3056 Lecture Three - Learners: Assessment, Style, Readiness to learn

Patient Education - Step 2 - Planning Setting goals Thinking Realistically:

-Goals should focus on what is necessary/ critical -Pay attention to patient concerns - they could stand in the way of progress -Respect stated limits- if a patient has refused to do something, try to work around the problem and incorporate something new as best you can.

Older Adulthood Teaching Strategies cont'

-speak slowly and clearly -use low-pitched tones -minimize distractions -rely on visual aids and supplement with verbal instructions -use large letters and well-spaced print -provide a safe environment -give time to reminisce

Principle 3

Educators can develop specific learning activities that reinforce each modality or style

Principle 5

Educators should be aware of various methods and materials available to address and augment different learning styles

Principle 4

Educators should not only use their own preferred method of teaching/learning

Patient Education Value - Results of clear communication Increased Compliance

Effective communication and patient education increases patient motivation to comply

School-aged Child Teaching Strategies

Encourage independence Use logical explanations and analogies Relate to child's experience Use subject-centred focus Use play therapy Provide group activities Use drawings, models, dolls, painting, audiotapes, and videotapes

Preschooler Erikson:

Erikson: initiative vs. guilt -taking on tasks for the sake of being involved and on the move; learning to express feelings through play

Adolescence Salient Characteristics Psychosocial

Example: Personal Fable - feels invulnerable, invincible/ immune to natural laws Example: imaginary audience - intense personal preoccupation

Middle-Aged Adulthood Salient Characteristics Cognitive

Example: ability to learn remains steady throughout this stage

Salient Characteristics School-Aged Child Cognitive

Example: able to draw conclusions and intellectually can understand cause and effect

Older Adulthood Salient Characteristics Psychosocial

Example: adjusting to changes in lifestyle and social status

Young Adulthood Salient Characteristics Psychosocial

Example: autonomous, independent; stress related to the many decisions being made regarding career, marriage, parenthood and higher education

Young Adulthood Salient Characteristics Cognitive

Example: cognitive capacity is fully developed, but continuing to accumulate new knowledge and skills

Middle-Aged Adulthood Salient Characteristics Psychosocial

Example: facing issues with grown children, changes in own health, and increased responsibility for own parents

Salient Characteristics School-aged Child Psychosocial

Example: fears failure and being left out of groups; fears illness and disability

Adolescence Salient Characteristics Cognitive

Example: propositional thinking; complex logical reasoning; can build on past experiences; conceptualizes the invisible

Adolescence Teaching Strategies

Establish trust Identify control focus Use peers for support and influence Negotiate for change, contract Focus on details Make information meaningful to life Ensure confidentiality and privacy Use audiovisuals, role play, contracts, and reading materials Allow for experimentation and flexibility within safe limits

Family Support

Establish who is "family" Family is the most important variable influencing patient outcomes JCAHO accreditation standards warrant family participation The nurse educator and family should be allies It is important to choose the most appropriate caregiver to receive information

Adulthood: Teaching & Learning Andragogy Adult Learning Principles

Andragogy: the art and science of helping adults learn Adult Learning Principles: relates learning to immediate needs; self-directed; teacher is facilitator; learner desires active role

Patient Education - Step 3 - Implementing (Reinforcing the message: How to use patient education materials) Check a Patient's Understanding

Ask your patient to repeat complex explanations back to you

4 Steps to Client/Patient Education

Assess - Define patient and family needs and concerns; observe readiness to learn Plan - Set objectives with your patient; select materials Implement - Put the plan in motion; help patients along the way to reach the objectives you've set together Document - Create a written history and keep records

Generational Differences

Assists in understanding cohorts of learners. Effective teaching methods that keep learners interested and motivated.

