Instructional Methods and Settings
Kathleen Fitzgerald
Kara Keyes
CHAPTER HIGHLIGHTS
Instructional Methods
Lecture
Group Discussion
One-to-One Instruction
Demonstration and Return Demonstration
Gaming
Simulation
Role Playing
Role Modeling
Self-Instruction
Selection of Instructional Methods
Evaluation of Instructional Methods
Increasing Effectiveness of Teaching
Techniques to Enhance the Effectiveness of Verbal Presentations
General Principles for Teaching Across Methodologies
Instructional Settings
Sharing Resources Among Settings
State of the Evidence
KEY TERMS
instructional strategy
instructional method
lecture
group discussion
team-based learning
cooperative learning
case studies
seminars
one-to-one instruction
demonstration
return demonstration
gaming
simulation
role playing
role modeling
self-instruction
skill inoculation
pacing
instructional setting
healthcare setting
healthcare-related setting
non-healthcare setting
OBJECTIVES
After completing this chapter, the reader will be able to
Define the term instructional method.
Explain the various types of instructional methods.
Describe how to use each method effectively.
Identify the advantages and limitations of each method.
Discuss the variables that influence the selection of the various methods.
Recognize techniques to enhance teaching effectiveness.
Explain how to evaluate instructional methods.
Classify instructional settings according to the primary purpose of the organization or agency in which the nurse functions as educator.
After an excellent presentation, you might have heard someone comment, “Now, there is a born teacher!” This comment would seem to indicate that effective teaching comes automatically. In reality, teaching effectively is a learned skill. Development of this skill requires knowledge of the educational process, including which instructional methods to use in which circumstances. The determination of which instructional method is most appropriate depends on a variety of differences: the age and developmental level of the learners; what the learners already know and what they need to know to succeed; the subject-matter content; the objectives for the learner; the available people, time, space, and material resources; and the physical setting.
Stimulating and effective educational experiences are designed, not accidental. An instructional strategy is the overall plan for a teaching-learning experience that involves the use of one or several methods of instruction to achieve the desired learning outcomes (Rothwell & Kazanas, 2008).
An instructional method is the way information is taught that brings the learner into contact with what is to be learned. Examples of such methods include lecture, group discussion, one-to-one instruction, demonstration and return demonstration, gaming, simulation, role playing, role modeling, and self-instruction modules. As the use of technology evolves, these methods may be incorporated into Web-based courses (Cook et al., 2008).
Instructional materials or tools, in contrast, are the objects or vehicles used to transmit information that supplement the act of teaching. An audience response system (ARS), books, videos, podcasts, and posters are examples of materials and tools that serve as adjuncts to communicate information. It is important to draw this distinction between the terms instructional methods and instructional materials because they often are used interchangeably by educators and not dealt with as distinctly separate entities—although they should be, when planning an educational activity.
This chapter reviews the types of instructional methods available and considers how to choose and use them most efficiently and effectively. In doing so, the advantages and limitations of each method, the variables influencing the selection of various methods, and the approaches for evaluating the methods are identified to improve the delivery of instruction. In all types of situations and settings, nurses are expected to teach to a variety of audiences. This chapter provides application
examples throughout to enhance teaching and learning experiences. Settings in which the nurse educator functions also are highlighted.
examples throughout to enhance teaching and learning experiences. Settings in which the nurse educator functions also are highlighted.
INSTRUCTIONAL METHODS
There is no one perfect method for teaching all learners in all settings. Also, no one method is necessarily more effective for changing behavior in any of the three learning domains. Whatever the method chosen, to optimize learning it usually is most effective if used in conjunction with other instructional techniques and tools.
Employing a variety of instructional methods and materials improves retention rates and positively affects learner outcomes (Ridley, 2007). The importance of selecting appropriate methods to meet the needs of learners should not be underestimated. The popular Chinese proverb “Tell me; I forget. Show me; I remember. Involve me; I understand.” (author unknown) clearly implies that information retention rates vary with different teaching methods and that using alternative approaches for interactive teaching has the potential to improve learning outcomes (Ridley, 2007).
The nurse educator functions in the vital role of facilitator by providing guidance and support for learning (Musinski, 1999). Even though an educator may tend to rely on one teaching method, he or she rarely adheres to that single method in a pure fashion, but rather often uses it in combination with various methods. For example, an educator may use lecture as the primary teaching format, but intersperse opportunities for question-and-answer periods and short discussion sessions throughout the lecture.
