1. Chapter 8
UNIT 12 Chapter 8
Teaching-Learning
Client Teaching

2. Teaching-Learning Process
Planned interaction that promotes behavioral change
Active process
The Teaching–Learning Process
Client education is an important part of nursing practice because it enables clients to restore and maintain an optimal level of functioning. Review and outline some of the major purposes and benefits of client education, types of teaching, and the domains of learning.
The teaching–learning process is a planned interaction promoting behavioral change that does not occur as the result of maturation or coincidence. The sharing of information between individuals, using goal-directed activities to promote behavioral change as a result of learning, is known as teaching.
Learning is a process whereby an individual integrates information that results in a behavioral change. The teaching–learning process is similar to the nursing process because it involves assessment, identification of learning needs (nursing diagnoses), planning, implementation of teaching strategies, and evaluation of learner progress and teaching proficiency. The role of the nurse as teacher is to bridge the gap between what a client knows and what the client needs to know to achieve optimal health.

3. Client Teaching Done for variety of reasons: Promote wellness
Prevent illness
Restore health
Facilitate coping abilities
Client Teaching Some of the purposes of client teaching are to promote wellness, to prevent illness, to restore health, and to assist in developing the client’s coping abilities. Among the benefits of client education are shorter hospital stays, improved quality of care, decreased chance of hospital readmission, and greater compliance with the prescribed treatment regimen

4. Potential Results of Client Education
Improved quality of care
Decreased length of hospital stays
Decreased chance of hospital readmission
Improved compliance with treatment regimens
Potential Results of Client Education
Improved quality of care
Decreased length of hospital stays
Decreased chance of hospital readmission
Improved compliance with treatment regimens

5. Teaching Formal Informal
Takes place at specific time in specific place on specific topic
Informal
Takes place any time, any place when learning need identified
Teaching can be either formal, taking place at a specific time and place about a specific topic, or informal, taking place whenever a learning need is identified. Formal teaching is planned and goal-directed, requiring the teacher to prepare for the experience by obtaining necessary information needed by learners and by planning learning activities related to the topic. The learner may be one individual or a group of learners who have the same learning need. Nurses have unlimited opportunities to engage in informal teaching any time they identify a learning need. Informal teaching may also occur within a formal teaching setting, when a learner poses a question that may not be related to the formal topic.

6. Learning Domains Cognitive Affective Psychomotor
Acquiring facts and data
Used in decision making and problem solving
Affective
Attitude-changing, emotion, and belief
Used in making judgments
Psychomotor
Gaining motor skills
Used in physical application of knowledge
Learning domains are usually classified as cognitive, related to intellectual understanding (e.g., learning to identify the risk factors for development of breast cancer); affective, related to attitudes, beliefs, and emotions (e.g., recognizing the value of performing breast self-examination); and psychomotor, related to performance of motor skills (e.g., learning to perform breast self-examination). The nurse as teacher must be aware of all these domains when developing teaching plans for clients.
(continued)

7. Teaching Strategies

8. Learning Principles
Personality develops in orderly fashion from dependence to independence
Readiness affected by developmental stage and sociocultural factors
Prior learning experiences are foundation for further learning
Immediacy reinforces learning
major principles of learning and basic assumptions about adult learners. identify at least five major learning principles.
There are four basic assumptions about adult learners: (1) an individual’s personality develops in an orderly fashion from dependence to independence, meaning that a nurse should choose learning activities for the client that encourage self-care through empowerment; (2) learning readiness is affected by developmental stages and sociocultural factors, meaning that it is extremely important for a nurse to conduct a psychosocial assessment of a client before planning a teaching–learning session; (3) a person’s previous learning experiences can be used as a foundation for further learning, meaning that it is important for the nurse to determine what a client already knows about a topic before planning and implementing a teaching session; and (4) immediacy reinforces learning, meaning that the nurse should structure opportunities for the client to apply the knowledge and skills acquired during the teaching session.
(continued)

