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