Nurse as Educator

The nurse must identify the information learners need as well as consider their readiness to learn and their styles of learning Educator serve as facilitator in helping the learner become aware of what needs to be known, the value of knowing, and how to be actively involved in acquiring information Assessment permits the educator to facilitate the process of learning by arranging experiences within the environment that assist the learner to find purpose, the will and the most suitable approaches for learning Educator is vital in giving support, encouragement and direction during the process of learning

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Learning Style how the learner best learns

LEARNING NEEDS
gaps in knowledge that exist between a desired level of performance and the actual level of performance gap between what someone knows and what someone needs or wants to know (gaps exist because of a lack of knowledge, attitude and skill) learning needs must be identified o that an instructional plan can be designed to address any deficits in the cognitive, affective or psychomotor domains education to begin at a point suitable to the learner rather than from an unknown or inappropriate place significant differences have been found to exist between the perception of needs identified by patients vs. The needs identified by the nurses caring for them

Crucial Role in Education Process

Assessing problems and deficit (through observation, interview) Providing important information presenting it in unique ways (give must know information because they are meaningful to them) Identifying progress being made Giving feedback and follow- up Reinforcing learning in acquisition of new knowledge, skills and attitudes Evaluating learners abilities (evaluating if you need to adjust teaching strategies)

IMPORTNT STEPS IN ASSESSING LEARNING NEEDS

1. Identified the learner Who is the audience? Is there more than one learner? Are their congruent or diverse? 2. Choose the right setting Establishing a trusting environment: o Learners feel a sense of security in confiding information o Learners believe their concerns are taken seriously o Learners considered important and feel respected Assuring privacy and confidentiality is essential 3. Collect data about the learner The nurse must explore typical health problems and issues of interest to that kinds of population Identifying the type and extent of content to be included in teaching sessions as well as the educational strategies for teaching a specific population based on the analysis of needs Patient and family members (most important source of assessment data) Allow what is important to them, how their support system can help and what assistance they can provide Actively engaging learners in defining their own problems and needs motivates them to learn because they have an investment in planning for a program specifically tailored to their unique circumstances 4. Involve members of the healthcare team Nurses are not the sole teachers and they must remember to collaborate with other members of the healthcare team for a richer assessment of learning needs Consult with other professional to gain insight into the needs of patients and their families

Assessment of the Learner

First and most important step in instructional design (but it is step most likely to be neglected) Individualizing teaching based on prior assessment improves patient outcomes Effectiveness of nursing care clearly depends on scope, accuracy and comprehensiveness of assessment prior to interventions Initial step that validates the need for learning and the approaches to be used in designing learning experiences Assessment of all 3 determinants should be based on theories, concepts and principles Assessment assist in identifying and prioritizing behavioural goals and objectives that provides background for selecting correct instructional intervention and in evaluating if learning has occurred Good assessment ensure that the best possible learning takes place with the least amount of stress and anxiety for the patient Assessment prevents needless repetition of known material, save time and energy on the part of both learner and the educator to increase the motivation to learn by focusing on what the patient feels is most important to know or to be able to do

Three Determinants
1. Learning Needs what the learner needs and wants to learn. Readiness to Learn when the learner is receptive to learning

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Collaborate with different associations that are excellent sources of health- related information 5. Prioritize needs Maslows Hierarchy of Needs may help the educator in prioritizing : learning needs are attended first and foremost before higher needs can be met Not all learners need to know everything

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CRITERIA:
1. Mandatory must to know Learning needs must be met immediately e.g. positioning post- operative maintaining NPO Desirable needs to know Needs are related to the overall ability to provide quality care in situations and not life dependent e.g. deep breathing post- operative Possible nice to know Not essential or required in which the learning need is not directly related to daily activities 5. 6. Take time- management issues into account TIME- SAVERS: o Do good initial assessment o Learners must be given time to offer their own perceptions of their learning needs by actively involved in education process o Assessment can be made anytime and anywhere (e.g. giving a bath, serving a meal, making rounds, distributing meds) o Informing someone ahead of time o Minimizing interruptions and distractions during planned assessment interviews 6. 4.