Patient Education - Step 3 - Implementing (Reinforcing the message: How to use patient education materials) Build on Success

Build on skills the patient is confident in and motivated by

Preschooler Teaching Strategies

Build trust Allow for manipulation of objects Use positive reinforcement (reward following desired action) Encourage questions Provide simple drawings and stories Focus on play therapy Simulate senses

Patient Education - Step 3 - Implementing (Getting your Message Across) Use visuals

Drawings, visuals, illustrations can reinforce key concepts Some people learn visually Illustrations boost comprehension

Older Adulthood Salient Characteristics Cognitive - Fluid intelligence Crystallized intelligence

Fluid intelligence: capacity to perceive relationships, to reason, and to perform abstract thinking, which declines with aging Crystallized intelligence: -the intelligence absorbed over a lifetime, which increases with experience

Principle 6

Identification of both the learner and the educators preferred method should occur

Assessment of Learning Needs - Overview

Identify the learner Choose the right setting Collect data about, and from the learner Involve members of the healthcare team Prioritize needs Determine the availability of educational resources Assess demands of the organization Take-time management issues into account

Assessment of Learning Needs

Identify the learner Choose the right setting Collect data about, and from, the learner Involve members of the healthcare team Prioritize needs Determine the availability of educational resources Assess demands of the organization Take time-management issues into account

Patient Education - Step 2 Setting goals Helping a Patient Make Life Changes

If your patient needs to make lifestyle changes, make sure he or she: -Understands the need for changing behaviour -Has the confidence to complete the required tasks -Successfully begins to change behaviour

Knowledge and Attitude Changes

Increased understanding Increased confidence Increased satisfaction Improved emotional state

3. Focus Groups

Involve small number of potential learners Determine areas of educational need by discussion of points of view about a certain topic Are ideal during the initial stage of information gathering to provide qualitative data for a complete assessment of learning needs ideally groups should be homogenous similar characteristics such as age, gender, and past experiences with the topic under discussion

Knowledge Readiness

Present knowledge base Cognitive ability Learning disabilities

Patient Education

Print Verbal Multimedia Combination

Rate of learning and capacity for learning

Rate of learning and capacity for learning, as well as situational and emotional barriers to learning, vary according to stages of development

Readiness to learn in children vs adults

Readiness to learn in children is very subject-centered, and motivation to learn in adults in very problem-centered

Andragogy Assumption Self-concept

Self-directed

How many learning style principles are there?

Six Learning Style Principles

Andragogy Assumption Readiness

Social and life roles

Andragogy Assumption Need to know

Learner driven

Principle 2

Learners should be encouraged to diversify their style preferences

Principle 1

Learners should have the opportunity to learn through their preferred style

Costs

Length of stay Utilization Provider image Regulatory compliance

Patient Education Value - Results of clear communication Utilization

More effective use of medical services - fewer unnecessary phone calls and visits

Patient Education - Step 3 - Implementing (Reinforcing the message: How to use patient education materials) Highlight Key Concepts

Open and flip through booklet or brochure with the patient Write in any notes of your own

Patient Education - Step 3 - Implementing (Overcoming Challenges) Reassessing Patient Concerns

Patient can become resistant Physical and emotional stress of illness can present challenges Ask open ended questions to understand new concerns - What's standing in your way? What concerns you about doing?

Patient Education - Step 4 - Documenting

Patient records inform colleagues what you've done. A record of patient education provides future health care providers a starting point should your patient need assistance in the future

Determining readiness to learn Motivation

Patients are motivated when they learn how their lives could improve. Focus on the benefits of education

Patient Education Value - Results of clear communication Informed Consent

Patients feel you've provided the information they need

Patient Education Value - Results of clear communication Patient outcomes

Patients more likely to respond well to their treatment plan -fewer complications

Developmental Stages of Childhood Pedagogy

Pedagogy is the art and science of helping children learn -Infancy and Toddlerhood -Preschooler -School-aged Child -Adolescence

Health Status

Physical health Well-being Symptoms Complications

School- Aged Child Piaget

Piaget: Concrete operations stage -Developing logical thought processes and ability to reason syllogistically; understands cause and effect

