Chapter 27 Learning Objectives PDF

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Learning Outcomes - Chapter 27: Teaching 1. Discuss the importance of the teaching role of the nurse. Teaching client education is a major aspect of nursing practice and an important independent nursing function. In 1992, the American Hospital Association passed A Patient’s Bill of Rights mandating client education as a right of all clients. State nurse practice acts include client teaching as a function of nursing, thereby making teaching a legal and professional responsibility. In addition, The Joint Commission includes standards for Patient and Family Education (PFE) to “help patients better participate in their care and make informed care decisions”. This requirement means that providers must “perform a learning needs assessment that includes the patient’s cultural and religious beliefs, emotional barriers, desire and motivation to learn, physical or cognitive limitations, and barriers to communication”. Client education is multifaceted, involving promoting, protecting, and maintaining health. It involves teaching about reducing health risk factors, increasing a person’s level of wellness, and taking specific protective health measures.

2. Compare and contrast andragogy, pedagogy, and geragogy. Andragogy is the art and science of teaching adults, in contrast to pedagogy, the discipline concerned with helping children learn. Geragogy is the term used to describe the process involved in helping older adults to learn. An individual’s developmental stage influences the learning abilities of children, adults ,and older adults. Nurses can use the following andragogic concepts about adult learners as a guide for client teaching: • As people mature, they move from dependence to independence.

• An adult’s previous experiences can be used as a resource for learning. • Learning is related to an immediate need, problem, or deficit. • An adult is more oriented to learning when the material is useful immediately, not sometime in the future. • Learning is reinforced by application and prompt feedback.

3. Describe the three learning domains. The cognitive domain, the “thinking "domain, includes six intellectual abilities and thinking processes including six intellectual abilities and thinking processes beginning with knowing, comprehending, and applying to analysis, synthesis, and evaluation. The affective domain, known as the "feeling” domain, deals with personal issues such as “attitudes, beliefs, behaviors, and emotions”. The psychomotor domain, the “skill” domain, includes fine and gross motor abilities such as giving an injection.Nurses should include each of Bloom’s three domains in client teaching plans. For example, teaching a client how to self-administer insulin is in the psychomotor domain. But an important part of a teaching plan for a client with diabetes is to teach why insulin is needed and what to do when not feeling well; this is in the cognitive domain. Helping the client accept the chronic implications of diabetes and maintain self-esteem is in the affective domain.

4. Discuss the learning theories of behaviorism, cognitivism, and humanism and how nurses can use each of these theories.

Thorndike originally advanced behaviorism. His major contribution that applied to teaching is that learning should be based on the learner’s behavior and what is directly observable. In the behaviorist school of thought, an act is called a response when it can be traced to the effects of a stimulus. Behaviorists closely observe responses and then manipulate the environment to bring about the intended change. Thus, to modify a person’s attitude and response, a behaviorist would either alter the stimulus condition in the environment or change what happens after a response occurs. To increase the probability of a response, Skinner introduced the importance of positive reinforcement (ex. a pleasant experience such as praise and encouragement) in fostering repetition of an action. Bandura, however, claims that most learning comes from observational learning and instruction rather than trial-and-error behavior. Bandura’s research focuses on imitation, the process by which individuals copy or reproduce what they have observed, and modeling, the process by which a person learns by observing the behavior of others. Nurses using the behaviorist theory identify what is to be taught, and they immediately identify and reward correct responses. However, the theory is not easily applied to complex learning situations and limits the learner’s role in the teaching process. In summary, nurses applying behavioristic theory will: • Provide sufficient practice time including both immediate and repeat testing and return demonstration. • Provide opportunities for learners to solve problems by trial and error. • Select teaching strategies that avoid distracting information and that evoke the desired response. • Praise the learner for correct behavior and provide positive feedback at intervals throughout the

