Ch 24 - NUR304 - Adult Health

Ch 24: The nurse is teaching a patient newly diagnosed with type 1 diabetes mellitus about how to best manage his blood sugar. Which outcome in the patient's plan of care is associated with the cognitive domain of learning? The patient: 1) identifies signs and symptoms of hypoglycemia. 2) nods affirmatively with direct eye contact. 3) demonstrates fingerstick glucose monitoring. 4) independently self-administers insulin.

1) identifies signs and symptoms of hypoglycemia. Rationale: Cognitive behavior includes recall and comprehension, which is demonstrated by stating information, such as indicators of hypoglycemia. Nodding with eye contact is an action that exhibits the listener is dealing with the information with emotion (respect), which shows affective domain. Affective learning is the manner in which we deal with things emotionally, such as feelings, values, appreciation, enthusiasms, motivations, and attitudes. Willingness to hear and showing attention falls within the affective domain. Demonstration of skills depicts the psychomotor domain, such as performing a test to check blood sugar or injecting insulin.

Ch 24: Fill in the blanks with the letter of the correct learning domain (A, B, or C): A. Cognitive domain B. Psychomotor domain C. Affective domain 1. ____ Patient will ambulate one hall-length this shift. 2. ____ Patient will perform self-injection. 3. ____ Patient will verbalize feelings about having chronic obstructive pulmonary isease. 4. ____ Patient will identify three situations or physical changes that require notification of the healthcare provider.

1, B 2, B 3, C 4, A

Ch 24: The nurse working in a hospital with a diverse population strives to offer culturally sensitive care. What nursing action would be most appropriate? 1) Act as if familiar with cultural practices or values even if uncertain. 2) Allow patient to include cultural practices in plan of care unless harmful. 3) Use common, slang phrases as they are familiar to many people. 4) Incorporate humor into interactions with patients to put them at ease.

2) Allow patient to include cultural practices in plan of care unless harmful. Rationale: Find ways to incorporate the client's current healthcare practices and beliefs into the plan of care unless there is potential for harm. When the nurse is unfamiliar with the patient and family's cultural practices, she should admit lack of knowledge, seek clarification, and express willingness to learn. She should not fake it. The nurse should avoid using slang expressions because they can take on different meanings in different cultures. Slang can lead to miscommunication and offensive messages. Avoid using humor; jokes often do not translate well because of subtle meaning changes.

Ch 24: A nurse strives to teach a spouse how to monitor a patient's blood pressure. Which teaching method is best? 1) Provide the patient and spouse with written instruction about how to obtain blood pressure. 2) Demonstrate the technique for taking blood pressure, and then request a return demonstration. 3) Schedule the spouse for a class about high blood pressure, including monitoring technique. 4) Provide the spouse with a patient education brochure about blood pressure monitoring.

2) Demonstrate the technique for taking blood pressure, and then request a return demonstration. Rationale: The best way to teach a psychomotor skill, such as obtaining blood pressure, is through demonstration and return demonstration. Cognitive learning, which includes storage and recall of information, is most often taught through lecture and print and audiovisual materials.

Ch 24: How might the nurse improve health literacy between patients and healthcare providers? 1) Ask patients simple yes or no questions. 2) Speak with passive voice instead of active. 3) Avoid medical jargon and technical terms. 4) Provide information printed in English.

2) Speak with passive voice instead of active. Rationale: Health literacy is the ability to understand basic health information and services needed to make appropriate healthcare decisions. A gap in health literacy results when a healthcare provider uses terminology that is unfamiliar or misunderstood by the patient, thus resulting in an unintended message or lack of meaningful information. Therefore, healthcare providers should avoid unnecessary medical jargon and technical terms. Speak using common words, short sentences, and structuring sentences with active rather than passive voice. To be sure the patient understands your questions clearly, ask questions that involve "how" and "what" rather than "yes" and "no." Patients with limited language proficiency might use words of agreement "yes" or disagreement "no" simply because of reduced vocabulary and poor understanding of the question. Do not assume that a client who smiles, nods, and says "yes" really understands what you are teaching. The client may be embarrassed to ask questions or may feel that it will embarrass you. An interpreter might help communication when language is the barrier.

Ch 24: Why is patient education important in today's healthcare environment? 1) Primarily it is offered to increase patient confidence for self-care. 2) Nurses do patient teaching to transfer responsibility for care to patients. 3) Patient education contributes to rising healthcare costs. 4) More healthcare is delivered in the home and outpatient settings.

4) More healthcare is delivered in the home and outpatient settings. Rationale: With shorter hospital stays and complex care increasingly being given in homes and the community, teaching is essential to protect patient well-being and safety in the outpatient environment. The primary goal of patient education is to increase the knowledge and skills needed for quality self-care or for providers delivering care in the outpatient setting. Although patients often feel more confident in the home care they will perform after receiving patient education, the primary objective is to facilitate healing and prevent complications. Patients participate in healthcare decisions. Patients have a responsibility for their own health and the care needed to prevent illness, maintain health, treat disease, and evaluate the response to medical treatment. The cost of healthcare is rising. Patient education can help to decrease the overall cost of healthcare and prevent complications leading to rehospitalization.

