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Professional Nursing Practice Concepts and Perspectives Seventh Edition Chapter 8 The Nurse as Learner and Teacher Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objectives 8.1 Discuss selected learning theories as they apply to nurse and client learning. 8.2 Describe the various teaching roles of the nurse. 8.3 Describe the three domains of learning and how they differ. 8.4 Identify guidelines for effective learning and teaching. 8.5 Discuss the relevance of literacy for client learning. 8.6 Develop a teaching plan. 8.7 Describe strategies for teaching learners of different cultures. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Hallmark Features • A focus on foundational knowledge related to professional nursing – Includes nursing history, nursing theory, ethics, and legal aspects, etc. • An overview of professional nursing roles, issues, and changes in the profession – Discusses nurses as healthcare providers, learners and teachers, and leaders Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Challenges and Opportunities • Federal and state regulations • Healthcare client variations • Constant change in information • Numerous available resources • Need to stay up to date with theory and practice • New opportunities for nurses as teachers of clients and their families, nursing assistants, colleagues, and others Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 8.1 Discuss selected learning theories as they apply to nurse and client learning. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Nurses as Learners • Ways to learn – Continued formal academic education Master’s degree Doctoral degree May be in nursing or other disciplines that enhance nurses’ practice Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Nurses as Learners • Ways to learn – Institution-based human resource development programs Administered by employer; intent is to benefit institution Designed to upgrade employees’ knowledge and skills Orientation programs Equipment or technique updates Information about new policies Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Nurses as Learners • Ways to learn – Voluntary or legislatively mandated continuing education More specific and shorter than advanced academic degree study Individually driven Through institutions, professional organizations, or colleges and universities State or professional organization mandates • • Some states require specific content instruction CE requirements must be met for each state where nurse holds licensure To meet certification and recertification for specialty practice Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Nurses as Learners • Ways to learn – Episodic individually selected educational pursuits Distinct and separate from formal or planned education Journals, newsletters, newspapers, and magazines Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved The Learning Process • Androgogy – The art and science of helping adults learn • Pedagogy – The discipline concerned with helping children learn Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved The Learning Process • Theories of learning – Six contemporary theoretical constructs Behaviorism Cognitivism Humanism Categorization Constructivism Multiple intelligences Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Theories of Learning • Behaviorism – Environment influences behavior and how a person controls it – Environment is an essential factor determining human action – An act is a response that is traced to the effects of a stimulus Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Theories of Learning • Behaviorism – Skinner’s operant conditioning theory Classical conditioning • Association with new stimulus; Pavlov’s dogs Operant conditioning • • • Frequency of a response can be increased or decreased depending on the extent it is reinforced Reinforcement is the consequence of an action Extinction is the process in which a conditioned behavior is “unlearned” Studies of conditioning produced laws of learning that were thought to be universal Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Theories of Learning • Social learning theory – Bandura states that the learning process involves three highly interdependent factors Characteristics of the person The person’s behavior The learning environment Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Theories of Learning • Social learning theory – Reciprocal determinism Believed that the behavior affects or creates the environment – Observational learning Acquisition of new skills Alteration of old behaviors – Imitation – Modeling Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Theories of Learning • Cognitivism – Learning is a complex cognitive activity – Learning as the development of understandings and appreciations that help the individual function in a larger context – Learning is largely a mental, intellectual, or thinking process – Learner’s perceptions are influenced by personal characteristics and experiences – Social, emotional, and physical contexts affect learning Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Theories of Learning • Cognitivism – Developmental readiness and individual readiness are other key factors – Major theorists Jean Piaget Kurt Lewin Robert Gagné Benjamin Bloom Jerome Bruner Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Theories of Learning • Piaget’s phases of cognitive development – Orderly sequential process requiring stimuli – Four phases Sensorimotor Preoperational Concrete operations Formal operations Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Theories of Learning • Piaget’s phases of cognitive development – Each phase has three primary abilities Assimilation Accommodation Adaptation Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Theories of Learning • Lewin’s field theory – Theories of motivation and perception – Learning involved four different types of changes Cognitive structure Motivation One’s sense of belonging to the group Gain in voluntary muscle control Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Theories of Learning • Lewin’s field theory – Theory of change has three basic stages Unfreezing Moving Refreezing Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Theories of Learning • Gagné’s information-processing theory – Eight levels of intellectual skills Signal or cue Stimulus-response Chaining Verbal association Multiple discrimination Concept formation Principle formation Problem solving Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Theories