Fluent Essays

to do presentation and involve all topics in chapter one Nurse as Educator Principles of Teaching and Learning for Nursing Practice FIFTH EDITION © Helaine Weide/Moment/Getty Nurse as Educator: Principles of Teaching and Learning for Nursing Practice, Fifth Edition drives comprehension through various strategies that meet the learning needs of students, while also gen- erating enthusiasm about the topic. This interactive approach addresses different learning styles, making this the ideal text to ensure mastery of key concepts. The pedagogical aids that appear in most chapters include the following: The Pedagogy Chapter Highlights Chapter high- lights provide a quick-look over- view of the content presented in each chapter. Key Terms Found in a list at the be- ginning of each chapter, these terms will create an expanded vocabulary. © Helaine Weide/Moment/Getty Overview of Education in Health Care Susan B. Bastable Kattiria M. Gonzalez CHAPTER 1 CHAPTER HIGHLIGHTS ■ Historical Foundations for Patient Education in Health Care ■ The Evolution of the Teaching Role of Nurses ■ Social, Economic, and Political Trends Affecting Health Care ■ Purposes, Goals, and Benefits of Patient and Nursing Staff/Student Education ■ The Education Process Defined ■ The Contemporary Role of the Nurse as Educator • Nursing Education Transformation • Patient Engagement • Quality and Safety Education in Nursing • The Institute of Medicine Report: The Future of Nursing ■ Barriers to Teaching and Obstacles to Learning • Factors Affecting the Ability to Teach • Factors Affecting the Ability to Learn ■ Questions to Be Asked About Teaching and Learning ■ State of the Evidence KEY TERMS education process teaching/instruction learning patient education staff education barriers to teaching obstacles to learning 3 Objectives These learning objectives provide instructors and students with a snapshot of the key information they will encounter in each chapter. They serve as a checklist to help guide and focus study. Evaluation is defined as a systematic pro-cess that judges the worth or value of some-thing—in this case, teaching and learning. Evaluation can provide evidence that what nurses do as educators makes a value-added difference in the care they provide. Early consideration of evaluation has never been more critical than in today’s healthcare en- vironment, which demands that “best” practice be based on evidence. Crucial decisions regard- ing learners rest on the outcomes of learning. Can the patient go home? Is the nurse provid- ing competent care? If education is to be jus- tified as a value-added activity, the process of education must be measurably efficient and must be measurably linked to education out- comes. The outcomes of education, both for the learner and for the organization, must be measurably effective. For example, the importance of evaluating patient education is essential (London, 2009). Patients must be educated about their health needs and how to manage their own care so that patient outcomes are improved and healthcare costs are decreased (Institute for Healthcare Im- provement, 2012; Schaefer, Miller, Goldstein, & Simmons, 2009). Preparing patients for safe dis- charge from hospitals or from home care must be efficient so that the time patients are under the supervision of nurses is reduced, and it also must be effective in preventing unplanned read- missions (Stevens, 2015). Monitoring the hos- pital return rates of patients is not a new idea as a method to evaluate effectiveness of patient OBJECTIVES After completing this chapter, the reader will be able to 1. Define the term evaluation . 2. Discuss the relationships among evaluation, evidence-based practice, and practice-based evidence. 3. Describe the differences between the terms evaluation and assessment. 4. Identify the purposes of evaluation. 5. Distinguish between five basic types of evaluation: process, content, outcome, impact, and program. 6. Discuss characteristics of various models of evaluation. 7. Explain the similarities and differences between evaluation and research. 8. List the major barriers to evaluation. 9. Examine methods for conducting an evaluation. 10. Explain the variables that must be considered in selecting appropriate evaluation instruments for the collection of different types of data. 11. Identify guidelines for reporting the results of evaluation. 12. Describe the strength of the current evidence base for evaluation of patient and nursing staff education. KEY TERMS evaluation evidence-based practice (EBP) external evidence internal evidence practice-based evidence assessment process evaluation (formative evaluation) content evaluation outcome evaluation (summative evaluation) impact evaluation total program evaluation evaluation research reflective practice 596 Chapter 14 Evaluation in Healthcare Education Review Questions Review key con- cepts from your reading with these exercises at the end of each chapter. The importance of evaluation as internal evidence has gained even greater momentum with the movement toward EBP. Perhaps the most important point to remember is this: Each aspect of the evaluation process is important, but all these considerations are meaningless if the results of evaluation are not used to guide future action in planning and carrying out ed- ucational interventions. Review Questions 1. How is the term evaluation defined? 2. How does the process of evaluation differ from the process of assessment? 3. How is evidence-based practice (EBP) related to evaluation? 4. How does internal evidence differ from external evidence? 5. What is the first and most important step in planning any evaluation? 6. What are the five basic components included in determining the focus of an evaluation? 7. How does formative evaluation differ from summative evaluation, and what is another name for each of these two types of evaluation? 