Ch 24: When teaching nursing students about how to provide culturally sensitive care to a diverse group of patients, which teaching strategy is most likely to promote affective learning? 1) Demonstration 2) Computer-assisted instruction 3) Concept mapping 4) Role-modeling

4) Role-modeling Rationale: Affective learning involves changes in feelings, beliefs, attitudes, and values. It is considered the "feeling domain." Strategies for promoting affective learning include role-modeling, panel discussion, support group, one-to-one instruction, audiovisual materials, and possibly printed materials. Strategies for cognitive learning include concept mapping, panel discussion, and computer-assisted instruction. Strategies for psychomotor learning include demonstration, simulation, audiovisual materials, and printed materials.

Ch 24: Which of the following factors should the nurse consider when planning client education? Select all that apply. A. Health beliefs B. Culture C. Age D. Developmental stage

A, B, C, D Rationale: All of the factors should be considered when planning patient education. In addition, you should assess the following personal factors that affect learners' ability to process and retain information: learning needs, client's knowledge level, health beliefs and practices, emotional readiness to learn, ability to learn, literacy level, preferred learning styles, and neurosensory factors, such as vision, hearing, and manual dexterity.

Ch 24: Caruana, E. (2007, August). Patient information (pre-operative): Knowledge retention. Evidence Summaries—Joanna Briggs Institute. Retrieved September 25, 2008, from ProQuest Nursing & Allied Health Source database. (Document ID: 1451740781) An analysis of 19 scientific trials was done to determine which patient education strategies are most effective in promoting patient knowledge and use of good technique for self-care activities after surgery. The researcher found studies were generally poor to moderate quality. Of the studies reviewed, four were more than 20 years old. This analysis suggests patient education before surgery is useful for improving patients' knowledge of postoperative treatment and their ability to perform the care needed after surgery. Instruction is likely to be more effective if provided before admission. If done after admission, teaching in a group format is equally as effective as individual instruction. The researchers supported the use of educational pamphlets to inform patients and improve their skills. Palmer, M. H., Kowlowitz, V., Campbell, J., Carr, C., Dillon, R., Durham, C. F, Gainer, L. A., et al (2008). Using clinical simulations in geriatric nursing continuing education. Nursing Outlook, 56(4), 159-166. This study of 312 nurses attending a continuing education program to improve geriatric nursing competencies was conducted to determine whether simulation is effective for adult education. Three types of clinical simulations were studied, including unfolding cases, human patient simulator, and online case studies. The researchers found clinical simulations increased geriatric nursing knowledge significantly. Clinical simulations involving the human patient simulator were most highly rated of all types of simulation, especially when it came to relevance of the experience to real-life scenarios (97.9% of participants strongly agreed or agreed). Most participants (97.5%) strongly agreed or agreed that human patient simulators helped to apply the information with clinical practice. Unfolding cases and online case studies were rated nearly as high. Nurse participants enjoyed the interactive nature of the human patient simulator. Further research is needed to demonstrate if the self-reported increase in skills levels actually means better patient care. 2. In the first article discussing patient retention of information, why do you think group learning for postoperative care could be an effective approach for patient teaching after admission?

After admission to the hospital, group learning has been shown to be as effective as individual instruction of skills for postoperative care. Considering time constraints and demands of patient care, a group learning situation is efficient for the nurse and effective for patients.

Ch 24: List and define six factors that affect the learning process.

Answers may include any six of the following factors influencing the learning process: ● Motivation is desire from within that is linked to behavior. Motivation may be based on physical needs, emotion, social needs, the need for task mastery, and health beliefs. ● Readiness is the demonstration of behaviors that indicate that the learner is motivated and able to learn at a specific time and conducive situation or environment. ● Physical condition includes pain, strength, coordination, energy, senses, mobility; it is one aspect of readiness. ● Emotions are feelings, such as anxiety, stress, emotional pain, or happiness. Emotions are another aspect of readiness. ● Timing means either the time at which the material is presented in relation to the client's readiness or how soon the person has an opportunity to use the information after it is presented. ● Active involvement refers to how actively engaged the learner is in the goal planning and acquiring new knowledge, skill, or attitudes, as opposed to just listening passively. Active learning involves participation in the learning process. ● Feedback is evaluative information to the learner about the learner's performance. ● Repetition means to go over the information more than once. It includes practice. ● Environment includes both the setting in which the teaching takes place and the relationship among the learner(s), the conditions, and the instructors' or mentors' teaching strategies. ● Scheduling the session involves planning undistracted time to allow for adequate assessment and understanding of the client. ● Amount and complexity of content implies that the more complex or detailed the content, the more difficult it is to learn and retain. However, when a learner is highly motivated or the material is perceived as relevant, learning information is easier. ● Communication is the giving and receiving of information. It is central to the teaching-learning process. Teachers and learners communicate information, perceptions, and feelings to each other. It can be verbal or nonverbal. ● Special population refers to clients with conditions that might interfere with learning (e.g., those with learning disabilities, attention-deficit disorder, mental illness, communication disorders, or brain injury). ● Developmental stage refers to the cognitive and psychosocial abilities of the person, which develop throughout the life span and differ at various stages. An understanding of intellectual development helps the teacher to customize teaching strategies and content to the level and learning style of the learner. ● Cultural factors involve norms, values, communication, social structure, time orientation, language spoken, and cultural identification. All are important in planning. ● Health literacy is the ability to understand basic health information and services needed to make appropriate healthcare decisions

Ch 24: List six teaching strategies.