Decisions about which methods to use must be based on a consideration of such major factors as the following:
Audience characteristics (size, diversity, learning style preferences)
Educator’s expertise
Objectives of learning
Potential for achieving learning outcomes
Cost effectiveness
Instructional setting
Evolving technology
These and many other variables are addressed in the following review of the instructional methods available for teaching and learning.
Lecture
Lecture can be defined as a highly structured method by which the educator verbally transmits information directly to a group of learners for the purpose of instruction. It is one of the oldest and most often used approaches to teaching.
The word lecture comes from the Latin term lectura, which means “to read.” The lecture method has been much maligned in recent years because in its purest form, the lecture format allows for only minimal exchange between the educator and the learner. Also, critics of the lecture method have expressed particular concern about the passive role of learners (DeYoung, 2008). However, as Brookfield (2006) points out, “An abused method calls into question the expertise of those abusing it, not the validity of the method itself” (p. 99).
Thus, if a lecture is well organized and delivered effectively, it can be a very useful method of instruction (Bain, 2004; Bartlett, 2003; Brookfield, 2006; Woodring & Woodring, 2007). The lecture format can demonstrate patterns, highlight main ideas, and present unique ways of viewing information, such as introducing an agency’s mission statement to new nursing staff orientees or explaining diabetes mellitus to a group of lay people. The lecture should not be employed, however, to give people the same information that they could read independently at another time and place. It is the lecturer’s expertise, both in theory and in experience, that can substantially contribute to the learner’s understanding of a subject.
The lecture is an ideal way to provide foundational background information as a basis for subsequent group discussions. Also, it is a means to summarize data and current research findings not available elsewhere (Boyd, Gleit, Graham, & Whitman, 1998; Brookfield, 2006). In addition, the lecture can easily be supplemented with handout materials and other audiovisual aids.
Lecturing is an acquired skill that is learned and honed over time, and it is a more complex task than commonly thought (Young & Diekelmann, 2002). Specific strategies exist to strengthen the effectiveness of a lecture (Cantillon, 2003).
According to Silberman (2006), five approaches to the effective transfer of knowledge during a lecture are the following:
Use an opening summary. At the beginning of the lecture, present major points and conclusions to help students organize their listening.
Present key terms. Reduce the major points in the lecture to key words that act as verbal subheadings or memory aids.
Offer examples. When possible, provide real-life illustrations of the ideas in the lecture.
Use analogies. If possible, make a comparison between the content of the lecture and knowledge that the learners already have.
Use visual backups. Use a variety of media to enable learners to see as well as hear what is being said.
Each lecture should include three main parts: introduction, body, and conclusion. These three parts are described in the following subsections (Miller & Stoeckel, 2011; Woodring & Woodring, 2007).
INTRODUCTION
During the introduction phase of a lecture, the educator should present learners with an overview of the behavioral objectives pertinent to the lecture topic, along with an explanation as to why these objectives are significant. The use of set (the opening to a presentation) can engage attention and focus the group on the speaker, which sets the stage for learners to be ready to listen (Kowalski, 2004). This technique of set captures attention, clarifies goals and objectives, motivates the learner, and demonstrates the relevance of the content in a way that can stimulate the interest of learners in the subject. For example, prior to a lecture on creative problem solving, the speaker might ask each member of the audience to solve a puzzle that requires them to think in a different manner (Kowalski, 2004). Educators might also engage learners’ attention by conducting an informal survey or stating the objectives as questions that will be answered during the body of the lecture.
If the occasion is one of a series of lectures, the educator needs to make a connection with the overall subject and the topic being presented as well as explicate its relationship to previous topics covered and both prior lectures and those that will follow. Lastly, the educator should establish a rapport with the audience by letting his or her personality shine through and by using humor, if appropriate.
BODY
The next portion of the lecture involves the actual delivery of the content related to the topic being addressed. Careful preparation is needed so that the important aspects are covered in an organized, accurate, logical, cohesive, and interesting manner. Examples should be used throughout to enhance the salient points, but extraneous facts and redundant examples should be avoided so as not to reduce the impact of the message. Because the lecture format tends to be a passive approach to learning, the educator can enhance the effectiveness of the presentation by combining it with other instructional methods, such as discussion or question-and-answer sessions, to enhance active learner participation.
