Unit 2 Week 7: Assessment Cont'd, Literacy, Teaching Preparation Flashcards
4 Steps to Providing Culturally Sensitive Patient Teaching
- Examine Personal Culture
* What and who has shaped us? What are our bias? - Familiarity with patient culture
* Be a generalist, and curious with our patient’s culture - Identify Adaptations made by patient
* How do they live out their culture? Do not prescribe what we believe about their culture on to them - Modify Patient teaching based on data from previous steps
What is cultural competence>
can be viewed as a process – never fully achieved
Deliberate cognitive process is which we become appreciative and sensitive. Must Involve and begin with assessment of one’s own bias.
- self awareness
- other awareness
- bridging skills
General Assessment and Teaching Interventions for Culturally Competent Care
- Identify client’s primary language
- Observe interactions between client and family members.
- Listen to the client.
- Consider communication abilities and patterns.
- Explore customs or taboos.
- Determine the notion of time.
- Be aware of cues for interaction
- Assess client’s religious practices.
What to avoid in cultural assessment
- Do not overgeneralize or stereotype patients based on their ethnic heritage
- Never assume a patient’s learning needs or preferences for health treatment will be alike simply based on ethnicity.
- We do not want to view all members of a cultural group homogenously or expect certain beliefs or practices presumably.
- ASSESSING & TAILORING with EACH PATIENT IS VITAL
Define literacy
the ability of adults to read, write, and comprehend information at the 8th-grade level or above
Define illiteracy
the ability of adults to read, write, and comprehend information at the fourth-grade level or below, or not at all
Define low literacy
(marginally literate or illiterate): the ability of adults to read, write, and comprehend information between the fifth to eighth-grade levels of difficulty
Define functional illiteracy
in adults, the lack of fundamental reading, writing, and comprehension skills needed to operate effectively in today’s society
Define health literacy
“the ability to access, understand, evaluate and communicate information as a way to promote, maintain, and improve health in a variety of settings across the life-course.”
What 4 things should a client with health literacy be able to do?
- Access?
- Understand?
- Process and evaluate?
- Communicate?
_________ + __________ = utilizatoin of health information
Context + Skills = Utilization of health information
* Ex) if taught about healthy eating habits, must consider context (poverty/financial stability) and skills (cooking) to be able to utilize the Information
Many people read at least __________ grade levels below their reported grade level of education.
2-4
At risk groups for health illiteracy
- Economically disadvantaged
- Older adults
- Immigrants
- English as second language
- Racial minorities
- High school dropouts
- Unemployed
- Prisoners
Ask me 3 for health literacy
- What is my problem?
- What do I need to do?
- Why do I need to do that?
7 Key Strategies to Combat Health LIteracy
- look for the cues – how would you know?
- use audiovisuals
- highlight/circle key points on handouts
- plain handouts
- teach back method
- partnerships for self-care
- use demonstration
List some telltale signs you should be concerned with literacy
- reacting to complex learning with withdrawal/avoidance
- Excuses: too busy, tired, not feeling well enough to participatie
- Lost/broken/forgot glasses
- Surrounding themselves with books to give impression they can read
- Insist on reading information later
- Asking someone to read for them
- Being nervous when asked to read
- Talking out of context about topic of conversation
How do individuals with poor literacy skils think?
in very concrete, specific, and literal terms
- Characteristics of thinking:
- Disorganization of thought
- Limited perception of ideas
- Slow rate of vocabulary and language development
- Poor problem-solving skills
- Difficulty analysing and synthesizing information
- Difficulty formulating questions
- Struggles when handling more than one piece of information at a time
Poor outcomes associated with decreased functional health literacy
- Increased morbidity and mortality
- Poorer adherence
- More medication errors
- Decreased ability to interpret labels and health messages
- Dependence (decreased autonomy and empowerment)
- Increased use of ERs or EMS
- Increase in re-admission
- Decrease in overall health status and wellness
- Decrease in use of preventative services
3 P’s of Health Literacy
Plain, Personal, Possible
What reading grade level should PEM be kept at?