Older Adulthood Piaget

Piaget: formal operations stage -abstract though; reasoning is both inductive and deductive

Adolescence Piaget

Piaget: formal operations stage -abstract thought; reasoning is both inductive and deductive

Middle-Aged Adulthood Piaget

Piaget: formal operations stage -abstract thought; reasoning is both inductive and deductive

Young Adulthood Piaget

Piaget: formal operations stage (beings in adolescence and carries through adulthood) -Abstract thought; reasoning is both inductive and deductive

Preschooler Piaget:

Piaget: preoperational stage -egocentric; thinking is literal and concrete; pre-causal thinking

Infancy and Toddlerhood Piaget

Piaget: sensorimotor Learning is through sensory experiences and through movement and manipulation of objects

Patient Education - Step 3 - Implementing (Getting your Message Across) Setting Implementation Priorities Let your patients know:

What they should do and why When they should expect results Possible danger signs to watch for What they should do if problems arise Whom they should contact for referrals

Adulthood: Developmental Stages

Young Adulthood Middle- Aged Adulthood Older Adulthood

Patient Education - Step 3 - Implementing (Getting your Message Across) Environment & Privacy

Your priorities and your patient's should be clearly stated, mutually understood, and mutually agreed upon. Environment: -Good lighting -Comfortable temperature -Low noise -Room to spread out Privacy: -If possible, seek out a place you work privately with the patient and his or her support system

Developmental Characteristics Developmental Stage

acknowledges that human growth and development are sequential, but not always specifically age-related

Patient Education - Step 3 - Implementing (Getting your Message Across) Keep content simple

Speak with all patients using simple language Focus on one goal or behaviour change per visit Highlight key concepts and provide printed materials Stay interactive - let the patient show you what he/she learned

Patient Education - Step 3 - Implementing (Getting your Message Across) Providing a good learning Environment

Tone of voice, eye contact, and touch vary for all cultural backgrounds - Use the knowledge you gained during assessment

Infancy and Toddlerhood Erikson

Trust vs. mistrust (birth to 12 months) Autonomy vs shame (1-3 year Building trust and establishing balance between feelings of love and hate; learning to control willful desires

Middle - Aged Adulthood Salient Characteristics Teaching strategies

maintain independence and re-establish normal life patterns assess positive and negative past learning experiences assess potential sources of stress provide information relative to life concerns and problems

Older Adulthood Geragogy

the teaching of older persons, accommodating normal physical, cognitive and psychosocial changes

Adolescence Erikson

Erikson: identity vs role confusion -struggling to establish own identify; seeing independence and autonomy

Older Adulthood Teaching Strategies

-Use concrete examples -Build on past experiences -Focus on one concept at a time -Use a slow pace -Use repetition and reinforcement -Provide brief explanations -Use analogies

Methods Used for Assessing Learner Needs

1. Informal Conversation 2. Structured Interviews 3. Focus Groups 4. Self-Administered Questionnaires 5. Tests

Assessment of the learner includes attending to the 3 determinants of learning:

1. Learning Needs (WHAT the learner needs to learn) 2. Readiness to Learn (WHEN the learner is receptive to learning) 3. Learning Style (HOW the learner best learns)

2 Other Methods & Reminders for Assessing Learner Needs

1. Observation 2. Patient Charts Assessment provides you with essential information about your patient Patient education success depends on the assessment of needs, concerns, and preferences Assessment should be ongoing- make it a part of every encounter with your patient

Patient Education Rationale Model of Patient Education Outcomes

1. Patient Education 2. Knowledge and Attitude Changes 3. Health Status 4. Behaviour Changes 5. Health Status 6. Costs

4 Components of Readiness to Learn

1. Physical Readiness 2. Emotional Readiness 3. Experiential Readiness 4. Knowledge Readiness PEEK

Determining readiness to learn Outlook

A patient's beliefs about their situation could effect education. Let them know that learning new skills can help them feel better or slow disease progression.