Answers may include any six of the following teaching strategies: ● Lecture ● Group discussion ● Demonstration and return demonstration ● One-to-one instruction and mentoring ● Printed materials ● Distance learning ● Simulation ● Self-instruction ● Electronic learning platforms, listservs and Web sites, computer-assisted instruction, and online coursework ● Gaming ● Role-playing ● Role modeling ● Concept mapping

Ch 24: When adapting the teaching strategies to geriatric clients, the nurse understands that there are changes that occur with aging that may hinder learning. Which of the following would be considered an abnormal finding? A. Hearing impairment B. Long-term memory loss C. Visual impairment D. Short-term memory loss

B. Long-term memory loss Rationale: Declines in visual perception and hearing acuity, as well as short-term memory loss, occur commonly with aging.

Ch 24: The nurse providing preoperative teaching understands that immediacy of need is a motivator for learning. Based on this concept, which topic would the nurse avoid when teaching the patient before surgery? A. Instruction for turning, deep breathing, and coughing B. An explanation of what to expect during the preoperative phase C. Follow-up resources D. Orientation to the hospital

C. Follow-up resources Rationale: The topic of follow-up resources will not be covered during preoperative teaching because it is too distant to the immediate need of the patient before surgery. Teaching will focus on what the patient will experience as he enter the hospital and through to his surgery.

Ch 24: True or False: A person's reading level is an indicator of his health literacy.

False Rationale: A person's reading level is not a good indicator of the person's health literacy. Many other factors are involved in understanding information necessary for planning and participating in healthcare decisions. For instance, if the healthcare provider uses medical jargon or technical terminology that the patient does not understand, then there would be a gap in understanding, which is health illiteracy. General verbal skills and capacity for language in addition to knowledge about health-related terminology and concepts contribute to health literacy.

Ch 24: What are some aspects of the environment that can enhance or interfere with learners functioning with low cognitive ability?

For some, an ideal learning environment is private, quiet, physically and psychologically comfortable, and free from distractions. For others, the most effective learning environment is rich with sensory stimulation and contains opportunities for socially interactive learning experiences. People take in information, process, and retain it in different ways, depending on personal learning styles. Seating should be comfortable and lighting suitable for reading. The teacher should be organized with expectations clearly defined and evaluated.

Ch 24: Define learning

Learning is a change in behavior, knowledge, skills, or attitudes resulting from planned or spontaneously occurring situations, events, or exposures. Learning can be either goal oriented or conscious (intended and deliberate, involving motivation to learn) or subconscious (without active participation in the learning process). It can occur by rote learning, informal acquisition, formal instruction, and combined approaches.

Ch 24: What is one strategy you could use to motivate a client who seems uninterested in learning?

Motivation may be based on physical needs, social needs, the need for task mastery, and health beliefs. Students may include the following or other "factors that affect learning" (see the preceding question): ● Conveying interest in and respect for the learner and the learning process helps to motivate the learner. ● Creating an open, friendly environment where learners are interactive can increase the learner's desire to learn. A healthy learning environment is one where students are encouraged to be responsive in the classroom (whether physical or virtual) and do not fear criticism. Interactive teaching/learning style can stimulate participants to engage in the educational experience. ● You can sometimes motivate clients by helping them identify a physical need that is relevant to the teaching point. For example, Heather ("Meet Your Client," in Volume 1) may not be aware that her child is at risk for accidents and injury from home hazards. Helping her to understand the normal behavior of a 4-year-old preschooler may help her to see the need for childproofing her home. ● As people have a basic need to achieve and succeed in various ways, learning can be gratifying and raise self-esteem. When a person masters a goal or competently handles a situation or performs a task, he often is motivated to continue learning. Therefore, setting up the learning experience in a way so that learners will achieve the goal can motivate learning. Rewards and incentives can also provide this type of motivation. ● The client will be motivated to learn only if she believes the information taught is important. In the example from the book, Heather may understand that a 4-year-old preschooler likes to explore and may recognize that there are safety hazards in the home, but she will not be motivated to learn safety measures if her attitude is that "it is no big deal."

Ch 24: Identify at least three reasons why nurses have a responsibility to teach clients.

