CHAPTER 7

Teaching and Learning Principles

Marjorie Lovell

OBJECTIVES

Introduction

Learning is an ongoing and life-long process. People learn within social and cultural contexts, independently and through interaction with others. This chapter will focus on the vascular patient as the adult learner and will discuss ways to achieve effective patient education. Patient education is often the key to helping patients fully benefit from their care, with the nonoperative management, and during and after a hospital stay. The goal of patient education has changed from telling the patient the best actions to take, to now assisting patients in learning about their health care to improve their own health. This view of health education requires more communication between patients and healthcare providers.

Education will help patients understand their condition, how to effectively use any medications or medical equipment required, and how to perform any necessary self-care. It must be ongoing, interactive, and consistent with the patients’ plan of care, comprehension, educational level, and needs for continuity of care.

I. Learning and Motivation

A. Theories (Theories that explain behavior change can be applied as guidelines for patient education; these theories come from the disciplines of sociology, psychology, adult education, communication, and organizational development)

1. Health belief model—behavior of individual’s health action dependant upon

a. Belief of risk of developing a specific condition

b. Belief that condition will have serious effect on life (Janz & Becker, 1984)

c. Belief that behavior change outweighs barriers to action (Goeppinger & Lorig, 1996)

2. Transtheoretical model

a. Intentional change requires movement through distinct motivational changes over period of time

b. Five-stage process or continuum related to person’s readiness to change

1) Precontemplation—little interest in changing specific behavior

2) Contemplation—thinking about changing specific behavior

3) Preparation for action—considering attempts to change behavior

4) Action—actively working toward changing behavior

5) Maintenance—changes to behavior minimized

3. Social cognitive theory

a. Behavior modeling learned through environmental reinforcements (Bandura, 1991)

b. Individuals most likely to model behavior observed by others they identify with

4. Theory of reasoned action

a. Effects of attitudes toward behavioral intentions (DeBono, 1993)

b. Individual may require family members and friends to agree with changed behavior

B. Principles of Motivation (Principles of Motivation, 2013)

1. The environment can be used to focus patient attention on what needs to be learned

2. Incentives motivate learning

3. Internal motivation is longer lasting and more self-directive than is external motivation

4. Learning is most effective when an individual is ready to learn, that is, when one wants to know something

5. Motivation is enhanced by the way in which the instructional material is organized

C. Learning Behavior Classifications—There are three domains of learning educational activities: cognitive, affective, and p sychomotor

1. Cognitive: includes knowledge, intellectual abilities, and information; six levels within this domain (Benjamin, Bloom, Mesia, & Krathwohl, 1964)

a. Knowledge: recalling information (e.g., list, describes, defines, arrange, repeat)

b. Comprehension: lowest level of understanding (e.g., describe, explain, locate, discuss, report)

c. Application: use of information in concrete situations (e.g., apply, demonstrate, solve, show)

d. Analysis: ability to break down material into parts so it is easily understood (e.g., analyze, arrange, explain, diagrams, compare)

e. Synthesis: putting elements together to make a whole (e.g., combine, plan, categorizes, modifies)

f. Evaluation: ability to make judgments about value of ideas or materials (e.g., assess, compare, summarize, measure, test)

2. Affective: includes feelings, emotions, and attitudes; five categories within this domain

a. Receiving—awareness, willingness to hear, selected attention (asks, chooses, names)

b. Responding—attends and reacts to particular phenomenon (e.g., answers, greets, discusses, reports)

c. Valuing—accepting, commitment to a value (e.g., completes, demonstrates, initiates, selects)

d. Organization—organizes values into priorities (e.g., arranges, combines, organizes, integrates)

e. Characterization—internalizing values—has value system that controls behavior (e.g., discriminates, acts, displays, practices)

3. Psychomotor: includes physical movement, coordination, and motor skills. Seven categories within this domain (Simpson, 1972)

a. Perception—ability to use sensory cues to guide motor activity (e.g., chooses, describes, relates, selects)

b. Set—readiness to act (e.g., begins, displays, moves, shows, states)

c. Guided response—learning a skill, imitation (e.g., copies, traces, follows, responds)

d. Complex overt response—skilful performance of motor acts that involve complex movements (e.g., assembles, builds, dismantles, calibrates)

e. Adaptation—skills are well developed and can adapt to new problems (e.g., adapts, alters, changes, varies)

f. Orientation—creates new movement skills to a specific situation or problem (e.g., combines, designs, creates, constructs)

D. Andragogy and Pedagogy

1. Andragogy: art and science of teaching adults; the six key principles include

a. Adults are autonomous

b. Adults are relevancy orientated—must have “need to know”

c. Adults have a lifetime of experience and knowledge

d. Adults must be shown respect in an environment conducive to learning

e. Adults’ learning shifts from subject-centeredness to problem-centeredness

f. Adults are motivated by external and internal factors (Knowles, 1984)

2. Pedagogy: art and science of teaching children and youth

a. Teacher or parent assumes responsibility for what is learned

b. Knowledge acquired is for application when appropriate

II. Patient Education

A. Patient Education—Acquisition of a skill or knowledge by practice, study, or instruction that should provide the patient with the knowledge needed for maintenance and promotion of optimal health and illness prevention (Davis, 1995)

