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) & explain the procedure

• Consists of a deliberate set of actions - acquired through knowledge and skill of reinforced practice

• Learning is dynamic and fluid and is 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 prone 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 and prompt feedback - “actually doing”

Learning Principles

• What needs to be learned - H&P (history and 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 the hospital

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

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

*The nurse can ask the patient how they have learned things best in the past and how they like to learn*

Domains of Learning

• 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 and nonverbally (reacting to information you’re given)

  • Valuing- attaching worth to an object or behavior, shown through a learners behavior, value the information (higher level)

  • Organizing- developing a system by identifying, organizing values, and resolving conflicts

  • Characterizing- acting and 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, eye contact

• Psychomotor Domain (Physical) » Skills » Do: acquiring skills that require integration not only mental but muscular activity

  • Perception- being aware of objects and qualities through use of sense organs; a persons 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 the 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 and involves several steps

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

  • Adaptation- when a person is able to change a motor response when unexpected problems arise (troubleshooting)

  • Origination- highly complex motor act involving creating a new movement pattern and 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- the patient needs to be ready to learn. Patient’s 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 » Involved

• 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 the simple to the 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 environment is quiet and the patient is attentive »

  not noisy and temperature is not too hot or cold

Factors That Inhibit Learning

• Emotions - anxiety, fear, depression

• Physiologic events - takes the energy away from learning and impairs the learning process becaues 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- 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- physically (strength), emotional, cognitive

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

• Health Literacy- ability to obtain, process, and understand basic health information and services to make appropriate health decisions (Health People 2030 Goal)

Nursing Diagnosis

• Knowledge Deficit

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

• Noncompliance (comorbidities)

Goal Setting

• SMART goals:

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

  • Observable or measurable

  • Timing or conditions under which objective is measured

  • Goals mutually set

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 and energy of the patient — pain free, not fatigued, not nauseous

  • Organize- plan

  • Promote learner attention and participation

  • Build on their existing knowledge and assess what the patient already

  • Selection of teaching methods- visual, audio, demonstration

  • Written teaching plans- learning objectives, content, time frame, strategies depend 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- 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