Patient Education and Health Promotion
After reading this chapter you will be able to:
Write learning objectives in the cognitive, affective, and psychomotor domains.
Compare and contrast how adults and children learn.
Describe the methods that are used to evaluate patient education.
Explain the importance of health education.
Identify the settings that are appropriate for the implementation of health promotion activities.
Describe the respiratory therapist’s role in a disease management program.
The top five causes of death in the United States are heart disease, cancer, cerebrovascular disease, chronic obstructive lung disease (i.e., bronchitis and emphysema), and accidents.1 It is believed by most experts in health care that the majority of these illnesses are preventable. Public education about risk factors is the key to the prevention of these diseases and probably has the greatest potential for making an impact on health care in this country. Therefore, the emphasis in health care should be on health promotion and disease prevention. RTs will play a greater role in health promotion and prevention in the future.
Patient Education
Performance Objectives
Learning Domains
Cognitive Domain
1. List the indications for oxygen therapy.
2. Discuss the importance of using the prescribed liter flow.
Any factual information that you expect the patient to understand and apply falls under the cognitive domain. Action verbs for the cognitive domain are included in Table 49-1.2
TABLE 49-1
Verbs for the Cognitive Domain
Purpose | Example Verbs |
1. Knowledge | Cite, define, read, identify, list, label, name, outline, recognize, select, state |
2. Comprehension | Convert, describe, defend, explain, illustrate, interpret, give examples of, predict, paraphrase, summarize, translate |
3. Application | Apply, compute, construct, demonstrate, change, calculate, use, estimate, modify, present, prepare, solve, proceed, relate, utilize |
4. Analysis | Analyze, associate, compare, contrast, determine, diagram, differentiate, discriminate, distinguish, outline, illustrate, separate |
5. Synthesis | Categorize, combine, compile, compose, create, design, develop, devise, integrate, modify, organize, plan, propose, rearrange, reorganize, revise, rewrite, translate, write |
6. Evaluation | Appraise, assess, compare, conclude, contrast, critique, discriminate, make a decision, support, evaluate, judge, weigh |
Modified from French D, Olrech N, Hale C, et al: Blended learning: an ongoing process for Internet integration, Victoria, Canada, 2003, Trafford Publishing.
Psychomotor Domain
Examples of action verbs for the psychomotor domain are included in Table 49-2.2
TABLE 49-2
Verbs for the Psychomotor Domain
Purpose | Example Verbs |
1. Perception: prepares and recognizes sensory cues to want to respond | Detect, distinguish, differentiate, identify, isolate, relate, recognize, observe, perceive, see, watch |
2. Ready to act and respond | Begin, explain, move, react, show, state, establish a body position, place, posture, assume a stance, sit, stand, position |
3. Guided response: imitate and practice; rough sequencing of events | Copy, duplicate, imitate, manipulate, operate, try, practice, dismantle |
4. Efficiency: smooth sequencing of events | Assemble, calibrate, construct, display, fasten, fix, grind, manipulate, measure, mix, sketch, demonstrate, execute, increase speed, improve, make, show dexterity, pace, produce |
5. Perform alone: modifies, responds as needed | Act habitually, advance confidently, control, excel, guide, manage, master, organize, perform quickly and more accurately |
6. Creates a new or original model | Adapt, alter, rearrange, reorganize, revise |
Modified from French D, Olrech N, Hale C, et al: Blended learning: an ongoing process for Internet integration, Victoria, Canada, 2003, Trafford Publishing.
Affective Domain
The patient’s attitudes and motivations influence his or her ability to learn. It is important to remember that, with patient education, timing is everything. Patients who have recently been given a poor prognosis or who are in pain are not in an optimal position to learn. Maslow suggested a hierarchy of needs, and he identified physiologic needs as the most basic of human needs, followed by safety, love, esteem, and self-actualization.3 Lower-level needs must first be satisfied before moving on to higher-level needs. For example, if a patient is dyspneic or in pain, he or she will probably not be receptive to learning the steps that are involved in cleaning a small-volume nebulizer. It is important for RTs to assess a patient’s readiness to learn by talking with the patient and his or her family and by listening to the patient’s concerns. It is important to develop a relationship of trust and to be empathetic with the patient.
1. Demonstrate genuine concern for yourself by using your oxygen therapy correctly.
2. Demonstrate a willingness to learn by being an active participant in the program.
Affective domain action verbs are included in Table 49-3.2
TABLE 49-3
Verbs for the Affective Domain
Purpose | Example Verbs |
1. Receive: becoming aware of | Accept, acknowledge, alert, choose, give, attend, notice, perceive, tolerate, select |
2. Respond: interested in or doing something about something | Agree, assist with, aid, answer, assist, comply, conform, communicate, consent, label, obey, cooperate, follow, read, report, visit, volunteer, study |
3. Value: concerned about, developing an attitude | Adopt, assume, behave, choose, demonstrate, commit, desire, initiate, join, exhibit, express, prefer, seek, share |
4. Organize: arranging systematically, confirming | Adapt, adjust, arrange, classify, conceptualize, group, rank, validate, verify, strengthen, substantiate, corroborate, confirm |
5. Characterize: internalizing a set of values, championing | Demonstrate a change in lifestyle, discriminate, defend, influence, invite, listen, preach, qualify, question, serve, act upon, advocate, devote, expose, justify, support |
Modified from French D, Olrech N, Hale C, et al: Blended learning: an ongoing process for Internet integration, Victoria, Canada, 2003, Trafford Publishing.
Teaching Tips
Following is a list of time-honored suggestions for improving patient education:
• Address the patient’s immediate concerns first.
• Create an optimal learning environment. Teach in a quiet and relaxed setting.
• Have patients use as many of their senses as possible during their learning session. Whenever possible, include hearing, seeing, smelling, speaking, touching, and doing.
• Keep sessions short. If the material is complex, break it down into brief segments.
• Provide many opportunities for the patient to practice psychomotor skills.
• Be organized. People learn more quickly when they are presented with information that is well organized.
• Demonstrate enthusiasm for what you are doing. The learner can always sense your level of motivation.
• Evaluate in a nonthreatening manner, and provide helpful feedback. Use evaluation as a learning tool.
Teaching Children As Compared With Teaching Adults
Teaching children is often very different than teaching adults. Children are more motivated by external factors (e.g., prizes) as compared with adults, who tend to have internal motivating factors. This suggests that adults will learn quicker if they can easily see the intrinsic value of knowing more about their illness. Alternatively, children may need a more obvious reward system in place before learning can take place. They have no problem taking instruction from adults, because they are often dependent on such instruction. Adults, however, are more independent, and they do not like being dependent on others. This suggests that adults should be more involved in setting program goals and that they will readily learn skills that make them more independent. Other important issues related to differences between children and adult learners are listed in Box 49-1, and allocated time for teaching is given by age in Box 49-2.4