CONCLUSION
The educator should always include a wrap-up with every lecture. This final section of the lecture format is reserved for summarizing the information provided in the presentation. At this juncture, the educator can review the major concepts presented. Try to leave some time for questions and answers. During the question-and-answer time, the educator should repeat the questions asked so that the rest of the audience can hear them and understand the response. If time runs short, the educator can limit the question-andanswer forum to a few queries, but then welcome immediate follow-up by meeting with interested individuals alone or in a smaller group or by suggesting relevant readings.
The educator’s speaking skills also are important to the delivery of a lecture. According to Jacobs (2009), the following variables of speech need to be considered:
Volume
Rate
Pitch/tone
Pronunciation
Enunciation
Proper grammar
Avoiding annoying habits such as the use of “ums”
Not only are speaking skills important, but body language should also be considered. Presentation skills that lecturers can employ include the following:
Demonstrate enthusiasm.
Make frequent eye contact with audience.
Use posture and movement.
Convey self-confidence.
Convey professionalism.
Use gestures.
Avoid repetitive movement.
Rely on head and hands to emphasize points and to keep the audience’s attention.
Nervous or inexperienced educators should practice first before a mirror, a video camera, or a colleague (Germano, 2003). They should outline just the key points of their presentation on index cards, handouts, overhead projections, or PowerPoint slides. During the actual lecture, they can use this outline information to elaborate on the topic by giving examples and further explanations. Reading a printed copy of the entire presentation word for word is exceedingly boring and is a sure way to turn off the audience.
Educators should address a large audience as if speaking to an individual listener (Woodring & Woodring, 2007). Also, they should move around the stage or room and vary their presentation style and tone of voice to avoid monotony. Demonstrating enthusiasm, expertise, and interest in the topic will capture and hold the audience’s attention. Finally, educators should be sure to keep within the time allotted. Lectures of long duration can result in loss of attention and boredom on the part of the learners.
The use of audiovisual materials, such as a video, a podcast, an audience response system, or PowerPoint slides, can also add variety to a lecture. The widespread availability of technology makes it easy to enhance a presentation—but only if the technology is used wisely. When developing PowerPoint slides, for example, educators should adhere to the following general guidelines (Evans, 2000):
Do not put all content on slides, but include only the key concepts to supplement the presentation.
Use the largest font possible.
Do not exceed 25 words per slide.
Choose colors that provide a high level of contrast between background and text if presenting in a large room with bright lights.
Use graphics for presenting large amounts of numerical data.
Do not overdo the use of animation, which can be very distracting to the audience.
Overall, it is important to keep the following caveats in mind: Make sure that the visual aids are large enough and positioned well enough for all to see, and keep them simple and easy to understand (Jacobs, 2009).
Thanks to new technologies, lectures are now being delivered to an ever wider variety of learners in locations remote from one another. Distance learning is an ideal way to maximize resources and to transmit current information to people separated by space and time. Through this strategy, the cost, time, and inconvenience of travel no longer can keep an audience from meeting face-to-face with an expert (Cook et al., 2008).
Although the lecture method is considered efficient and cost-effective, the effort put into its design and delivery should not be determined just by calculating the educator-learner ratio of contact hours. Educators must take into consideration other factors, such as educator preparation time, the frequency with which the same material needs to be repeated to different audiences, and follow-up time required to individualize learning and evaluate outcomes. Table 11-1 highlights the major advantages and limitations of lecture as a method of instruction.
TABLE 11-1 Major Advantages and Limitations of Lecture | ||||
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Group Discussion
Group discussion, by definition, is a method of teaching whereby learners get together to exchange information, feelings, and opinions with one another and with the educator. Group discussion, as a broad active instructional method, can incorporate other specific types of instruction, such as guided learning, collaborative learning, small-group learning, team-based learning, cooperative learning, case studies, and seminars. Group discussion instructional methods such as team-based learning and cooperative learning may not be pertinent for client and family teaching but could be an effective strategy for staff
development and nursing students. In general, the benefits of group discussions are that they lead to deeper understanding and longer retention of information, increased social support, greater transfer of learning from one situation to another, more positive interpersonal relationships, more favorable attitudes toward learning, and more active learner participation (Brookfield, 2006; Johnson, Johnson, & Smith, 2007; Oakley & Brent, 2004; Springer, Stanne, & Donovan, 1999). As a commonly employed instructional technique, this method is learner centered as well as subject centered. Group discussion is an effective method for teaching in both the affective and cognitive domains (Springer et al., 1999).