Self Administered Questionnaires Checklists are one of the most common forms of questionnaires Easy o administer, provide more privacy than interviews and yields east to tabulate data Checklist reflect what the nurse perceives as needs there should be a space for the learner to add any other items of interest or concern Observations Observing health behaviour in several different time periods can help to determine conclusions about established patterns of behaviour Actually watching the learner perform skill more than once is an excellent way of assessing a psychomotor need Reflection on Action learners who observe themselves performing a skill that is videotaped can more easily identify their learning needs Patient Charts Physicians Progress Notes, NCP, Nurses Notes and Discharge Planning Forms can provide information on the learning needs of the learner Nurse needs to follow a consistent format from chart to chart so that each chart is reviewed in the same manner to identify leaning needs based on some information Documentation of other healthcare team can yield valuable insights with respect to the needs of the learner Focus Groups Involve 4 to 12 potential learners to determine areas of educational needs by using group discussion to identify POV or knowledge about certain topic Learners should be homogeneous with similar characteristics such as age, gender, and past experiences with the topic under discussion Ideal during the initial stage of information gathering to provide qualitative data for a complete assessment of learning needs Tests Giving written pretest before teaching can help identify the knowledge levels of potential learners regarding a particular subject and assist in identifying their specific learning needs This approach prevents the educator from repeating already known material in teaching plan Pretest helped to determine whether learning has taken place by comparing pretest and posttest scores Educator must always consider the reported characteristics of self-

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Methods to Assess Learning Needs

1. Casual Conversations Learning needs will be discovered during impromptu conversation Nurse must rely on active listening Open - ended questions will encourage learners to reveal information about what they perceive their learning needs to be Structured Interviews Most common form on needs assessment to solicit learners POV Ask the learner direct and often predetermined questions to gather information about learning needs Establish a trusting environment Use open ended questions Choose a setting that is free of distractions All the learner to state what are believed to be the learning needs Telephone is a good tool to use for an interview if it is impossible to ask Qs in person

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administered questionnaire or test before using it Educator needs to consider the purpose, conceptual basis, development and psychometric properties when evaluating adequacy of any test

Health Status
Assess if the learner is well, acutely ill, or chronically ill Healthy learners have energy available for learning- desire to learn on both preventive and promotion measures Acutely Ill- tend to focus their energies on the physiological and psychological demands of their illness o Observe energy levels and comfort status o Medications and its side effects reduce task- handling capacity o IMPROVEMENT- more receptive to learning Chronically Ill no time limits and is of longterm duration o If the learner is on the avoidance stage, readiness to learn will be limited to simple explanations because patients energy concentrated on denial o Patients asks Qs (ready to learn)

READINESS TO LEARN
The time when the learner demonstrates interest in learning the information necessary to maintain optimal health or to become more skillful in a job Patient ask Qs time is prime for learning Occurs when the learner is receptive, willing and able to participate in the learning process TIMING is important the point at which teaching should takes place

Four Types of Readiness to Learn

Which may be obstacle or enhancers to learning, must be taken into consideration P hysical Readiness E motional Readiness E xperential Readiness K nowledge Readiness

Gender
WOMEN o More receptive to medical care and take fewer risk to their health o More open to health promotion teaching o More frequent contacts with HCP while bearing and raising children MEN o Tend to be less receptive to healthcare interventions and more likely to be risk takers

PHYSICAL READINESS

Measures of Ability
Ability to perform task requires fine/ gross motor movement, sensory acuity, adequate strength, flexibility coordination and endurance Create a stimulating and accepting environment by using instructional tools to match learners physical and sensory abilities will encourage readiness to learn e.g. person has visual deficit, eyeglasses or magnifying glass should be available to allow learner to see the lines in the insulin syringe

