One key nursing function is to promote and restore health. This involves teaching clients new psychomotor skills, general knowledge, coping attitudes, and social skills related to health and illness (e.g., proper diet, exercises, colostomy care, wound care, insulin injections, urine testing). The teaching function of the nurse is vital in assisting normal development and helping clients meet health-related needs.

1. PURPOSE OF HEALTH TEACHING:
1. General goal: motivate health-oriented behavior.
2. Nursing interventions:
1. Fill in gaps in information.
2. Clarify misinformation.
3. Teach necessary skills.
4. Modify attitudes.
2. EDUCATIONAL THEORIES on which effective health teaching is based:
1. Motivation theory:
1. Health-oriented behavior is determined by the degree to which person sees health problem as threatening, with serious consequences, high probability of occurrence, and belief in availability of effective course of action.
2. Non–health-related motives may supersede health-related motives.
3. Health-related motives may not always give rise to health-related behavior, and vice versa.
4. Motivation may be influenced by:
1. Phases of adaptation to crisis (poor motivation in early phase).
2. Anxiety and awareness of need to learn. (Mild anxiety is highly motivating.)
3. Mutual versus externally imposed goal setting.
4. Perceived meaningfulness of information and material. (If within client's frame of reference, both meaningfulness and motivation increase.)
2. Theory of planned change:
1. Unfreeze present level of behavior—develop awareness of problem.
2. Establish need for change and relationship of trust and respect.
3. Move toward change—examine alternatives, develop intentions into real efforts.
4. Freeze on a new level—generalize behavior, stabilize change.
3. Elements of learning theory:
1. Drive must be present based on experiencing uncertainty, frustration, concern, or curiosity; hierarchy of needs exists.
2. Response is a learned behavior that is elicited when associated stimulus is present.
3. Reward and reinforcement are necessary for response (behavior) to occur and remain.
4. Extinction of response, that is, elimination of undesirable behavior, can be attained through conditioning.
5. Memorization is the easiest level of learning, but least effective in changing behavior.
6. Understanding involves the incorporation of generalizations and specific facts.
7. After introduction of new material, there is a period of floundering when assimilation and insight occur.
8. Learning is a two-way process between learner and teacher; defensive behavior in either makes both activities difficult, if not impossible.
9. Learning flourishes when client feels respected, accepted by nurse who is enthusiastic; learning occurs best when differing value systems are accepted.
10. Feedback increases learning.
11. Successful learning leads to more successes in learning.
12. Teaching and learning should take place in the area where targeted activity normally occurs.
13. Priorities for learning are dependent on client's physical and psychological status.
14. Decreased visual and auditory perception leads to decreased readiness to learn.
15. Content, terminology, pacing, and spacing of learning must correspond to client's capabilities, maturity level, feelings, attitudes, and experiences.
3. ASSESSMENT OF THE CLIENT-LEARNER:
1. Characteristics: age, sex, race, medical diagnosis, prognosis.
2. Sociocultural-economic: ethnic, religious group beliefs and practices; family situation (roles, support); job (type, history, options, stress); financial situation, living situation (facilities).
3. Psychological: own and family's response to illness; premorbid personality; current self-image.
4. Educational:
1. Client's perception of current situation: what is wrong? Cause? How will lifestyle be affected?
2. Past experience: previous hospitalization and treatment; past compliance.
3. Level of knowledge: what has client been told? From what source? How accurate? Known others with the same illness?
4. Goals: what client wants to know.
5. Needs: what nurse thinks client should know for self-care.
6. Readiness for learning.
7. Educational background; ability to read and learn.
4. ANALYSIS OF FACTORS INFLUENCING LEARNING:
1. Internal:
1. Physical condition.
2. Senses (sight, hearing, touch).
3. Age.
4. Anxiety.
5. Motivation.
6. Experience.
7. Values (cultural, religious, personal).
8. Comprehension.
9. Education and language deficiency.
2. External:
1. Physical environment (heat, light, noise, comfort).
2. Timing, duration, interval.
3. Teaching methods and aids.
4. Content, vocabulary.
5. TEACHING PLAN must be:
1. Compatible with the three domains of learning:
1. Cognitive (knowledge, concepts): use written and audiovisual materials, discussion.
2. Psychomotor (skills): use demonstrations, illustrations, role models.
3. Affective (attitudes): use discussions, maintain atmosphere conducive to change; use role models.
2. Appropriate to educational material.
3. Related to client's abilities and perceptions.
4. Related to objectives of teaching.
6. IMPLEMENTATION—teaching guidelines to use with clients:
1. Select conducive environment and best timing for activity.
2. Assess the client's needs, interests, perceptions, motivations, and readiness for learning.
3. State purpose and realistic goals of planned teaching/learning activity.
4. Actually involve the client by giving him or her the opportunity to do, react, experience, and ask questions.
5. Make sure that the client views the activity as useful and worthwhile and that it is within the client's grasp.
6. Use comprehensible terminology.
7. Proceed from the known to the unknown, from specific to general information.
8. Provide opportunity for client to see results and progress.
9. Give feedback and positive reinforcement.
10. Provide opportunities to achieve success.
11. Offer repeated practice in real-life situations.
12. Space and distribute learning sessions over a period of time.
7. EVALUATION/OUTCOME CRITERIA:
1. Client's deficit of knowledge is lessened.
2. Increased compliance with treatment.
3. Length of hospital stay is reduced.
4. Rate of readmission to hospital is reduced.