to effectively develop in the client at least 70% awareness, acceptance and
implementation of healthy behaviors that will lead to promotion of health and prevention of disease.
2. Develop the attitudes, skills and competencies with at least 75% compliance in adapting and using the teaching contents and
strategies to address the needs of the community

Formulating Course Objectives

Educational Objectives suggested by Bloom (1984) are divided into 3 domains:

1. Cognitive (knowing)
2. Psychomotor (doing)
3. Affective (feeling, valuing)

Value of Objectives:
1. Guides in the selection and handling of course materials
2. Helps in determining whether people in the class have learned what they have been taught
3. Essential from the learner’s perspective

♦ Objectives for a course are naturally broader than class objectives

♦ They should be discussed in the first session of each class so learners are immediately clear about what they are
expected to learn
♦ Course objectives should be designed to be achieved by most or all learners in the class

Taxonomy of Objectives
♦ Bloom’s Taxonomy of Educational Objectives was developed by Benjamin Bloom in 1956.
♦ Taxonomy – branch of science concerned with classification
♦ The levels of this taxonomy are considered to be hierarchical (arranged in the order of rank). That is,
learners must master lower level objectives first before they can build on them to reach higher level
objectives.
Three (3) Learning Domains
I. Cognitive Domain
You can measure:
a. Knowledge d. Analysis
b. Comprehension e. Synthesis
c. Application f. Evaluation
II. Psychomotor Domain
♦ You can observe what learners are actually doing when they perform a skill.
♦ Learners can demonstrate what they have learned and their performance can be rated.
Ex Objective: The student will correctly perform proper hand washing technique. The teacher can
observe the student doing hand washing to see if the performance meets the stated
criteria
III. Affective Domain
♦ Related to beliefs, attitude, and values
♦ The process is rather subjective
♦ Not so easy to write and measure.
♦ Eg: defends in writing the refusal of the nurse to divulge confidential information given by a client.

BEHAVIORAL VERBS USEFUL FOR WRITING OBJECTIVES

COGNITIVE DOMAIN

• Knowledge Recall data or information

Define, delineate, describe, identify, list, name, state

What does inflammation mean?

• Comprehension Grasping the meaning of material or giving meaning to the information

Classify, discuss, estimate, explain, rephrase, summarize

Discuss why there is swelling in inflammation

• Application Using information in correct situation.

Adjust, apply, compute, demonstrate, generate, prove, explain

Demonstrate proper hand washing technique before dressing a wound

• Analysis Breaking down material into parts

Analyze, compare, contrast, critique, defend, differentiate

Given a poem, identify the specific poetic strategies employed in it

• Synthesis Putting parts together into a whole

Create, develop, propose, suggest, write

Based from the data gathered what is the problem of the patient

• Evaluation Judging the value of a product for a given purpose, using definite criteria

Assess, choose, conclude, defend, evaluate, judge

Evaluate how the nurse performed the wound dressing by using written or oral test
 PSYCHOMOTOR DOMAIN Arrange, assemble, calibrate, combine, copy, correct, create, demonstrate, execute,
handle, manipulate, operate, organize, position, produce, remove, revise, show, solve

AFFECTIVE DOMAIN Accept, agree, choose, comply, commit, defend, explain, influence, integrate,
recommend, resolve, volunteer.

3. Selecting Content
a. Start developing objectives and a content outline for your class
♦ How much information should you include and into how much detail should you go?
♦ How much time you can devote to the topic?
b. Students’ background
c. If a textbook has already been selected for the course, its depth of content can give you some hints as to what you
need to include.

4. Selecting Teaching Methods

Factors Affecting Choice of Method:
a. Depends on the objectives and type of learning you are trying to achieve.
b. Course content also dictates methodology to some extent.
c. Choice of teaching strategy also depends on the abilities and interests of the teacher.
d. Compatibility between teachers and teaching method is important, but so is compatibility between learners
and teaching method.
e. Number of people in the class
f. Resources of the institution

5. Choosing a Textbook
♦ Textbooks provide a stable and uniform source of information for students to use in their individual study, and
teachers expect students to use the book extensively.