9. Learning Principles Relevance Motivation Readiness Maturation
Reinforcement
Participation
Organization
Repetition
Learning principles that are important for nurses in client teaching include relevance, motivation, readiness, maturation, reinforcement, participation, organization, and repetition. Relevance relates to information that is meaningful, understood by a client, and related to the client’s previous learning; unless clients believe that it is personally necessary to learn certain information, they will not learn the information, no matter how important it may be to their self-care. Motivation reflects a client’s desire to act, such as to learn certain information that she or he considers personally valuable. Nurses can increase client motivation by setting realistic teaching–learning goals and by presenting information incrementally so the client does not feel overwhelmed. Readiness is closely tied to a client’s growth and development and indicates that the client is both able and willing to learn specific information. Indications of client readiness include asking questions and becoming involved in learning activities. Lack of readiness may be indicated by client anxiety, avoidance, or denial, and lack of participation in self-care or learning activities. Maturation is a developmental process; the nurse must assess the client’s developmental stage to ensure that the planned teaching–learning activities are appropriate. The client’s developmental stage—including cognitive skills, problem-solving abilities, and attention span—determines what teaching methods and vocabulary the nurse should use and what content the nurse should present. Participation indicates client involvement in the learning process; greater client involvement promotes learning of the designated content, regardless of domain. Organization refers to the presentation of material in a logical sequence, such as familiar to unfamiliar or simple to complex. The nurse should start with what a client already knows about a topic. Repetition involves reinforcement of designated learning material to assist with retention of the material. Increasing the frequency with which a client hears or sees specific content increases the probability that learning will be retained.

10. Learning Styles Visual learners Auditory learners Kinesthetic learners
Review:
Visual learners
Learn by processing information visually
Auditory learners
Learn by listening to words
Kinesthetic learners
Learn by experiencing information or by touching, feeling, or doing

11. Barriers to Teaching-Learning
Environmental
Sociocultural
Psychological
Physiological
barriers to the teaching–learning process that affect the client, the nurse, or both.
Barriers may be either internal, involving physiological or psychological factors, or external, involving environmental or sociocultural factors.
Physiological barriers can affect a client’s ability to learn or a nurse’s ability to teach. The client who is experiencing severe pain is unable to attend to teaching content, no matter how important it may be to effective self-care. The nurse who has a health problem such as a severe cold or headache is unable to focus as effectively on the assessment, planning, and implementation of a planned teaching session.
Psychological barriers can also affect clients as learners and nurses as teachers. Clients (and their families) can experience anxiety, anger, depression, or fear about their health problems; any of these factors can impede learning. Nurses may be anxious about conducting a teaching session or concerned about personal issues, such as a conflict with a close friend or family member; these factors can detract from a nurse’s ability to focus on the client situation and teaching plan.
Environmental barriers affect both client and nurse. For example, trying to conduct a teaching session on a busy nursing unit with a high noise level and frequent interruptions detracts from the effectiveness of the teaching–learning process, no matter how well planned the session or how motivated the learner.
Sociocultural barriers such as client–nurse differences in language, culture, or education are significant obstacles to the teaching–learning process. Even when nurse and client share the same language, learning may not occur if the nurse resorts to technical jargon or clichés or talks down to the client. Body language of both nurse and client is subject to misinterpretation if they are from different cultures. Nurses should also respect clients’ value systems and recognize the influence of their own personal value systems on the teaching–learning process.

