0133427269 Module41 TeachingLearning LectureOutline

Module 41 Teaching and Learning The Concept of Teaching and Learning Nurses as teachers and learners Teaching is a system of activities designed to produce learning Learning is a change in human disposition or capability that persists Cannot be solely accounted for by growth Represented by change in behavior Attributes of learning Occurs inside the learner Discovery of the personal meaning and relevance of ideas Consequence of experience Collaborative and cooperative process Evolutionary process that builds on past learning and experiences Process that is both intellectual and emotional Teaching-learning process involves dynamic interaction between teacher and learner Communication of information, emotions, perceptions, attitudes Nurses as teachers Teaching is one of many roles of professional nurse Primarily teach clients and families Teach professional colleagues and other healthcare personnel Teach each other Factors affecting teaching Federal and state regulations Developmental level, cultural, and socioeconomic background Primary language, previous knowledge, and experience Information and resources Nurses as learners Nursing education programs prepare practitioner with effective beginning nursing skills Nurses must continue learning to keep current American Nurses Association (ANA) State board of nursing (BON) outlines continuing education requirements See CONCEPTS RELATED TO TEACHING AND LEARNING, p. 2501 The art of teaching Teaching ( activities intentionally designed to produce specific learning Goal-directed More than giving information Creating learning environment conducive for learner to gain Knowledge Skills Desire within learner to change some aspect of life Characteristics of effective teaching Knowledge of subject matter Understanding of the learning process Judgment Intuition See Box 412 CHARACTERISTICS OF EFFECTIVE TEACHING, p. 2500 Relationship between teacher and learner Trust and respect Teaching process continues until participants Achieve mutually agreed-on learning goals Change the goals Decide that the goals cannot be met Nurses must understand a number of learning theories Develop more successful teaching plans Aspects of learning Learning need ( desire or requirement to know something that is presently unknown Individual desire to learn and act on learning ( compliance Coincides with medical or health advice View of term compliance ( adherence ( ability to maintain health-promoting regimens, which are determined largely by a healthcare provider Pedagogy ( teaching children and adolescents Andragogy ( art and science of teaching adults Geragogy ( process of stimulating and helping older adults to learn Different learning needs ( developing specific approaches to teaching and learning Learning theories Adult learning theory Knowles, Holton, Swanson ( adult education theory Four basic differences between adult and child education Self-concept Experience Readiness to learn Time perspective Andragogy As people mature, move from dependence to independence Adults previous experiences can be used as a resource for learning Adults readiness to learn is often related to developmental task or social role Adult oriented to learning when material is useful immediately Behaviorist theory Learning takes place when individuals reaction to stimulus is either positively or negatively reinforced To modify attitude and response ( behaviorist alters stimulus condition or changes what happens after response occurs Thorndike, Skinner, Pavlov, Bandura Increase probability of response ( positive reinforcement Nurses applying behavioristic theory Provide sufficient practice time Immediate and repeat testing and redemonstration Provide opportunities for learners to solve problems by trial and error Select teaching strategies that avoid distracting information, evoke desired response Praise learner for correct behavior Provide role models of desired behavior Cognitive theory Recognizes developmental level of learners, acknowledges learners motivation and environment Learning primarily mental, intellectual or thinking process Social emotional and physical contexts in which learning occurs Developmental readiness Individual readiness Piaget and Bloom Piagets five major phases of cognitive development Sensorimotor Preconceptual Intuitive Concrete operations Formal operations Bloom identified three domains Cognitive domain ( thinking domain, six intellectual abilities/thinking processes Knowing Comprehending Applying Analyizing Synthesizing Evaluating Affective domain ( feeling Feelings Emotions Interests Attitudes Appreciations Psychomotor domain ( skill domain Motor skills Nurses should include each of Blooms domains in teaching plans Nurses applying cognitive theory will Provide social, emotional, and physical environment conducive to learning Encourage a positive teacherlearner relationship Select multisensory teaching strategies because perception is influenced by senses Recognize that personal characteristics affect how cues are perceived Develop appropriate teaching approaches to target different learning styles Assess a persons developmental and individual readiness to learn Adapt strategies to the learners developmental level Select behavioral objectives, teaching strategies that encompass all domains Case Study A ( Mr. Lowe is a 76-year-old man who had hip surgery 12 hours ago , p. 2503 Social learning theory Bandura Entire learning process involves three interdependent factors Characteristics of the person Persons behavior Environment Most learning comes from observational learning Imitation Modeling Models provide information rather than elicit matching behavior Social cognitive theory Learning defined as knowledge acquisition through cognitive processing information Nurses