Guidelines when choosing a textbook:

a. Evaluate the content, scope and quality.
b. Credibility of authorship
c. Format
c.1. Table contents
c.2. Index
c.3. Organization
c.4. Length
c.5. Graphics
d. Issues
d.1. Cost
d.2. Permanency
d.3. Quality of print
.
6. Conducting the Class
First Class
a. Begin by introducing yourself
♦ If you have a preference for a form of address, first name or last name, or title, make it known at the outset.
b. Tell the class a little about yourself.
♦ Professional or Personal
c. Establish a pleasant atmosphere
d. Welcoming the class
e. Reading names and getting correct pronunciation
f. Making sure that everyone gets the handouts
g. Commenting on current situations like weather, etc
h. A little humor is helpful on the first day
i. Best time to communicate the expectations for the course
j. Review the course syllabus
k. Answer questions about
k.1. Content
k.2. Methods
k.3. Assignments
l. Give class a general idea of the workload and your expectations in terms of preparation for the class and in terms
of learning outcomes.
m. Cover general classroom rules or policies
n. End the first class giving the group something to look forward to for the rest of the course.
 Subsequent Classes
a. Begin by gaining and controlling the attention of the learners.
b. Assess the learners to determine their backgrounds and how much they already know about the
content of the course

DEVELOPING the TEACHING PLAN

Content
• Topic
• Purpose
• Goal
• Venue
• Participants

Day 10

II. CHARACTERISTICS OF THE LEARNER

A. DETERMINANTS OF LEARNING
1. Learner’s Characteristics
1. Culture
♦ Invisible patterns that form the normal ways of acting, feeling, judging, perceiving and organizing the world.
♦ Is a learned set of shared norms and practices of a particular group that direct thinking, decisions, & actions.
♦ Affects health behaviors and the teaching-learning process in many ways.
♦ Affects the way people experience and describe illness and will therefore affect the educational approach to
be used.

Cultural Influences:
Gender roles Exercise Drug use
Diet Communication Personal hygiene
Body image Sexual behavior Educational pursuit

Examples:
Hispanic or Latino population: Decision making involves the other family members or the head of the
family.
Native Americans and Alaskan tribal groups: Herbal medicines
Buddhism, Taoism, Confuscian have aversion to public admission of mental or physical illness or
personal weakness which affect assessment
2. Age
♦ Teaching older adult present some challenges
♦ Older adults needs more time to learn
♦ Older adults enjoy learning in groups
♦ Be cognizant of possible hearing and visual deficits
♦ Face client while speaking clearly, softly, and loudly if necessary while avoiding shouting.
♦ Use large print materials or print in larger letters if using flip charts or chalkboard.
♦ When reading is not possible, make a tape recording of pertinent instructions.
 3. Emotional Status
♦ Emotional and mental status should be acknowledged and taken into account when planning an educational
intervention.
♦ Depression, stress, denial, fear, anger and anxiety can all impact the effectiveness of teaching.
4. Socioeconomic Level
♦ Has more to do with being able to use the information being taught rather than the process of learning.
♦ May dictate where a client lives
♦ Take into account a number of factors including:
a. Income
b. Education level
c. Occupation or employment
♦ For students, A lower socioeconomic level may mean that time that could be used for studying is taken up
by a part time job
5. Literacy level
♦ Client’s ability to read and understand what is being read is an essential
♦ Materials at too high level are useless as they will not be understood. When too low level would be insulting,
though some would be of value.
♦ Establishing the reading level and using materials that are consistent with the client’s ability is paramount.
6. Education level and health status
♦ Education level is significantly associated with health status (the more educated, the healthier)
♦ The more educated client is the one who seeks treatment earlier in the disease process.
♦ The client’s level of knowledge or depth of understanding are important in teaching, which enables the
educator to provide the information, the basic or great medical detail.

2. Assessment of the Learner

Assessment of the learner includes attending to the following three determinants:
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 best learns

3. Assessing Learning Needs

LEARNING NEEDS
▪ are gaps in knowledge that exist between a desired level of performance and the actual level of performance
▪ is the gap between what someone knows & what someone needs to know or wants to know
▪ Once learning need is identified or discovered, determination can be made when and how learning can most
optimally occur.

Steps in the Assessment of Learning Needs

1. Identify the learner 6. Prioritize needs
2. Choose the right setting 7. Determine availability of educational resources
3. Collect data about the learner 8. Assess demands of the organization
4. Include the learner as a source of information 9. Take time management issues into account
5. Involve members of the healthcare team

Types of Needs (Maslow’s Hierarchy of Needs)

Physiological Needs
Safety and Security Needs
Belonging and Love Needs
Esteem Needs
Self – Actualization Needs

Methods to Assess Learning Needs

Informal Conversations Structured Interviews
Focus Groups Self-administered Questionnaires
Tests Observations
Patient Charts

READINESS TO LEARN
▪ Defined as the time when the learner demonstrates an interest in learning the type or degree of information
necessary to maintain optimal health or to become more skillful in a job.
▪ Readiness to learn occurs: when the learner is receptive, willing and able to participate in the learning process.
 ▪ Once a learner asks questions, then the time is ripe, for learning

Four Types of Readiness (PEEK)

