midterms1&2 Flashcards
defined as gaps in knowledge that exist between a desired level of performance and the actual level of performance (HealthCare Education Associates, 1989).
Learning needs
In other words, it is the gap between what someone knows and what someone needs or wants to know. Such gaps may arise because of a lack of knowledge, attitude, or skill.
Learning Needs
important steps in assessment of learning needs
- Identify the learner
- Choose the right setting
- Collect data about the learner
- Collect data from the learner
- Involve members of the healthcare teams
- Prioritize needs
- Determine Availability of educational resources
- Assess the demands of the organization
- Take time-management issues into account
the development of formal and informal education programs for patients and their families, nursing staff, or students must be based on accurate identification of the learner. For example, an educator may believe that all parents of children with asthma need a formal class on potential hazards in the home. This perception may be based on the educator’s interaction with a few patients and may not be true of all families.
Identify the learner
Establishing a trusting environment helps learners feel a sense of security in confiding information, believe their concerns are taken seriously and are considered important, and feel respected.
Ensuring privacy and confidentiality is recognized as essential to establishing a trusting relationship.
Choose the right setting
Once the learner is identified, the educator can determine characteristic needs of the population by exploring typical health problems or issues of interest to that population.
Subsequently, a literature search can assist the educator in 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.
collect data about the learner
Learners are usually the most important source of needs assessment data about themselves.
Allow patients and/or family members to identify what is important to them, what they perceive their needs to be, which types of social support systems are available, and which type of assistance these supports can provide.
Actively engaging learners in defining their own problems and needs motivates them to learn because they are invested in planning for a program specifically tailored to their unique circumstances.
collect data from the learner
Other health professionals likely have insight into patient or family needs or the educational needs of the nursing staff or students resulting from their frequent contacts with both consumers and caregivers.
Nurses are not the sole educators of these individuals; thus they must remember to collaborate with other members of the healthcare team for a richer assessment of learning needs.
This consideration is especially important because time for assessment is often limited. In addition to other health professionals, organizations such as the American Heart Association, the American Diabetes Association, and the American Cancer Society are excellent sources of health information
involve members of the healthcare team
Maslow’s (1970) hierarchy of human needs can help the educator prioritize so that the learner’s basic needs are attended to first and foremost before higher needs are addressed.
Prioritizing the identified needs helps the patient or staff member to set realistic and achievable learning goals. Choosing which information to cover is imperative, and nurse educators must make choices deliberately.
Without good assessment, a common mistake is to provide more information than the patient wants or needs. To avoid this problem, the nurse must discriminate between information that patients need to know versus information that is nice for them to know
prioritize needs
Criteria for prioritizing learning needs
1 . mandatory
- desirable
- possible
Needs that must be learned for survival or situations in which the learner’s life or safety is threatened. Learning needs in this category must be met immediately. The nurse who works in a hospital must learn how to do cardiopulmonary resuscitation or be able to carry out correct isolation techniques for self-protection.
mandatory
Needs that must be learned for survival or situations in which the learner’s life or safety is threatened. Learning needs in this category must be met immediately. The nurse who works in a hospital must learn how to do cardiopulmonary resuscitation or be able to carry out correct isolation techniques for self-protection.
desirable
Needs for information that is nice to know but not essential or required or situations in which the learning need is not directly related to daily activities.
possible
The educator may identify a need, but it may be useless to proceed with interventions if the proper educational resources are not available, are unrealistic to obtain, or do not match the learner’s needs.
For example, a patient who has asthma needs to learn how to use an inhaler and peak-flow meter. If the proper equipment is not available for demonstration/return demonstration at that moment, it might be better for the nurse educator to concentrate on teaching the signs and symptoms the patient might experience when having poor air exchange than it is to cancel the encounter altogether.
determine availability of educational resources
This assessment yields information that reflects the climate of the organization.
The educator should be familiar with standards of performance required in various employee categories, along with job descriptions and hospital, professional, and agency regulations.
assess the demand of the organization
Because time constraints are a major impediment to the assessment process, Rankin, Stallings, and London (2005) suggest the educator should emphasize the following important points with respect to time-management issues:
1.It is much more efficient and effective to take the time to do a good initial assessment upfront than to waste time by having to go back and uncover information that should have been obtained before beginning instruction.
2.Learners must be given time to offer their own perceptions of their learning needs if the educator expects them to take charge and become actively involved in the learning process. Learners should be asked what they want to learn first, because this step allays their fears and makes it easier for them to move on to other necessary content (McNeill, 2012).
3.Assessment can be conducted anytime and anywhere the educator has formal or informal contact with learners. Data collection does not have to be restricted to a specific, predetermined schedule.
4.Informing a patient ahead of time that the educator wishes to spend time discussing problems or needs gives the person advance notice to sort out his or her thoughts and feelings.
