Lesson 3: Health Education Process

The Educators Role

The role of educating others is one of the most essential interventions that a
nurse performs. To do it well, the nurse must both identify the information
learners need and consider their readiness to learn and their styles of learning.

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

The educator is vital in giving support, encouragement, and direction during the process of learning.
Learners may make choices on their own without the assistance of an educator, but these choices may
be limited or inappropriate. For example, the nurse facilitates necessary changes in the home
environment, such as minimizing distractions by having family members turn off the television to provide
a quiet environment conducive for concentrating on a learning activity.

- Assessing the Learner

• Assessment of learners’ needs, readiness, and styles of learning is the first and
most important step in instructional design—but it is also the step most likely to
be neglected. The importance of assessment of the learner may seem self-
evident, yet often only lip service is given to this initial phase of the educational
process. Frequently, the nurse dives into teaching before addressing all of the
determinants of learning.
• Nurses are taught that any nursing intervention should be preceded by an
assessment. Few would deny that this is the correct approach, no matter
whether planning for giving direct physical care, meeting the psychosocial needs
of a patient, or teaching someone to be independent in selfcare or in the delivery
of care. The effectiveness of nursing care clearly depends on the scope,
accuracy, and comprehensiveness of assessment prior to interventions.
• What makes assessment so significant and fundamental to the educational
process? This initial step in the process validates the need for learning and the
approaches to be used in designing learning experiences. Patients who desire or
require information to maintain optimal health as well as nursing colleagues who
must have a greater scope or depth of knowledge to deliver quality care to
patients deserve to have an assessment done by the educator so that their needs
as learners are appropriately addressed.

Determinants of Learning
Assessment of the learner includes attending to the three determinants of learning:
1. Learning needs—what the learner needs and wants to learn
2. Readiness to learn—when the learner is receptive to learning
3. Learning style—how the learner best learns
 Criteria for Prioritizing Learning Needs

• Mandatory: Needs that must be learned for survival or situations

in which the learner’s life or safety is threatened. Learning needs
in this category must be met immediately. For example, a patient
who has experienced a recent heart attack needs to know the signs
and symptoms and when to get immediate help. The nurse who works in a hospital
must learn how to do cardiopulmonary resuscitation or be able to carry out correct
isolation techniques for self-protection.
• Desirable: Needs that are not life dependent but that are related to well-being or the
overall ability to provide quality care in situations involving changes in institutional
procedure. For example, it is important for patients who have cardiovascular disease
to understand the effects of a high-fat diet on their condition. It is desirable for nurses
to update their knowledge by attending an in-service program when hospital
management decides to focus more attention on the appropriateness of patient
education materials in relation to the patient populations being served.
• Possible: Needs for information that is nice to know but not essential or required or
situations in which the learning need is not directly related to daily activities. For
example, the patient who is newly diagnosed as having diabetes mellitus most likely
does not need to know about self-care issues that arise in relationship to traveling
across time zones or staying in a foreign country because this information does not
relate to the patient’s everyday activities.

1. Learning Needs
The following are important steps in the assessment of learning needs:
1. Identify the learner. Who is the audience? If the audience is one individual, is there a single
need or do many needs have to be fulfilled? Is there more than one learner?
Example: an educator may believe that all parents of children with asthma need a formal class
on potential hazards in the home. This perception may be based on the educator’s interaction
with a few patients and may not be true of all families. Similarly, the manager of a healthcare
agency might request an in-service workshop for all staff on documentation of infection control
because of an isolated incident involving one staff member’s failure to appropriately follow
established infection control procedures. This break in protocol may or may not indicate that
everyone needs to have an update on policies and procedures.
2. Choose the right setting. Establishing a trusting environment helps learners feel a sense of
security in confiding information, believe their concerns are taken seriously and are considered
important, and feel respected. Ensuring privacy and confidentiality is recognized as essential
to establishing a trusting relationship.
3. Collect data about the learner. Once the learner is identified, the educator can determine
characteristic needs of the population by exploring typical health problems or issues of interest
to that population.
4. Collect data from the learner. Learners are usually the most important source of needs
assessment data about themselves. Allow patients and/or family members to identify what is
important to them, what they perceive their needs to be, which types of social support systems
are available, and which kind of assistance these supports can provide. If the audience for
teaching consists of staff members or students, solicit information from them as to those areas
of practice in which they feel they need new or additional information.
Actively engaging learners in defining their own problems and needs motivates them to learn
because they are invested in planning for a program specifically tailored to their unique
circumstances. Also, the learner is important to include as a source of information because, as
noted previously, the educator may not always perceive the same learning needs as the learner.
5. Involve members of the healthcare team. Other health professionals likely have insight
into patient or family needs or the educational needs of the nursing staff or students as a result
of their frequent contacts with both consumers and caregivers. Nurses are not the sole teachers
of these individuals; thus they must remember to collaborate with other members of the
healthcare team for a richer assessment of learning needs. This consideration is especially
important because time for assessment is often limited. In addition to other health
professionals, associations such as the American Heart Association, the American Diabetes
Association, and the American Cancer Society are excellent sources of health information.
6. Prioritize needs. A list of identified needs can become endless and seemingly impossible to
accomplish Maslow’s hierarchy of human needs can help the educator prioritize so that the
learner’s basic needs are attended to first and foremost before higher needs are addressed. For
example, learning about a low-sodium diet cannot occur if a patient faces problems with basic
physiological needs such as pain and discomfort; these latter needs must be addressed before
any other higher-order learning can occur.