8. What are the five basic types (levels) of eval- uation, in order from simple to com plex, as identified in Abruzzese’s RSA evalua- tion model? 9. What is the purpose of each type (level) of evaluation as described by Abruzzese in her RSA evaluation model? 10. Which data collection methods can be used in conducting an evaluation of educational interventions? 11. What are the three major barriers to conducting an evaluation? 12. When and why should a pilot test be conducted prior to implementing a full evaluation? 13. What are three guidelines to follow in reporting the results of an evaluation? results. Process, content, and outcome evalu- ations also are more frequently conducted as research projects, however, underscoring the importance of evidence as a basis for making practice decisions. Sinclair, Kable, Levett-Jones, and Booth (2016) conducted a systematic re- view of randomized clinical trials to determine the effectiveness of e-learning programs on health professionals’ behavior and patient out- comes. After screening articles initially iden- tified for review, the authors found 12 process and outcome RCTs worthy of further appraisal and 7 articles worthy of inclusion in the final systematic review. This is just one example of the increase in level of rigor in evaluations of healthcare education. ▸ Summary Conducting evaluations in healthcare educa- tion involves gathering, summarizing, inter- preting, and using data to determine the extent to which an educational activity is efficient, effective, and useful for those who participate in that activity as learners, teachers, or sponsors. Five types of evaluation were discussed in this chapter: (1) process, (2) content, (3) outcome, (4) impact, and (5) program evaluations. Each of these types focuses on a specific purpose, scope, and questions to be asked of an educational activity or program to meet the needs of those who ask for the evaluation or who can benefit from its results. Each type of evaluation also re- quires some level of available resources for the evaluation to be conducted. The number and variety of evaluation models, designs, methods, and instruments are growing exponentially as the importance of evaluation becomes widely accepted in today’s healthcare environment. Many guidelines, rules of thumb, suggestions, and examples were in- cluded in this chapter’s discussion of how a nurse educator might go about selecting the most ap- propriate model, design, methods, and instru- ments for a certain type of evaluation. 627Review Questions Case Studies Case studies encour- age active learning and promote critical thinking skills in learners. Students can read about real-life scenarios and then analyze the situation they are presented with. Ammerman, A., Smith, T. W., & Calancie, L. (2014). Practice- based evidence in public health: Improving reach, relevance, and results. Annual Reviews in Public Health , 35 , 47–63. doi:10.1146/annurev-publhealth-032013-182458 Bahreini, M., Moattari, M., Shahamat, S., Dobaradaran, S., & Ravanipour, M. (2013). Improvement of Iranian nurses’ competence through professional portfolio: A quasi-experimental study, Nursing and Health Sciences , 15 , 51–57. doi:10.1111/j.1442-2018.2012.00733.x Balas, M. C., Burke, W. J., Gannon, D., Cohen, M. Z., Colburn, L., Bevil, C., . . . Vasilevskis, E. E. (2013). Implementing the ABCDE bundle into everyday care: Opportuni- ties, challenges, and lessons learned for implementing the ICU pain, agitation, and delirium (PAD) guidelines. Critical Care Medicine , 41 (9 Suppl. 1), S116–S127. doi: 10.1097/CCM.0b013e3182a17064 Bates, O. L., O’Connor, N., Dunn, D., & Hasenau, S. M. (2014). Applying STAAR interventions in incremental bundles: Improving post-CABG surgical patient care. Worldviews on Evidence-Based Nursing , 11 (2), 89–97. References Abruzzese, R. S. (1992). Evaluation in nursing staff development. In R. S. Abruzzese (Ed.), Nursing staff development: Strategies for success (pp. 235–248). St. Louis, MO: Mosby–Year Book. Adams, R. J. (2010). Improving health outcomes with better patient understanding and education. Dovepress , 2010 (3), 61–72. Retrieved from http://www.ncbi.nlm.nih.gov /pubmed/22312219 Allen, J., Annells, M., Clark, E., Lang, L., Nunn, R., Petrie, E., & Robins, A. (2012). Mixed methods evaluation research for a mental health screening and referral clinical pathway. Worldviews on Evidence-Based Nursing, 9 (3), 172–185. American Nurses Credentialing Center, Commission on Accreditation. (2014, September). The importance of evaluating the impact of continuing nursing education on outcomes: Professional nursing practice and patient care. Retrieved from http://www.nursecredentialing .org/Accreditation/ResourcesServices/Evaluating-the -Impact-CNE-Outcomes.pdf CASE STUDY Having recently completed her master’s degree in nursing, Sharon has accepted a new role as clinical nurse educator for three adult medicine units in the medical center where she has been employed as a staff nurse for the past 6 years. Eager to put her education to practice in a manner that would benefit both patients and staff, Sharon meets with the nurse managers of the three units to learn what they view as priority issues on which she should focus. All three managers agree that their primary concern is teaching their staff how to better prepare patients with type 2 diabetes to care for themselves after they are discharged home. One manager comments, “Half of my nurses are new graduates. I’m not even certain that they know much about type 2 diabetes—how on earth can they teach the patients?” The other two managers nod, agreeing with the first, and chime in: “The patients aren’t being taught what they need to know, they don’t believe what they’re hearing, or they don’t understand what they’re hearing. As a result, I’m being told by ambulatory service nurses that our discharged patients aren’t taking their medications, aren’t making any changes in diet or lifestyle, and seem unconcerned about their hyperglycemia.” You next meet with Eric, the certifi ed diabetes educator at your hospital, and he reminds you that all nurses are mandated to annually review the patient and family education program for patients with type 2 diabetes and complete the cognitive posttest. 