apply social learning theory Provide information Model how to perform new skill Humanistic learning theory Maslow and Rogers Focuses on cognitive and affective qualities of learner Learning self-motivated, self-initiated, self-evaluated Focuses on self-development and achieving full potential Maslows Hierarchy of Needs Prioritize interventions ( Physiologic Safety and security Love and belonging Esteem and self-esteem Growth Focus on feelings and attitudes of learners Individual identifying learning needs Taking responsibility for them Self-motivation of learners to work toward self-reliance and independence Nurses apply humanistic theory Convey empathy in nurseclient relationship Encourage learner to establish goals and promote self-directed learning Encourage active learning by serving as facilitator, mentor, resource Using active learning strategies to assist clients adoption of a new behavior Expose learner to new relevant information, ask appropriate questions to encourage learner to seek answers Categorization Bruner Perception, conceptualizing, learning, and decision making All depend on categorizing information Learning bones Formation of a coding system Facilitates transfer, retention, increases problem-solving motivation Constructivism Individuals actively constructing knowledge to solve realistic problems Change in meaning constructed from experience Multiple intelligence Early psychologists ( IQ New theories argue intelligence has a number of dimensions Not fixed and unchangeable by training Gardner ( seven intelligences first cited Linguistic Musical/rhythmic Logical/mathematical Spatial Body/kinesthetic/movement Personal Symbols as intellectual strengths or way of knowing Since added eighth naturalist Factors affecting learning Many factors can facilitate or hinder learning Factors facilitating learning Motivation ( desire to learn Influences how quickly and how much Greatest when person recognizes need Often nurses task to help work through, identify need Readiness to learn ( demonstration of behaviors, cues that reflect learners motivation to learn at a specific time Desire or willingness and ability Willing but in pain Active involvement ( learning becomes more meaningful Active participation ( learn quickly, retain more information Promotes critical thinking Relevance ( learn more quickly, retain, when what they are learning is personally relevant Connect new knowledge with what they know, or have experienced Feedback ( information regarding a persons performance in relation to desired goal Has to be meaningful to learner Positive feedback ( enhances learning Negative feedback ( can lead to withdrawal from learning Nonjudgmental support ( acceptance and belief they will not be judged No poor or good Gain confidence when successful Motivates learning Simple to complex ( logically organized material Comprehend new information, assimilate with previous learning, form new understandings Repetition ( key concepts and facts, practice of psychomotor skills Timing ( retain information, psychomotor skills when short time interval between learning and using what is learned Environment ( optimal ( reduce distraction, physical, psychologic comfort Choose time with no visitors, distractions unlikely Privacy Case Study B (Millie Delaney, a 36-year-old woman, is being transferred from the hospital to a long-term care facility , p. 2506 Factors inhibiting learning Emotions ( impede learning Fear, anger, depression, anxiety May decrease with information Physiologic events ( illness, pain, sensory deficits Analgesics, rest before teaching Cultural aspects ( language, beliefs, values differ Conflict of Western medicine Psychomotor ability Muscle strength Motor coordination Energy Sensory acuity Case Study C ( Angela Simpson is a new mother who believes a fat baby is a healthy baby, p. 2508 The Internet and health information E-health ( application of Internet, other related technologies in healthcare industry Improve access, efficiency, effectiveness, quality of clinical and business process Used by organizations, practitioners, clients, consumers Online health information Healthcare online use growing twice as fast as any other type of use Affects decision making Older adults and the use of the internet Fifty-three percent of Americans over the age of 65 use the Internet or e-mail Of older adults who use the Internet, 70 use it daily Internet usage drops significantly with those ages 75 and older Sixty-nine percent of Americans over the age of 65 own a cell phone Thirty-four percent of Americans over the age of 65 use social networking sites Review The Concept of Teaching and Learning Relate Link the Concepts and Exemplars Refer Go to Nursing Student Resources Reflect Case Study Exemplar 41.1 Client/Consumer Education Overview Mandated in American Hospital Association (AHA) A Patients Bill of Rights Legal and professional nursing responsibility Include evidence client/significant others understand Includes promoting, protecting, maintaining health See Box 414 AREAS FOR CLIENT EDUCATION, p. 2509 Teaching environments Nurses teach a variety of clients in a variety of settings Hospitals Primary care clinics Urgent care Managed care The home Assisted living Long-term care Teaching individual clients Teaching may be with individual clients, parents, grandparents, spouse Goal to ensure safe transition from one level of care to another Rules for teaching Provide a calm environment Take time in teaching Adapt your teaching plan to reflect the clients reactions Repeat instructions several times Evaluate the clients ability to perform skills Teaching in the community Community health programs Local health departments Schools Colleges and universities May be designed for small groups Developing a teaching plan Assess needs of client or group Of client