Education in and of itself is not always the answer to a problem. Often, healthcare providers believe that more
education is necessary when something goes wrong, when something is not being done, when a patient is not
following a prescribed regimen, or when a staff member does not adhere to a protocol. In such instances, always
look for other nonlearning needs. For example, the nurse may discover that the patient is not taking his medication
and may begin a teaching plan without adequate assessment. The patient may already understand the importance
of taking a prescribed medication, know how to administer it, and be willing to follow the regimen, but his financial
resources may not be sufficient to purchase the medication. In this case, the patient does not have a learning need
but rather requires social or financial support to obtain the medication.

7. Determine availability of educational resources. The educator may identify a need, but
it may be useless to proceed with interventions if the proper educational resources are not
available, are unrealistic to obtain, or do not match the learner’s needs. In this case, it may
be better to focus on other identified needs.
Example: A patient who has asthma needs to learn how to use an inhaler and peak-flow meter.
The nurse educator may determine that this patient learns best if the nurse first gives a
demonstration of the use of the inhaler and peak-flow meter and then allows the patient the
opportunity to perform a return demonstration.
 - If the proper equipment is not available for demonstration/return demonstration at that
moment, it might be better for the nurse educator to concentrate on teaching the signs and
symptoms the patient might experience when having poor air exchange than it is to cancel the
encounter altogether. Thereafter, the educator would work immediately on obtaining the
necessary equipment for future encounters.
8. Assess the demands of the organization. This assessment yields information that reflects
the climate of the organization. What are the organization’s philosophy, mission, strategic plan,
and goals? The educator should be familiar with standards of performance required in various
employee categories, along with job descriptions and hospital, professional, and agency
regulations.
Example: The organization is focused on health promotion versus trauma care, then there likely
will be a different educational focus or emphasis that dictates learning needs of both consumers
and employees.
9. Take time-management issues into account.
• Although close observation and active listening take time, it is much more efficient and
effective to take the time to do a good initial assessment upfront than to waste time by
having to go back and uncover information that should have been obtained before beginning
instruction.
• Learners must be given time to offer their own perceptions of their learning needs if the
educator expects them to take charge and become actively involved in the learning process.
Learners should be asked what they want to learn first, because this step allays their fears
and makes it easier for them to move on to other necessary content. This approach also shows
that the nurse cares about what the learner believes is important.
• Assessment can be conducted anytime and anywhere the educator has formal or informal
contact with learners. Data collection does not have to be restricted to a specific,
predetermined schedule. With patients, many potential opportunities for assessment arise,
such as when giving a bath, serving a meal, making rounds, and distributing medications. For
staff, assessments can be made when stopping to talk in the hallway or while enjoying lunch
or break time together.
• Informing a patient ahead of time that the educator wishes to spend time discussing problems
or needs gives the person advance notice to sort out his or her thoughts and feelings. In one
large metropolitan teaching hospital, this strategy proved effective in increasing patient
understanding and satisfaction with transplant discharge information. Patients and their
families were informed that a specific topic would be discussed on a specific day. Knowing
what to expect each day allowed them to review the appropriate handouts ahead of time and
prepare questions. It gave patients and family members the time they needed to identify
areas of confusion or concern.

