Unit 9 Teaching and Learning

Teaching & Learning

• Teaching is an interactive process – identify the patient (nurse is the teacher, the patient is the learner, nurse can also be the learner) & explaining the procedure

• Consists of a deliberate set of actions – acquired through knowledge & skill of reinforced practice

• Learning is dynamic and fluid and is a shared, a lifelong event

• Designed to produce specific learning

Teaching/Learning Malcom Knowels

• As people mature they move from dependence to independence

• An adult’s previous experience can be used as a source for learning

• Learning is related to an immediate need, problem, or deficit  to be successful

• Adults are more oriented to learning when material is useful immediately – readiness to learn; depends upon on level of pain & anxiety  teaching meds and monitoring

• Learning is reinforced by application & prompt feedback – “actually doing”

Learning Principles

• What needs to be learned – H&P (history & physical), age, health beliefs, problem of the patient, support system

• Motivation to learn – desperation, social approval, self-esteem, task mastery are based on needs such as achievements & competence, success encourages a greater motivation to achieve success, most motives of a patient are physical if a person suffers change in a function that change may become a motivator/stimulus for learning

• Ability to learn – think of the developmental capacity/cognitive level of the person think about older adult experiencing dementia, developmentally delayed people impacts how we teach, materials used to teach, impacts response of the person  Do they need translation

• Teaching environment – patients learn best at home because they’re in a comfortable environment but for others learning may be best at a hospital

• Resources for learning – nurses, social workers, physician, materials

• Learning styles – the best way to learn varies with every individual

Domains of Learning

Cognitive Domain (Mental) » knowledge » think

Affective Domain (Emotional » attitude » feel

Psychomotor Domain (Physical) » skills » do

Cognitive Domain (mental) » knowledge » think

Intellectual behaviors – using your intellect to do all of these things

• Remembering – acquiring new facts of information and being able to recall them; memorizing (lowest on the domain) (L1)

• Understanding – ability to understand the meaning of the learning material (L2)

• Applying – using abstract newly learned ideas in concrete situations (L3) (higher than memorizing)

• Analyzing – relating ideas in an organized way; allows the person to distinguish important from unimportant, able to arbitrate what is priority (H1) (highest level)

• Evaluating – judgement of the worth of information for a given purpose (H2)

• Creating – assembling, constructing, designing, developing, formulating something new (H3)

Lower (L) - higher (H) levels of thinking

Affective Domain (Emotional) » attitude » feel

Deals with expression of feelings and acceptance of attitudes, opinions, and values

• Receiving – being willing to listen to another person’s words

• Responding – active participation through listening & reacting verbally & nonverbally (reacting to information you’re given)

• Valuing – attaching worth to an object or behavior, shown through a learner’s behavior, value the information (higher level)

• Organizing – developing a system by identifying, organizing values, & resolving conflicts

• Characterizing – acting & responding with a consistent value system, behavior will be consistently the same when their values are challenged, how you’re going to respond

• Patient’s willingness and attention span

• Patient is engaging, asking questions, and eye contact

Psychomotor Domain (Physical) » skills » do

Acquiring skills that require integration, not only mental but muscular activities

• Perception – being aware of objects & qualities through use of sense organs; a person associates sensory cues with the task to perform; sight, smell, touch, hearing

• Self – readiness to take a particular action, 3 sets » mental, physical, emotional

• Guided response – performance of an act under guidance of the instructor; imitation of a demonstrated act (teach, observe, reinforce)

• Mechanism – higher level of behavior where the person has started to gain confidence, more complex & involves several steps

• Complex covert response – the performing of motor skill involving complex motor movement but the person is now performing the skill smoothly & accurately without hesitation

• Adaptation – when a person is able to change a motor response when unexpected problems arrive (trouble shooting)

• Origination – highly complex motor act involving creating a new movement pattern & a person acts on the basis of their existing psychomotor skills and abilities

• Performance of a skill » Patient learning how to inject themselves » someone is there to give feedback

Factors That Facilitate Learning

Readiness, Motivation, Active Involvement, Relevance, Feedback, Nonjudgmental, Simple to Complex, Repetition, Timing, Environment.

Readiness

The patient needs to be ready to learn. Patients may not be ready because anxiety, pain, denial, cognitive development, if they are not physically able to, extreme fatigue.

Motivation

A desire to learn and their ability to learn at that specific time, may get motivated to learn by an idea, emotion, or a physical need, going home will motivate a patient to learn » ready and motivated to learn.