Minimizing interruptions and distractions during planned assessment interviews maximizes productivity
take time-management issues into account
can be defined as the time when the learner demonstrates an interest in learning the information necessary to maintain optimal health or to become more skillful in a job.
readiness to learn
occurs when the learner is receptive, willing, and able to participate in the learning process. It is the responsibility of the educator to discover through assessment exactly when patients or staff are ready to learn, what they need or want to learn, and how to adapt the content to fit each learner.
readiness to learn
To assess, the educator must first understand what needs to be taught, collect and validate that information, and then apply the same methods used previously to assess learning needs, including making observations, conducting interviews, gathering information from the learner as well as from other healthcare team members, and reviewing documentation.
readiness to learn
four types of readiness to learn
- Physical Readiness
- Emotional readiness
- Experiential readiness
- Knowledge readiness
•Ability to perform a task requires fine and/or gross motor movements, sensory acuity, adequate strength, flexibility, coordination, and endurance.
Creating a stimulating and accepting environment by using instructional tools to match learners’ physical and sensory abilities encourages readiness to learn.
measures ability
•affect the extent to which the learner can master the behavioral changes in the cognitive, affective, and psychomotor domains.
Psychomotor skills, once acquired, are usually retained better and longer than learning in the other domains (Greer, Hitt, Sitterly, & Slebodnick, 1972). Once ingrained, psychomotor, cognitive, and affective behaviors become habitual and may be difficult to alter.
complexity of task
Research suggests that women are generally more receptive to medical care and take fewer risks with their health than do men (Ashton, 1999; Bertakis, Rahman, Helms, Callahan, & Robbins, 2000; Harris, Jenkins, & Glaser, 2006; Rosen, Tsai, & Downs, 2003; Stein & Nyamathi, 2000).
•This difference may arise because women traditionally have taken on the role of caregivers and, therefore, are more open to health promotion teaching.
•Men, by comparison, tend to be less receptive to healthcare interventions and are more likely to be risk takers. A good deal of this behavior is thought to be socially induced.
gender
influences a person’s ability to perform at cognitive, affective, and psychomotor levels. In particular, it affects patients’ ability to concentrate and retain information (Kessels, 2003; Sandi & Pinelo-Nava, 2007; Stephenson, 2006).
anxiety level
•Members of the patient’s support system who are available to assist with self-care activities at home should be present during at least some of the teaching sessions so that they can learn how to help the patient if the need arises.
A strong positive support system can decrease anxiety, whereas the lack of one can increase anxiety levels.
support system
•the time when a nurse truly connects with the client by directly meeting the individual on mutual terms. The reachable moment allows for the mutual exchange of concerns and a sharing of possible intervention options without the nurse being inhibited by prejudice or bias.
When the client feels emotionally supported, the stage is set for the teachable moment because it is then that the person is most receptive to learning.
reachable moment
•Knowing the motivational level of the learner assists the educator in determining when that person is ready to learn.
•The nurse educator must be cognizant of the fact that motivation to learn is based on many varied theories of motivation and, thus, be careful to link a specific theory’s concepts or constructs to the appropriate method of assessment and subsequent educational interventions.
The learner who is ready to learn shows an interest in what the nurse educator is doing by demonstrating a willingness to participate or to ask questions.
motivation
•The educator can assist patients in developing strategies that help reduce the level of risk associated with their choices.
Educators can, however, help individuals learn how to take risks. First, the person must decide to take the risk. The next step is to develop strategies to minimize the risk. Then, the learner needs to develop worst-case, best case, and most-probable-cause scenarios. Last, the learner must decide whether the worst-case scenario developed is acceptable.
risk-taking behavior
•involves concern about the here and now versus the future. If survival is of primary concern, readiness to learn will be focused on the present to meet basic human needs.
•People from lower socioeconomic levels, for example, tend to concentrate on immediate, current concerns because they are trying to satisfy everyday need
•Older individuals, although they gather information from a variety of sources, tend to make health decisions primarily based on information provided by the healthcare professional (Cutilli, 2010).
•Children regard life in the here and now because they are developmentally focused on what makes them happy and satisfied.
Adults who have reached self-actualization and those whose basic needs are met are most ready to learn health promotion tasks and are said to have a more futuristic orientation.
frame of mind
•Each task associated with human development produces a peak time for readiness to learn, known as a teachable moment (Hansen & Fisher, 1998; Hotelling, 2005; Tanner, 1989; Wagner & Ash, 1998).
•Adults can build on meaningful past experiences and are strongly driven to learn information that helps them to cope better with real-life tasks. They see learning as relevant when they can apply new knowledge to help them solve immediate problems.
Children, in contrast, desire to learn for learning’s sake and actively seek out experiences that give them pleasure and comfort.
developmental stage
• refers to the learner’s past experiences with learning.
•The educator should assess whether previous learning experiences have been positive or negative in overcoming problems or accomplishing new tasks.
Someone who has had negative experiences with learning is not likely to be motivated or willing to take a risk to change behavior or acquire new behaviors
experiential readiness
four elements of physical readiness
- aspiration
- past coping mechanism
- cultural background
- locus of control
•The extent to which someone is driven to achieve is related to the type of short- and long-term goals established—not by the educator but by the learner.
•Early successes are important motivators in learning subsequent skills.
Satisfaction, once achieved, elevates the level of aspiration, which in turn increases the probability of continued performance output in undertaking future endeavors to change behavior.
level of aspiration
•Educators must explore the coping mechanisms that learners have been using to understand how they have dealt with previous problems.
Once these mechanisms are identified, the educator needs to determine whether past coping strategies have been effective and, whether they work well in the present learning situation.
past coping mechanism
•The educator’s knowledge about other cultures and sensitivity to behavioral differences between cultures are important so that the educator can avoid teaching in opposition to cultural beliefs.
•Building on the learner’s knowledge base or belief system (unless it is dangerous to well-being), rather than attempting to change it or claim it is wrong, encourages rather than dampens readiness to learn.
•Language is also a part of culture and may prove to be a significant obstacle to learning if the educator and the learner do not speak the same language fluently.
•Medical terminology in and of itself may be a foreign language to many patients, even if they are from a non-dominant culture or their primary language is the same as or different from that of the educator.
Educators should not start teaching unless they have determined that the learner understands what they are saying and that they understand and respect the learner’s culture.
cultural background
When patients are internally motivated to learn, they have what is called an _______ ; that is, they are ready to learn when they feel a need to know about something.
internal locus of control
, they are externally motivated—then someone other than themselves must encourage the learner to want to know something.
external locus of control
refers to the learner’s present knowledge base, the level of cognitive ability, the existence of any learning disabilities and/ or reading problems, and the preferred style of learning.
knowledge readiness
•If educators make the mistake of teaching subject material that has already been learned, they risk at the very least inducing boredom and lack of interest in the learner.
•The nurse educator must always find out what the learner knows prior to teaching and build on this knowledge base to encourage readiness to learn.
•In teaching patients, the educator also must consider how much information the patient wants to receive.
Some patients want to know the details to make informed decisions about their care, whereas others prefer a more general and less in-depth approach and can be overwhelmed by the provision of too much information.
present knowledge base
•The educator must match the level of behavioral objectives to the cognitive ability of the learner.
•The learner who is capable of understanding, memorizing, recalling, or recognizing subject material is functioning at a lower level in the cognitive domain than the learner who demonstrates problem solving, concept formation, or application of information.
Nurse educators should be sure to make information meaningful to those persons with cognitive impairments by teaching at their level and communicating in ways that learners can understand.
cognitive ability
• which may be accompanied by low-level reading skills, are not necessarily indicative of an individual’s intellectual abilities, but they do require educators to use special or innovative approaches to instruction to sustain or bolster readiness to learn.
Individuals with low literacy skills and learning disabilities become easily discouraged unless the educator recognizes their special needs and seeks ways to help them accommodate or overcome their problems with encoding words and comprehending information.
learning and reading disabilities
•assessing how someone learns best and likes to learn helps the educator to select appropriate teaching approaches.
Knowing the teaching methods and materials with which a learner is most comfortable or, conversely, those that the learner does not tolerate well allows the educator to tailor teaching to meet the needs of individuals with different styles of learning, thereby increasing their readiness to learn.
learning styles
takes place not by the teacher initiating and motivating the learning process but rather by the teacher removing or reducing obstacles to learning and enhancing the process after it has begun.
adult learning
- are defined as those factors that impede the nurse’s ability to deliver educational services.
barriers to teaching
- are defined as those factors that negatively affect the ability of the learner to pay attention to and process information.
obstacles to learning
cited by nurses as the greatest barrier to being able to carry out their educator role effectively. (E.g. Early discharge from inpatient and outpatient settings often results in nurses and clients having fleeting contact with each other.
lack of time to teach
many nurses and other healthcare personnel admit that they do not feel competent or confident enough with their teaching skills. (E.g. although nurses are expected to teach, few have ever taken a specific course on the principles of teaching and learning).
lack of confidence
- it plays an important role in determining the outcome of a teaching–learning interaction. Motivation to teach and skill in teaching are prime factors in determining the success of any educational endeavor.
personal characteristics of the nurse educator
- with the strong emphasis of TJC mandates, the level of attention paid to the educational needs of both consumers and healthcare personnel has changed significantly. However, budget allocations for educational programs remain tight and can interfere with the adoption of innovative and time-saving teaching strategies & techniques.
Administrators and supervisory personnel assigned a low priority to patient and staff education
lack of space, lack of wprivacy, noise, and frequent interruptions caused by patient treatment schedules and staff work demands are just some of the factors that may negatively affect the nurse’s ability to concentrate and effectively interact with learners.
The environment in the various settings where nurses are expected to teach is not always conducive to carrying out the teaching–learning process
refer 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 (James & Gardner, 1995) and their preferred approaches to different learning tasks (Furnham, 2012).
learning styles
ways in which an individual processes information or different approaches or methods of learning.
learning styles