of Learning • Humanism – Focuses on cognitive and affective areas of the learner – Holistic philosophy of care – Prominent members Abraham Maslow Carl Rogers – Learning is believed to be self-motivated, self-initiated, and self-evaluated – Learning focuses on self-development and achieving full potential Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Theories of Learning • Categorization – Jerome Bruner postulated the system of categorization – People interpret information in terms of the similarities and differences detected and arrange the information in related categories – Formation of a coding system Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Theories of Learning • Constructivism – John Dewey originated and Jerome Bruner expanded on constructivism – Learning is change in meaning constructed from experience – Knowledge becomes an individual interpretation of experience – Learning is the construction of new interpretations – Applicable to learning with technology Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Theories of Learning • Howard Gardner’s multiple intelligences – Intelligence has multiple dimensions Linguistic Logical/mathematical Musical/rhythmic Spatial Body/kinesthetic/movement Intrapersonal Interpersonal Naturalist Existential Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 8.3 Describe the three domains of learning and how they differ. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Theories of Learning • Bloom’s domains of learning – Three domains Cognitive Affective Psychomotor – Domains broken down into further categories – Each domain should be included in client teaching plans Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Applying Learning Theories • Behaviorist – Identification of what is to be taught and the immediate identification of and reward for correct response • Cognitive theory – Recognition of developmental levels of learning and learner’s motivation and environment Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Applying Learning Theories • Humanism – Focus on feelings and attitudes – Importance of identifying learning needs, responsibility, and self-motivation Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Cognitive Learning Process • Acquiring information – Sensory reception – Discrimination • Processing information – Association – Generalization – Concept formation Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Cognitive Learning Process • Using information – Application of information in the cognitive, affective, and/or psychomotor areas Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Factors That Facilitate Learning • Motivation – Incentive to learn Influences how quickly and how much Greatest when a person recognizes a need Need must be experienced by the client – Readiness Motivation at a specific time Willingness and ability to learn Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Factors That Facilitate Learning • Active involvement – Makes learning more meaningful – Active participation in planning and discussing results in faster learning and better retention – Passive learning does not foster optimal learning – Person who expects to be judged poorly will not learn as well as person who feels no such threat Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Factors That Facilitate Learning • Feedback – Information or critique relating a person’s performance to the desired goal – Support desired behavior through praise, positively worded corrections, and suggestions of alternative methods – Negative feedback may cause the client to avoid the teacher to avoid the punishment Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Factors That Facilitate Learning • Simple to complex – Learning is facilitated by material that is logically organized and proceeds from the simple to the complex • Repetition – Helps link new learning to prior learning Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Factors That Facilitate Learning • Timing – Retain information and psychomotor skills when the time between learning and use is short • Environment – Optimal learning environment Reduces distraction Provides physical and psychological comfort Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Factors That Inhibit Learning • Emotions – Greatly elevated anxiety level impedes learning • Physiological factors – Pain, impaired hearing, critical illness – Ability to concentrate affects learning • Cultural and spiritual factors – Language or value differences Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Factors That Inhibit Learning • Health literacy – Limits on capacity to obtain, process, and understand basic health information and services to make appropriate health decisions Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 8.2 Describe the various teaching roles of the nurse. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Nurses as Teachers • Nurses teach – – – – – – Individuals Groups Different types of learners Clients and their families Healthcare professionals Community members Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Nurses as Teachers • Nursing roles – Primary teaching role is in teaching patients and their families – Instruction includes self-care, taking medications – Teach in various settings Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved The Art of Teaching • Teaching is a goal-directed activity that results in improved learning for the learner • More than giving information • Develops the knowledge, skill, and desire within the learner to change some aspect of his or her life • Requires strong social and communication skills Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved The Art of Teaching • Effective teaching requires – – – – Knowledge of the subject matter Understanding of the learning process Judgment Intuition • Relationship between teacher and learner is essentially one of trust and respect • Nurses have the responsibility to keep their clinical knowledge current Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 8.4 Identify guidelines for effective learning and teaching. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Guidelines for Learning and Teaching • Teaching activities should help the learner meet individual learning objectives • Rapport between teacher and learner is essential • Use the client’s previous learning situations in the present situation • Communicate clearly and concisely Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Guidelines for Learning and Teaching • Know the learner and factors that affect the person’s learning before teaching • Involve the client in the learning • Use strategies that involve multiple senses • Anticipate behavioral changes relevant to the client’s lifestyle and resources Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 8.5 Discuss the relevance of literacy for client learning. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Assessing Learning Needs • Factors to consider – – – – – – – – Age and developmental level Health beliefs and practices Cultural and spiritual factors Economic factors Learning styles Readiness to learn Motivation Reading level Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 8.6 Develop a teaching plan. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Planning Content and Teaching Strategies • Accomplished in a series of steps • Determine teaching priorities • Setting learning objectives or outcomes – – – – State the learner behavior or performance Reflect an observable, measurable behavior Add conditions or modifiers for clarity as needed Include criteria specifying the time by which learning should have occurred Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Planning Content and Teaching Strategies • Choosing content – What is to be taught is determined by the learning objectives Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Planning Content and Teaching Strategies • Choosing content – Content should be Accurate Current Based on learning objectives Adjusted for the learner’s age, culture, language, and ability Consistent with information the nurse is teaching Selected with consideration of how much time and resources are available for teaching Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Planning Content and Teaching Strategies • Selecting teaching strategies – Methods for teaching should be suited to the Individual Material to be learned Teacher Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Planning Content and Teaching Strategies • Organizing learning experiences – Start with something the learner is concerned about – Begin with what the learner knows – Address first any area that is causing the learner anxiety – Teach basics first – Schedule time for review of content and questions Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Implementing a Teaching Plan • Guidelines for teaching – – – – – – Schedule best time for learner Include family or caregivers as appropriate Pace the session appropriately Control the environment and avoid distractions Use teaching aids Assist learners in discovering content for themselves Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Implementing a Teaching Plan • Guidelines for teaching – – – – Repetition Organize information Use layperson’s vocabulary Provide written material for future reference Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Evaluating Learning and Teaching • Evaluating learning – Ongoing Formative – Final Summative – Evaluation method depends on the type of learning (cognitive, psychomotor skill, or affective learning) Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Evaluating Learning and Teaching • Evaluating methods for cognitive learning – – – – Observation Written measurement Oral questioning Self-reports and self-monitoring • Evaluating methods for psychomotor skills – Demonstration Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Evaluating Learning and Teaching • Evaluating methods for affective learning – Difficult to evaluate – Inferred through listening and observing • Behavior change does not always take place immediately after learning Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Evaluating Learning and Teaching • Evaluating teaching – Consider all factors Timing Environment for learning Teaching strategies Amount of information – Whether teaching was helpful or not Learner and teacher should evaluate the learning experience Have learner be active in learning process Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Special Teaching Strategies • Contracting – Specifies learning objectives, responsibilities of learner and nurse, and teaching plan • Group teaching – Economical; provides members an opportunity to share with and learn from others Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Special Teaching Strategies • Computer-assisted instruction (CAI) – – – – Cognitive learning Complex problem-solving skills Application of information through simulation scenarios Psychomotor skills • Used by individuals, small and large groups • Individuals can set their own pace • May act as a barrier to learning Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Special Teaching Strategies • Multimedia presentations – Combine audio, film, video, and computers to stimulate many senses • Discovery/problem solving – Teacher guides the learners through the thinking process necessary to reach the best solution to the question or best action to take in the situation Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Special Teaching Strategies • Behavior modification – Desirable behavior is regarded and undesirable behavior is ignored – Learning contract is often combined with a behavior modification Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 8.7 Describe strategies for teaching learners of different cultures. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Teaching Clients of Different Cultures • Guidelines – – – – – – – Obtain teaching materials in languages used by client Use visual aids such as pictures, charts Use concrete rather than abstract words Allow time for questions Avoid use of medical terminology Validate in writing if pronunciation is a problem Use humor cautiously Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Transcultural Client Teaching • Guidelines – – – – Avoid slang Don’t assume that a nod means comprehension Invite and encourage questions Consider same-sex teacher if content is related to personal areas of the body – Include the family – Evaluate whether learning objectives have been met Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Documentation of Teaching • Include – – – – – – Diagnosed learning needs Learning objectives Topics taught Client learning outcomes achieved Need for additional teaching Resources provided Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Documentation of Teaching • Written teaching plan is a resource and should include – Actual information on skills taught – Teaching strategies used – Time framework and content of each class Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved