LEC 4: Teaching

Teaching

A system of activities intended to produce learning

• Clients & Their Families

• Community

• Health Personnel

Who are considered Learners?

Leaning Need

Desire or a requirement to know something that is presently unknown to the learner

Change in human disposition or capability that persists and that cannot be solely accounted for by growth

Compliance

Individual’s desire to learn and to act on the learning

Adherence

Commitment or attachment to a regimen

(1) health-promoting regimens

(2) health care provider

Compliance and adherence refer to the ability to maintain (1) ___ ___, which are largely determined by a (2) ___ ___ ____

Andragogy

Learning of adults

1. As people mature, they move from dependence to independence

2. As adult’s previous experiences can be used as a resource for learning

3. An adult’s readiness to learn is often related to a developmental task or social role

4. An adult is more oriented to learning when the material is useful immediately, not sometime in the future

4 Andragogic Concepts about adult learners that can be used as a guide for client teaching

1. Behaviorism

2. Cognitivism

3. Humanism

3 Learning Theories

behavior

In Behaviorism, learning should be based on the learner’s ____

(1) alter the stimulus condition in the environment

(2) change what happens after a response occurs

In Behaviorism, to modify a person’s attitude and response a behaviorist would either (1) _________________ or (2) ________________

Skinner

Who introduced positive reinforcement?

Positive Reinforcement

Described as a pleasant experience such as praise and encouragement

Bandura

Who focused on Imitation?

Imitation

Process by which individuals copy or reproduce what they have observed

Modeling

Process by which a person learns by observing the behavior of others

Imitation is done by the learner, while modeling is done by the teacher.

What is the difference between imitation and modeling?

1. Provide sufficient practice time and both immediate and repeat testing and redemonstration

2. Provide opportunities for learners to solve problems by trial and error

3. Select teaching strategies that avoid distracting information and that evoke the desired response

4. Praise the learner for correct behavior and provide positive feedback at intervals throughout the learning experience

5. Provide role models of desired behavior

5 Applications of the Behavioristic Theory

Cognitivism

One of the learning theories

Learning is largely a mental or intellectual or thinking process

1. 0-2 years old/Sensorimotor

2. 2-6 years old/Pre-Operational

3. 7-11 years old/Concrete Operational

4. >12 years old/Formal Operational

4 Stages According to Piaget’s Periods of Cognitive Development

0-2 years old/Sensorimotor

One of the Stages According to Piaget’s Periods of Cognitive Development

Uses senses and motor skills, items known by use

Object permanence learned by the end of the period

2-6 years old/Pre-Operational

One of the Stages According to Piaget’s Periods of Cognitive Development

Symbolic thinking, language used; egocentric thinking

Imagination/experience grow, child de-centers by the end of this stage

7-11 years old/Concrete Operational

One of the Stages According to Piaget’s Periods of Cognitive Development

Logic applied, has objective/rational interpretations

Conservation, numbers, ideas, classifications by the end of this stage

>12 years old/Formal Operational

One of the Stages According to Piaget’s Periods of Cognitive Development

Thinks, abstractly, hypothetical ideas (broader issues)

Ethics, politics, social/moral issues explored

1. Unfreeze

2. Change

3. Refreeze

3 Stages of Lewin’s Change Model

Unfreeze

One of the stages of Lewin’s Change Model

• Determines what needs to change

• Ensure there is strong support from management

• Create the need for change

• Manage and understand the doubts and concerns

Change

One of the stages of Lewin’s Change Model

• Communicate often

• Dispel rumors

• Empower action

• Involve people in the process

Refreeze

One of the stages of Lewin’s Change Model

• Anchor the changes into the culture

• Develop ways to sustain the change

• Provide support and training

• Celebrate successes

1. Cognitive

2. Affective

3. Psychomotor

What are the 3 domains of Bloom’s Taxonomy?

Cognitive

One of the 3 domains of Bloom’s Taxonomy

Includes knowledge, understanding, thinking

Psychomotor

One of the 3 domains of Bloom’s Taxonomy

Includes physical/manual skills

Affective

One of the 3 domains of Bloom’s Taxonomy

Attitudes, beliefs, emotions, values

1. Remember

2. Understand

3. Apply

4. Analyze

5. Evaluate

6. Create

6 Levels of Bloom’s Taxonomy (Lowest to Highest Order)

Remember

One of the levels of Bloom’s Taxonomy

Recall facts and basic concepts

define, duplicate, list, memorize, repeat, state

Understand

One of the levels of Bloom’s Taxonomy

Explain ideas or concepts

classify, describe, discuss, explain, identity, locate, recognize, report, select, translate

Apply

One of the levels of Bloom’s Taxonomy

Use information in new situations

execute, implement, solve, use, demonstrate, interpret, operate, schedule, sketch

Analyze

One of the levels of Bloom’s Taxonomy

Draw connections among ideas

differentiate, organize, relate, compare, contrast, distinguish, examine, experiment, question, test

Evaluate

One of the levels of Bloom’s Taxonomy

Justify a stand or decision

appraise, argue, defend, judge, select, support, value, critique, weigh

Create

One of the levels of Bloom’s Taxonomy

Produce new or original work

Design, assemble, construct, conjecture, develop, formulate, author, investigate

Remember, Understand, Apply

What are the low order levels of Bloom’s Taxonomy?

Analyze, Evaluate, Create

What are the high order levels of Bloom’s Taxonomy?

1. Provide social, emotional, and physical environment conducive to learning

2. Encourage a positive teacher-learner relationship

3. Select multisensory teaching strategies since perception is influenced by the senses

4. Recognize that personal characteristics have an impact on how cues are perceived and develop appropriate teaching approaches to target different learning styles

5. Assess a person’s developmental & individual readiness to learn and adapt teaching strategies to the learner’s developmental level

6. Select behavioral objectives and teaching strategies that encompass the cognitive, affective, psychomotor domains of learning

6 Applications of Cognitive Theory

Humanism

One of the learning theories

• Focuses on both cognitive and affective qualities of the learner

• Learning is believed to be self-motivated, self-initiated, and self-evaluated

• The learner identifies the learning needs and take initiative to meet the needs

• The learner is an active participant and takes responsibility for meeting individual learning needs

1. Convey empathy in the nurse-client relationship

2. Encourage the learner to establish goals and promote self-directed learning

3. Encourage active learning by serving as a facilitator mentor, or resource for the learner'

4. Use active learning strategies to assist the client’s adoption of new behavior

5. Expose the learner to new relevant information and ask appropriate questions to encourage the learner to seek answers

5 Applications of Humanistic Theory

1. Motivation

2. Readiness

3. Active Involvement

4. Relevance

5. Feedback

6. Nonjudgmental Support

7. Simple to Complex

8. Repetition

9. Timing

10. Environment

11. Emotional

12. Physiologic Events

13. Cultural Aspects

14. Psychomotor Abilities

14 Factors Affecting Learning

Motivation

One of the factors affecting learning

Desire to learn

Generally greatest when a person recognizes a need and believes the need will be met through learning

Readiness

One of the factors affecting learning

Demonstration of behaviors or cues that reflect the learner’s motivation to learn at a specific time

Ability to learn at a specific time

Active Involvement

One of the factors affecting learning

When the learner is actively involved in the process of learning, learning becomes more meaningful, is faster and retention is better

Relevance

One of the factors affecting learning

Clients learn more easily if they can connect the new knowledge to that which they already know or have experienced

Feedback

One of the factors affecting learning

• The information regarding a person’s performance to a desired goal

• Several ways to provide positive feedback

• Negative feedback can lead people to withdraw from learning

1. Support of desired behavior through praise

2. Positively worded corrections

3. Suggestions of alternative methods

Part of the “Feedback” factor of learning

3 Ways of providing positive feedback

Ridicules, anger, sarcasm

Part of the “Feedback” factor of learning

Examples of negative feedbacks

Nonjudgmental Support

One of the factors affecting learning

People learn best when they believe they are accepted and will not be judged

Simple to Complex

One of the factors affecting learning

Enables the learner to comprehend new information, assimilate it with previous learning, and form new understandings

Repetition

One of the factors affecting learning

Facilitates retention of newly learned material

Timing

One of the factors affecting learning

People retain information and psychomotor skills best when the time between learning and active use of the learning is short

The longer the time interval, the easier it is to forget the learning

Environment

One of the factors affecting learning

• Reduced distractions and provides physical and psychologic comfort

• Adequate lighting

• Comfortable room temperature

• Good ventilation

• Free of noise

• Private

Emotions

One of the factors affecting learning

Such as fear, anger, depression, and high level of anxiety can impede learning

Physiologic Events

One of the factors affecting learning

Examples are critical illness, pain, or sensory deficits that inhibit learning

Cultural Aspects

One of the factors affecting learning

Examples are language and values

Requires nurses to be culturally sensitive and competent

Psychomotor Ability

One of the factors affecting learning

The following physical abilities are important for learning this:

1. Muscle strength

2. Motor coordination

3. Energy

4. Sensory acuity

1. Muscle strength

2. Motor coordination

3. Energy

4. Sensory acuity

What are the physical abilities important for learning “psychomotor ability” (one of the factors affecting learning)?

1. Determining teaching priorities

2. Setting learning outcomes

3. Choosing content

4. Selecting teaching strategies

5. Organizing learning experiences

5 Components of Developing a Teaching Plan

Determining teaching priorities

One of the components of developing a teaching plan

Should be done by both the nurse and client, with the client’s priorities always being considered

Setting Learning Outcomes

One of the components of developing a teaching plan

• State the client (learner) behavior or response not nurse behavior

• Reflect an observable, measurable activity

• Avoid using words such as knows, understands, believes, and appreciates

• May add conditions of modifiers as required to clarify what, where, when, or how the behavior will be performed

• Include criteria specifying the time by which learning should have occurred

Choosing Content

One of the components of developing a teaching plan

What is to be taught

Should be:

• Accurate

• Current

• Based on learning outcomes

• Adjusted for the learner’s age, culture, and ability

• Consistent with information the nurse is teaching

• Selected with the consideration of how much time and what resources are available for teaching

Selecting Teaching Strategies

One of the components of developing a teaching plan

Method of teaching that the nurse chooss should be suited to the individual and to the material to be learned

Explanation of Description

Teaching strategy

Teacher controlled content and pace, learner passive

Example are lectures

One-to-One Discussion

Teaching strategy

Encourages learner participation

Answering Questions

Teaching strategy

Cognitive

Teacher controlled, teacher must understand questions and what it means to the learner

Demonstration

Teaching strategy

Psychomotor

Often used with explanation and learner is passive

Discovery

Teaching strategy

Cognitive, affective

In which teacher guides the learners; learners are active participants

Group Discussion

Teaching strategy

Affective, cognitive

Learners are placed together and allowed to converse regarding a topic

Practice

Teaching strategy

Psychomotor

Allows repetition, immediate feedback encouraged

Printed and Audio-Visual Materials

Teaching strategy

Cognitive

Includes pamphlets, books, films and learner proceeds at own speed

Role-Playing

Teaching strategy

Cognitive, Affective

Permits expression of attention, values, and emotions and assists with communication skills

Modelling

Teaching strategy

Affective, Psychomotor

Nurse sets model by attitude and psychomotor skills

Computer-Assisted Learning

Teaching strategy

Cognitive, affective, psychomotor

Organizing Learning Experiences

One of the components of developing a teaching plan

1. Start with something the learner is concerned about

2. Discover what the learner knows and then proceed to the unknown

3. Address early on any area that is causing the client anxiety

4. Teach the basics before proceeding to the variations or adjustments

5. Schedule time for review of content and questions the client may have to clarify information

1. Obtain teaching materials, pamphlets and instructions in languages used by the client

2. Use visual aids, such as pictures, charts, or diagrams to communicate meaning

3. Use concrete rather than abstract words

4. Allow time for questions

5. Avoid the use of medical terminology or health care language

6. If understanding another’s pronunciation is a problem, validate brief information in writing

7. Use humor cautiously

8. Do not use slang words or colloaquialisms

9. Do not assume that a client who nods, uses eye contact or smiles is indicating an understanding of what is being taught

10. Invite and encourage questions during teaching

11. When explaining procedures or functioning related to personal areas of the body, it may be appropriate to have a nurse of the same sex do the teaching

12. Include the family in planning and teaching

13. Consider the client’s time orientation

14. Identify cultural health practices and beliefs

14 Considerations when teaching clients from various ethnic groups

1. Direct observation of behavior

2. Written measurements

3. Oral questioning

How to evaluate Cognitive learning?

Observing the client how well they carry out the procedure

How to evaluate Psychomotor skills?

1. Listening to client’s responses to questions

2. Noting how the client speaks about relevant subjects

3. Observing the client’s behavior that expresses feelings and values

How to evaluate Affective learning?

Documenting

Essential because it provides a legal record that the teaching took place and communicates the teaching to other health professionals

If this is not done, legally it did not occur

1. Diagnosed learning needs

2. Learning outcomes

3. Topics taught

4. Client outcomes

5. Need for additional teaching

6. Resources provided

6 Parts to be Documented

1. Actual information and skills taught

2. Teaching strategies taught

3. Time framework and content for each class

4. Teaching outcomes and methods of evaluation

Elements that may be included in documenting

Feedback Questionnaires

Way to evaluate teaching