I.

Perspective on Teaching and Learning

Objectives: 1. 2. 3. 4. 5. 6. 7. 8. Discuss the evolution of the teaching role of nurses. Recognize trends affecting the healthcare system in general and nursing practice in particular. Identify the purposes, goals, and benefits of client & staff/ student education. Compare the education process to the nursing process. Define the term education process, teaching, and learning. Identify the hallmarks of effective teaching. Discuss the barriers to education and obstacles to learning. Differentiate learning theories to health care practice

Teaching is a major aspect of the nurses professional role (Carpenter & Belle, 2002). Trend: clients be prepared to assume responsibility for self-care management.

HISTORICAL FOUNDATIONS FOR THE TEACHING ROLE OF NURSES: Patient education has long been considered a major component of standard of care given by nurses. The role of the nurse as educator is deeply entrenched in the growth & development of the profession. Mid-1800s when nursing was first acknowledge as a unique discipline, the responsibility for teaching has been recognized as an important role of nurse as caregivers. The focus of teaching has not only been promoting the health of the well public; but also on educating nurses for future professional practice. Florence Nightingale, the founder of modern nursing was the ultimate educator. By the 1900s, public health nurses clearly understood the significance of the role of the nurse as teacher in preventing disease and in maintaining the health of the society (Chachkes & Christ, 1996). For decades, then, the patient teaching has been recognized as an independent nursing function. As early as 1918, the National League of Nursing Education (NLNE) in the US [now the National League for Nursing (NLN)] observed the importance of health teaching as a function within the scope of nursing practice. Two decades later, this organization recognized nurses as agents for the promotion of health and the prevention of illness in all settings in which they practiced. NLNE identified course content in nursing school curricula to prepare nurses to assume the role as teachers of others. Today, all state nurse practice acts (NPAs) include teaching within the scope of nursing practice responsibilities. Nurses are expected to provide instruction to consumers to assist them to maintain optimal levels of wellness and manage illness.

In addition, the Patients Bill of Rights, first developed in the 1970s by the American Hospital Association, has been adopted by hospitals nationwide. It establishes the guidelines to ensure that patients receive complete and current information concerning their diagnosis, treatment, and prognosis in terms they can reasonably be expected to understand. 1998, Recommendations for the practice of nursing: Provide clinically competent and coordinated care to the public Involve patients and their families in the decision-making process regarding health interventions Provide clients with education and counseling on ethical issues. Expand public access to effective care Ensure cost-effective & appropriate care for the consumer Provide for prevention of illness and promotion of healthy lifestyles As described by Grueninger 1995, this transition toward wellness has entailed a progression from disease-oriented patient education(DOPE) to prevention oriented patient education(POPE). This new approach has changed the role of nurse from one of wise healer to expert advisor/teacher to facilitator of change The key to success of our profession is for nurses teach other nurses. We are primarily educators of our colleagues and other healthcare staff personnel (Donner, Levonian & Slutsky, 2005).

Purpose, Goals, and Benefits of Client and Staff Education: The purpose of patient education is to increase the competence and confidence of clients for self-management. This can be achieved by supporting patients through the transition from being invalids to being involved participants, from being dependent recipients to being involved participants in the care process, from being passive listeners to active learners (Cipriano, 2007). Effective teaching by the nurse has demonstrated the potential to: Increase consumer satisfaction Improve quality of life Ensure continuity of care Decrease client anxiety Effectively reduce the complications of illness & the incidence of disease Promote adherence of treatment plans Maximize independence in the performance of activities of daily living Energizes and empower consumers to become actively involved in planning of their care

THE EDUCATION PROCESS DEFINED Education Process is a systematic, sequential, logical, scientifically based, planned course of action consisting of two major interdependent operations, teaching and learning. - this process forms a continuous cycle that also involves two interdependent players, the teacher and the learner. - The education process has always been compared to the nursing process rightly so, because the steps of each process run parallel to one another, although they have different goals and objectives. - The education process, like nursing process consists of the basic elements of assessment, planning, implementation and evaluation. - The two are different in that the nursing process focuses on the planning and implementation of care based on the assessment and diagnosis of the physical and psychological needs of the patient. The education process, on the other hand focuses on the planning and implementation of teaching based on an assessment and prioritization of the clients learning needs, readiness to learn, and learning styles (Carpenter & Belle, 2002). Teaching or Instruction the actual act of teaching or instruction is merely one component of the education process. - Are deliberate interventions that involve sharing information and experiences to meet the intended learner outcomes in the cognitive, affective and psychomotor domains according to the educational plans. - Are often formal, structured, organized activities prepared days in advance, but they can be performed informally on the spur of the moment during conversations or incidental encounters with the learners. - Teaching and instruction are nevertheless deliberate and conscious acts with the objective of producing learning (Carpenter & Belle, 2002). - The cues that someone has the need to learn can be communicated in a form of a verbal request, a question, a puzzled or confused, a blank stare, or a gesture of defeat or frustration. Learning a change in behavior (knowledge, attitudes, and or skills) that can be observed or measured and that occur at any time or in any place as a result of exposure to environmental stimuli. The success of the nurse educators endeavors at teaching is measured not by how much content has been imparted, but rather by how much the person has learned (Musinski, 1991).