4-5
7 Things to Consider when Evaluating Printed Materials
- Nature of the audience
- Literacy level required
- Linguistic variety available
- Brevity and clarity
- Layout and appearance
- Opportunity for repetition
- Concreteness and familiarity
PEM should use an _____ voice
active
PEM should write _____ to the reader ______
directly
reader
PEM should include ____ terms with no _______
simple
jargon
PEM should use _____ sentences/_______ points
short
bullet
PEM should ______ key information
highlight
PEM should write instructions in order of __________
enactment
Assessment of Instructional Material Understandability:
The material makes its _________ completely evident
The material does not include ______
The material uses _________ language
The material provides a _________
The visuals _____ rather than _________
purpose
information or content that distracts from its purpose
common, everyday language
summary
reinforce
distract
Assessment of Instructional Material Actionability
The material identifies:
The material breaks down action into:
The material provides a ______ whenever it could help the user act
At least one action the user can take
Manageable, explicit steps
tangible tool
Learners typically read at least _____ grade levels lower than their highest level schooling
two
Flesch-Kincaid Scale
Readability Formula
- appropriate for grade 5 to university levels
- uses average sentence length (in words) and average word length (in syllables)
Cloze Procedure
Comprehension Test
- does not provide grade level rating
- measures ability to comprehend written material
- administered to patients who demonstrate difficulty reading/comprehension at a grade 6 level
- every 5th word is removed and patient asked to fill in blank
- easier the material to comprehend = higher score
Listening Test
Comprehension Test
- measures ability to comprehend verbally delivered
- can be used for low literacy (below grade 6)
- choose a grade.5 level sample that takes around 3 minutes to read
- formulate 5-10 questions around key information
- Ask questions and grade as correct answers
< 75%: needs to be simplified
75-89: additional assistance in comprehension required
>90%: easily understood
Teaching Strategies for Hearing Deficits
- Use natural speech patterns; do not over articulate.
- Use simple sentences.
- Get attention of the client by a light touch on arm.
- Face the client, standing no more than 6 feet away.
- Avoid standing in front of bright light, which obscures your face.
- Minimize motions of your head while speaking.
- Refrain from placing IV in hand that the client needs for sign language.
Teaching Strategies for Visually Impaired
- Secure services of a low-vision specialist to obtain adaptive optical devices.
- Avoid the tendency to shout and to use nonverbal cues.
- Always announce your presence and identify yourself.
- Allow the client to touch, handle, and manipulate equipment
- Be descriptive in explaining procedures.
- Use large font size for printed or handwritten materials.
- Avoid color; rely on black and white for printed materials.
- Use alternative instructional tools that stimulate auditory and tactile senses
Define learning disability and give 3 examples
Heterogeneous group of disorders of listening, speaking, reading, writing, reasoning, or mathematical abilities.
- may have normal or superior intelligence
- Dyslexia
- Auditory processing disorders
- Dyscalculia
4 Domains of Learning Disabilities
- The academic domain - includes reading, written expression, spelling and mathematics.
- The information-processing domain- includes how information is received through the senses, attended to, perceived, organized, stored in memory, retrieved and expressed.
- The social/adaptive domain encompasses social competence that involves the ability to engage successfully in interpersonal relationships and adapt to the environment.
- The communication domain- includes auditory skills, receptive language skills, expression of language. thinking hypothetically or understanding jokes/puns
Accommodations and 3 Types
A change or alteration to the regular way a person is expected to learn, complete projects or participate in activities.
Accommodations lessen or remove the impact of a person’s learning disability giving them more equal opportunities to succeed.
- Environmental
- Instructional/Assignment
- Evaluation/Testing
Developmental Disability and 3 Examples
A severe chronic disability that is present before 22 years of age likely to continue indefinitely
Include:
* Attention-deficit/hyperactivity disorder
* Intellectual disabilities
* Autism spectrum disorder
Define intellectual Disabilities and 3 Examples
Defined as an intellectual condition that originates before the age of 18 that results in impaired reasoning, problem solving, and adaptive behaviors.
