Download The Nurse as Learner and Teacher

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
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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
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Learning Objective 8.1
Discuss selected learning theories as they apply
to nurse and client learning.
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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
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Nurses as Learners
• Ways to learn
– Institution-based human resource development
programs
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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
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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
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Nurses as Learners
• Ways to learn
– Episodic individually selected educational pursuits
 Distinct and separate from formal or planned education
 Journals, newsletters, newspapers, and magazines
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The Learning Process
• Androgogy
– The art and science of helping adults learn
• Pedagogy
– The discipline concerned with helping children learn
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The Learning Process
• Theories of learning
– Six contemporary theoretical constructs
 Behaviorism
 Cognitivism
 Humanism
 Categorization
 Constructivism
 Multiple intelligences
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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
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Theories of Learning
• Behaviorism
– Skinner’s operant conditioning theory
 Classical conditioning
•
Association with new stimulus; Pavlov’s dogs
 Operant conditioning
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•
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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
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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
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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
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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
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Theories of Learning
• Cognitivism
– Developmental readiness and individual readiness are
other key factors
– Major theorists
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Jean Piaget
Kurt Lewin
Robert Gagné
Benjamin Bloom
Jerome Bruner
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Theories of Learning
• Piaget’s phases of cognitive development
– Orderly sequential process requiring stimuli
– Four phases
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Sensorimotor
Preoperational
Concrete operations
Formal operations
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Theories of Learning
• Piaget’s phases of cognitive development
– Each phase has three primary abilities
 Assimilation
 Accommodation
 Adaptation
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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
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Theories of Learning
• Lewin’s field theory
– Theory of change has three basic stages
 Unfreezing
 Moving
 Refreezing
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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
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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
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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
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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
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Theories of Learning
• Howard Gardner’s multiple intelligences
– Intelligence has multiple dimensions
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Linguistic
Logical/mathematical
Musical/rhythmic
Spatial
Body/kinesthetic/movement
Intrapersonal
Interpersonal
Naturalist
Existential
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Learning Objective 8.3
Describe the three domains of learning and how
they differ.
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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
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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
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Applying Learning Theories
• Humanism
– Focus on feelings and attitudes
– Importance of identifying learning needs, responsibility,
and self-motivation
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Cognitive Learning Process
• Acquiring information
– Sensory reception
– Discrimination
• Processing information
– Association
– Generalization
– Concept formation
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Cognitive Learning Process
• Using information
– Application of information in the cognitive, affective,
and/or psychomotor areas
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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
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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
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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
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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
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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
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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
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Factors That Inhibit Learning
• Health literacy
– Limits on capacity to obtain, process, and understand
basic health information and services to make
appropriate health decisions
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Learning Objective 8.2
Describe the various teaching roles of the nurse.
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Nurses as Teachers
• Nurses teach
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Individuals
Groups
Different types of learners
Clients and their families
Healthcare professionals
Community members
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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
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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
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The Art of Teaching
• Effective teaching requires
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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
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Learning Objective 8.4
Identify guidelines for effective learning and
teaching.
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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
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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
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Learning Objective 8.5
Discuss the relevance of literacy for client
learning.
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Assessing Learning Needs
• Factors to consider
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Age and developmental level
Health beliefs and practices
Cultural and spiritual factors
Economic factors
Learning styles
Readiness to learn
Motivation
Reading level
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Learning Objective 8.6
Develop a teaching plan.
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Planning Content and Teaching
Strategies
• Accomplished in a series of steps
• Determine teaching priorities
• Setting learning objectives or outcomes
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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
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Planning Content and Teaching
Strategies
• Choosing content
– What is to be taught is determined by the learning
objectives
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Planning Content and Teaching
Strategies
• Choosing content
– Content should be
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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
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Planning Content and Teaching
Strategies
• Selecting teaching strategies
– Methods for teaching should be suited to the
 Individual
 Material to be learned
 Teacher
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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
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Implementing a Teaching Plan
• Guidelines for teaching
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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
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Implementing a Teaching Plan
• Guidelines for teaching
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Repetition
Organize information
Use layperson’s vocabulary
Provide written material for future reference
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Evaluating Learning and Teaching
• Evaluating learning
– Ongoing
 Formative
– Final
 Summative
– Evaluation method depends on the type of learning
(cognitive, psychomotor skill, or affective learning)
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Evaluating Learning and Teaching
• Evaluating methods for cognitive learning
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Observation
Written measurement
Oral questioning
Self-reports and self-monitoring
• Evaluating methods for psychomotor skills
– Demonstration
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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
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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
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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
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Special Teaching Strategies
• Computer-assisted instruction (CAI)
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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
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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
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Special Teaching Strategies
• Behavior modification
– Desirable behavior is regarded and undesirable
behavior is ignored
– Learning contract is often combined with a behavior
modification
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Learning Objective 8.7
Describe strategies for teaching learners of
different cultures.
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Teaching Clients of Different Cultures
• Guidelines
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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
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Transcultural Client Teaching
• Guidelines
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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
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Documentation of Teaching
• Include
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Diagnosed learning needs
Learning objectives
Topics taught
Client learning outcomes achieved
Need for additional teaching
Resources provided
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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
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