2. Structured Interviews

A structured interview is important in assessing the learner's point of view. The health care professional asks the learner direct and often-predetermined questions. The educator should establish: -a trusting environment -use open ended questions -choose a setting that is free of distractions -and allow the learners to state what are believed to be the learning needs Examples of questions asked may be: -What do you think caused the problem -What does your illness mean to you -What are your strengths and weaknesses as a leaner? -How do you learn best?

Pedagogy Assumptions Self-concept

Accepts

Patient Education - Step 1 - Assessment Asking the Right Questions

Answers should uncover core beliefs - Ask specific questions - ask to discover what motivates your patient: -What are you afraid might happen? -What barriers get in your way? -When you tried this before, what problems did you have? Asking open-ended questions - Increases the information you get and decreases the number of questions you need to ask Closed - Are you upset? Open - What's bothering you?

Emotional Readiness

Anxiety Level Support System Motivation Risk-taking behaviour Frame of mind Developmental Stage

Physiological Changes that Affect Teaching/Learning

Appearance Musculoskeletal system Cardiovascular system Respiratory system Gastrointestinal system Neurological system Sensory changes: vision & hearing

Pedagogy Assumptions Readiness

Biology and academic based

1. Informal Conversation

Casually speak to the client or clients, the health care member or team can begin to assess the learner's needs -Active listening -Open-ended questions -Verifying statements

4. Self-Administered Questionnaires

Checklists are the most common form of questionnaire They are easy to administer and tabulate data from Extra space for the learner's comments should be included to compensate for the educators bias toward what the educator perceives as needs

Developmental Characteristics

Chronological age vs. Stage of Development E.g., Children with chronic illness often are delayed developmentally; an adolescent who suffers traumatic event may regress developmentally.

Preschooler Salient Characteristics Cognitive

Cognitive: Example: animistic thinking; limited sense of time; egocentric transductive reasoning

Patient Education - Step 3 - Implementing (Overcoming Challenges) Reading Patient Signals

Continually assess and ease into your plan Emphasize the benefits of education instead of nagging the patient

Determining readiness to learn Attitude

Denial Fear Anger Anxiety All could be barriers to education. Patient must know that he or she will make gains by learning new skills.

Grasping Patient Concerns

Determining readiness to learn - Your patient will present challenges if resistant to education

Facilitating Client Learning BPG

Developed 2013 Want clients to navigate the system independently as possible, have access to health information, supports & tools and to participate in their care.

Why do we Need to Educate?

Early d/c from hospital Complicated TX plans To make informed decisions To maintain a healthy lifestyle To communicate their needs, values, perspectives How to access resources More output procedures Increased day surgery procedures E-health Patient safety **Want patients to see teachable moments as Challenges not defeats!

Infancy and Toddlerhood Erikson

Erikson: trust vs. mistrust (birth to 12 months) autonomy vs shame (1-3) -building trust and establishing balance between feelings of love and hate; learning to control willful desires

School-Aged Child Erikson

Erikson: Industry vs. inferiority -gaining a sense of responsibility and reliability; increased susceptibility to social forces outside the family; gaining awareness of uniqueness of special talents and qualities

Young Adulthood Erikson

Erikson: Intimacy vs. Isolation -Focusing on relationships and commitment to others in their personal, occupation, and social lives

Older Adulthood Erikson

Erikson: ego integrity vs. despair -coping with reality of aging, morality, and reconciliation with past failures

Middle-Aged Adulthood Erikson

Erikson: generativity vs. self absorption and stagnation -reflecting on accomplishments and determining if life changes are needed

Pedagogy Assumptions Motivation

External

Middle - Aged Adulthood Promote and Retain Health

General health habits General living conditions Medications Sexual habits Pregnancy/children Industry/ employment Disease prevention Adjusting to retirement Continued employment Economic issues Adjustments to living situation Changing social roles Interests/ hobbies Volunteer work