IQ is low on an IQ test
o Down syndrome
o FAS
o Neurological impairments suffered in utero, or through birth trauma, LBW
In intellectual disabilities _____ and _________ of RN is important
tone and facial expression
Teaching stratgies for Mental Illness
- Teach by using small and brief words, repeating information over and over
- Keep sessions short and frequent
- Involve all possible resources, including client and family
Acquired brain injury teaching strategies
- Use group teaching approach.
- Involve immediate caregiver.
- Invite rehabilitated patients to share experiences.
- Conduct family group sessions.
- Focus on client safety and family coping.
- Give step-by-step instructions.
- Allow time for responses.
- Provide small amounts of information.
- Keep sessions short.
Teaching strategies for Cognitive Disorders
- Emphasize memory techniques that focus on the need for attention, repeating information, and practicing retrieval
- Encourage client to take notes
- Assist client to create a system of reminders
- Emphasize memory techniques that focus on the need for attention, repeating information, and practicing retrieval
- Encourage client to take notes
- Assist client to create a system of reminders
- Incorporate visualization
- Teach clients to “chunk” information
- Arrange brief, frequent repetitive sessions to provide constant reinforcement
Aphasia vs Dysarthria (Communication Disorders)
Aphasia: a disorder that affects how you communicate. It can impact your speech, as well as the way you write and understand both spoken and written language. Aphasia usually happens suddenly after a stroke or a head injury.
Dysarthria: Dysarthria is where you have difficulty speaking because the muscles you use for speech are weak. It can be caused by conditions that damage your brain or nerves and some medicines.
Teaching Strategies for Aphasia
Encourage and praise participation.
Acknowledge client’s frustrations.
Keep distractions to a minimum.
Speak slowly using a normal tone and short sentences.
Have only one person speak at a time.
Stand where the client can see your face.
Check to be sure each message is understood.
Allow each person time to respond
Teaching Strategies for Dysarthria
- Ensure a quiet environment.
- Encourage concentration and intention to improve speech clarity.
- Ask questions that need only short replies.
- Use alternative methods of communication.
- Encourage client to speak slower and louder.
- Do not simplify message because the client’s comprehension is not affected.
Teaching Strategies for Chronic Illness
- Acknowledge loss or change in roles.
- Recognize effects of illness on self-esteem.
- Emphasize regimens that match physical strength.
- Individualize instruction relevant to problems encountered.
- Encourage integration of new knowledge for problem-solving.
- tell the person they are about to hear important info. “I want you to remember this”
- provide a count of details. There are 5 reasons why….
- use index cards with question on one side, answer on the other
- create chants, rhymes, acronyms, crazy phrases to remember lists, multiplication tables etc.
Goals vs Objectives
Goals
- global
- broad
- longterm
- multidimensional
Objectives
- specific
- singular
- short-term
- unidimensional
3 Types of Objectives
- Educational
- Instructional
- Behavioural
Define educational objective
Assess the intended outcomes of the education process.
Nursing example: The objectives of a cardiac rehabilitation patient program
Define instructional objective
The teaching activities and resources utilized to facilitate learning.
Nursing example: Group sessions & exercise drop in for cardiac rehab
Define behavioural objective
also referred to as learning objectives - action orientated, describe what learner will aim to do following a learning situation.
Nursing example: Pt. will gain an accurate understanding of the importance of behavioral change within cardiac rehabilitation after completing the five program sessions.
The Importance of Using Behavioural Objectives
- Keeps teaching learner-centered
- Communicates plan to others
- Helps learners stay on track
- Organizes educational approach
- Ensures that process is deliberate
- Tailors teaching to learner’s needs
- Creates guides for teacher evaluation
- Focuses attention on learner
- Orients teacher and learner to outcomes
- Helps learner visualize skills
What is Blending?
Occurs when the professional (nurse as teacher) and client (learner) collaborate and mutually decide on objectives.
The focus is on results not the act of teaching.
