Download TeachingLearningINSTRUCTOR

TEACHING/LEARNING
The Nurse as Teacher
• Teaching:
– Planned method or series of methods
– Used to help someone learn
– The person using these methods  teacher
• Learning
– Process by which a person acquires or increases
knowledge or
– Changes behavior in an obvious way as a result of
experience
• The nurse is the teacher
• The patient is the learner
• This relationship enhanced by the helping
relationship
– Mutual trust
– Mutual respect
• Both patient and nurse have identified this
learning need as important
Focus of patient education:
• Three critical areas:
– Prepare patient for receiving care
– Prepare patient/family for discharge from hospital
– Document patient education activity
• V.I.P. for insurance reimbursement
Teaching Acronym
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T – tune into the patient
E – edit patient information
A – act on every teaching moment
C – clarify often
H – honor the patient as partner in the
education process
Process of patient teaching:
• Resembles the nursing process and includes:
– Assess learning needs and readiness
– Diagnose the patient’s learning needs
– Develop learning outcomes (goals)
– Develop a teaching plan
– Implement Teaching plan and strategies
– Evaluate Learning
• Will review sample care plan later in class
Why the need for an effective
teacher?
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Shorter hospital stays
Dependence on complex technologies
Helps to empower the consumer
Cost containment
↑ in chronic illness
Need to meet The Joint Commission goals
and standards
Our challenges?
• Lots to teach!
• ↓ time
• ↓ resources
• Getting patients to want to learn
What makes teaching effective?
• Effective = More than just pass on facts!
• Engage the patient in learning!
Effective Communication Is
Essential in the Teaching–Learning
Process
LEARNING
PROCESS OF LEARNING
• Life-long process
• Involves acquiring:
– New information
– Skills
– Attitudes
– Understanding
– Values
DOMAINS OF LEARNING
• Patients learn in three domains:
– Cognitive
– Affective
– Psychomotor
1. Cognitive
• The storing and
recalling of new
knowledge in the
brain
• Intellectual
behavior
• Example:
2. Affective
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Includes:
Changes in attitudes
Values
Feelings
Example: patient expresses renewed selfconfidence after physical therapy
3. Psychomotor
• Acquire skills that
combine mental and
muscular activity
• Example: demonstrates
dressing change
Summary
• Any topic you teach may involve one or more
of these domains.
FACTORS AFFECTING PATIENT LEARNING
• Age and developmental level
– Patient’s physical maturation and abilities
– Psychosocial development
– Cognitive capacity
– Emotional maturity
– Spiritual development
FACTORS AFFECTING PATIENT LEARNING
• Adult learners:
– Must believe they need to learn before they are
willing to learn
– May need to be shown the importance of learning
new information
– Identify any learning barriers. Older adults may
experience:
• Sensory loss (vision, hearing)
• Limited physical mobility
• Inability to comply with regimen
FACTORS AFFECTING PATIENT LEARNING
• Family support Networks and Financial
resources
– Try to get family involved with teaching/learning
• Cultural influences and language issues
Providing Culturally Competent
Patient Education
• Develop an understanding of the patient’s
culture.
• Work with multicultural team.
• Be aware of personal assumptions, biases, and
prejudices.
• Understand the core cultural values of the
patient or group.
• Develop written material in native language of
the patient.
• Health literacy
– Average American reads at the 8th or 9th grade
level
– Most health-care literature written at the 10th
grade level!
SOME LEARNING PRINCIPLES
1. Readiness
How ready is the person to learn? Assess the
following:
– How alert is this person? Need to consider:
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Physical discomfort
Primary disease
Imbalance of fluid/electrolyte
Nutritional status
Mental changes due to medications
Physical mobility
Level of endurance
• Anxiety level - mild motivates, high prevents learning
• Environmental factors - unplanned interruptions;
uncomfortable environment
• Ask yourself:
– “Is there anything that is keeping my patient from
learning?
– Control those factors.
2. Motivation
 How motivated is my patient?
 Internal desire
 Causes a person to act
 If someone does not want to learn, will he/she
learn?
 Some motivating forces:
 easy to learn
 necessary for survival
 ex - insulin for the diabetic
• Ask yourself:
– “Is my client motivated to learn?”
– What behaviors show you this?
– Record them in your data column.
3. Psychosocial Status
• Loss of health --> grieving
• Stages of grieving
• Ex. - anger, denial - not good for learning
• Ask yourself,
– “Is my patient showing any of the signs of
grieving?
– If so, will it effect his learning?”
– Record this in the data column.
4. Active participation
• Will learn better if involved
• Ask yourself:
– “How can I get my patient to be more actively
involved with my teaching?”
5. Compliance
• Patients who follow the treatment plan
• Patients more likely to be compliant when
they:
– Understand their diagnosis;
– Treatment rationale;
– Medication regimen; and
– Benefits of compliance.
• Increased patient compliance is a direct
outcome of effective patient teaching!
Ways to improve compliance:
• Make sure instructions are understandable
• Include patient and family as partners in the
teaching/learning process
• Use interactive teaching strategies
• Remember that teaching and learning are
processes that rely on strong interpersonal
relationships with patients and their families.