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

PHYSICAL READINESS EMOTIONAL READINESS

Measures of ability Anxiety level
Complexity of task Support system
Environmental effects Motivation
Health status Risk – taking behavior
Gender Frame of mind
Developmental stage
EXPERIENTIAL READINESS KNOWLEDGE READINESS
▪ Refers to the learner’s past experiences with learning ▪ Refers to learner’s present knowledge base,
Five elements: the level of learning capability, and preferred
1. Level of aspiration style of learning
2. Past coping mechanism Present knowledge base
3. Cultural background Cognitive ability
4. Locus of control Learning and reading disabilities
5. Orientation Learning styles

PHYSICAL READINESS
- The educator needs to consider five major components of physical readiness measures of ability, complexity of task,
environmental effects, health status, and gender-because they affect the degree or extent to which learning will occur.
A. MEASURES OF ABILITY
- Ability to perform a task requires fine and/or gross motor movements, sensory acuity, adequate strength, flexibility,
coordination, and endurance. Each development stage in life is characterized by physical and sensory abilities or is affected by
individual disabilities.
B. COMPLEXITY OF A TASK
- Variations in the complexity of the task affect the extent to which the learner can master the behavioral changes in cognitive,
affective, and psychomotor domains.
- The more complex the task, the more difficult it is to achieve.
C. ENVIRONMENTAL EFFECTS
- An environment conductive to learning helps to hold the learner’s attention and stimulate interest in learning. Unfavorable
conditions, such as extremely high levels of noise or frequent interruptions, can interface with a learner’s accuracy and precision
in performing cognitive and manual dexterity tasks.

.HEALTH STATUS
- The amounts of energy available and the individual’s present comfort level are factors that significantly influence that
individual’s readiness to learn. Energy-reducing demands associated with the body’s response to illness require the learner to
expend large amounts of physical and psychic energy, leaving little reserve for actual learning.
. GENDER
- In addition, women traditionally have more frequent contacts with health providers while bearing and raising children. Men,
by comparison tent to be less receptive to healthcare interventions and are more likely to be risk takers.

EMOTIONAL READINESS
- Learners must be emotionally ready to learn. Like physical readiness, emotional readiness includes several factors that need
to be assessed. These factors include anxiety level, support system, motivation, risk-taking behavior, frame of mind, and
development stage.

A. ANXIETY LEVEL
- Anxiety influences a person’s ability to perform at cognitive, affective, and psychomotor levels. The level of anxiety may or
not be a hindrance to the learning of new skills; some degree of anxiety is a motivator to learn, but anxiety that is too low or too
high interferes with readiness to learn.
B. SUPPORT SYSTEM
- The availability and strength of a support system also influence emotional readiness and are closely tied to how anxious an
individual might feel. Members of the patient’s support system who are available to assist with self-care activities at home should
be present during at least some of the teaching sessions so that they can learn how to help the patient if the need arises.
C. MOTIVATION
- Emotional readiness is strongly associated with motivation, which is a willingness to take action. Knowing the motivational
level of the learner assist the educator in determining when that person is ready to learn. The nurse educator must be cognizant
of the fact that motivation to learn is based on many varied theories of motivation and, thus, be careful to link a specific theory’s
concepts or constructs to the appropriate method of assessment and subsequent educational interventions.
D. RISK-TAKING BEHAVIOR
- Taking risk is intrinsic in the activities people perform daily. Indeed, many activities are done without about the outcome.
According to Joseph (1993), some patients, by the very nature of their personalities, take more risks than others do. The
educator can assist patients in developing strategies that help reduce the level of risk associated with their choices.
E. FRAME OF MIND
- Frame of mind involves concern about the here and now versus the future. If survival is of primary concern, readiness to
learn will be focused on the present to meet basic human needs. According to Maslow (1970), physical needs such as food,
warmth, comfort, and safety as well as psychosocial needs of feeling accepted and secure must be met before someone can
focus on higher order learning.
F. DEVELOPMENTAL STAGE
- Each task associated with human development produces a peak time for readiness to learn, known as a teachable moment.
Unlike children, adults can build on meaningful past experiences and are strongly driven to learn information that helps them to
cope better with real-life tasks. They see learning as relevant when they can apply new knowledge to help them solve immediate
problems.