3 Important Characteristics of Behavioural Objectives
- Performance: What the learner is expected to do that will evidence objectives have been achieved
- Condition: Describes condition under which behaviour will occur
- Criterion: Time frame + level of competence the learner will strive to achieve
ABCD Rule
4 Step Method of What to Include in Objectives
Audience (who)
Behaviour (what)
Condition (under what circumstances)
Degree (how much, to what extent)
Common Mistakes When Writing Objectives
- focus on what instructor will do
- including > 1 behaviour in a single objective
- Forgetting to include the BCD characteristics (behaviour, condition, degree)
- Using performance terms subject to many interpretation
- unattainable/unrealistic
- Objectives unrelated to stated goal
- Cluttering with unnecessary information
- Too general so outcome is not clear
- Not altering/evaluating as you go
What is Bloom’s Taxonomy of Objectives
A longstanding educational theory that identifies things that need to be able to happen at baseline levels before moving to higher levels of learning.
6 Levels of Cognitive Domain Levels from lowest to highest level skill
- Knowledge
- Comprehension
- Application
- Analysis
- Synthesis
- Evaluation
Knowledge Verbs
Defines
Describes
Identifies
Labels
Lists
Names
States
Comprehension Verbs
Discusses
Estimates
Explains
Gives examples
Identifies
Locates
Paraphrases
Reports
Restates
Summarizes
Application Verbs
Apply
Changes
Computes
Demonstrates
Modifies
Operates
Prepares
Produces
Relates
Selects
Solves
Uses
Analysis Verbs
Analyzes
Arranges
Breaks down
Compares
Differentiates
Illustrates
Infers
Outlines
Relates
Sorts
Selects
Categorizes
Criticizes
Detects
Synthesis Verbs
Arranges
Categorizes
Combines
Compiles
Composes
Designs
Formulates
Generates
Modifies
Organizes
Plans
Relates
Reconstructs
Revises
Summarizes
Evaluation Verbs
Appraises
Assesses
Compares
Concludes
Contrasts
Criticizes
Debates
Defends
Evaluates
Judges
Justifies
Revises
Scores
Summarizes
Supports
Cognitive knowledge is an _________ for learning affective and psychomotor skills.
essential prerequisit
3 Stages of Motor Learning
Cognitive
Associative
Autonomous
Psychomotor Domain Levels from Lowest to Highest Level Skill
1.Perception
2.Set
3.Guided Response
4.Mechanism
5.Complex Overt Act
6.Adaptation
7.Origination
Perception Verbs
Chooses
Describes
Detects
Differentiates
Identifies
Selects
Separates
Set Verbs
Copies
Displays
ExpressesMoves
Positions
Proceeds
Reacts
Responds
Shows
Guided Response Verb
Applies
Assembles
Demonstrates
Discriminates
Dismantles
Manipulates
Operates
Organizes
Simulates
Solves
MECHANISM OR COMPLEX OVERT RESPONSE verbs
Examines
Finds
Practices
Reassembles
Tests
Adaptation Verbs
Adapts
Alters
Changes
Corrects
Creates
Designs
Modifies
Rearranges
Reorganizes
Revises
Shifts
Substitutes
Varies
Origination Verbs
Arranges
Builds
Combines
Creates
Designs
Originates
Produces
__________ that demand a cognitive or affective response during psychomotor learning interferes with psychomotor performance.
Asking questions
Affective Domain Levels from lowest to highest level
1.Receiving
2.Responding
3.Valuing
4.Organizing
5.Characterizing
Receiving Verbs
Accepts
Asks
Attends
Focuses
Follows
Listens
Observes
Responding Verbs
Agrees
Answers
Complies
Chooses
Complies
Discusses
Practices
Presents
Selects
Valuing Verbs
Askes
Accepts
Chooses
Completes
Defends
Explains
Follows
Initiates
Justifies
Selects
Shares
Organization Verbs
Adheres
Alters
Arranges
Chooses
Combines
Commits
Completes
Defends
Explains
Integrates
Modifies
Relates
Resolves
Characterizing Verbs
Acts
Adheres
Commits
Continues
Discriminates
Defends
Displays
Endures
Explains
Influences
Modifies
Performs
Practices
Uses