Nurses have a responsibility to teach clients for the following reasons: ● To shorten client's hospital stay or recuperation period ● As part of their professional role ● Because teaching is included in nurse practice acts ● To ensure that an informed decision can be made by the client ● To increase client compliance with therapies ● To help decrease the costs of healthcare ● To promote client self-care after being released from the hospital ● Because clients expect it

Ch 24: Caruana, E. (2007, August). Patient information (pre-operative): Knowledge retention. Evidence Summaries—Joanna Briggs Institute. Retrieved September 25, 2008, from ProQuest Nursing & Allied Health Source database. (Document ID: 1451740781) An analysis of 19 scientific trials was done to determine which patient education strategies are most effective in promoting patient knowledge and use of good technique for self-care activities after surgery. The researcher found studies were generally poor to moderate quality. Of the studies reviewed, four were more than 20 years old. This analysis suggests patient education before surgery is useful for improving patients' knowledge of postoperative treatment and their ability to perform the care needed after surgery. Instruction is likely to be more effective if provided before admission. If done after admission, teaching in a group format is equally as effective as individual instruction. The researchers supported the use of educational pamphlets to inform patients and improve their skills. Palmer, M. H., Kowlowitz, V., Campbell, J., Carr, C., Dillon, R., Durham, C. F, Gainer, L. A., et al (2008). Using clinical simulations in geriatric nursing continuing education. Nursing Outlook, 56(4), 159-166. This study of 312 nurses attending a continuing education program to improve geriatric nursing competencies was conducted to determine whether simulation is effective for adult education. Three types of clinical simulations were studied, including unfolding cases, human patient simulator, and online case studies. The researchers found clinical simulations increased geriatric nursing knowledge significantly. Clinical simulations involving the human patient simulator were most highly rated of all types of simulation, especially when it came to relevance of the experience to real-life scenarios (97.9% of participants strongly agreed or agreed). Most participants (97.5%) strongly agreed or agreed that human patient simulators helped to apply the information with clinical practice. Unfolding cases and online case studies were rated nearly as high. Nurse participants enjoyed the interactive nature of the human patient simulator. Further research is needed to demonstrate if the self-reported increase in skills levels actually means better patient care. 4. Based on the results of the second study, why do you think simulation might be an effective method of instruction?

Nurses rating simulation experiences found their role in the scenario to be clear—that is, they knew what the task at hand was and what they were supposed to do in that. They gave feedback that using simulation was useful for linking the testing point to authentic nursing. More than anything, nurses reported being able to tie the learning experience to the real-life demands of patient care, making the educational session relevant to their learning needs.

Ch 24: Caruana, E. (2007, August). Patient information (pre-operative): Knowledge retention. Evidence Summaries—Joanna Briggs Institute. Retrieved September 25, 2008, from ProQuest Nursing & Allied Health Source database. (Document ID: 1451740781) An analysis of 19 scientific trials was done to determine which patient education strategies are most effective in promoting patient knowledge and use of good technique for self-care activities after surgery. The researcher found studies were generally poor to moderate quality. Of the studies reviewed, four were more than 20 years old. This analysis suggests patient education before surgery is useful for improving patients' knowledge of postoperative treatment and their ability to perform the care needed after surgery. Instruction is likely to be more effective if provided before admission. If done after admission, teaching in a group format is equally as effective as individual instruction. The researchers supported the use of educational pamphlets to inform patients and improve their skills. Palmer, M. H., Kowlowitz, V., Campbell, J., Carr, C., Dillon, R., Durham, C. F, Gainer, L. A., et al (2008). Using clinical simulations in geriatric nursing continuing education. Nursing Outlook, 56(4), 159-166. This study of 312 nurses attending a continuing education program to improve geriatric nursing competencies was conducted to determine whether simulation is effective for adult education. Three types of clinical simulations were studied, including unfolding cases, human patient simulator, and online case studies. The researchers found clinical simulations increased geriatric nursing knowledge significantly. Clinical simulations involving the human patient simulator were most highly rated of all types of simulation, especially when it came to relevance of the experience to real-life scenarios (97.9% of participants strongly agreed or agreed). Most participants (97.5%) strongly agreed or agreed that human patient simulators helped to apply the information with clinical practice. Unfolding cases and online case studies were rated nearly as high. Nurse participants enjoyed the interactive nature of the human patient simulator. Further research is needed to demonstrate if the self-reported increase in skills levels actually means better patient care. 1. What important points does the first study pertaining to preoperative teaching make that you could use in your teaching?

Preoperative teaching is effective and does make a difference for patients' knowledge and behavior in performing their own postoperative care. Preoperative teaching done prior to admission is most effective. Group learning is worthwhile after admission. Pamphlets are useful for individual patients and can reinforce teaching afterwards.

Ch 24: What two strategies might you use with a learner who is functioning with low cognitive ability?

Strategies depend on the exact nature and extent of the cognitive development, but they may include the following: ● Consider a variety of teaching approaches most suited to the individual needs of the learner—one size does not fit all. For example, use small, frequent learning sessions or pay special attention to minimizing distractions in the environment. ● Present content slowly, use repetition, and build in concrete examples the learner can relate to. ● Be satisfied with small amounts of progress.