development and nursing students. In general, the benefits of group discussions are that they lead to deeper understanding and longer retention of information, increased social support, greater transfer of learning from one situation to another, more positive interpersonal relationships, more favorable attitudes toward learning, and more active learner participation (Brookfield, 2006; Johnson, Johnson, & Smith, 2007; Oakley & Brent, 2004; Springer, Stanne, & Donovan, 1999). As a commonly employed instructional technique, this method is learner centered as well as subject centered. Group discussion is an effective method for teaching in both the affective and cognitive domains (Springer et al., 1999).
Group size is a major consideration in group teaching and should be determined by the chosen group discussion instructional method, the purpose or task to be accomplished, and concepts for application in practice situations. Group size can vary somewhat, but discussion is most effective with relatively small groups because learners are more cooperative and interactive (DeYoung, 2008). Small groups will allow learners to question the meaning of content and internalize the significance to practice (Feingold et al., 2012).
TEAM-BASED LEARNING
Team-based learning is an innovative and newly popular teaching method in nursing education. Team-based learning offers educators a structured student-centered learning environment (Mennenga, 2012). Team-based learning is meant to enrich the students’ learning experience through active learning strategies. According to Mennenga (2012), team-based learning uses a structured combination of preclass preparation, individual and group readiness assurance tests, and application exercises. According to Sisk (2011), team-based learning incorporates four key principles:
Forming heterogeneous teams
Stressing student accountability
Providing meaningful team assignments focusing on solving real-world problems
Providing feedback to students
Heterogeneous teams consist of 5 to 10 students, who work together as a team throughout the semester. The team members are required to be prepared for class and contribute to the team. Preparation is evaluated through individual quizzes given in the beginning of class that are handed in; the same quiz is then taken as a group. Team learning grades are assigned based on group performance, quiz grades, and peer evaluation (Sisk, 2011). Table 11-2 summarizes what team-based learning is, how it works, which rules govern its use, and how grading is accomplished.
COOPERATIVE LEARNING
The terms team-based learning and cooperative learning sometimes are used interchangeably. This is a reasonable response due to the interactive student participation observed with both methods. However, cooperative learning is the methodology of choice for transmitting foundational knowledge. Additionally, cooperative learning is distinguished by the instructor’s role, in which the instructor is the center of authority in the class, with group tasks usually more closedended and often having specific answers (Conway, 2011). Cooperative learning is a highly structured form of group work that focuses on problem solving that leads to deep learning and critical thinking. According to Millis (2010), cooperative learning includes four key components:
Extensive structuring of the learning tasks by the teacher
Strongly interactive student-student execution of the tasks
Immediate debriefing or other assessments to provide the teacher and students with
prompt feedback about the success of the intended learning
Instructional modifications by the teacher based on feedback
In the profession of nursing. the use of cooperative learning stresses the importance of foundational knowledge and understanding.
CASE STUDIES
The case study approach offers learners an opportunity to become thoroughly acquainted with a client situation before discussing client needs and identifying health-related problems. Case studies in the clinical practice arena lead to the development of analytical and problemsolving skills, exploration of complex issues, and application of new knowledge and skills. An example of the creative use of this teaching method with staff is arranging a panel presentation by clients who are coping with a specific disease or problem. Following the panel, a group session is most beneficial—in particular, for affective learning. This was found to be a useful approach to breaking down the negative stereotypes of persons living with AIDS on the part of some healthcare workers (Peters & Connell, 1991).
TABLE 11-2 Team Learning Handbook | |||||||||||||||||||||||||
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SEMINARS
Interactions in seminar groups are dominated by the posing of questions by the educator. The educational format of seminars consists of several sessions in which a group of staff nurses or students, facilitated by an educator, discuss questions and issues that emerge from assigned readings on a topic of practical relevance (Jaarsma et al., 2009). Seminars should be designed so that each learner reads an assignment and considers questions prior to the discussion; with such preparation, all learners can actively participate in
the discussion. The active engagement of sharing ideas and thoughts provides the learners with a deeper understanding of the content. When disagreements arise, students are expected to search for new explanations and new justifications of knowledge (Jaarsma et al., 2009).
the discussion. The active engagement of sharing ideas and thoughts provides the learners with a deeper understanding of the content. When disagreements arise, students are expected to search for new explanations and new justifications of knowledge (Jaarsma et al., 2009).
