1. 1 The Need for the Diabetes Nurse to be a Professional Educator by Prof. Morsi Arab University of Alexandria

2. Causes of Failure of Patients Education 1- unqualified educators 2- pour resources 3- patient uncompliance

3. The Education Triangle Objectives Evaluation Strategy ( Tests ) ( Methods of teaching )

4. Teaching and Education * a gift ? * Teaching competence is a science, with rules to be learned and skills to be acquired…….?.

5. Adjusting the Education to the Community Needs : 1. The community needs certain jobs. 2.In each job certain tasks have to be performed. 3. To perform each task we need specific : knowledge, skills and attitudes (Task analysis) 4. Accordingly, we design a curriculum with specific objectives 5. At the end we evaluate achievement of objectives.

6. Example : The Job: “ A Diabetes Foot Care Nurse”: Tasks : 1- Examine feet: 2- Diagnose problems 3- Manage care 4- Educate patients

7. Education objectives for the tasks of a Diabetes Foot Care Nurse AttitudesSkillsKnowledge - Show respect - Accuracy - Show care & sympathy…etc. --Foot examination - cutting nails -- dressing wounds --------------------- - Debridement ?..etc - Anatomy - Factors-> foot vuln. - Mechanics of walking - Circulation - Pain sensation…etc

8. Objectives

9. The selection of objectives depends on what the learner needs to know and is going to do i.e. (tasks) during the job, and at which level of competence

10. In an Education Course : N.B.: You can not teach everything,… So, stick to some “selected” priorities : 1- obligatory to learn 2- useful to learn 3- if possible learn

11. Objectives General Considerations 1- Set clear-cut objectives………. So, 2- Describe in behavioral terms what the learner ultimately will be able to do) : 1- If cognitive : e.g. enumerate causes of..... 2- In skills : e.g. examine pulse, cut nails…. 3- In attitudes : demonstrate punctuality, sympathy, etc…. -

12. Objectives ( cont.): 3- The education Faculty: (team work) … ( to avoid contradictions ) 4- Different objectives to different learners 5- Different teaching methods to suit different objectives.

13. Objectives ( cont.): 6- Different objectives at different stages of the disease. 7- Overloading leads to confusion, depression and hopelessness. 8- Only achievable objectives.

14. Some variables that define different patient objectives: 1- Their existing Knowledge about DM. 2- Their general educational competences (e.g. if illiterate?). 3- Their belief, perception of their illness, misconceptions., etc. 4- Readiness to learn acc. to psychol. stage 5- State of illness : controled ? complicated, ? handicapped ?,etc. 5- Socioeconomics: cost, feasibility, etc.

15. STRATEGY

16. To prepare for an educational presentation : 1- identify the needs of the learners 2- identify their background (what they already know). Repetition? Revision ? Re-enforcement ? 3- select the content, and never “tell all” 4- focus objectives to the outcome: (what they can do, think, believe and know, at the end of the lecture, which they could not do before ).

17. The Big Group Presentation The start ( Introduction) : - to gain attention and interest : e.g. by a question, a story,problem, case presentation, etc….. (or) - provide a skeleton of the contents to be covered

18. The Flow of the presentation: I- To keep capturing attention : 1- repeat significant points. 2- check perception of the main points. 3- have reasonable sense of humor. 4- face audience and distribute eye contact. 5- keep logical sequence:.

19. The flow of the presentation ( cont.) 6- change methods. 7- avoid unclear expressions, sophisticated words and long complicated sentences. 8- avoid monotony, mannerism. 9- ensure that everybody sees and hears well.

20. The flow of the presentation ( cont.) 10- Use properly selected A.V. aids 11- Be aware of the time allowed. 12- Prepare for the unexpected mishaps

21. The Audience : 1- show respect : ( punctuality, dress?) 2- be concerned with negative responses: ( yawns, expressions of perplexity, whispering questions, looks of unbelief or disapproval, etc. )…Don’t ignore !! 3- do not be angered or intimidated, but react by re-shaping the presentation. 4- get final feedback

22. The End : 1- Draw conclusions, …or invite independent conclusions. 2- Make end flows naturally from introduction (e.g. answering the questions, solve the problem …). 3- Simple summary…. (pin point important aspects.) 4- Tie up loose points, to make the whole presentation as one unit.. 5- Suggest ways for application and benefits. 6- suggest ways for continued learning.

23. Small Group Education - Select suitable size of the group ? - Educate, not teach (active participation). - Monitor Group behaviour dynamics at different stages. - Control individual dynamics: *positive behaviors…(encourage) * negative behaviors..(checked )

24. The One-to-One Education 1- Listen. 2- Motivate. 3- Individualize (quality) according to * stage of disease. * educational level…etc. 4- Not too much (quantity). 5- Reward, more than blame.