Ch 24: Caruana, E. (2007, August). Patient information (pre-operative): Knowledge retention. Evidence Summaries—Joanna Briggs Institute. Retrieved September 25, 2008, from ProQuest Nursing & Allied Health Source database. (Document ID: 1451740781) An analysis of 19 scientific trials was done to determine which patient education strategies are most effective in promoting patient knowledge and use of good technique for self-care activities after surgery. The researcher found studies were generally poor to moderate quality. Of the studies reviewed, four were more than 20 years old. This analysis suggests patient education before surgery is useful for improving patients' knowledge of postoperative treatment and their ability to perform the care needed after surgery. Instruction is likely to be more effective if provided before admission. If done after admission, teaching in a group format is equally as effective as individual instruction. The researchers supported the use of educational pamphlets to inform patients and improve their skills. Palmer, M. H., Kowlowitz, V., Campbell, J., Carr, C., Dillon, R., Durham, C. F, Gainer, L. A., et al (2008). Using clinical simulations in geriatric nursing continuing education. Nursing Outlook, 56(4), 159-166. This study of 312 nurses attending a continuing education program to improve geriatric nursing competencies was conducted to determine whether simulation is effective for adult education. Three types of clinical simulations were studied, including unfolding cases, human patient simulator, and online case studies. The researchers found clinical simulations increased geriatric nursing knowledge significantly. Clinical simulations involving the human patient simulator were most highly rated of all types of simulation, especially when it came to relevance of the experience to real-life scenarios (97.9% of participants strongly agreed or agreed). Most participants (97.5%) strongly agreed or agreed that human patient simulators helped to apply the information with clinical practice. Unfolding cases and online case studies were rated nearly as high. Nurse participants enjoyed the interactive nature of the human patient simulator. Further research is needed to demonstrate if the self-reported increase in skills levels actually means better patient care. 5. Have you experienced simulation as part of your own nursing education? Was it beneficial to you for learning new information or nursing skills? Why or why not?

Students may report simulation as a possible, neutral, or negative experience, depending on the individual student. This study showed high levels of learner satisfaction in the areas of quality of resources, flow of the case, accuracy of content, clarity of the case and questions, clarity of nursing roles, and, most important, relevance of the experience and integration of information into real-life situations that nurses commonly encounter. The responses might be similar in nature to these.

Ch 24: Define teaching.

Teaching is an interactive process of instruction that is designed to meet learners' educational needs. Teaching also involves creating and delivering a suitable learning environment and in a manner that allows the learner to learn.

Ch 24: Give an example of each of the domains of learning.

The following are examples of each learning domain. Answers, of course, may vary. ● Affective—appreciating the importance of following a prescribed diet ● Cognitive—memorizing the steps of a skill, such as taking a blood pressure ● Psychomotor—learning to perform a skill, such as taking a blood pressure

Ch 24: What are the three domains of learning?

The three domains of learning are affective, cognitive, and psychomotor.

Ch 24: Caruana, E. (2007, August). Patient information (pre-operative): Knowledge retention. Evidence Summaries—Joanna Briggs Institute. Retrieved September 25, 2008, from ProQuest Nursing & Allied Health Source database. (Document ID: 1451740781) An analysis of 19 scientific trials was done to determine which patient education strategies are most effective in promoting patient knowledge and use of good technique for self-care activities after surgery. The researcher found studies were generally poor to moderate quality. Of the studies reviewed, four were more than 20 years old. This analysis suggests patient education before surgery is useful for improving patients' knowledge of postoperative treatment and their ability to perform the care needed after surgery. Instruction is likely to be more effective if provided before admission. If done after admission, teaching in a group format is equally as effective as individual instruction. The researchers supported the use of educational pamphlets to inform patients and improve their skills. Palmer, M. H., Kowlowitz, V., Campbell, J., Carr, C., Dillon, R., Durham, C. F, Gainer, L. A., et al (2008). Using clinical simulations in geriatric nursing continuing education. Nursing Outlook, 56(4), 159-166. This study of 312 nurses attending a continuing education program to improve geriatric nursing competencies was conducted to determine whether simulation is effective for adult education. Three types of clinical simulations were studied, including unfolding cases, human patient simulator, and online case studies. The researchers found clinical simulations increased geriatric nursing knowledge significantly. Clinical simulations involving the human patient simulator were most highly rated of all types of simulation, especially when it came to relevance of the experience to real-life scenarios (97.9% of participants strongly agreed or agreed). Most participants (97.5%) strongly agreed or agreed that human patient simulators helped to apply the information with clinical practice. Unfolding cases and online case studies were rated nearly as high. Nurse participants enjoyed the interactive nature of the human patient simulator. Further research is needed to demonstrate if the self-reported increase in skills levels actually means better patient care. 3. In the first article, why do you think a patient education pamphlet is important as a teaching aid before admission?

There is some evidence suggesting patient education using pamphlets and videotape is more effective when done prior to admission. A patient's most teachable moment might be in the comfort of the patient's home or at a time that is convenient.

Ch 24: True or False: People of differing ages have different learning needs and may require different approaches when being taught new material.