Preset behavioral objectives should be the focus when using guided, collaborative, and small-group discussions. These objectives guide the achievement of the learning outcomes for the interaction and should be presented at the beginning of each session. Careful adherence to them will prevent the discussion from becoming an aimless wandering of ideas or a forum for the strongest group member to expound on his or her opinions and feelings (Billings & Halstead, 2012). The group, functioning as a “dynamic whole,” motivates its members to move toward accomplishing one or more common goals (Johnson et al., 2007). The educator’s role is to act as a facilitator to keep the discussion focused and to tie important points together. The educator must be well versed in the subject matter to field questions, to move the discussion along in the direction intended, and to give appropriate feedback (Miller & Stoeckel, 2011).
Educator involvement and control of the process will vary with the needs of the group members. Group discussion requires the educator to be able to tolerate less structure and organization than other teaching methods, such as lecture or one-to-one instruction. In addition, the group itself must have some knowledge of the content before this method can be effective (Billings & Halstead, 2012); otherwise, the discussion will be based on pooled ignorance. For example, a group of staff with a significant amount of practical knowledge and expertise may need little input while they work out a complex client problem. In contrast, a new group of clients or family members with little understanding of a topic will need to access information directly from the educator or another source before they can meaningfully participate in problem solving integral to the discussion process.
No matter which group discussion method is used, the educator’s responsibility is to make sure that every member of the group has interpreted information correctly, because failure to do so will lead to conclusions based on faulty data. Although diversity within a group is beneficial, a wide range of literacy skills, states of anxiety, and experiences with acute and chronic conditions within the group may lead to difficulty in meeting any one member’s needs. For this reason, client groups need to be prescreened.
Carkhuff (1996), Musolino and Mostrom (2005), and Wainwright, Shepard, Harman, and Stephens (2010) address the reflection-on-action technique for workgroups as learning groups to develop the critical thinking skills of nursing staff in the workplace. With this approach, the educator facilitates staff in critically analyzing their actions and determining whether a viable alternative to their action exists. Such an approach helps learners “learn to learn.”
It is important for the educator to sustain trust within the group. Everyone must feel safe and comfortable enough to express his or her point of view. Harsh or sarcastic treatment resulting in insults will break down the relationship between the educator and the learners as well as relationships among learners, which creates an environment unsuitable for learning. One helpful approach is for the educator to tell the group at the beginning of the session that the goal is to hear from all members by asking for their input and points of view during the discussion period. Learners who digress from that goal should be requested to hold questions that can be handled privately until the end of class, because these inquiries are important but unique to their circumstances.
Respectful attention and tolerance toward others should be modeled by the educator and required of all group members. Of course, this consideration does not preclude correcting errors
or disagreements. A clear message must be given that while personal opinions may be debatable, the inherent value of what each member has to say and the member’s right to participate is guaranteed (Ridley, 2007).
or disagreements. A clear message must be given that while personal opinions may be debatable, the inherent value of what each member has to say and the member’s right to participate is guaranteed (Ridley, 2007).
Teaching people in groups rather than individually allows the educator to reach a number of learners at the same time. The group discussion method is economically beneficial from a timeefficiency perspective when compared with educating each learner individually. With healthcare costs rising, this method should be considered as an efficient and effective method to teach simultaneously a number of individuals who have similar learning needs, such as information to prepare for childbirth or cardiac bypass surgery. In a study on the effects of educational interventions on patient satisfaction, Oermann (2003) reported that a group of clients in a waiting room of an ambulatory care center were educated via a videotape about glaucoma, which was then followed by group interaction with a nurse to discuss key points and answer questions. This approach led to higher satisfaction with the education received during their visit.
Discussion is effective in assisting learners to identify resources and to internalize the topic being discussed by helping them to reflect on its personal meaning (Brookfield & Preskill, 2005). Through group work, members share common concerns and receive reinforcement from one another. The idea that “everyone is in the same boat” or “if one person can do it, so can the others” serves to stimulate motivation for learning as a result of peer support.