EXPERIENTIAL READINESS
- Experiential readiness refers to the learner’s past experiences with learning and includes four elements: level of aspiration,
past coping mechanisms, cultural background, and locus on control. The educator should assess whether previous learning
experiences have been positive or negative in overcoming problems or accomplishing new tasks.
A. LEVEL OF ASPIRATION
- The extent to which someone is driven to achieve is related to the type of short-and long-term goals established-not by the
educator but by the learner. Previous failures and past successes influence the goals that learners set for themselves.
B. PAST COPING MECHANISMS
- Educators must explore the coping mechanisms that learners have been using to understand how they dealt with previous
problems. One these mechanisms are identified, the educator needs to determine whether past coping strategies have been
effective and, if so, whether they work well in the present learning situation.
C. CULTURAL BACKGROUND
- The educator’s knowledge about other cultures and sensitivity to behavioral differences between cultures are important so
that the educator can avoid teaching in opposition to cultural beliefs.
D. LOCUS OF CONTROL
- Educators can determine whether readiness to learn is prompted by internal or external stimuli in ascertaining the learner’s
previous life patterns of responsibility and assertiveness.
a. Internal locus
- This drive to learn comes from the within the learners.
b. External locus
-The responsibility often falls on the educator to motivate the patient to want to learn.
E. ORIENTATION
a. Parochial
-Persons who demonstrate close-mindedness in thinking, conservativeness, and less willingness to learn new material
and who place trust in traditional authority figures; a component of experiential readiness.
b. Cosmopolitan - more worldly perspective and receptive to new or innovative ideas like current trends
- the individual in question has the ability to situate and orient him or her- self in the global world, to
recognize the vast interconnection of political communities in different realms (including the social,
economic and environment)

KNOWLEDGE READINESS
- Knowledge readiness refers to the learner’s present knowledge base, the level of cognitive ability, the existence of any
learning disabilities and/ or reading problems, and the preferred style of learning.
A. PRESENT KNOWLEDGE
- If the educators make the mistake of teaching subject material that has already been learned, they risk at the very least
inducing boredom and lack of interest in the learner or at the extreme insulting the learner, which could produce resistance to
further learning.
B. COGNITIVE ABILITY
- The extent to which information can be processed is indicative of the learner’s capabilities. The educator must match the
level of behavioral objectives to the learner.
C. LEARNING STYLE
- indicate how people learn in uniquely different ways
- Some are global thinkers while some are analytic; Some learn better from auditory sources than visual stimuli; Some
learn better when with the group than independently alone.

SIX LEARNING STYLE PRINCIPLES

Learning style
▪ refers to the ways individual process information.
1. Both the style by which the educator prefers to teach and the style by which the student prefers to learn can be
identified.
2. Educator need to guard against over teaching by their own preferred learning styles.
3. Educators are most helpful when they assist students in identifying and learning through their own style preference.
4. Learners should have the opportunity to learn through their preferred style.
5. Learners should be encouraged to diversify their style preferences.
6. Educators can develop specific learning activities that reinforce each modality or style.

Learning Principles
a. Use several senses
▪ 10% - READ, 20% - HEAR, 30% - SEE, 50% HEAR AND SEE, 70% - SAY, 90%- SAY AND DO.
Learning is more likely to occur if they apply what is being taught.
b. Actively involve the patients or clients in the learning process
▪ Passive Methods: Lecture, Videos, Print materials. The more interactive the educational
experience, the likelihood of success.
▪ Use methods that engage the participants: Discussion, Role playing, Small group discussion, Q&A,
rather than lecture. Use case scenarios
c. Provide an environment conducive to learning (Cold, sweltering hot)
 d. Assess the extent to which the learner is ready to learn
e. Determine the perceived relevance of the information
f. Repeat information
g. Generalize information
h. Make learning a pleasant experience
i. Begin with what is known; move toward what is unknown
j. Present information at an appropriate rate

LEARNING STYLE MODELS

1. Right Brain/Left Brain and Whole Brain Thinking

-understanding of brain functioning that are associated with learning.
Right brain Hemisphere dominance:
1. Creative, intuitive, divergent thinking
2. Prefers drawing & manipulating objects
3. Responds to written instructions & explanations
4. Recognizes & remembers faces
5. Loose organizational skills, sloppy
6. Likes change and uncertainty
7. Lose contact with time & schedules
8. Geometry is the preferred math
9. Good at interpreting body language
10. Free of emotions
11. Solves problems as a whole, using patterns

Left brain Hemisphere dominance:

1. Critical, logical, analytical thinking
2. Prefers talking and writing
3. Responds to verbal instructions & explanations
4. Recognizes & remembers names
5. Neat, good organizational skills
6. Likes stability, adheres to rules
7. Conscious of time & schedules
8. Algebra is the preferred math
9. Controls emotions
10. Relies on language in thinking & remembering
11. Solves problems sequentially

2. Field-Independent / Field-Dependent Perception

-learners have preference styles for certain environmental cues.
Field-Independent Learner
1. They want to be separated from others
2. Not affected by criticism
3. Will not conform with peer pressure
4. They learn best organizing their own material
5. Less influenced by external feedback
6. Self-directed goals, objectives and reinforcement
7. Interested in new ideas/concepts for own sake.
8. Place emphasis on applying principles
9. Have an impersonal orientation to the world
10. Favors an active participant role
11. Eager to test their ideas or opinions in a group

Field-Dependent Learner
1. Externally focused
2. Socially-oriented
3. They need extrinsic motivation
4. Easily affected by criticism
5. Will conform to peer pressure
6. Influenced by feedback
7. Learn best when material is organized
8. They have social orientation to the world.
9. Prefers learning to be relevant to own experience.
10. Prefers discussion method
11. Learning emphasis on facts
12. Need external goals, objectives and reinforcements.