True

Ch 24: True or False: When present with limited intensity and for a short period of time, anxiety can be a positive factor in learning.

True

Ch 24: True or false: Learning objectives are short term and ideally should be accomplished in one or two teaching sessions.

True

Ch 24: True or false: When a patient has a learning disability, you should use a non-NANDA diagnosis (e.g., Impaired Ability to Learn) to describe the problem.

True

Ch 24: True or False: A thorough assessment of the patient's educational needs and learning-style preferences should be conducted before beginning any patient teaching session.

True Rationale: For health teaching to be effective, the nurse needs to know what the patient needs and wants to learn. If the teaching is not geared toward mutually defined goals, it will not be useful to the patient. Knowing the way a person best takes in and retains information is the best way to plan a teaching session.

Ch 24: List and state the advantages and disadvantages of at least six teaching strategies. (part 2)

● Audiovisual materials make use of visual illustrations and sound. It may include simulation, streaming video, video/DVD or digital recording, audio format, slides, or computer-generated material. It is most effective as a supplement to other methods, especially when accompanied by an opportunity for question-and-answers, demonstration, or participation in an application-based learning activity. Pretest and posttest reinforce information offered to learners in the audiovisual format. Printed materials can help to expand understanding. Audiovisual materials are more effective when you precede them and follow up with a discussion of the content. Advantages: ● Is appealing to those with auditory and visual preferred learning style ● Can be used with large groups Limitations: ● Can be expensive because audiovisual instruction requires specialized hardware (e.g., projection equipment, Internet connection, display screens), software (e.g., media player software, slide presentation program, image gallery, word processing software), and media (e.g., DVDs), which must be replaced when they become outdated ● Simulation portrays realistic patient-based situations. In nursing, simulation is an educational method in which a learning experience is artificially created to imitate a patient care situation but without risks and consequences that can be incurred by the novice nurse practicing a new skill or procedure. It involves performance of skills, decision making, problem solving, and a sequence of actions involving the patient, nurse, and possibly other members of the healthcare team. Simulations are often enacted through written case studies as well as models, computer programs, and physical setups. Advantages: ● Human patient simulators offer hands-on instruction and practice—a memorable approach that is effective for most learners, particularly those with kinesthetic learning style. ● Practicing through simulations can increase confidence, evaluate effectiveness of teaching, and troubleshoot areas of concern before an actual situation arises. ● Simulation allows nurses to learn new skills without risk to patients. Limitations: ● Simulation mannequins are expensive. ● Human patient simulators require a computer with specialized software as well as other specialized equipment to deliver the learning experience. ● If commercially prepared cases are not available, the instructor would have to create the case and sequence of actions. This is a skill that not all faculty would have experience doing, nor might they have the time it would take to develop original case studies. ● The preparation time can be extensive in terms of setup. ● Role-playing is a method used primarily with groups to achieve learning in the affective domain. Participants take on unrehearsed roles without a script to follow. The teacher must develop the situation so that participants can take and develop understanding of the roles they are given. Role-playing can involve a typical patient scenario the student is likely to encounter. One person takes on a specific patient role, acting as a "real patient," reacting differentially depending on the action of the learners. Learners are challenged to respond appropriately and might be evaluated by the instructor accordingly. Advantages: ● Similar to simulation, this method is a safe method to rehearse real-life situations before being confronted with them. ● Role-playing is usually even less structured than simulation, although the two can be combined. ● This method works well for social learners who are stimulated by interaction with others. Limitations: ● Follow-up discussion needs to occur to allow for expression of feelings, attitudes, and observations. ● Learners must be willing to participate either as an observer or role-player. Some students may feel self-conscious when role-playing. ● Others might dominate and occupy some of the learning experience for less social or quieter classmates.

Ch 24: What are strategies and tools to promote learning within each of the three domains of learning?

● Cognitive learning—Strategies and tools to support teaching cognitive-type content include lecture, reading materials, panel discussion, audiovisual materials, programmed instruction, computer-assisted instruction (CAI), and problem-based learning (e.g., case studies and care plans). ● Psychomotor learning—Strategies and tools used to teach psychomotor skills include demonstration and return demonstration, simulation models, audiovisual materials (e.g., videotapes), and printed materials (especially with photographs and illustrations). ● Affective learning—Strategies and tools for promoting affective learning include role-modeling, panel discussion, mentoring, one-to-one counseling and discussion, audiovisual materials (e.g., DVDs, streaming video, movies), and printed materials.