METHODS TO ASSESS LEARNING NEEDS

The nurse in the role of educator must obtain objective data about the learner as well as
subjective data from the learner. This section describes various methods that educators can
use to assess learner needs and that should be used in combination to yield the most reliable
information.
o Informal Conversations
Often learning needs are discovered during impromptu conversations that take place with
other healthcare team members involved in the care of the client and between the nurse and
the patient or his or her family. The nurse educator must rely on active listening to pick up
cues and information regarding learning needs. Staff can provide valuable input about their
learning needs by responding to open-ended questions.
o Structured Interviews
The structured interview is perhaps the form of needs assessment most commonly used to
solicit the learner’s point of view. The nurse educator asks the learner direct and often
predetermined questions to gather information about learning needs. As with the gathering of
any information from a learner in the assessment phase, the nurse should strive to establish a
trusting environment, use open-ended questions, choose a setting that is free of distractions,
and allow the learner to state what are believed to be the learning needs.
Interviews yield answers that may reveal uncertainties, conflicts, inconsistencies, unexpected
problems, anxieties, fears, and present knowledge base. Examples of questions that nurse
educators can ask patients as learners are as follows:
• What do you think caused your problem?
• How severe is your illness?
• What does your illness/health mean to you?
• What do you do to stay healthy?
• Which results do you hope to obtain from treatments?
• What are your strengths and limitations as a learner?
• How do you learn best?
If the learner is a staff member or student, the following questions could be asked:
• What do you think are your biggest challenges to learning?
• Which skill(s) do you need help in performing?
• Which obstacles have you encountered in the past when you were learning new
information?
• What do you see as your strengths and limitations as a learner?
• How do you learn best?
These types of questions help to determine the needs of the learner and serve as a foundation
for beginning to plan an educational intervention.
o Focus Groups
Focus groups involve getting together a small number (4 to 12) of potential learners to
determine areas of educational need by using group discussion to identify points of view or
knowledge about a certain topic. With this approach, a facilitator leads the discussion by
asking open-ended questions intended to encourage detailed discussion
o Self-Administered Questionnaires
Nurse educators can obtain learners’ written responses to questions about learning needs by
using survey instruments. Checklists are one of the most common forms of questionnaires.
They are easy to administer, provide more privacy compared to interviews, and yield easy-to-
tabulate data.
o Tests
Giving written pretests before teaching is planned can help identify the knowledge levels of
potential learners regarding a particular subject and assist in identifying their specific
learning needs. In addition, this approach prevents the educator from repeating already
known material in the teaching plan. Furthermore, pretest results are useful to the educator
after the completion of teaching when pretest scores are compared with posttest scores to
determine whether learning has taken place.
The Diabetes Knowledge Test is an example of a tool used to assess learning needs for self-
management of diabetes. When investigating this tool, researchers compared patients’
diabetes knowledge with their glycemic control.
o Observations
Observing health behaviors in several different time periods can help the educator draw
conclusions about established patterns of behavior that cannot and should not be drawn from
a single observation. Learners may believe they can accurately perform a skill or task (e.g.,
walking with crutches, changing a dressing, giving an injection), but by observing the skill
performance the educator can best determine whether additional learning may be needed.
o Documentations
Initial assessments, progress notes, nursing care plans, staff notes, and discharge planning
forms can provide information about the learning needs of clients. Nurse educators need to
follow a consistent format for reviewing charts so that they review each chart in the same
manner to identify learning needs based on the same information. Also, documentation by
other members of the healthcare team, such as physical therapists, social workers,
respiratory therapists, and nutritionists, can yield valuable insights with respect to the needs
of the learner.
o Assessing the Learning Needs of Nursing Staff
Specifically addresses the importance of identifying the learning needs of staff nurses using
the methods described in this section.
WRITTEN JOB DESCRIPTIONS
A written description of what is required to effectively carry out job responsibilities can
reflect the potential learning needs of staff. Such information forms the basis for establishing
content in an orientation program for new staff, for example, or for designing continuing
education opportunities for experienced staff members.
FORMAL AND INFORMAL REQUESTS
Often staff are asked for ideas for educational programs, and these ideas reflect what they
perceive as needs. When conducting a formal educational program, the educator must verify
that these requests are congruent with the needs of other staff members.
QUALITY ASSURANCE REPORTS
Trends found in incident reports indicating safety violations or errors in procedures are a
source of information in establishing learning needs of staff that education can address.
CHART AUDITS
Educators can identify trends in practice through chart auditing. Does the staff have a
learning need in terms of the actual charting? Is a new intervention being implemented? Does
the record indicate some inconsistency with implementation of an intervention?
RULES AND REGULATIONS
A thorough knowledge of hospital, professional, and healthcare requirements helps to identify
possible learning needs of staff. The educator should monitor new rules of practice arising
from changes occurring within an institution or external to the organization that may have
implications for the delivery of care.
FOUR-STEP APPRAISAL OF NEEDS
Knox’s interpretation of how adults learn has important implications for the development and
coordination of education programs that are responsive to the backgrounds and aspirations of
various adult learners. Panno’s four steps in assessing learning needs are as follows:
1. Define the target population
2. Analyze learner and organizational needs
3. Analyze the perceived needs of the learner and compare them to the actual needs
4. Use data to prioritize identified learning needs.

