General Principles of Education

Evaluating Learning

-Methods of evaluation (follow-up questions, return demonstrations) -Timing of Evaluation (time frame for measurable goals) -Reinforcing and celebrating learning -Evaluating teaching (for effectiveness; should we continue) -Revising the plan

Factors Affecting Patient Learning

Age and developmental level Family/caregiver support networks Financial resources Cultural influences and language Health literacy

Cognitive Learning Domain

storing and recalling of new knowledge in the brain (ex: if teaching patient about blood pressure, the cognitive domain = describe how salt intake affects blood pressure)

Effective Communication Techniques

-Be sincere and honest; show genuine interest and respect. -Avoid giving too much detail; stick to the basics. -Ask if the patient has any questions. -Be a "cheerleader" for the patient. Avoid lecturing. -Use simple words. -Vary your tone of voice. -Keep the content clear and concise. -Ensure the environment is conducive to learning and free from interruptions -Be sensitive to the timing and length of the session

Suggested Teaching Strategies for the Psychomotor Domain (learning a physical skill involving the integration of mental and muscular activity)

-Demonstration -Discovery -Printed Materials

Role of the Nurse as Coach

-Establishing relationships and identifying readiness for change -Identifying opportunities, issues, and concerns -Establishing patient-centered goals -Creating the structure of the coaching interaction -Empowering and motivating patients to reach goals -Assisting the patient to determine progress towards goals (help patient see progress they make)

Assessment of the Learner

-Identify learning needs (gaps in knowledge as to what the patient knows and what they need to know) -Assess learning readiness (is the patient anxious, willing to engage, ready to learn, support systems) -Assess learning style (ex: how do they like to learn - videos, written, demos) -Assess learning strengths (fast learner? eager to learn? good listener? motivated?) -Consider the patient's motivation (when someone is willing, eager, and able to learn, education and learning process is more successful)

Outcome Identification and Planning

-Involves the development of a teaching plan -Determine patient learning outcomes and teaching content -Determine teaching methods and materials

Suggested Teaching Strategies for the Cognitive Domain (storing and recalling of new knowledge in the brain)

-Lecture -Panel -Discovery -Written materials

Suggested Teaching Strategies for the Affective Domain (changing attitudes, values, and feelings)

-Role modeling -Discussion -Audiovisual Materials

Documentation of the Teaching-Learning Process

-Summary of the learning need (ex: new diagnosis) -The Plan (how we taught) -The Implementation of the Plan (now we carried it out) -Evaluation Results (effective or not)

Adherence is promoted when

-instructions are clear and support patient goals -patient/caregivers are included as partners in the process -interactive teaching strategies are used -strong interpersonal relationships are developed with the patient and their families

Knowles' Four Assumptions about Adult Learners

1.) As a person matures, one's self concept is likely to move from dependence to independence (self-directed learning; pedagogy --> androgogy) 2.) The previous experience of the adult is a rich resource for learning (experience as a resource) (get to know your patient and relate something they already do: ex: check blood sugar like you check your blood pressure) 3.) An adult's readiness to learn is often related to a developmental task or a social role (problem-centered) (adults need to be motivated to learn and believe they need to learn before willing to learn; not necessarily about being in perfect health but just feeling better) 4.) Most adults' orientation to learning is that material should be useful immediately, rather than at some time in the future (relevance of materials) (how will this impact me now; address any learning barriers and provide an optimal learning environment)

Steps in the Teaching/Learning Process (learning is a process where a person acquires the knowledge and there is a measurable change in behavior that helps us understand whether the teaching was effective or ineffective and if a change is needed or not)

1.) Assess the learning needs and learning readiness 2.) identify the patient's learning needs (what kinds of learning barriers a patient may have) 3.) Develop the learning outcomes (ex: pt will be able to identify hypo- or hyperglycemia and what they feel like) 4.) Develop the teaching plan (how will you teach this patient to check their blood sugar and recognize the signs and symptoms of high and low blood sugar and administer insulin) 5.) Implement teaching plan and strategies (listen to patient and family; use every interaction as a moment to teach and keep education patient-centered; visual, demonstration, etc.) 6.) Evaluate Learning (have them show you they know how to do it)

The Learning Domains

1.) Cognitive: storing and recalling of new knowledge in the brain (ex: if teaching patient about blood pressure, the cognitive domain = describe how salt intake affects blood pressure) 2.) Psychomotor: learning a physical skill involving the integration of mental and muscular activity (ex: is the patient able to do a dressing change after you showed them?) 3.) Affective: changing attitudes, values, and feelings (ex: patient has renewed self confidence after physical therapy)