Patient Education is a process of assisting people to learn health-related behaviors that can be incorporated into everyday life with the goal of optimal health and independence in self-care. Staff education is the process of influencing the behavior of nurses by producing changes in their knowledge, attitudes, and skills to help nurses maintain and improve their competencies for the delivery of quality care to the consumer. A useful paradigm to assist nurses to organize and carry out the education process is the ASSURE model (Rega, 1993). The acronym stands for: Analyze the learner State the objectives Select the instructional methods and materials Use the instructional methods and materials Require learner performance Evaluate the teaching plan and revise as necessary

ROLE OF THE NURSE AS EDUCATORS Teaching is an essential responsibility of all registered nurses in caring for both well and ill clients. For nurses to fulfill the role of educator, no matter whether their audience consists of patients, family members, nursing students, nursing staff, or other agency personnel, they must have a solid foundation in the principles of teaching and learning. The role of educator is not primarily to teach, but to promote learning and provide for an environment conducive to learning to create the teachable moment rather than just waiting for it to happen (Wagner & Ash, 1998). A learner cannot be made to learn, but an effective approach in educating others is to actively involve learners in the education process (Bodenheimer et al., 2002). Effective education and learner participation go hand in hand. No longer should teachers see themselves as simply transmitters of content. Indeed the role of educator has shifted from the traditional position of being the giver of information to that of a process designer and coordinator. The teacher becomes the guide on the side, assisting the leaner in his or her effort to determine objectives and goals for learning with both parties being active partners in decision making throughout the learning process.

Hallmarks of Good Teaching: Effective Teaching in Nursing Jacobson (1966) delineated six major categories of effective teaching in nursing: 1. Professional Competence - Teacher who enjoys nursing, shows genuine interest in patients, & displays confidence in his or her professional abilities is rated high. - The teacher who is creative and stimulating can excite student interest in nursing, can demonstrate clinical skills with expertise is also valued ()Benor& Leviyof, et al. 1997) - The teacher who aims at excellence develops a thorough knowledge of subject matter and polishes skills throughout his or her career. - Learners need to know that they can trust the clinical expertise of the teacher, that information given is accurate, and skills are being demonstrated correctly. - A teacher who portrays excellent clinical skills and judgment becomes a positive role model for learners. - Part of building trust is for the teacher to also admit to errors and weaknesses in practice, if any. 2. Interpersonal Relationships - This a skill is demonstrated by taking a personal interest in learners, being sensitive to their feelings and problems, conveying respect for them, alleviating their anxieties, being accessible for conferences, being fair, permitting learners to express differing points of view, creating an atmosphere in which they feel free to ask questions, and conveying a sense of warmth (Berg & Lindseth, et al. 2004). - Studies indicate that students actually learn more in classrooms and clinical settings where the teachers are student oriented and emphatic (Cook, 2005; Rogers 1996). - Todays student is tomorrows colleague. 3. Teaching Practices - The mechanics, methods, and skills in classroom and clinical teaching (Jacobson, 1996). - Students and colleagues value a teacher who has a thorough knowledge of the subject matter and can present material in an interesting, clear, and organized manner (Berg & Lindseth, 2004, et al.) 4. Personal Characteristics - Qualities such as authenticity, enthusiasm, cheerfulness, self-control, patience, flexibility, a sense of humor, a good speaking voice, self-confidence, and a caring attitude are all desirable personal characteristics of teachers (Berg & Lindseth, 2004 et al.) - Students value these personal qualities because they make learning more interesting, fun, or pleasant. 5. Evaluation Process Valued by students include clearly communicating expectations, providing timely feedback on students progress, correcting students tactfully, being fair in the evaluation

process, and giving tests that are pertinent to the subject matter (Benner & Leviyof, 1997 et al.) - Fairness in evaluation is a rather subjective phenomenon. What is fair to me may not seem so to you. However complaints of unfairness can be minimized if evaluation is based on published criteria and if those criteria are pertinent to the learning objectives. 6. Availability to Students - Nursing students, especially those taking clinical courses, expect the instructor to be available to them when needed. - this may take the form of being there in stressful clinical situations, physically helping students give nursing care, giving appropriate amounts of supervision, freely answering questions, and acting as the resource person during clinical learning experience (Fairbrother,1996; Kotzabassaki et al., 1997)