12. Teaching Methods Cognitive Domain: Affective Domain:
Discussion, Formal lecture, Question-and-answer sessions, Role play, Games or computer activities
Affective Domain:
Discussion, Role play
Psychomotor Domain:
Demonstration, Supervised practice, Return demonstration
Teaching strategies that are appropriate for nurses to use when addressing client learning needs in the cognitive domain include discussion, formal lecture, question-and-answer sessions, role play, and games and computer activities. Discussion is used when the nurse identifies one or more clients who share a learning need. This method encourages active learning and provides peer support for learners. Formal lecture is used for large groups of learners (e.g., community-based classes on reducing risk for cardiovascular disease), where the nurse presents the information with minimal learner participation. Question-and-answer sessions can be structured for a nurse to ask clients questions to promote application of material presented or for clients to ask a nurse questions about a specific topic. In role play, a nurse and client assume particular roles to explore potential scenarios; it provides clients with an opportunity to apply knowledge in a controlled environment that is comfortable and safe. These exchanges help clients prepare for actual discussions they may have with others. Games and computer activities can take advantage of clients’ readiness to learn and to use the information in various situations while having fun.
Teaching methods that are appropriate for nurses to use with learners who have needs in the affective domain include role play, in which clients express feelings and attitudes and “try out” different values and attitudes in a controlled environment, and discussion, in which a nurse and a client talk about personal or sensitive topics related to values, feelings, attitudes, and emotions. Teaching strategies that are appropriate for nurses to use with clients who have learning needs in the psychomotor domain include demonstration, in which a nurse presents a skill or procedure in a systematic way while explaining what is being done and why; supervised practice, in which a client performs a skill or procedure while a nurse observes and provides suggestions or corrections as the client proceeds; and return demonstration, in which a client performs a skill or procedure without any coaching from a nurse until the task is completed, at which time the nurse offers feedback and reinforcement.

13. Lifelong Learning All people are capable of learning
Learning needs and abilities change throughout life
Teaching approaches must be altered depending on client’s developmental stage and level of understanding
Life long learning All people are capable of learning
Learning needs and abilities change throughout life
Teaching approaches must be altered depending on client’s developmental stage and level of understanding

14. Teaching Children Readiness and maturation level
Children learn through play
Goals of educating children
Use various visual stimuli to share information and assess understanding
Use terms easily understood by child and caregiver
Provide frequent repetition and reinforcement
Develop realistic goals consistent with developmental level
Readiness for learning varies during childhood depending on maturation level
Children learn primarily through play
Goals of educating children:
Improve cooperation
Prevent excessive anxiety
Hasten recovery process
Use various visual stimuli to share information and assess understanding
Use terms easily understood by child and caregiver
Provide frequent repetition and reinforcement
Develop realistic goals consistent with developmental level
(continued)

15. Teaching Children Ensure comfort Encourage participation of caregiver
Assess child’s development level, readiness, motivation, and psychological status
Determine child’s self-care abilities
Use play, imitation, and role play
Ensure comfort
Encourage participation of caregiver
Assess child’s development level, readiness, motivation, and psychological status
Determine child’s self-care abilities
Use play, imitation, and role play
(continued)

16. Teaching Adolescents
Better able to understand relationships between things
More advanced reading and comprehension ability
More complex information understood
Peer support through group meetings often useful
Show them respect
Boost their confidence by seeking their input and opinions on health care matters
Encourage exploration of feelings
Be sensitive to peer pressure
Help them identify and build on their positive qualities
Teaching Adolescents: Better able to understand relationships between things
More advanced reading and comprehension ability
More complex information understood
Peer support through group meetings often useful
Show them respect
Boost their confidence by seeking their input and opinions on health care matters
Encourage exploration of feelings
Be sensitive to peer pressure
Help them identify and build on their positive qualities
Use clear language appropriate to health care setting
Encourage independent and informed decision making by engaging them in problem-solving activities
(continued)

17. Teaching Older Adults memory-impaired clients
visually impaired clients
hearing-impaired clients
Teaching Older Adults
Many physiological changes accompany aging
Some older adults experience perceptual impairments in vision and hearing
Assess for and adjust teaching materials accordingly
Assess for perceptual impairments and individualize teaching strategies
For memory-impaired clients:
Repeat material
Use different spoken words, pictures, written materials, and symbols
For visually impaired clients:
Use large-print materials
Provide magnifying glass
Ensure wearing of prescription eyeglasses
Arrange adequate lighting
Reduce glare
For hearing-impaired clients:
Face client when speaking
Use short sentences with simple words
Use gestures and demonstrations to reinforce verbal information
Eliminate distractions as much as possible
E.g., activities, noises in environment
(continued)