Ch 24: List and state the advantages and disadvantages of at least six teaching strategies. (part 1)

● Lecture is a traditional method in which one or more presenters orally share information while a group of learners listens (Figure 24-3). It can be enhanced by including discussion and question-and-answer periods for clarifying content and by use of computer-projected slide presentation, streaming video, flip charts, transparencies, posters, brochures, models, and other audiovisual formats. Teachers can engage learners' attention with an attention-getting opening and support teaching points with stories, quotes, images, analogies or metaphors, and humor. Advantages: ● Efficient and cost-effective way to impart information, particularly for large groups ● Can integrate media-rich formats into lectures to reach learners with auditory- and visual-preferred learning styles ● Can be recorded for future use Limitations: ● Does not allow for individualization of teaching ● Is not effective for teaching in the psychomotor or affective domains ● Does not promote retention of material, particularly for some who learn best by doing ● Can lead to oversaturation if too much information is presented in too short a time frame; boredom is common ● Tends to offer information that does not cause learners to engage in critical thinking ● Less opportunity for assessment of learner comprehension ● Group discussion involves participants exchanging information and presenting individual perspectives within an interactive setting. Discussions can be controversial or involve opposing viewpoints. The teacher acts as facilitator to achieve objectives shared with the group of learners at the beginning of the session. Effective group discussion requires an atmosphere of trust and participation by the participants. Advantages: ● It is learner centered and effective for teaching in the affective and cognitive domains. ● Social involvement can enhance content. Limitations: ● The teacher must be competent with teaching using an approach with less structure and unpredictable responses. ● May be less effective with large groups. ● Not as well suited for teaching in the psychomotor domain. ● Brainstorming fails when participants are distracted, overdominant or fail to get involved, fear rejection or ridicule by peers or instructor for unpopular ideas, and disruptive or intentionally sabotage the activity. ● Can be negatively affected by "group think"—a force that stifles creativity by succumbing to the often subtle pressure of agreeing with the group even though affirmation doesn't reflect the learner's individual opinion. Disruptive students can intentionally sabotage the group discussion. ● Demonstration/return demonstration involves explanation with a physical display of a skill or task, incorporating client limitations, if necessary. The client then shows understanding of the concept or skill by repeating the skill. Return demonstrations should be scheduled close to the initial teaching. Advantages: ● Most effective in teaching psychomotor skills (e.g., use of equipment, self-injection, dressing changes, injection technique) ● Can be used in small groups if enough equipment is available Limitations: ● Does not work well with large groups ● Is time-consuming and labor intensive ● Requires equipment and supplies ● Space must be suitable for demonstration

Ch 24: List and state the advantages and disadvantages of at least six teaching strategies. (part 5)

● One-to-one instruction and mentoring generally involves one teacher presenting information to an individual learner. Objectives are mutually formulated at the beginning of the session. Follow-up is often done using printed or audiovisual materials. You will often use this method as a nurse for patient education. Mentoring involves a more personal interaction between teacher and learner, involving not only the exchange of information but also role-modeling and problem solving. It offers opportunity to directly observe and offer feedback on the learner's performance. Mentoring often involves learners in an authentic clinical setting. Advantages: ● Gives the teacher the opportunity to establish a relationship with a client and convey interest in his learning needs ● Allows a reluctant learner to more readily ask questions to better grasp the information ● Enables the teacher to obtain frequent feedback so that material can be tailored to meet the learning need and clarified as needed ● Useful for teaching in all three domains: affective, psychomotor, and cognitive ● Provides opportunity for learners to build skills and solve problems in situations with expert supervision, guidance, and feedback. Limitations: ● Labor intensive and reaches the fewest numbers of clients ● Tends to isolate the learner from others who may share the same learning needs and who could provide support ● Can be hampered by personality conflicts ● Relies heavily on the instructor, preceptor, or nurse being a good role model and having effective teaching skills ● Printed materials may be in the form of fact sheets, discharge instructions, printed pamphlets, or detailed patient education booklets. To ensure comprehension, you must provide an opportunity for clients to ask questions after they have read the materials. You will usually use printed materials to supplement other teaching strategies, such as demonstration. Advantages: ● Allows for standardized information to be presented to each client, but with some room for individualization ● Ensures the intended material is presented to the learner and not incidentally omitted ● Are portable, allowing clients to read information on their own time, so it makes efficient use of teacher time Limitations: ● The method assumes literacy, motivation to read materials, cognitive ability, and visual acuity. ● Materials at an average reading level (sixth-grade equivalent), with words that most people understand, must be available. ● Concept Mapping. A concept map is a diagram used to represent a specified teaching point or educational idea by using key words, symbols, images, or other code words or phrases. This spatial learning strategy visually portrays how key concepts are logically related. The relationship among concepts is shown with graphic connectors and linking phrases, such as "includes" or "results in." The graphic schematic drawing displays the structure of a concept that learners can visualize and begin to classify, organize, and interpret. The main types of concept maps are hierarchical (vertical or linear structure) or nonhierarchical (less formal). Concept maps can be used to construct care plans, synthesize key concepts from lectures, organize papers prior to beginning the actual writing, outline review materials prior to a test, create a summary of reading assignments, undertake comprehensive review of the research literature, and as a patient teaching device to simplify the presented content. Advantages: ● Promotes reflection and critical thinking ● Helps to identify patterns and structure within the content ● Takes a large amount of information and summarizes the key aspects into a concise, visual format ● Discourages rote learning Limitations: ● Constructing a concept map might be difficult for learners with limited spatial reasoning ability. ● Some learners might not prefer this educational approach. ● Instruction is needed to teach a patient how to create a concept map.