EMOTIONAL READINESS

Anxiety Level
Impacts on the patients ability to concentrate and retain information Influences the ability to perform at KSA level May or may not be hindrance to the learning of new skills Moderate level of anxiety is best for success in learning and considered the optimal time for teaching Fear is major contributor of anxiety and lead patients to deny their illness which interferes their ability to learn if a situation is life- threatening or overwhelming, anxiety will be high and readiness to learn diminished ! Nurse must identify first the source and level of anxiety

Complexity of Task
the more complex the task, the more difficult it is to achieve Once ingrained, psychomotor, cognitive and affective become habitual and may difficult to alter e.g. learner has been performing a psychomotor skill over a long period of time and then the procedural steps of the task change, the learner will need to unlearn those steps and relearn a new way

Support System
Availability and strength of a support system and are closely tied to how anxious someone might feel Social support is important in buffering the effects of stressful events A strong support system can decrease anxiety while the lack one increase anxiety level Reachable moment allows for mutual exchange of concerns and sharing a possible

Environmental Effects
Environment conducive to learning will help to keep the learners attention and stimulate interest Intermittent noise tends to have greater disruptive effects rather than more rapidly habituated steady- state noise

interventions option without the nurse being inhibited by prejudice or bias when the learner feels emotionally supported, the stage is set for the teachable moment, when the learner will be most receptive to learning

ASSESS whether previous learning experiences have been positive or negative in overcoming problems or accomplishing new tasks

Motivation
Willingness to take action Ascertain the level of motivation Interest in teacher- learner interaction is a cue to motivation Shows interest by: o Demonstrating a willingness to participate o Ask Qs

Level of Aspiration
The extent to which someone is driven to achieve is related to the type of short- and long- term goals established by the learner SATISFACTION elevates the level of aspiration and increases the probability of continued performance output in undertaking future endeavours to change behaviour

Risk- Taking Behavior

Taking intrinsic in the activities people perform daily Educator can assist patients to develop strategies that help reduce the risk of their choices Educator must be willing to teach patients how to recognize certain body symptoms and then what to do if they have them (participating in activities that may shorten the life span) 1. Decision has to be made to take the risk 2. Develop strategies to minimize the risk 3. Develop worst, best and most probable scenario 4. Decide whether worst- case scenario developed is acceptable

Past Coping Mechanism

Coping mechanism must be explored to understand how the learner has dealt with previous problems MUST Determine if past coping mechanism strategies are effective

Cultural Background
Avoid teaching in opposition to cultural beliefs Building on the learners knowledge base or belief system unless it is dangerous to wellbeing ASSESS whether the learner understands English well enough to be able to express himself so others will understand Teaching should not be started unless you have determined that the learner understands you and you have an understanding of the learners culture

Frame of Mind
Involves concerns about the here and now vs. the future If survival is the primary concern, R.O.L will be focused on the present to meet the basic human needs

Locus of Control
Ascertain the learners previous life patterns of responsibility and assertiveness Internal Locus of Control o Learners are internally motivated to learn o Ready to learn when they feel they need to know something o Asking Qs External Locus of Control o Externally motivated o Someone other than themselves must encourage a feeling of wanting to know something (educator)

Developmental Stage
Each task can be associated with human development produces a peak of time (teachable moment) ADULT o Strongly driven to learn information that will help them to cope better with the real- life tasks and build on meaningful past experiences CHILDREN o Desire to learn for learning sake and actively seek out experiences that give the pleasure and comfort

Orientation
Tendency to adhere to a parochial or cosmopolitan POV Parochial Orientation o Tend to be more close minded in their thinking o More conservative in their approach to situations o Less willing to learn new materials o Place the most trust in traditional figures (physician) Cosmopolitan Orientation

EXPERENTIAL READINESS
Refers to the learners past experiences with learning

o More worldly perspective on life due to broader experiences outside their immediate spheres of influences o More likely to be receptive to new ideas and to opportunities to learn new ways of doing things o Not to stereotype individuals