3. Dunn & Dunn Learning Styles - Rita and Kenneth Dunn (1978) define Learning Styles as, “The way in which each learner
begins to concentrate, process and retain new and difficult information. That interaction occurs differently for everyone.”
- This model is a comprehensive model that identifies each individual’s strengths and preferences across the full spectrum of
five categories.

4,. Jung & Myers-Briggs Typology of Learning

The Jung typology is the result of the work of Carl Gustav Jung, an eminent Swiss psychiatrist who developed a theory of
psychological types designed to categorize people in terms of various personality patterns.
Jung's Theory of Personality Types
Jung’s theory focuses on four basic psychological functions:
1. Extravert vs. Introvert
2. Sensation vs. Intuition
3. Thinking vs. Feeling
4. Judging vs. Perceiving

Extraverted Learning Style

- Extraverted learners enjoy generating energy and ideas from other people. They prefer socializing and working in groups.
Characteristics of Extravert Learners
• Learns best through direct experience
• Enjoys working with others in groups
• Often gathers ideas from outside sources
• Willing to lead, participate and offer opinions

Introverted Learning Style

- Introverted learners are still sociable, however, they prefer to solve problems on their own.
- They enjoy generating energy and ideas from internal sources, such as brainstorming, personal reflection, and theoretical
exploration. These learners prefer to think about things
before attempting to try a new skill.
Characteristics of Introvert Learners
• Prefers to work alone
• Enjoys quiet, solitary work
• Prefers to listen, watch and reflect
• Likes to observe others before attempting a new skill
• Often generates ideas from internal sources
• These people are thoughtful, reflective, slow to act
• Their thoughts are well formulated before they are willing to share them with others.

Sensing Learning Style

- Sensing learners are focused on aspects of the physical environment. These individuals are interested in the external world.
They tend to be realistic and practical, preferring to rely on information gained through experience. While people with a sensing
learning style enjoy order and routine, they also tend to be very quick to adapt to changing environments and situations.

Intuitive Learning Style

- Intuitive learners tend to focus more on the world of possibility. They enjoy considering ideas, possibilities, and potential
outcomes. These learners like abstract thinking, daydreaming and imagining the future

Thinking Learning Style

- Individuals with a thinking learning style tend to focus more on the structure and function of information and objects. Thinking
learners utilize rationality and logic when dealing with problems and decisions. These learners often base decisions on personal
ideas of right, wrong, fairness, and justice.

Feeling Learning Style

- People with a feeling style manage information based on the initial emotions and feelings it generates. They are more
interested in personal relationships, feelings, and social harmony.
Judging Learning Style
- Judging learners tend to be very decisive. In some cases, they may actually make decisions too quickly before learning
everything they need to know about a situation. These learners prefer order and structure, which is why they tend to plan out
activities and schedules very carefully. They are also highly organized, detail-oriented, and have strong opinions.

Perceiving Learning Style

- Perceiving learners tend to make decisions impulsively in response to new information and changing situations. They tend to
focus more on indulging their curiosity rather than making decisions. They prefer to keep their options open, tend to start many
projects at once (often without finishing any of them), avoid strict schedules, and jump into projects first without planning.

5. Kolb's Learning Styles and Experiential Learning Model

- Our individual learning styles emerge due to our genetics, life experiences, and the demands of our current environment.
(David Kolb, 1984)
The 4MAT System helps the learners integrate knowledge and skills; experiment and solve problems, reflect on what they have
learned.
4 types of learners:
1. Innovative
2. Analytical
3. Common Sense
4. Dynamic

6. Gardner's Theory of Multiple Intelligences

- Gardner’s theory: The Theory of Multiple Intelligences," suggested that all people have different kinds of "intelligences."
- Gardner proposed that there are eight intelligences and in order to capture the full range of abilities and talents that people
possess, Gardner theorizes that people do not have just an intellectual capacity, but have many kinds of intelligence, including
musical, interpersonal, spatial-visual, and linguistic intelligences.
- And while a person might be particularly strong in a specific area, such as musical intelligence, he or she most likely
possesses a range of abilities.