learning needs from history, physical assessment Common learning needs for all clients experiencing similar health problems Client health history Age and developmental level Provides information on developmental status May indicate distinctive teaching content and approaches See LIFESPAN CONSIDERATIONS Teaching Across the Life Span on p. 2512 See LIFESPAN CONSIDERATIONS Teaching Tools for Children on p. 2519 Clients understanding of health problem May indicate deficient knowledge or misinformation Effects of problem on clients usual activities may alert nurse Other areas requiring instruction Health beliefs and practices May be unreasonable to expect client to change beliefs completely Cultural factors Folk beliefs and practices Relate to diet, health, illness, lifestyle Economic factors Ability to obtain medication and supplies Learning styles Best way to learn varies with individual Learning style may be based in cultural background Oral tradition ( videos Nurse has time constraints Use variety of teaching techniques Vary activities Support systems Explore support system Determine extent to which others may enhance, support learning Physical examination General survey Mental status Energy level Nutritional status Physical capacity to learn perform self-care activities Readiness to learn Ready ( search out information, ask questions, reading, showing interest Not ready ( avoid subject or situation Physical readiness Focus on things other than physical status Pain, fatigue, immobility Emotional readiness Anxious or grieving ( not ready Cognitive readiness Think clearly or effects of analgesia, anesthesia Motivation to learn Relates to whether client wants to learn Greatest when ready, information meaningful Nonverbal behaviors may indicate decreased motivation to learn Health literacy Ability to read, understand, act on health information Prescription labels, insurance forms, instructions for diagnostic tests Limited literacy often in certain groups Older adults, limited educations, poor people, minority populations, limited English proficiency Low health-literacy skills associated with poor health outcomes, higher costs Poor adherence, less information about health promotion Challenge to teach client with low or no reading, writing skills Majority of people at lowest reading levels will report that they read well Behaviors that may indicate literacy problem Pattern of noncompliance Insisting they already know information Having a friend, family member read document Pattern of excuses for not reading the instructions Readability of written material Tools in word processing programs Write tools for education for lower reading levels See CLIENT TEACHING Developing Written Teaching Aids, p. 2514 See CLIENT TEACHING Teaching Client With Low Literacy Levels, p. 2515 Case Study D ( David Rodriquez is a 28-year-old man who had an emergency appendectomy yesterday, p. 2514 Identifying learning needs Learning need as the diagnostic label Deficient Knowledge absence of deficiency of cognitive information related to a specific topic Either client seeking health information or nurse identified learning need Examples Deficient Knowledge (low-calorie diet) related to inexperience with newly ordered therapy Deficient Knowledge (home safety hazards) related to denial of declining health and living alone Nurse provides information that has potential to change clients behavior Readiness for Enhanced Self-Health Management active seeking of ways to alter health habits and/or environment in order to move toward a higher level of health Client is seeking informationmay or may not have an altered response/dysfunction Examples Health-Seeking Behavior (exercise and activity) related to desire to improve health behaviors and decrease risk of heart disease Health-Seeking Behavior (home safety hazards) related to desire to minimize risk of injury Noncompliance behavior of person and/or caregiver that fails to coincide with health-promoting or therapeutic plan agreed on by person and healthcare professional Use with caution ( generally associated with intent to comply but situational factors make it difficult Factors that influence compliance Understanding or comprehension for teaching Experienced negative side effects of the treatment Financial inability to carry out treatment plan Language barriers Poor teaching NOT to be used for client who is unable to follow instructions Deficient Knowledge as the etiology Risk for Impaired Parenting related to deficient knowledge of skills in infant care and feeding Risk for Infection related to deficient knowledge of sexually transmitted diseases and their prevention Anxiety related to deficient knowledge of bone marrow aspiration Risk for Injury Ineffective Breastfeeding Impaired Individual Resilience Ineffective Coping Ineffective Health Maintenance Planning Developing teaching plan accomplished in series of steps Involving client promotes formation of meaningful plan Stimulates client motivation More likely to achieve desired outcomes Determining teaching priorities Learning needs must be ranked according to priority Client and nurse do it together Use theoretical frameworks to establish priorities (e.g., Maslows) Setting learning outcomes State the client behavior or performance Identify personal risk factors for heart disease, NOT teach the client about cardiac risk factors Reflect an observable, measurable activity Performance may be visible or invisible Performance of an outcome might be written Selects low-fat foods from a menu See Box 416 EXAMPLES OF VERBS FOR WRITING LEARNING OUTCOMES, p. 2517 May add conditions or modifiers Clarify what, where, when, how behavior will be performed Include criteria specifying the time by which learning should have occurred Reflect learners command of simple to complex concepts Be