1. READINESS TO LEARN
Once the educator has identified learning needs, the next step is to determine the learner’s
readiness to receive information. Readiness to learn can be defined as the time when the
learner demonstrates an interest in learning the information necessary to maintain optimal
health or to become more skillful in a job. Often, educators have noted that when a patient or
staff member asks a question, the time is prime for learning.
❖ Readiness to learn occurs when the learner is receptive, willing, and able to participate
in the learning process. It is the responsibility of the educator to discover through
assessment exactly when patients or staff are ready to learn, what they need or want
to learn, and how to adapt the content to fit each learner.
To assess readiness to learn, the educator must first understand what needs to be taught,
collect and validate that information, and then apply the same methods used previously to
assess learning needs, including making observations, conducting interviews, gathering
information from the learner as well as from other healthcare team members, and
reviewing documentation. The educator must perform these tasks before the time when
actual learning is to occur.

Four Types of Readiness to

- No matter how important the information is or how much
Learn the educator feels the recipient of teaching needs the
information, if the learner is not ready, then the
P = Physical Readiness
• Measures of ability
information will not be absorbed.
• Complexity of task
• Environmental effects - Timing—that is, the point at which teaching should take
• Health status place—is very important. Timing also becomes an important
• Gender
factor when working with nursing staff. Readiness to learn
is based on the current demands of practice and must
E = Emotional Readiness correspond to the ever-constant changes in health care.
• Anxiety level Adults—whether they are patients, family, nursing staff, or
• Support system students—are eager to learn when the subject of teaching
• Motivation
is relevant and applicable to their everyday concerns.
• Risk-taking behavior
• Frame of mind
• Developmental stage

E = Experiential Readiness
• Level of aspiration
• Past coping mechanisms
• Cultural background
• Locus of control
• Orientation

K = Knowledge Readiness
• Present knowledge base
• Cognitive ability
• Learning disabilities
• 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.

MEASURES OF ABILITY
Ability to perform a task requires fine and/or gross motor movements, sensory acuity, adequate
strength, flexibility, coordination, and endurance. Each developmental stage in life is
characterized by physical and sensory abilities or is affected by individual disabilities. For
example, walking on crutches is a psychomotor skill for which a patient must have the physical
ability to be ready to learn.
COMPLEXITY OF TASK
Variations in the complexity of the task affect the extent to which the learner can master the
behavioral changes in the cognitive, affective, and psychomotor domains. The more complex
the task, the more difficult it is to achieve.
Example: If the learner has been performing a psychomotor skill over a long period of time and
then the procedural steps of the task change, the learner must unlearn those steps and relearn
the new way. This requirement may increase the complexity of the task and put additional
physical demands on the learner by lengthening the time the learner needs to adjust to doing
something in a new way.
ENVIRONMENTAL EFFECTS
An environment conducive 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 interfere with a learner’s accuracy and precision in performing cognitive and
manual dexterity tasks. Intermittent noise tends to have greater disruptive effects on learning
than the more rapidly habituated steady-state noise.
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. Nurse educators must seriously
consider a person’s health status, whether well, acutely ill, or chronically ill, when assessing
for readiness.
Learners who are acutely ill tend to focus their energies on the physiological and psychological
demands of their illness. Learning is minimal in such persons because most of these individuals’
energy is needed for the demands of the illness and gaining immediate relief. Any learning that
may occur should be related to treatments, tests, and minimizing pain or other discomforts. As
these patients improve and the acute phase of illness diminishes, they can then focus on
learning follow-up management and the avoidance of complications.
Educators must assess the readiness to learn of acutely ill patients by observing their energy
levels and comfort status. Improvement in physical status usually results in more receptivity to
learning. However, medications that induce side effects such as drowsiness, mental depression,
impaired depth perception, decreased ability to concentrate, and learner fatigue also reduce
task-handling capacity. For example, giving a patient a sedative prior to a learning experience
may result in less apprehension, but cognitive and psychomotor abilities may be impaired.

GENDER
Research indicates that women are generally more receptive to medical care and take fewer
risks with their health than do men This difference may arise because women traditionally have
taken on the role of caregivers and, therefore, are more open to health promotion teaching. In
addition, women have more frequent contacts with health providers while bearing and raising
children. Men, by comparison, tend 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 developmental stage.
ANXIETY LEVEL
Anxiety influences a person’s ability to perform at cognitive, affective, and psychomotor levels.
In particular, it affects patients’ ability to concentrate and retain information.
The level of anxiety may or may 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.

2. Learning Styles
Reflective Activity:

What type of learner are you? I want to know what type of approach will work
best for you in terms of your learning pace?

Format: Use Class Template

Font Size: 12
Font Style: Times New Roman/ Bookman
Pass it on time!!