SIX LEARNING STYLE PRINCIPLES

1. Both the style by which the educator prefers to teach and the style by which the learner prefers to learn can be identified Understanding ones own learning style offers specific clues as to the way a person learns 2. Educators need to guard against relying on teaching methods and tools that match their own preferred learning styles It is much easier to change teaching approaches than for learners adapt to the educators style 3. Educators are most helpful when they assist learners in identifying and learning through their own style preferences Making learners aware of their individual style preferences will lead to an understanding of which teaching- learning approaches work best for them 4. Learners should have the opportunity to learn through their preferred style Educator can provide the means by which each learner can experience successful learning 5. Learners should be encouraged to diversify their style preferences The more frequently learners are exposed to different methods of learning, the less stressful those methods will be in future learning situations 6. Educators can develop specific learning activities that reinforce each modality or style Awareness of various methods and materials available is the key to address and augment different learning styles

KNOWLEDGE READINESS

Present Knowledge Base

Educator must always find out what the learner knows prior to teaching and build on this knowledge base Educator must consider how much information the patient wants to receive

Cognitive Ability
Extent to which information can be processed Educator must match the level of behavioural objectives to the cognitive ability of the learner Be sure to make information meaningful to those with cognitive impairments by teaching at their level and communicating in ways that the learner will be able to understand Enlisting the help of members of the patients support system by teaching them requisite skills with allow them to positively contribute to the reinforcement of selfcare activities

Learning and Reading Disabilities

May be accompanied by low- level reading skills Will require special or innovative approaches to instruction to sustain or bolster readiness to learn

THREE MECHANISM
1. Observation Educator can ascertain how the learner grasps information and problem solves Interviews Educator asks the learner about preferred ways of learning as well as the environment most comfortable for learning Administration of Learning Style Instruments

Learning Styles
Assess how someone learns best and likes to learn will help the educator to select teaching approaches accordingly

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LEARNING STYLES
Refers to the ways in which and conditions under which, learners most efficiently and most effectively perceive, process, store and recall what they are attempting to learn and how they prefer to approach different learning tasks o Accepting diversity of style can help educator create an atmosphere for learning that offers experiences that encourage each individual to reach his full potential

Learning Style Models And Instruments

1. Right Brain/ Left Brain and Whole Brain Thinking The BRAIN operates in many ways as who brains, with each hemisphere having separate and complementary functions ---Dr. Roger Sperry Left Hemisphere: o Vocal and Analytical Side Verbalization Reality- based & Logical Thinking

Right Hemisphere o Emotional, Visual- Spatial, Non- verbal Side Thinking processes Intuitive, Subjective, Relational, Holistic and Time- Free Corpus Callosum o Connector between the two hemispheres for the learners to able use both sides of the brain Brain Hemisphericity o Linked to cognitive learning style or the way individuals perceive and gather information to problem solve, complete assigned tasks, relate to others, and meet the daily challenges of life o Neuroimaging methods provide the educator with knowledge on how the brain works such as PET (Positron Emission Tomography) and fMRI (functional Magnetic Resonance Imaging) Whole- brain Thinking o Allows the learner to get of both worlds in developing his/ her thought processes Duality of Thinking o What educators should strive to teach to encourage learners to reach their full learning potentials

INSTRUMENTS
1.Brain Preference Indicator (BPI) Set of Qs used to determine hemispheric functioning Reveals a general style of thought that results in a consistent pattern of behaviour in all areas of the individuals life Provide a starting point for the educator 2.Herrmann Brain Dominance Instrument (HBDI) Quadrant A o Left Brain, Cerebral o Logical, analytical, factual, quantitative, critical Quadrant B o Left Brain, Limbic o Sequential, organized, planned, detailed, structured Quadrant C o Right Brain, Limbic o Emotional, interpersonal, sensory, kinesthetic, symbolic Quadrant D o Right Brain, Cerebral o Visual, holistic, innovative