Group discussion has proved particularly helpful to clients and families dealing with chronic illness. This instructional method is most effective during the accommodation stage of psychological adjustment to chronic illness, because the interactions reduce isolation and foster identification with others who are in similar circumstances (Fredette, 1990). Discussion in a group offers members a forum in which to share information for cognitive growth as well as an opportunity to learn selfefficacy The resulting increase in the confidence levels of clients and families enhances their ability to handle an illness (Lorig & Gonzalez, 1993).
The group process informs people about how to respond to situations, improve their coping mechanisms, and explore ways to incorporate needed changes into their lives. Group self-management education for people with diabetes, for example, has been found in some instances not only to be more cost-effective but also to result in greater treatment satisfaction and to be slightly better in supporting lifestyle changes (Tang, Funnell, & Anderson, 2006). Table 11-3 highlights the main advantages and limitations of group discussion as a method of instruction.
TABLE 11-3 Major Advantages and Limitations of Group Discussion | ||||
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Be aware that third-party reimbursement for some types of group client education programs may be difficult to obtain when the traditional fee-for-service payment system is not in place. Nevertheless, these programs may be economically valuable in preventing hospitalization or reducing time in acute care. Documenting these benefits based on measurable outcomes can justify the importance of group discussion as a cost-effective method of instruction.
One-to-One Instruction
One-to-one instruction, which may be given either formally or informally, involves face-to-face delivery of information specifically designed to meet the needs of an individual learner. Educational strategies such as one-to-one instruction have a positive effect on client education and compliance (Vermeire, Hearnshaw, Van Royen, & Denekens, 2001). Formal one-to-one instruction is a planned activity, whereas informal one-to-one instruction is an unplanned interaction, such as capitalizing on a “teachable moment” that occurs unexpectedly when the client demonstrates a readiness to learn (Miller & Stoeckel, 2011). Such instruction offers an opportunity for both the educator and the learner to communicate knowledge, ideas, and feelings primarily through oral exchange, although nonverbal messages can be conveyed as well. Thus this method of teaching is a process of mutual interchange between the client and the health professional. It requires interpersonal skill and sensitivity on the part of the educator and the ability to establish rapport with the learner (Falvo, 2010).
One-to-one instruction should never be a lecture delivered to an audience of one to meet the educator’s goals. Instead, the experience should actively involve the learner and be based on his or her unique learning needs. Ideally, a one-to-one teaching session should be 15 to 20 minutes in length, and the educator should offer information in small, bite-sized portions to allow time for processing (Haggard, 1989). Research shows that the more information that is given at any one time, the less information that is remembered and correctly recalled. Thus effective communication depends more on the quality of the information presented than on the quantity to increase adherence to, and client participation in, a recommended plan of care (Kessels, 2003).
One-to-one instruction can be tailored to meet objectives in all three domains of learning. It begins with an assessment of the learner and the mutual setting of objectives to be accomplished (Burkhart, 2008). As part of the assessment process, it is very important to determine whether any problem behaviors exist, such as smoking, and at which stage of change the person is with
respect to dealing with such behaviors. Once this information is determined, the educator can tailor educational interventions to that stage (Prochaska, DiClemente, Velicer, & Rossi, 1993).
respect to dealing with such behaviors. Once this information is determined, the educator can tailor educational interventions to that stage (Prochaska, DiClemente, Velicer, & Rossi, 1993).
The stages of change model is generalizable across a broad range of behaviors, including but not limited to smoking cessation, weight control, avoidance of high-fat diets, safer sex, and exercise initiation (Prochaska et al., 1994). The following describes how nurse educators can focus their interactions to help a learner through the stages of change (Saarmann, Daugherty, & Riegel, 2000):
Precontemplation stage—provide information in a nonthreatening manner so that the learner becomes aware of the negative aspects or consequences of his or her behavior.
Contemplation stage—support decision making for change by identifying benefits, considering barriers to the change, and making suggestions for dealing with these obstacles.
Preparation stage—support a move to action by contracting with the learner in establishing small, realistic, and measurable goals; providing information on effective ways to achieve the desired change; and giving positive reinforcement.