specific in writing learning outcomes What behaviors and knowledge learners must have Choosing content Determined by learning outcomes desired Select from many sources of information that must be Accurate Current Based on learning outcomes Adjusted for leaners age, culture, ability Consistent with information nurse is teaching Selected with consideration of how much time, what resources available Selecting teaching strategies Suited to individual and material to be learned Individual who cannot read will not benefit from written material ( video, demonstration Discussion not best strategy for teaching how to give an injection Nurse using group discussion for teaching should be competent group leader Individual learning style See Table 413 SELECTED TEACHING STRATEGIES, p. 2518 See CLIENT TEACHING Sample Teaching Plan for Wound Care, p. 2516 Organizing learning experiences Teaching guides standardize content, teaching methods Ensure consistency of content Start with something learner is concerned about Discover what learner knows, then proceed to unknown Address early any area causing client anxiety Teach basics before proceeding to variations or adjustments Simple to complex Schedule time for review of content, question client may have If no questions, introduce questions by saying, A few frequently asked questions are . . . Showing flexibility ( plan may need revising Alter plan, discuss desired information, provide another demonstration, defer teaching psychomotor skill Use teaching techniques that enhance learning, reduce or eliminate barriers to learning Guidelines for teaching Knowledge alone not enough to motivate person to change behavior Stages of change, willingness and perceived need to change, barriers to change ( important elements to consider when implementing teaching plan Guidelines include Rapport between teacher and learner essential Use clients previous learning in present situation ( encourage client, facilitates learning new skills Optimal time for session depends on learner Nurse teacher must be able to communicate clearly and concisely Use laypersons vocabulary No jargon Pace of teaching session affects learning Environment can detract from or assist learning Hot/cold Noise Interruptions Bed usually associated with sleep, rest, not learning Teaching aids can foster learning, focus attention Assemble all equipment, visual aids Ensure equipment functioning effectively Involve a number of senses to enhance learning Learning more effective when learners discover content for themselves Include stimulating motivation, self-direction Realistic, specific achievable outcomes Give feedback Encourage client to explore sources of information Repetition reinforces learning Summarize content Rephrase Approach from another point of view Clarify content Organizers ( connecting material ( generate logical relationships Anticipated behavioral changes must be within context of clients lifestyle, resources Special teaching strategies Anticipatory guidance Health promotion in pediatrics Helps to prevent health alterations or complications Consider clients age, developmental stage, health status, and health literacy level Client contracting Learning contract, drawn up by client and nurse Specifies learning outcomes, time frame Can be changed Group teaching Economical, share with and learn from others All members of group should have common need Consider sociocultural factors in formation of group Technology-assisted instruction Can be used for factual information Can set pace that meets needs Small groups can work togetherpacing might be difficult Read, view material ( answer questions ( immediate feedback Negative attitude ( might act as barrier Variety of sources for information about computer software programs Discover/problem solving Nurse presents some initial information ( presents situation related to information Work alone or in groups Behavior modification Used to prompt individuals to change behavior Basic assumptions Behaviors are learned and can be selectively strengthened, weakened, eliminated, replaced Can be Learning contract combined with behavior modification Positive reinforcement used Client participates in development of learning plan Undesirable behavior is ignored, not criticized Expectation of client and nurse is that task will be mastered Transcultural teaching Different cultural/ethnic backgrounds ( additional teachinglearning barriers Guidelines to consider Obtain teaching materials in languages used by clients Use visual aids to communicate meaning Use concrete rather than abstract words Allow time for questions Avoid use of medical terminology or healthcare language If understanding pronunciation is a problem, validate brief information in writing Use humor very cautiously Do not use slang words or colloquialisms Do not assume client who nods, uses eye contact, smiles, is indicating understanding Invite and encourage questions during teaching When explaining procedures, functioning related to personal areas of body ( same-sex nurse to do teaching Include family in planning and teaching Consider clients time orientation Identify cultural health practices and beliefs Evaluation Ongoing and final process Evaluating learning Direct observation of behavior Written measurements Oral questioning Self-reports and self-monitoring Psychomotor skills ( evaluate by observation Modify/repeat teaching plan if objectives not met/partially met Behavior change not always immediate Evaluating the learning experience Timing Strategies used Amount of information provided Was teaching helpful or overwhelming Boring or motivating Feedback questionnaires Retention Have clients write down information Repeating information during teaching Giving handouts on the information Having clients be active in the learning process Documenting