Considerations for Successful Patient Teaching

1.) Forming contractual agreements (nurse and patient agree) 2.) Considering time constraints (how much time is the patient going to be here) 3.) Scheduling 4.) Group vs. Individual Teaching 5.) Formal vs. Informal Teaching 6.) Manipulating the Physical Environment (quiet environment)

How will we know learning was effective

Ask patient relevant questions or for a demonstration

Teaching Strategy Materials

Audiovisual materials Printed materials Programmed instruction Web-based instruction and technology (not google)

Suggested Teaching Strategies for the 3 Learning Domains

Cognitive Domain (storing and recalling of new knowledge in the brain): -Lecture -Panel -Discovery -Written materials Affective Domain (changing attitudes, values, and feelings): -Role modeling -Discussion -Audiovisual Materials Psychomotor Domain (learning a physical skill involving the integration of mental and muscular activity): -Demonstration -Discovery -Printed Materials

What would be the best teaching strategy to teach a patient how to care for an indwelling catheter? A.) Lecture B.) Role modeling C.) Discovery D.) Demonstration

D.) Demonstration Rationale: demonstration of techniques procedures, exercises, and the use of special equipment, combined with a lecture and discussion, is an effective strategy to facilitate psychomotor learning, such as caring for a catheter

The Purpose of Patient Education

Develop self care abilities -effect change in knowledge, skills, attitudes -maximizing functioning and quality of life (process of assisting people to learn health related behaviors that they can incorporate into everyday life with the goal of achieving optimal health and independence in self care - trying to influence behaviors to effect change in knowledge, attitudes, and skills; by doing so, (educating patients) they are able to make informed decisions) (It is ongoing and interactive to allow a patient to take control of their health and care for themselves and have an optimal level of independence)

Teach Back Method

Keep in mind this is not a test of the patient's knowledge (it is a test of how well you explained the concept) Plan your Approach (think about how you will ask your patients to teach back the information; Ex: "We covered a lot today and I want to make sure that I explained things clearly. So let's review what we discussed. Can you please describe 3 things you agreed to do to help you control your diabetes?" Chunk and Check (Don't wait until the end of the visit to initiate teach-back; chunk information into small segments and have your patient teach it back; repeat several times during a visit) Start Slowly and Use Consistently (At first, you may want to try teach-back with the last patient of the day. Once you are comfortable with the technique, use teach-back with everyone, every time!) Practice (It will take a little time, but once it is part of you routine, teach-back can be done without awkwardness and does not lengthen a visit) Use the show-me method (When prescribing new medicines or changing a dose, research shows that even when patients correctly say when and how much medicine they'll take, many will make mistakes when asked to demonstrate the dose. You could say for example, "Ive noticed that many people have trouble remembering how to take their blood thinner. Can you show me how you are going to take it?" Use handouts along with teach-back (Write down key information to help patients remember instructions at home. Point out important information by reviewing written materials to reinforce your patients' understanding. You can allow patients to refer to handouts when using teach-back, but make sure they use their own words and are not reading the material back verbatim.)

Teaching Strategy Methods

Lecture Discussion Panel Discussion (Collaborative) Demonstration Discovery Role Playing

Aims of Teaching and Counseling

Maintaining and promoting health (keep patient healthy or help them be healthier) Preventing illness (screening and preventative medicine) Restoring Health (get patient back to their baseline) Facilitating Coping (help them see their own strengths -Focusing on improving coping skills and reinforcing healthy behavior -fostering positive interactions -helping them prevent illness and disability -listen, advise, and guide -therapeutic and caring relationship with active listening and empathy) Promoting Outcomes (goals for care; ex: patient will be able to recognize the signs and symptoms of hyperglycemia and how to ensure/measure this occurs)

Promoting Patient and Family/Caregiver Adherence (adherence = preferred term instead of compliance)

Refers to the extent to which: -a person's behavior corresponds with agreed-upon recommendations from a health care provider -uses a team approach to the treatment plan -reflects the patient's right to choose -supports inclusive and active patient role

True

T or F: an education plan is typically developed by an interdisciplinary team

Affective Learning Domain

changing attitudes, values, and feelings (ex: patient has renewed self confidence after physical therapy)

Psychomotor Learning Domain

learning a physical skill involving the integration of mental and muscular activity (ex: is the patient able to do a dressing change after you showed them?)