Pedagogy Assumptions Role of experience

Happens to learner

Behaviour Changes

Health services utilization Compliance Lifestyle Self-care

5. Tests

Help identify knowledge level and learning needs of learner to provide appropriate starting point Prevents teacher from repeating material learner already knows Criteria to consider... -Purpose of tool -Whether results will be meaningful -Whether each measured construct is well defined -Whether adequate testing of instrument been conducted -Whether instrument been used with similar population as educators

Andragogy Assumption Role of experience

Integral to leaner

Andragogy Assumption Motivation

Internal

Experiential Readiness

Level of aspiration Past coping mechanisms Cultural Background Locus of Control Orientation

Andragogy Assumption Orientation

Life-centered

What We Know

Lifestyle changes and health promotion go beyond individuals Major health problems in adults are a global concern 1 in 3 Canadians has a chronic illness We focus on reducing preventable risk factors

1. Physical Readiness

Measures of ability Complexity of task Health Status Gender Anxiety Level Support System

Patient Education - Step 2 - Planning

Once you know your patients needs, planning begins You both should set some mutually agreeable goals Gather the materials you need to meet these goals When building your plan, make building patient skills and addressing concerns the top priority!

Patient Education - Step 2 -Planning Setting Goals Finding Resources

Printed Materials, Video or Audio CDs/DVDs, Electronic content Look for inconsistencies between your goals and those of the materials Make sure the resources are up-to-date Patient Education publishers provide information on patient education techniques and practices Premade plans may be available from pharmaceutical companies or other organizations. Be careful they are not biased!! Clinical pathways that your facility already uses can work as effective plans Disease-specific or voluntary organizations may provide materials. Experienced colleagues can be useful resources in helping come up with a plan.

Preschooler Salient Characteristics Psychosocial

Psychosocial Example: separation anxiety; play is his/her work; fears loss of body integrity; active imagination; interacts with playmates

Patient Education - Step 3 - Implementing Assess continually

Reassess the patient during each contact The success of your plan depends on the quality of your assessment and the patient's ability to meet goals.

Patient Education - Step 3 - Implementing (Overcoming Challenges) Helping a patient over a barrier

Reassess, looking for core concerns Address concerns such as pain, fear, misunderstanding Consult with other members of the health care team Arrange for follow-up care Get help from the patient's support person when appropriate

Determining readiness to learn Assessing Patient Skills

Request a demonstration of what he or she has learned in the past

Pedagogy Assumptions Orientation

Subject central

Patient Education - Step 3 - Implementing (Reinforcing the message: How to use patient education materials) Involve a Patient's Family

Suggest bringing in a support person to show the materials to also and to hear your instructions

Patient Education - Step 3 - Implementing Implementing your plan begins with reassessment

Surprises can arise that will cause you to adjust the plan

Pedagogy Assumptions Need to know

Teach driven

Andragogic Assumptions about learning

The need to know The learners' self-concept The role of the Learners' Experiences Readiness to learn Orientation to learning Motivation to learn

Patient Education - Introduction

Time is limited Patient Education must be as efficient and effective as possible Educators must think of every moment with patients as a TEACHABLE MOMENT Maximizing teach moments

Young Adulthood Teaching Strategies

Use problem-centered focus Draw on meaningful experiences Focus on immediacy of application Allow for self-direction and setting own pace Organize material Encourage role play

ID your learner... Ask Yourself

Who is the audience Is it a single individual or a group Approximate age or ages of the audience Developmental level, formal or informal Level of knowledge on the topic

Teaching Strategies

focus on normal development, safety, health promotion, and disease prevention use repetition and imitation stimulate the senses provide safety allow for play and manipulation of objects

Developmental Characteristics Chronological age

is not a good predictor of learning ability. At any given age, there can be a wide variation in physical, cognitive, and psychosocial variables