learning experience. • Provide role models of desired behavior. Cognitivism depicts learning as a complex cognitive activity. In other words, learning is largely a mental or intellectual or thinking process. The learner structures and processes information. Perceptions are selectively chosen by the individual, and personal characteristics have an impact on how a cue is perceived. Cognitivists also emphasize the importance of social, emotional, and physical contexts in which learning occurs, such as the teacher–learner relationship and the environment. Developmental readiness and individual readiness (expressed as motivation) are other key factors associated with cognitive approaches. Cognitive theory recognizes the developmental level of the learner and acknowledges the learner’s motivation and environment. However, some or many of the motivational and environmental factors may be beyond the teacher’s control. Nurses applying cognitive theory will: • Provide a social, emotional, and physical environment conducive to learning. • Encourage a positive teacher–learner relationship. • Select multisensory teaching strategies because perception is influenced by the senses. • Recognize that personal characteristics have an impact on how cues are perceived and develop appropriate teaching approaches to target different learning styles. • Assess a person’s developmental and individual readiness to learn and adapt teaching strategies to the learner’s developmental level.

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

Humanistic learning theory focuses on both the cognitive and affective qualities of the learner. According to humanistic theory, learning is believed to be self-motivated, self-initiated, and self evaluation. Each individual is viewed as a unique composite of biologic, psychological, social, cultural, and spiritual factors. Learning focuses on self-development and achieving full potential; it is best when it is relevant to the learner. Autonomy and self-determination are important; the learner identifies the learning needs and takes the initiative to meet these needs. The learner is an active participant and takes responsibility for meeting individual learning needs. Using humanistic learning theory, the nurse focuses on the feelings and attitudes of learners, on the importance of the individual in identifying learning needs and in taking responsibility for them, and on the self-motivation of the learners to work toward self-reliance and independence.

5. Identify factors that affect learning. ● Age ● Developmental stage ● Readiness ● Motivation

6. Discuss the implications of using the Internet as a source of health information.

The Internet is an important source of health information for many adult clients in the United States. Therefore, nurses need to know and be able to integrate this technology into the teaching plans for those clients who use the Internet. Nurses involved in e-health can advocate for website designs that provide accessibility accommodations for older adults. On the other hand, nurses also need to apply effective teaching strategies for those clients who do not use the Internet. Findings from a national survey by the Pew Research Center’s Internet & American Life Project reported that 81% of U.S. adults use the Internet, and 59% say they have looked online for health information in the past year. The report called this group “online health seekers.” Thirty-five percent said that they went online specifically to try to figure out what medical condition they or someone else might have. The report called these individuals “online diagnosers.” Of this group, 46% sought the attention of a medical professional with 41% stating that the medical professional confirmed their diagnosis. These findings point out that many consumers are using the Internet as another resource to search for health information for either themselves or on behalf of someone else.

7. Assess learning needs of learners and the learning environment. The general survey part of the physical examination provides useful clues to the client’s learning needs, such as mental status, energy level, and nutritional status. Other parts of the physical examination reveal data about the client’s physical capacity to learn and to perform self-care activities. For example, visual ability, hearing ability, and muscle coordination affect the selection of content and approaches to teaching. The client’s learning needs must be ranked according to priority. The client and the nurse should do this together, with the client’s priorities always being considered. Once a client’s priorities have been addressed, the client is generally

more motivated to concentrate on other identified learning needs.

8. Discuss the implications of low health literacy skills. Low health literacy skill is one of the contributing factors to non-compliant clients. This diagnosis indicates that the behavior of the person and/or caregiver fails to coincide with a health promotion or therapeutic plan agreed on by the person (and/or family and/or community) and health care professional. In the presence of an agreed-on, health promotion or therapeutic plan, the person’s or caregiver’s behavior is fully or partially nonadherent and may lead to clinically ineffective or partially ineffective outcomes

9. Identify nursing diagnoses, outcomes, and interventions that reflect the learning needs of clients. ● Deficient Knowledge as the Etiology: Another way to deal with identified learning needs of clients is to write deficient knowledge as the etiology, or second part, of the diagnosis statement. Such nursing diagnoses are written in the following format: ● Risk for (Specify) related to deficient knowledge (specify). Examples include the following: ● Risk for Impaired Parenting related to deficient knowledge (skills in infant care and

feeding) ● Risk for Infection related to deficient knowledge (sexually transmitted infections and their prevention) ● Anxiety related to deficient knowledge (bone marrow aspiration). Other nursing diagnoses in which a knowledge deficit can be the etiology follow: ● Risk for Injury ●

Ineffective Breastfeeding

● Ineffective Coping ●

Ineffective Health Maintenance.

A second nursing diagnostic label where a learning need may be the primary concern is: ● Readiness for Enhanced Knowledge ● Readiness for Enhanced Knowledge (Exercise and Activity) related to a desire to improve health behaviors and decrease risk of heart disease. ● Readiness for Enhanced Knowledge (Home Safety Hazards) related to a desire to minimize risk of injury. This diagnosis may be appropriate for parents of a toddler who are seeking additional information to ensure that their home is safe for their child. The diagnosis might also be used when an adult child seeks information to ensure that the home of an aging parentis free of risk factors for falls or other injuries common to the older adult.

10. Describe the essential aspects of a teaching plan. The nurse needs to be flexible in implementing any teaching plan because the plan may need revising. The client may become tired sooner than anticipated or be faced with too much information too quickly, the client’s needs may change, or external factors may intervene behavior. In this case, the nurse alters the teaching plan and discusses any desired information, provides another demonstration, and defers teaching the psychomotor skill until the next day. It is also important for nurses to use teaching techniques that enhance learning and reduce or eliminate any barrier to learning such as pain or fatigue.

11. Discuss guidelines for effective teaching. Providing information will not automatically result in clients changing their behavior. Learning what needs to be done to change behavior and acting on that knowledge are two different processes. The stages of change, the person’s willingness and perceived need to change, and barriers to change are important. Elements to reflect on when implementing a teaching plan, a respectful relationship between teacher and learner is essential. The teacher who uses the client’s previous learning in the present situation encourages the client and facilitates learning new skills. The nurse-teacher must be able to communicate clearly and concisely. An environment can detract from or assist learning. Teaching aids can foster learning and help focus a learner’s attention. Teaching that involves a number of the learner’s senses often enhances learning. For instance, when teaching about changing a surgical dressing, the nurse can tell the client about the

procedure (hearing), show how to change the dressing (sight), and show how to manipulate the equipment (touch).

12. Discuss strategies to use when teaching clients of different Cultures. The nurse and clients of different cultural and ethnic backgrounds with is an additional barrier to overcome in the teaching–learning process. These barriers include language and communication challenges ,differing concepts of time, conflicting cultural healing practices, beliefs that may positively or negatively influence compliance with health teaching, and unique high-risk or highfrequency health problems that can be addressed with health promotion instruction. ● Obtain teaching materials, pamphlets, and instructions in languages used by clients. ● Use visual aids, such as pictures, charts, or diagrams, to communicate meaning ● Use concrete rather than abstract words ● Allow time for questions ● Avoid the use of medical terminology or health care language ● If understanding another’s pronunciation is a problem, validate brief information in writing. ● When explaining procedures or functioning related to personal areas of the body, it may be appropriate to have a nurse of the same gender do the teaching. ● Identify cultural health practices and beliefs

13. Identify methods to evaluate learning. ● Direct observation of behavior (e.g., observing the client selecting the solution to a problem using the new knowledge) ● Written measurements (e.g., tests) ● Oral questioning (e.g., asking the client to restate information or correct verbal responses to questions) ● Self-reports and self-monitoring. These can be useful during follow-up phone calls and home visits. Evaluating individual self-paced learning, as might occur with computer instruction, often incorporates self-monitoring.

14. Describe effective documentation of teaching–learning activities. Documentation of the teaching process is essential because it provides a legal record that the teaching took place and communicates the teaching to other health professionals. If teaching is not documented, legally it did not occur. It is also important to document the responses of the client and support people to teaching activities. What did the client or support person say or do to indicate that learning occurred? Has the client demonstrated mastery of a skill or the acquisition of knowledge? The nurse records this in the client’s chart as evidence of learning. The parts of the teaching process that should be documented in the client’s chart include the following: ● Diagnosed learning needs ● Learning outcomes ● Topics taught

● Client outcomes ● Need for additional teaching ● Resources provided. ● The written teaching plan...