18. Teaching Older Adults Ensure comfort
Assess developmental level, motivation, and learning readiness
Assess for depression, anxiety, or denial
Determine older adult’s self-care abilities
Use words easily understood by client
Avoid talking down to client
Find time of day when client is most alert
Present material slowly
Encourage client participation
Ask for feedback and actively listen
Provide frequent feedback
(continued)

19. Professional Responsibilities
Teaching
Essential nursing function
Required in most states
One of the truly independent functions of nursing practice
Required by several accrediting bodies
Supports client’s behavioral changes
Client teaching is an essential function of every nurse, regardless of practice setting. All clients need information about disease prevention, growth and development, safety, hygiene, nutrition, and first aid. During hospitalization, clients need information about their health problems, the prescribed treatment regimen, and the environment of the health care facility. Prior to discharge, clients need information about post discharge care related to activity, medications, dietary modifications, prevention of complications, and plans for rehabilitation. When clients require care in their home setting, the client and family members must learn how to provide the care needed, such as special procedures or treatments. Client teaching is required of nurses in most states’ nurse practice acts and is also mandated by accrediting organizations such as the Joint Commission for Accreditation of Healthcare Organizations (JCAHO). The Patient’s Bill of Rights, issued by the American Hospital Association, includes statements related to client understanding of health status and treatment approaches. To be effective teachers, nurses need self-awareness of their current knowledge base and must know when it is necessary to refer clients to others for teaching that is beyond their knowledge or skills. Self-awareness of interpersonal skills is essential for nurses to establish a comfortable learning environment for clients; such skills include showing interest in the client, including the client in every step of the teaching–learning process, taking a nonjudgmental approach, and communicating at the client’s level without talking down to the client or over the client’s head. A final professional responsibility related to client teaching is documentation. Legally, if a nurse taught a client but did not document the teaching, the teaching never occurred. A nurse’s documentation of client teaching is also essential to promoting continuity of care and to communicating with other health care team members. Documentation should include the content taught, the teaching methods used, the learner(s) involved, and the client’s and family members’ response to the teaching activities.

20. Self-Awareness All-important first step in teaching
First step to maintaining efficacy and credibility as teacher:
Staying both current in knowledge and proficient in skills
Effective teaching based on nurse’s ability to establish rapport with client
Self Awareness
All-important first step in teaching
First step to maintaining efficacy and credibility as teacher:
Staying both current in knowledge and proficient in skills
Effective teaching based on nurse’s ability to establish rapport with client

21. Documentation Document education Content Teaching methods Learner(s)
Client-family response to teaching activities
Document education
Content
Teaching methods
Learner(s)
Client-family response to teaching activities

22. Teaching-Learning and the Nursing Process
Interdependent processes
Both are dynamic and comprise same phases:
Assessment
Diagnosis
Planning
Implementation
Evaluation
Teaching-Learning and the Nursing Process
Interdependent processes
Both are dynamic and comprise same phases:
Assessment-Consider:
Actual learning needs
Potential learning needs
Ability and readiness to learn
Client’s strengths and limitations
Previous experiences
Diagnosis-When lack of knowledge is primary learning need:
“Deficient Knowledge (specify)”
Planning-Specific learning goals should include:
Measurable behavioral change
Time frame
Methods and intervals for evaluation
Consider:
Why teach?
What should be taught?
How should teaching be done?
Who should teach, and who should be taught?
When and where should teaching occur?
Implementation-Get and keep client’s attention
Stick to basics
Use time wisely
Reinforce information
Evaluation-Two-fold process:
Determine what client has learned
Assess nurse’s teaching effectiveness

23. Evaluation of Client’s Learning Strategies:
Asking of questions
Observation
Return demonstration
Written follow-up
Evaluation of Teaching Effectiveness
Feedback from learner
Feedback from colleagues
Self-evaluation
Evaluation of Client’s Learning
Strategies:
Asking of questions
Observation
Return demonstration
Written follow-up
Evaluation of Teaching Effectiveness
Feedback from learner
Feedback from colleagues
Self-evaluation