1. Visual-Spatial Intelligence
- People who are strong in visual-spatial intelligence are good at visualizing things.
- These individuals are often good with directions as well as maps, charts, videos, and pictures.
2. Linguistic-Verbal Intelligence
 - People who are strong in Linguistic-Verbal intelligence are able to use words well, both when writing and speaking.
- These individuals are typically very good at writing stories, memorizing information, and reading.
3. Logical-Mathematical Intelligence
- People who are strong in logical-mathematical intelligence are good at reasoning, recognizing patterns, and logically
analyzing problems. These individuals tend to think conceptually about numbers, relationships, and patterns
4. Bodily-Kinesthetic Intelligence
- Those who have high bodily-kinesthetic intelligence are said to be good at body movement, performing actions, and
physical control. People who are strong in this area tend to have excellent hand-eye coordination and dexterity.
5. Musical Intelligence
- People who have strong musical intelligence are good at thinking in patterns, rhythms, and sounds. They have a strong
appreciation for music and are often good at musical composition and performance.
6. Interpersonal Intelligence
- Those who have strong interpersonal intelligence are good at understanding and interacting with other people. These
individuals are skilled at assessing the emotions, motivations, desires, and intentions of those around them.
7. Intrapersonal Intelligence
- Individuals who are strong in intrapersonal intelligence are good at being aware of their own emotional states, feelings,
and motivations. They tend to enjoy self-reflection and analysis, including daydreaming, exploring relationships with others, and
assessing their personal strengths.
8. Naturalistic Intelligence
- Individuals who are high in this type of intelligence are more in tune with nature and are often interested in nurturing,
exploring the environment, and learning about other species. These individuals are said to be highly aware of even subtle
changes to their environments.

7. VARK Learning Styles

-the VARK model technically focuses on learner’s preference for taking in & putting out information
VISUAL Learners
- Visual learners learn best by seeing. Graphic displays such as charts, diagrams, illustrations, handouts, and videos are all
helpful learning tools.
AURAL Learners
- Aural (or auditory) learners learn best by hearing information. They tend to get a great deal out of lectures and are good at
remembering things they are told.
Read/Write Learners
- Reading and writing learners prefer to take in information displayed as words and text.
- Reading/writing learners prefer materials that are primarily text-based.
Kinesthetic Learners
- Kinesthetic (or tactile) learners learn best by touching and doing. Hands-on experience is important

Day 10

B. COMPLIANCE, MOTIVATION AND BEHAVIOR OF THE LEARNER4

COMPLIANCE
- Is defined as the “extend to which the patient’s behavior (in terms of taking medications, following diets or executing other
lifestyle changes) coincides with the clinical advice” (Sackett & Haynes, 1976, p. 11)
- The act or process of complying to a desire, demand proposal, or regimen or to coercion; a disposition to yield to others”.
Defined as such, it has an authoritative undertone.

- Specifically, when applied to health care, it implies that the healthcare provider or educator is viewed as the authority, and the
patient learner is in a submissive role, passively following recommendations.
- Many nurses object to this hierarchical stance because they believe that patients have the right to make their own healthcare
decisions and not necessarily follow predetermined courses of action set by healthcare professionals.

PERSPECTIVE ON COMPLIANCE
- It can be viewed from various perspectives and are useful in explaining or describing compliance from a multidisciplinary
approach, including psychology and education.

These theories and models are follows.

1. Biomedical Theory - which links compliance with patient characteristics such as demographic, severity of disease, and
complexity of treatment regimen.
2. Behavioral/Social Learning Theory - which focuses on external factors that influence the patient’s adherence, such as
rewards, cues, contracts and social supports.
3. Communication Models - which attempt to explain compliance based on the communication between the patient and
healthcare professionals. These address aspects such as the feedback loop of sending, receiving, comprehending, retaining, and
accepting information.

Rational Belief Theory

- Which suggests that patients decide to comply or not by weighing the benefits of treatment and the risks of disease through
cost-benefit logic.

Self-regulatory Systems
- In which patients are seen as problem solve whose regulation of behavior is based on perception of illness, cognitive, skills and
past experiences that affect their ability to plan and cope with illness.

LOCUS OF CONTROL
- Refers to an individual’s sense of responsibility for his or her own behavior and the extent to which motivation to act
originates from within the person (internal) or is influenced by others (external).
ADHERENCE
- According to the World Health Organization (WHO), is “the extend to which a person’s behavior corresponds with agreed
recommendations from a health care provider” (Sabate, 2003, p. 3), such as taking medication, following a diet, and/or executing
lifestyle changes.
- Adherence define as ‘the act, action, or quality of adhering: steady or faithful attachment”, suggesting the need for the patient
to attach and commit to the healthcare regimen.
- Mihalko et al. (2004) define adherence as “level of participation achieved in a behavioral regimen once an individual has
agreed to the regimen”
- Hernshaw and Lidenmeyer (2006) describe adherence as the degree to which the patient follows the plan of care formulated
in conjunction with the healthcare provider.

Noncompliance and Nonadherence

Noncompliance
- Describes resistance of the individual to follow a predetermined regimen. It often results in blaming behavior when patient
goals are not achieved and condemns a patient’s behavior as flawed for the inability to conform treatment.