25. Teaching of Skills Types of Skills 1- Psychomotor skills 2- Communication skills 3- Cognitive skills ___________________________________________ How to Teach Skills ( 3 steps) : ( Describe - Demonstrate - Exercise) ___________________________________________ Step 1- Describe : importance, indications, tools, steps of performance, pitfalls & precautions…etc.

26. Teaching of Skills Step 2- Demonstration: a) every one should be able to see the demonstration. b) may have to be repeated c) describe again what you are doing during the performance ( to explain) d) support by AV aids

27. Teaching of Skills Step 3 :Exercising ( Training) a) everybody exercises. b) Feed back,to correct mistakes and advise for better performance. c) use helping methods :e.g. play role, simulation equipment, etc. d) give sufficient time for the training. e) initiate training in groups or projects

28. Teaching Attitudes Attitude = Tendency to behave in specific way.? * Could they be acquired by educational methods?

29. Ways to teach, develop and encourage behaviours 1- Provide relevant information. ……………..(to know ? ) 2- Give example results of good behavior…( to inspire ?). 3- Long observation on results of negative (bad) behaviors... ……………………………. ( to warn ?) 4- From close contact e.g. working or living with individuals with positive or negative attitude (camps..).( all the above) 5- Finally,discuss in small groups; every one must share in the discussion and should be free to express. (to finally convinvce)

30. Evaluation

31. Evaluation by judgment : A- Expert judgment by trained observers: * the expert Judge determines “ how well” is the candidate …., without having to define the concept of “well”

32. Evaluation by judgment : ( cont.) B- In Judging by the use of tests and scales : - The concept “well” has to be defined “ before hand”. - This standardization ensures objectivity.

33. How to ensure” reliability” of the judgement ? By using objective tests : e.g. MCQ s, check lists, rating scales and similar methods, ( We help the examiners to unify their judgments and under different personal i.e. subjective conditions ).

34. To ensure “validity”, be sure that evaluation is testing for the true requirements of the job: So, 1- Discard Qs on sophisticated Knowledge ( not needed in performing the required tasks in the job). 2- Do not ignore the skills and attitudes needed ( as defined in the task analysis and job description.)

35. Long Essay Questions : They h ave minimal advantages ( uncommonly used in patient education ) 1- Easy to prepare ( for the examiner). 2- Tests ability to construct an article (poor validity) 3- Poor reliability.

36. Multiple Short Essay Questions 1- covers a large part of the curriculum 2- less unreliable 3- answered and marked in shorter time 4- Still tests simple knowledge

37. MCQ Test - scored in a short time and precisely. - if numerous, covers widely the syllabus. - can be used for self assessment. - high reliability, very objective But,………………. - difficult to prepare good MCQs. - usually test only knowledge (rarely skills e.g. in decision making ).

38. Oral Examination - Few advantages : vivid, can probe increasing depth of knowledge (escalate). - Disadvantages: - induces anxiety (stress not existing in practical life). - consumes long time. -very subjective and unreliable - can not test skills - does not give good FB to the education process. Conclusion : better avoided

39. Evaluation of performance by Check Lists (very useful for testing skills). observe steps: well done 1-……………………………………………… √ 2-……………………………………………… √ 3-………………………………………………(X) 4-……………………………………………… √ 5-……………………………………………… √ 6-……………………………………………… √ 7-……………………………………………… √ 8-……………………………………………… √ 9……………………………………………… √ 10……………………………………………… √. Score = 9/10 - Has high reliability - Gives good feed-back.

40. Check List / Rating scale, for measuring attitudes (behaviours) of a person during his training or working (job) 543210 × × ×××× 1- shows interest 2- accepts instructions 3- cares for patients 4- shows desire to learn 5- keeps on time 6- ………………….. 0: strongly lacking…………5: strongly agree / evident

41. The Follow-up Record of Proper Performance during a training course for a group * The Record contains a number of tasks enlisted (1,2,3 …). * Each individual (A,B,C,…) should fulfill the performance of all tasks. * Satisfactory achievement of each task ( separately ) is monitored. * Unsatisfactory performance indicates repeat training for a specific individual or the whole group

42. Tasks Trainee DC(B)A X 1 X 2 XX 3 X 4 X 5 XXXX (6)

43. General Considerations in Evaluation: - There is no one ideal method for evaluation. - The choice of one method depends on : 1- is it reliable? 2- is it valid? 3- time consumed? 4- availability of its tools. 5- its FB (feed-back) value to the learning process 6- comprehensive testing of knowledge,skills and attitudes.

44. Alexandrie – Palais du Montazah Thank You