6. Ability to learn
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Developmental stage
Education level
Physical ability
Able to perform ADL’s
Able to read prescriptions, see colors, etc.
7. Learning Environment
• Factors:
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room temperature
need for privacy
lighting
noise
ventilation
furniture
Do changes need to be made in any of the above?
Learning Occurs If the Patient Can
Demonstrate What the Nurse
Taught
TEACHING
• Interactive process
• Promotes learning
• Aimed at changing the way persons can
and/or will behave
TEACHING PRINCIPLES
• Techniques for supporting the principles of
learning
– Get-and keep-your patient’s attention
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Clearly state your point
Vary your tone of voice
Use variety of teaching techniques
Use examples to get your point across
TEACHING PRINCIPLES
• Stick to the basics
– Keep it short, specific and simple
– Use simple, everyday language
• Make the most of your time
– What are some good times to teach?
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TEACHING PRINCIPLES
• Timing
– try to coincide with readiness to learn
– difficult in acute care setting
• Organization
– Simple to complex
– most important content first
TEACHING PRINCIPLES
• Maintain attention
– Enthusiasm
– Visual aids
– Humor
• Build on existing knowledge
• Reinforce (smile, nod)
• Match teaching method with learning need
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Reinforce content
Reinforce content
Reinforce content
Reinforce content
Reinforce what?
SUGGESTED TEACHING STRATEGIES FOR
THE THREE LEARNING DOMAINS:
Cognitive
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Panel discussion
Printed materials
DVD’s, Laptops, I-Pads, etc.
Question and answer
Lecture or discussion
• Lecture/explanation in sequence
– use simple terms
– know the subject well
– give feedback
– record patient’s response
– allow time to discuss feelings, concerns, questions
– correct any misunderstandings
Affective Domain
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Role play
Discussion
Panel discussion
Multi-media
Printed materials
Psychomotor Domain
• Demonstrate and practice
– Nurse demonstrates
– Patient returns demonstration
– Simple to complex - repetition
– Use same equipment as at home
– Ensure success for patient
• Multi-media
• Printed materials
Applying the Nursing Process to
Teaching
Assessment:
• Assess patient’s:
– Readiness to learn
– Ability to learn
– The learning environment
• Assess the learning environment
Nursing Diagnosis
1. Deficient Knowledge R/T:
– Cognitive limitation
– Lack of exposure
– Lack of interest in learning
– Lack of recall
– Not familiar with information resources
• As evidenced by: (the data that shows the
lack)
– Asks questions
– Unable to answer questions asked to him/her
– Not following the regimen
– Etc.
2. Ineffective self Health Management
• Definition:
– Pattern of not incorporating care for an illness to
meet goal of meeting health needs
• R/T:
– Economic difficulties
– Knowledge deficit
– Etc.
• A.E.B. – specific data
Plan Teaching
• Create appropriate learning environment
• Avoid interruptions
• Keep patient’s limitations in mind
Implement the Teaching Plan
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Keep sessions short
Avoid too much detail
Teach the “need to know” content
Teach in small amounts
Use examples the patient can relate to
Ask for questions
Involve the patient
Use a variety of media
Avoid lecturing
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Be sincere and honest.
Be a cheerleader for the patient.
Use simple vocabulary.
Vary the tone of voice.
Keep content clear.
Listen and do not interrupt.
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Teaching Strategies
Lecture
Discussion
Panel discussion
Demonstration
Discovery
Role playing
Audiovisual materials – DVD’s, I-Pads, Lap-tops
Printed materials/pamphlets
Programmed instruction
Web-based instruction
Multi-media, Printed Aids
National Group samples (Cancer Society,
Heart Assn., etc.)
Pictures/posters
Drug and Medical supply companies
Dieticians, patient educators
Anatomical models
Evaluate effectiveness of teaching
• Most effective – return demo
• Restating information
• Have patient list parts of the teaching
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Difficulty learning?
Usually requires more than one session
“I understand” is not reliable!
Documentation
• Document on appropriate forms
Teaching Plans for Older Adults
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Identify learning barriers.
Allow extra time.
Plan short teaching sessions.
Accommodate for sensory deficits.
Reduce environmental distractions.
The Teaching Care Plan
• One care plan due this module
• Review example
• Review grading sheet
Question
Which of the following is an example of
cognitive learning?
A. A patient demonstrates how to change his
wound dressing
B. A new mother follows instructions for
caring for the umbilical cord
C. A patient describes how to portion food to
maintain within a prescribed calorie range
D. A patient expresses renewed confidence
following a teaching session on caring for her
Answer
Answer: C. A patient describes how to portion
food to maintain within a prescribed calorie
range
Rationale:
Cognitive learning involves the storing and
recalling of new knowledge in the brain, such as
learning food portions to maintain a calorie
count.
Demonstrating how to change a wound dressing
Question
Which of the following would be the best
teaching strategy to teach a patient how to
care for an indwelling catheter?
A. Lecture
B. Role modeling
C. Discovery
D. Demonstration
Answer
Answer: D. Demonstration
Rationale:
Demonstration of techniques, procedures,
exercises, and the use of special equipment,
combined with a lecture and discussion, is an
effective strategy to facilitate psychomotor
learning, such as caring for a catheter.
Helping Children Express Feelings
Through Role-Playing