Action stage—encourage constant practice of the new behavior to instill commitment to change by pointing out the benefits of each step achieved, providing rewards and incentives, and assisting the learner to monitor his or her behavior through the implementation of such strategies as keeping a food diary.
Maintenance stage—continue encouragement and support to consolidate the new behavior and prevent relapses.
For example, the client with a chronic problem such as obesity must consider the options available for weight control; only then can the client and the educator mutually design an action plan that the client thinks can be accomplished. This client’s confidence level can be assessed by asking on a scale of 0-10 how certain he is of achieving this goal. A score of 7 or higher makes it more likely he will be successful (Lorig, 2003).
Mutual goal setting is a very important first step to be undertaken between the educator and the learner. Contracting, which clearly spells out the roles and expectations of both educator and learner, is one effective way to facilitate mutual goal setting. Contracts should be written in specific terms and evaluated by both participants in the teaching-learning process.
Whenever teaching is done on a one-to-one basis, instructions should be specific and time should be given for an immediate response from the learner, followed by direct feedback from the educator. Allowing learners the opportunity to state their understanding of information gives the educator an opportunity to evaluate the extent of learning. Also, communicating to learners what further information is forthcoming allows them to connect what they have just learned with what they will be learning in the future (Falvo, 2010). For example, the nurse teaching a client about hypoglycemia might say, “Now that you understand what causes low blood sugar, we will talk about how to tell when you have it and what to do if you experience it after discharge.”
The process of one-to-one instruction involves moving learners from repeating the information that was shared to applying what they have just learned. In the preceding example regarding hypoglycemia, the nurse might offer the learner a hypothetical situation similar to what the client might experience given his lifestyle and have him work through how to respond to it. In this type of one-to-one exchange, a potentially threatening situation can be presented in a nonthreatening manner (Boyd et al., 1998). For instance, the educator might ask a busy executive who has diabetes how he would respond to feeling shaky and sweaty at 2:00 p.m. on a day when a meeting runs late and he misses lunch.
Educators should clearly state that these types of scenarios are not meant to be a test but rather a “dress rehearsal” for real-world situations. They can change the scenarios with further questioning to help learners plan how they could prevent such occurrences in the future. This technique gives learners a chance to use the information at a higher cognitive level and provides an opportunity for the nurse educator to evaluate the client’s learning in a safe environment.
With the one-to-one method of instruction, questioning is an excellent technique. It encourages learners to be active participants in the learning process and gives educators important feedback on their progress (Falvo, 2010). Questions can be matched with the behavioral objectives to be achieved. For example, to determine a client’s knowledge level in the cognitive domain, the educator might ask, “What is the next step that you should take?” For the higher level of synthesis in the cognitive domain, the nurse educator might ask a staff nurse to plan for how he or she would respond to an angry family member (Abruzzese, 1996).
Questioning should not be interpreted by the learner as a test of knowledge but rather as a way to exchange information and stimulate thinking. However, two problems can occur with questioning: (1) Questions can be so ambiguous that the learner does not know what the question is, or (2) they can contain too many facts to process effectively (House, Chassie, & Spohn, 1990). The educator should watch the learner’s nonverbal reactions and rephrase the question if he or she detects either of these problems. If the learner seems confused, it is helpful to state that perhaps the question was not clear. This technique guards against the learner feeling guilty or becoming discouraged if the answer to a question was incorrect (Falvo, 2010).
Also, it is important to give learners time to process information and respond to your questions. Sometimes educators are uncomfortable waiting in silence for an answer or are impatient and attempt to correct an answer before learners complete their responses. Questioning is ineffective as a technique when educators do not give learners enough time to process information. Preliminary interruption may further interfere with a learner’s thinking abilities and create a tense atmosphere.
Many nurse educators conduct individualized teaching of other nurses or student learners in the skills laboratory and clinical settings. Clinical instruction is not a discrete instructional method but rather can be an extension of one-to-one teaching in a very complex setting for experiential learning. Educators can use a variety of methods other than one-to-one instruction, such as role modeling, demonstration, return demonstration, and group discussion. However, one-to-one instruction very well may be involved as a teaching approach during new employee orientation, student preceptorship, or a continuing staff education activity. The learner is singularly guided in the actual practice setting, and each learning experience requires specific objectives, known to both the educator and the learner, that are tailored to meet the individual’s needs (Emerson, 2007; Gaberson & Oermann, 2007; O’Connor, 2006).