Essential ( legal record that teaching took place Document responses to teaching activities Multiple copy client teaching forms Parts of teaching to document Diagnosed learning needs Learning outcomes Need for additional learning opportunities, sessions Resources provided For future reference, might include Information, skills included Teaching strategies used Time framework, content Teaching outcomes, methods of evaluation Review Client/Consumer Education Relate Link the Concepts and Exemplars Refer Go to Nursing Student Resources Reflect Case Study Exemplar 41.2 Mentoring Overview Mentor ( competent, experienced professional who develops a relationship with a novice for the purpose of providing advice, support, information, and feedback in order to encourage development of the individual Mentoring Sign of professional who values support and positive criticism Act as teachers Counselors Interveners Sponsors Positive impact on mentor, protg in most cases Match has to be good Three steps in mentoring relationship Selection phase Typically mentor selects protg Socializing relationship as mentor guides protg Mentor has time for relationship Mentor has skills Mentor willing to include protg in professional activities Goal setting Protg develops goals to accomplish Work together Evaluate periodically Working phase Boundaries established ( exchange feedback, resources Transition from protg to colleague Seek mentor to improve, advance professional practice Can be local or long distance Precepting Preceptor ( experienced nurse provides emotional support, strong clinical role model for the new nurse Assigned to nurses new to unit Assigned to new nurses ( patient, willing to teach, answer questions, clarify expectations Reality shock Preceptors usually assignedmentors voluntary, mutual growth Coaching Personal performance-focused conversation of discovery Improve performance, renew commitment to self-sufficiency, organizational goals, values Coaching tasks Assess Set expectations, goals Act Reflect Four strategies Help nurse master challenges Success breeds success Use vicarious experience to encourage action Role model Use social persuasion ( self-confidence improves Promote self-care ( taking care of self improves self-sufficiency Use to develop solutions to performance problems Create positive mind-set Get the facts straight Start on an up note Present the problem concisely Ask about the nurses perspective of the problem Search for solutions Networking Process by which people develop linkages throughout the profession to communicate, share ideas and information, and offer support and direction to each other Informal communication with others Advantages of building a network Share ideas and information Provide support, guidance and advice Foster personal and professional growth Create personal and professional opportunities Enhance communication Increase productivity Establish health policies Refine interpersonal skills Promote change Foster creativity Develop a sense of belonging Promote personal life and professional work satisfaction All members help one another Useful for student nurses Jobs Clinical site contacts Review Mentoring Relate Link the Concepts and Exemplars Refer Go to Nursing Student Resources Reflect Case Study Exemplar 41.3 Staff Development Overview Nurses must seek opportunities to maintain currency in practice Opportunities in workplace Teaching other nurses Critical care, perioperative areas Clinical instruction of students Teaching other health professionals Medical students Allied health Nurse managers major role is staff development Orientation Series of activities designed to acclimate new employees to the workplace Typically responsibility of staff development manager, nursing manager May be split between clinical/nursing and human resources (general policies, benefits, etc.) Nurse manager Be specific when discussing what they expect Standards of performance, attendance, treatment of clients Thorough orientation increases productivity, job satisfaction, and retention Preceptor model Benefits new nurses and preceptor Residency program Orient new graduates to work environment Staff development process Three main questions Can learner do what is required How should staff development program be arranged to facilitate learning What can be done to ensure learning will be transferred to job Assessment Nurse leaders assess for knowledge and skills deficits and plan staff education and training programs if the following occur New policies of procedures New equipment or materials Changes in routines or client care standards Changes in client population Quality improvement efforts Regulatory and accrediting bodies standards Planning Identifying the goal or goals of the educational or training program Develop learning objectives geared toward the diversity of the staff members Choose teaching strategies and develop learning activities that meet learning outcomes Select an evaluation method that measures the outcome Implementation Brings together educators, learners, materials, methods Internal or external Staff member who has had hands-on practice with performance feedback is more likely to apply the new knowledge and skills than a staff member who just watched or listened to a demonstration Evaluation Did the learner meet the learning objectives How effective was the teacher or teachers in implementing the educational plan How well did the teaching methods and strategies meet the needs of the learners How effective was the educational program Did the program meet the goals Will client outcomes or operational processes show improvement Review Staff Development Relate Link the Concepts and Exemplars Refer Go to Nursing Student Resources Reflect Case Study 2015 by Education, Inc. 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