Nonadherence
- Occurs when the patient does not follow treatment recommendations that are mutually agreed upon.

MOTIVATION- - Is defined as “an internal state that arouses, directs, and sustains human behavior” and as a willingness of the
learner to embrace learning, with readiness ad evidence of motivation.
- Is the process that initiates, guides, and maintains goal-oriented behaviors. It is what causes you to act, whether
it is getting a glass of water to reduce thirst or reading a book to gain knowledge. Motivation involves the biological, emotional,
social, and cognitive forces that activate behavior
- According to Kort (1987), motivation is the result of both internal and external factors and not result of external
manipulating alone.
- Motivation is the desire to reduce some drive (drive reduction). Hence, satisfied, complacent, and satiated
individuals have little motivation to learn and to change.

Motivational Factors
- Factors that influence motivation can serve as either incentives or obstacles to achieving desired behaviors. Both creating
incentives and decreasing obstacles to motivation pose a challenge for the nurse as educator.
- The cognitive (thinking processes), affective (emotions and feelings), and psychomotor (skill behavior) domains as well as the
social circumstances of the learner can be influenced by the educator, who can act as either a motivational facilitator or blocker.

MOTIVATIONAL INCENTIVES
- Which are those factors that influence motivation in the direction of a desired goal, need to be considered in the context of
the individual. What may be a motivational incentive for one leaner may be a motivational obstacle to another.
1. Personal attributes
- Which consist of physical, development, and psychological components of the individual learner.
2. Environmental influences
- Which include the physical and attitudinal climate
3. Relationship systems
Such as those of significant other, family, community, and teacher-learner interaction.

PERSONAL ATTIBUTES
- Personal attributes of the learner-such as development stage, age, gender, emotional readiness, values and beliefs, sensory
functioning, cognitive ability, educational level, actual or perceived state of health, and severity or chronicity of illness-can shape
an individual’s motivation to learn.

ENVIRONMENT INFLUENCES
1. Physical characteristics of the learning environment, accessibility and availability of human and material resources, and
different types of behavioral rewards all combine to influence the motivational level of the individual. The environment can
create, promote, or detract from a state of adaptable individualized surroundings.

RELATIONSHIP SYSTEMS
- Family or significant others in the support system; cultural identity; work, school and community rules; and teacher-learner
interaction are all relationship-based factors that influence an individual’s motivation.

MOTIVATIONAL AXIOMS
- Axioms are premises on which an understanding of a phenomenon is based. The nurse as educator needs to understand the
premises involved in promoting motivation of the learner.

MOTIVATIONAL AXIOMS are rules that set the stage for motivation. They include:
1. the stage of optimal anxiety
2. learner readiness
3. realistic goal setting
4. learner satisfaction/success
5. uncertainty-reducing or uncertainty-maintaining dialogue

State of Optimal Anxiety

- Learning occurs best when a state of moderate anxiety exists. In this optimal state for learning, the learner’s ability to observe,
focus attention, learn and adapt is operative.

- Perception, concentration, abstract thinking, and information processing are enhanced.

Learner Readiness
Desire to move toward a goal and readiness to learn are factors that influence motivation. Desire cannot be imposed on the
learner. It can, however, be significantly influenced by external forces and be promoted by the nurse as educator. By ensuring
that learning is stimulating, making information relevant and accessible, and creating an environment conducive to learning,
educators can enhance motivation to learn.

Realistic Goals
- Goals that are within a person’s grasp and possible to achieve will likely be something toward which an individual will work. In
contrast, goals that are significantly beyond the person’s reach are frustrating and counterproductive. Setting realistic goals by
determining what the learner wants to change is a motivating factor. The belief that one can achieve the task set before he or she
facilitates behavior geared toward achieving that goal. Mutual goal setting between the learner and the educator reduces the
negative effects of hidden agendas or the sabotaging of educational plans.

Learner Satisfaction/Success
- The learner is motivated by success. Success is self-satisfying and feeds the learner’s self-esteem. In cyclical process, success
and self-esteem escalate, moving the learner toward accomplishment of additional goals. When a learner feels good about step-
by-step accomplishments, motivation is enhanced.

Uncertainty Reduction of Maintenance

- Uncertainty is a common experience in the healthcare arena. An individual’s response to this type of uncertainty may vary
depending on the individual’s characteristics. Uncertainty (as well as certainty) can be a motivating factor in the learning situation.
Individuals may have ongoing internal dialogues that can either reduce or maintain uncertainty. Individuals carry on self-talk; they
think things through. When a person wants to change a state of health, behaviors often follow a dialogue that examines
uncertainty.

Michel (1990) reconceptualizes the concept of uncertainty in illness. She views uncertainty as a necessary and natural rhythm of
life rather than an adverse experience. Uncertainty in sufficient concentration influences choices and decision making, and it can
capitalize on receptivity or readiness for change.