Preceptors who assume clinical teaching roles are usually expert clinicians but may not necessarily be expert educators. If this is the case, to carry out their roles effectively, they need to be taught how to be educators through workshops and coaching sessions. One-to-one instruction has many strengths as a teaching method, but it also has its drawbacks. Table 11-4 summarizes the major advantages and limitations of this method.
From an economic standpoint, one-to-one instruction is a very labor-intensive method and should be thoughtfully tailored to make the expense worthwhile in terms of achieving learner outcomes. One-to-one teaching of clients and families is often considered an inefficient approach to learning because the educator is reaching only one person at a time. Clinical teaching of students and continuing education for staff are vital for professional development, but
they are costly endeavors when carried out on a one-to-one basis. Also, orientation of new staff is a significant expense to an institution or agency in terms of payroll dollars and the lack of shortterm productivity of the employee being oriented (Del Bueno, Griffin, Burke, & Foley, 1990); hence one-to-one instruction in this scenario is likely to be economically infeasible.
they are costly endeavors when carried out on a one-to-one basis. Also, orientation of new staff is a significant expense to an institution or agency in terms of payroll dollars and the lack of shortterm productivity of the employee being oriented (Del Bueno, Griffin, Burke, & Foley, 1990); hence one-to-one instruction in this scenario is likely to be economically infeasible.
TABLE 11-4 Major Advantages and Limitations of One-to-One Instruction | ||||
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Demonstration and Return Demonstration
It is imperative to begin this discussion by making a clear distinction between demonstration and return demonstration. Demonstration is done by the educator to show the learner how to perform a particular skill. Return demonstration is carried out by the learner in an attempt to establish competence by performing a task with cues from the educator as needed. These two methods require different abilities by both the educator and the learner. In particular, they are effective in teaching psychomotor domain skills. However, demonstration and return demonstration may be used to enhance cognitive and affective learning, such as when helping a staff member develop interactive skills for crisis intervention or assertiveness training.
Prior to giving a demonstration, the educator should inform learners of the purpose of the procedure, the sequential steps involved, the equipment needed, and the actions expected of them. It is important to stress why the demonstration is important or useful to the participants. Equipment should be tested prior to the demonstration to ensure that it is complete and in good working order. For the demonstration method to be employed effectively, learners must be able to clearly see and hear the steps being taught. Therefore, the demonstration method is best suited to teaching individuals or small groups. A large screen or multiple screens for video presentations of demonstrations can allow larger groups to participate.
Demonstrations can be a passive activity for learners, whose role is to observe the educator presenting an exact performance of a required skill. Demonstrations are more effective when verbalization accompanies them, such as a lecture followed by the demonstration. They can be enhanced if the educator slows down the pace
of performance, exaggerates some of the steps (Radhakrishna, John, & Edgar, 2011), or breaks lengthy procedures into a series of shorter steps. This incremental approach to sequencing discrete steps of a procedure is known as scaffolding and provides the learner with a clear and exacting image of each stage of skill development (Brookfield, 2006). In the process of demonstrating a skill to either nurses or clients, it is important to explain why each step needs to be carried out in a certain manner to prevent bad habits from being integrated prior to the learner performing a new skill set (Brookfield, 2006; De Young, 2008; Lorig, 2003). Demonstration as a teaching method provides educators with the opportunity to model their commitment to a learning activity, builds educator credibility, and inspires learners to achieve a level of excellence (Brookfield, 2006).
of performance, exaggerates some of the steps (Radhakrishna, John, & Edgar, 2011), or breaks lengthy procedures into a series of shorter steps. This incremental approach to sequencing discrete steps of a procedure is known as scaffolding and provides the learner with a clear and exacting image of each stage of skill development (Brookfield, 2006). In the process of demonstrating a skill to either nurses or clients, it is important to explain why each step needs to be carried out in a certain manner to prevent bad habits from being integrated prior to the learner performing a new skill set (Brookfield, 2006; De Young, 2008; Lorig, 2003). Demonstration as a teaching method provides educators with the opportunity to model their commitment to a learning activity, builds educator credibility, and inspires learners to achieve a level of excellence (Brookfield, 2006).
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