Active Involvement

Learning has to become meaningful to the person; involves critical thinking (problem solving). The learner begins to problem-solve more effectively » they’re included.

Relevance

Why they want to learn this (relevant to them).

Feedback

Validates efforts; the support of desired behavior by praise, positively rewarded corrections and suggestions, and giving alternative methods.

Nonjudgmental

People will learn this when they are accepted and will not be judged.

Simple to Complex

Materials should be developed and be presented logically and organized and always proceed from simple to complex. Assimilate previous experience with the new learning.

Repetition

Practice improves performance » repeat content.

Timing

The longer time interval between learning and the active use, the higher chance the patient will forget (teach and do) most successful » Remember: time must be right

Environment

Calm and quiet when teaching, turn TV off, lighting, temperature, make sure the area is quiet and that the patient is paying attention » not noisy and temperature must be right not too hot or too cold

Factors That Inhibit Learning

Emotions, physiologic Events, Cultural Barriers, Psychomotor Ability, Cognitive Ability

Physiologic Events

Can take the energy away from learning and impair the learning process because they are consumed with pain, energy pain (less than 3), critical illness, sensory deficits (hearing, sight)

Cultural Barriers

Language, values, folklore

Psychomotor Ability

Assess muscle strength, motor coordination, energy, sensory acuity

Cognitive Ability

Cognitive level » Dementia

Assessment

Nursing History, Physical Examination, Readiness to Learn, Motivation, Health Literacy

Nursing History

Age, reason for coming to hospital, economic, cultural, learning style/preference, support system

Physical Examination

General survey, provides useful clues to the patient’s learning needs such as their energy level, nutritional status, mental status

Readiness to Learn (Assessment)

Physically (strength), emotional, mental status

Motivation (Assessment)

Is greatest when the patient is ready to learn; use a positive attitude about the learning experience, make learning pleasant & non-threatening, relate the learning to something the patient values, offer support & encouragement, create a learning situation in which the patient is likely to succeed (small goals first), assist the patient to identifying benefits of the changing behavior

Health Literacy

Ability to obtain process and understand basic health information and services to make appropriate health decisions (Healthy People 2030 goal)

Nursing Diagnosis

• Knowledge Deficit

• Health Seeking Behavior (specify-exercise and activity, home safety hazards)

• Noncompliance (Comorbidities)

Goal Setting

• Learning Outcomes (Goals): SMART include:

  • Singular behavior (change step by step, not all at once)

  • Observable or measurable

  • Timing or conditions under which objective is measured

  • Goals mutually set

S- Specific M- Measurable A- Attainable R- Realistic T- Time Bound

Choosing The Proper Setting » Environment

• Number of persons being taught

• Need for privacy

• Lighting

• Noise

• Ventilation

• Temperature

• Furniture

Integrating Basic Teaching Principles (Interventions)

• The best way to teach is determined by each learning situation (collaboration)

  • Setting priorities

  • Right timing & energy of the patient – pain free, not fatigued, not nauseous

  • Organize – plan

  • Promote learner attention and participation

  • Build on their existing knowledge & assess what the patient already knows

  • Selection of teaching methods – visual, audio, demonstration

  • Written teaching plans – learning objectives, content, time frame, strategies depends on patient’s learning preference

Attentional Set

Definition- mental state of the learner and ability to focus and comprehend the material

Influencing Factors

• Environmental distractions

• Physical discomfort

• Anxiety

Teaching Strategies

• Contracts

• Group teaching

• Computer Assisted Instruction (CAI)

• Discovery/Problem solving

• Behavior Modification

• Transcultural teaching

• Set limits with clearly defined expectations (goals, outcomes)

• Communication skills

• Modify teaching as needed

• Provide a variety of teaching materials

• Visual Aids » videos

• Use concrete rather than abstract » Clear and specific

• Allow for questions

• Avoid the use of medical terminology

• Use humor cautiously

• Don’t use slangs or colloquialisms

• Observe body language

• Invite family in teaching

• Identify cultural health practices and beliefs

Evaluation

• How do we know learning has taken place?

Purpose of Assessment

Is to increase quality

Purpose of Evaluation

Is to judge quality

Health Literacy Defined

The degree to which individuals have the capacity to obtain, process, and understand basic health information and the services needed to make appropriate health decisions » prevents medical errors