6 Parameters for the Comprehensive Motivational Assessment of the Learner

Cognitive Variables
- Capacity to learn
- Readiness to learn
- Expressed self-determination
o Constructive attitude
o Expressed desire and curiosity
o Willingness to contract for behavioral outcomes
- Facilitating beliefs
- Affective Variables
- Expressions of constructive emotional state
- Moderate level of anxiety

Physiological Variables
- Capacity to perform required behavior

Experiential Variables
- Previous successful experiences

Environmental Variables
- Appropriateness of Physical Environment
- Social support systems
o Family
o Group
o Work
o Community resources

Educator-Learner Relationship System

- Prediction of positive relationship

** 5 general principles of MI
Motivational Interviewing (MI) is another motivational strategy the nurse educator can use with learners (Droppa & Lee, 2014). It
is a client-centered, directive counseling method in which clients’ intrinsic motivation to change is enhanced by exploring and
resolving their ambivalence toward behavior change (Miller & Rollnick, 2013). The following principles are not applied in a specific
order, and all the techniques should be used through-out the interview:
Roll with resistance
Express empathy
Avoid argumentation
Develop discrepancy
Support self-efficacy

7 Major Models or Theories Used to Describe, Explain, or predict health behaviors

**Health behavior frameworks are blueprints and, as such, serve as tools for the nurse as educator that can be used to maintain
desired patient behaviors or promote changes (Syx, 2008). As a result, a familiarity with models and theories that describe,
explain, or predict health behaviors can increase the range of health-promoting strategies for the nurse as educator. When the
educator understands these frameworks, the principles inherent in each can be used either to promote compliance with a health
regimen or to facilitate motivation.
Below are the major models or theories used to describe, explain, or predict health behaviors:
1. Health Belief Model
2. Health Promotion Model
3. Self-Efficacy Model
4. Protection Motivation Theory
5. Stages of Change Model
6. Theory of Reasoned Action and Theory of Planned Behavior
7. Therapeutic Alliance Model

Motivation and Behavior Change Theories

a. Health Belief Model

- Is a theoretical model that can be used to guide health promotion and disease prevention programs. It is used to explain
and predict individual changes in health behaviors. It is one of the most widely used models for understanding health behaviors.

b. Health Promotion Model

This model helps to provide an understanding of whether people choose to engage in health-promoting behaviors (Pender,
Murdaugh, & Parsons, 2002) and strongly supports the
partner relationship between healthcare provider and patient (Stewart, 2012). • The purpose of the model is to assist nurses in
understanding the major determinants of health behaviors as a basis for behavioral counseling to promote healthy lifestyles
(Pender, 2011)
c. Self-Efficacy Theory
- emphasizes the importance of the individual and the individual's perceptions of his/her personal capabilities as key
determinants of successful outcomes.

d. Theory of Reasoned Action Model

- aims to explain the relationship between attitudes and behaviors within human action. It is mainly used to predict how
individuals will behave based on their pre-existing attitudes and behavioral intentions.
e. Protection Motivation Theory
- This theory explains behavioral change in terms of threat and coping appraisal (PrenticeDunn & Rogers, 1986). These threat
and coping appraisals embedded within the protection motivation theory are beneficial for understanding why individuals
participate in behaviors that are unhealthy (MacDonell et al., 2013). A threat to health is considered a stimulus to protection
motivation. This linear theory includes sources of information (environmental and intrapersonal) that are cognitively processed
by appraisal of threat and coping to engender protective motivation, which leads to intent and ultimately to action.

f. Stages of Change Theory

- Stages of Change Model, also known as the Transtheoretical Model (TTM) of behavioral change (Prochanska & DiClemente,
1982).

- Contemplation, Preparation, Action, Maintenance, and Termination. This model is useful in health care to stage the client’s
intentions and behaviors for change as well as to determine those strategies that will enable completion of specific change.

g. Therapeutic Alliance Model

- A therapeutic alliance is formed between the caregiver and the care receiver in which the participants are viewed as having
equal power.
- According to Barofsky (1978), change is needed in treatment determinantschange from coercion in compliance and from
conforming in adherence to collaboration in alliance. The power in the relationship between the participants is equalized by
alliance.
Reference:

Bastable, Susan. (2019) Nurse as Educator: Princiles of Teaching and Learning for Nursing Practice 5 th Edition. ISBN: 978-
974-652-317-2, Published by Jones & Bartlett Learning, LLC., Boston.

Bastable, Susan. (2023) Nurse as Educator: Princiles of Teaching and Learning for Nursing Practice 6th Edition. ISBN: 978-974-
652-317-2, Published by Jones & Bartlett Learning, LLC., Boston.