Ch 24: List and state the advantages and disadvantages of at least six teaching strategies. (part 4)

● Online sources of information. Learners can obtain extensive information and support geared toward the lay public as well as healthcare professionals via the Internet through listservs and Web sites. Electronic learning platforms offer education through multimedia, search engines, electronic libraries, content portals, and social networking sites and blogs. Learners can connect with others in similar situations through listservs, which are online communities sharing a common focus or interest. Through listserv threaded discussions, participants exchange information, express opinions, offer support, inquire about topics of interest to the greater community, promote special interests, and network with others for personal or professional intent. Advantages: ● The Internet makes a vast amount of information readily available. ● Many government or professional organizations have a wealth of information for consumers to assist them in self-care and in making healthcare decisions. ● Patients feel empowered when they have access to relevant and understandable information; they often cope better and experience less uncertainty when using the Internet as a resource for obtaining health-related information. Limitations: ● The teacher has little control over the information learners access via the Internet. ● Prior to recommending a particular Web site to a patient, you need to read it yourself to be sure the information is accurate and the format and reading level is best suited to your patient. ● Computer-assisted instruction (CAI) and online coursework involves the use of computer software or a Web-based, learning-management system to present information and provide a virtual classroom experience. CAI may include video or audio clips that enhance learning. Advantages: ● This method allows learners to proceed at their own pace. ● It usually includes review questions or interactive quizzes, which enhances comprehension. ● Learners can access programs at a time that is convenient for them. ● It provides feedback while the learner progress through the study module. Limitations: ● Learners must have access to a computer. ● Learners must have adequate visual acuity and literacy skills and computer skills. ● Because this method is technology driven and because personal support facilitates learning, be sure to also plan occasional person-to-person contact with the learner. ● Gaming requires the learner to participate in an educational activity that leverages learning through specialized techniques using competition, distraction, activity, and pleasure. Gaming activities are structured with preset rules (e.g., a board game that allows players to move when they answer a question correctly). Games should be relevant to the teaching point with objectives clear to learners. The teacher serves as a facilitator who sets the ground rules and explains the process as well as keeps the flow going. Games can be created manually or purchased commercially. Advantages: ● Gaming can be used to actively involve individuals or groups and can make learning fun. ● It can be used to introduce new information or reinforce previous learning. ● Gaming provides a challenge that can lead to confidence in knowing and expressing the material. Limitations: ● Some participants may not enjoy the competitive atmosphere or may have physical or social impairments that preclude participation. ● Gaming might not interest learners who are not competitive by nature. ● Gaming can create feelings of insecurity for learners who are not skilled in gaming techniques. ● The technique can distract learners from the teaching point if winning is overemphasized.

Ch 24: List and state the advantages and disadvantages of at least six teaching strategies. (part 3)

● Role modeling. The instructor teaches by example, demonstrating the behaviors and/or attitudes that learners should adopt. Role modeling is even more effective when the teaching point corresponds with the role model's action. Role modeling is an integral part of a mentoring relationship where students or patients learn by seeing, hearing, and doing. Be aware that this occurs unconsciously as well as intentionally and consider what is being communicated. Connect learning to objectives. Be aware that learning occurs subtly; instructors using this method need to consider what is being communicated and connect the learning to the objectives. Role modeling is more successful when the teaching point is made visible to learners during the learning experience. Advantages: ● Identification with the teacher can be a subtle but powerful method to increase motivation and the ability to perform a desired behavior by the learner. ● Tends to generate high learner interest ● Doesn't usually require additional planning on part of role model Limitations: ● Learners need to be aware and receptive to this type of teaching. A role model who does not effectively represent desired behaviors can send the wrong message. ● Self-instruction is a method in which the learner studies independently using topic-driven materials. Self-study modules are developed with objectives and various types of materials, including workbooks, computer programs, media-rich formats (e.g., DVDs), PDAs, and podcasts with worksheets. Teachers can be accessed for questions or feedback at designated times. Advantages: ● Learners have the convenience of working at their own pace and time schedule; this is appealing to many learners, particularly those with other demands related to employment, marriage, and family life. ● Instructors and learners can access the self-instructional materials without the transportation, expense, and inconvenience of commuting to a traditional classroom setting. Limitations: ● It requires literacy skills and motivation to pursue individualized instruction; so it can be isolating for those who perform best with frequent feedback and support from others. ● Without access to an instructor, students might not be on track or accurately understanding material. ● It requires a great deal of time for the initial preparation of modules. ● Distance learning. With distance learning, teacher and learner are not in the same physical location. Live or recorded instructions are sent from the teacher to the learner. Two or more individuals or classrooms may be connected by video or teleconferencing. Advantages: ● Allows for teaching to remote or multiple sites at the same time; can link many individuals separated by great distances ● With current technology, opportunity is available for interactive teaching rather than a one-way process Limitations: ● Requires the teacher to have technological skills ● Requires expensive equipment ● Requires a great deal of time for preparation and organization