B. Goals and Objectives

1. Improve knowledge and awareness of vascular disease

2. Increase compliance to management of vascular disease

3. Develop skills to manage care

4. Family-centered care

C. Principles (Bartlett, 1999)

1. Relevant to patients needs

2. Adapt teaching to patients’ level of readiness, past experience, culture, and understanding

3. Involve patient in learning process by goal setting and progress evaluation

4. Create environment conducive to learning with trust, respect, and acceptance

5. Provide opportunities for demonstration of information and skills

D. Needs Assessment

1. Physical condition

2. Knowledge and understanding of disease and management

3. Demographics (age, family status, employment status education)

4. Stage of life development

5. Means of social support

6. Cultural beliefs

7. Learning style preferences

8. Spiritual beliefs

9. Educational preferences

E. Planning

1. Goal setting

2. Content

a. Specific to patient needs

b. Guidelines

F. Implementation

1. Instructional methods

a. One-on-one discussion

b. Group instruction

c. Preparatory instruction

d. Demonstration

2. Activities

a. Lecture

b. Discussion

c. Demonstration

d. Role play

3. Tools—enforces teaching by using a variety of tools to capture learning styles (auditory, visual, and psychomotor)

a. Printed materials

b. Audiotapes

c. Videotapes

d. CDs

e. Flipcharts

f. Physical models

g. Posters

h. Internet

G. Evaluation —Confirms teaching is effective and appropriate to meet individual needs (Fenwick & Parsons, 1999)

1. Methods (Kilpatrick, 1998)

a. Level 1—learner’s reactions-–how did you like it

b. Level 2a—modification of attitudes

Level 2b—acquisition of knowledge or increase in skill

c. Level 3—change in behavior

d. Level 4—change with benefits to patient (improve quality of life)

2. Tools

a. Interviews

b. Surveys

c. Questionnaires

d. Observations

III. Barriers to Patient Education (Beagley, 2011)

A. Physiological

1. Age

2. Health

B. Cognitive

1. Language development

2. Reading level

3. Processing skills

4. Learning style

5. Prior knowledge

C. Affective

1. Motivation to learn

2. Interests

3. Attitude toward learning

4. Anxiety level

5. Cultural/spiritual beliefs

6. Side effect of medication

7. Environment

D. Social

1. Relationship with peers, staff, or family

2. Feelings toward authority

3. Socioeconomic background

4. Ethnic background

IV.Strategies for Patient Education

A. Involve Patient in Goal Setting

B. Assess Learning Style of Patient

C. Move from Simple to Complex Ideas

D. Repetition

E. Support and Encouragement

V Limitations of Education in Vascular Disease

A. Patient Factors

1. Lack of knowledge

2. Poor access to medical system

3. Financial

4. Social

5. Geographical

B. Disease Factors

1. Unmanageable disease

REVIEW QUESTIONS

1. Learning the signs and symptoms of vascular disease is an example of which domain of learning?

a. Affective

b. Cognitive

c. Psychomotor

d. Behavioral

2. All of the following are barriers to patient education except

a. Age

b. Sex

c. Learning style

d. Language

3. This type of learner does well by demonstrating the action taught:

a. Visual

b. Kinesthetic

c. Auditory

d. Cognitive

4. Which of the following strategies would be best to demonstrate ace wrapping?

a. Lecture

b. Role playing

c. Demonstration with return demonstration

d. Instructional booklet

5. This theory reflects intentional change through distinct motivational changes over a period of time:

a. Health belief model

b. Social cognitive theory

c. Theory of reasoned action

d. Transtheoretical model

ANSWERS

1. b. Cognitive.

2. b. Sex.

3. b. Kinesthetic.

4. c. Demonstration with return demonstration.

5. d. Transtheoretical model.

REFERENCES

Bandura, A. (1991). Social cognitive theory of moral thought and action. In W. M. Kurtines & J. L. Gerwitz (Eds.),Handbook of moral behavior and development (Vol.1, pp. 45–103). Hillsdale, NJ: Erlbaum.

Bartlett, E. (1999). At last a definition of patient education. Patient Education and Counseling, 7, 323–324.

Beagley, L. (2011). Educating patients: Understanding barriers, learning styles, and teaching techniques. Journal of PeriAnesthesia Nursing, 26 (5), 331–337.

Benjamin, S., Bloom, B., Mesia, B., & Krathwohl, D. R. (1964). Taxonomy of educational objectives (Two vols: The affective domain & the cognitive domain). New York, NY: David McKay.

Davis, S. M. (1995). An investigation into nurses’ understanding of health education and health promotion within a neuro-rehabilitation setting. Journal of Advanced Nursing, 21 (5), 951–955.

DeBono, K. G. (1993). Individual differences in predicting behavioral intentions from attitude and subjective norm. The Journal of Social Psychology, 133 (6), 825–832.

Fenwick, T., & Parsons, J. (1999). The art of evaluation: A handbook for educators and trainers. Toronto, ON: Thompson Educational Publishing.

Goeppinger, L., & Lorig, K. (1996). What we know about what works: One rationale, two models, three theories. In K. Lorig (Ed.), Patient education: A practical approach (pp. 195–224). Thousand Oaks, CA: Sage Publications.

Janz, N. K., & Becker, M. H. (1984). The health belief model: A decade later. Education Quarterly, 11, 1–47.

Kilpatrick, D. L. (1998). Evaluating training programs, the four levels (2nd ed.). San Francisco, CA: Berrett-Koehler.

Knowles, M. (1984). Andragogy in action: Applying modern principles of adult learning. San Francisco, CA: Jossey-Boss.

Principles of Motivation. (2013, July 21). Retrieved from http://www2.honolulu.hawaii.edu/facdev/guidebk/teachtip/m-files/m-motiva.htm

Simpson, E. (1972). The classification of educational objectives in the psychomotor domain: The psychomotor domain (Vol. 3). Washington, DC: Gryphon House.