1. Which type of evaluation is being conducted every year when the nurses review the program and complete the cognitive test? 2. Which type(s) of evaluation would be most relevant to the nurse manager’s concerns? 3. Putting yourself into Sharon’s place, describe in detail an evaluation that you would conduct with the patients as a primary audience. 4. If evaluation is so crucial to healthcare education, what are some of the reasons why evaluation seems often an afterthought or is even overlooked entirely by the educator? 628 Chapter 14 Evaluation in Healthcare Education Susan B. Bastable, EdD, RN Nursing Education Consultant Professor Emerita and Founding Chair Department of Nursing Purcell School of Professional Studies Le Moyne College Syracuse, New York Nurse as Educator Principles of Teaching and Learning for Nursing Practice FIFTH EDITION World Headquarters Jones & Bartlett Learning 5 Wall Street Burlington, MA 01803 978-443-5000 [email protected] www.jblearning.com Jones & Bartlett Learning books and products are available through most bookstores and online booksellers. To contact Jones & Bartlett Learning directly, call 800-832-0034, fax 978-443-8000, or visit our website, www.jblearning.com. 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Parker Rights & Media Specialist: Wes DeShano Media Development Editor: Troy Liston Cover Image (Title Page, Part Opener, Chapter Opener): © Helaine Weide/Moment/Getty Printing and Binding: Edwards Brothers Malloy Cover Printing: Edwards Brothers Malloy Library of Congress Cataloging-in-Publication Data Names: Bastable, Susan Bacorn, editor. Title: Nurse as educator : principles of teaching and learning for nursing practice / edited by Susan B. Bastable. Description: Fifth edition. | Burlington, Massachusetts : Jones & Bartlett Learning, [2019] | Includes bibliographical references and index. Identifiers: LCCN 2017030094 | ISBN 9781284127201 (pbk.) Subjects: | MESH: Patient Education as Topic--methods | Teaching | Learning | Nurses’ Instruction Classification: LCC RT42 | NLM WY 105 | DDC 610.73--dc23 LC record available at https://lccn.loc.gov/2017030094 6048 Printed in the United States of America 21 20 19 18 17 10 9 8 7 6 5 4 3 2 1 In memory of my dear colleague and friend of 43 years, Dr. M. Louise Fitzpatrick, Dean of the College of Nursing at Villanova University for 4 decades. She was my advisor during my master’s program and chair of my doctoral dissertation committee at Columbia University and a mentor throughout my professional career. Louise wrote the foreword for my first, second, and third editions of this text. She was the ultimate educator and her advice, guidance, support, and friendship will be dearly missed. To nursing students and professional colleagues who over the years have shared their teaching experiences as well as their knowledge, skills, ideas, and reflections on the principles of teaching and learning. viii © Helaine Weide/Moment/Getty Chapter 2 Ethical, Legal, and Economic Foundations of the Educational Process . . . . . . . . . . . . . . . . . . . . 35 M. Janice Nelson and Kattiria M. Gonzalez A Differentiated View of Ethics, Morality, and the Law . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Evolution of Ethical and Legal Principles in Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Application of Ethical Principles to Patient Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 The Ethics of Education in Classroom and Practice Settings . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Legality of Patient Education and Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Legal and Financial Implications of Documentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Economic Factors in Healthcare Education: Justice and Duty Revisited . . . . . . . . . . . . . . . . . . . . 57 Financial Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Program Planning and Implementation . . . . . . . . . . 60 Cost-Benefit Analysis and Cost-Effectiveness Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 State of the Evidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Chapter 3 Applying Learning Theories to Healthcare Practice . . . . . . . . . 69 Margaret M. Braungart, Richard G. Braungart, and Pamela R. Gramet Psychological Learning Theories . . . . . . . . . . . . . . . . . 72 Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xii Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvi About the Author . . . . . . . . . . . . . . . . . . . . . . . . . . . . xviii PART 1 Perspectives on Teaching and Learning 1 Chapter 1 Overview of Education in Health Care . . . . . . . . . . . . . . . 3 Susan B. Bastable and Kattiria M. Gonzalez Historical Foundations for Patient Education in Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 The Evolution of the Teaching Role of Nurses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Social, Economic, and Political Trends Affecting Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 Purposes, Goals, and Benefits of Patient and Nursing Staff/Student Education . . . . . . . . . . 12 The Education Process Defined . . . . . . . . . . . . . . . . . . 13 The Contemporary Role of the Nurse as Educator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Barriers to Teaching and Obstacles to Learning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Questions to Be Asked About Teaching and Learning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 State of the Evidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Contents Contents ix Neuropsychology and Learning . . . . . . . . . . . . . . . . . 93 Comparison of Learning Theories . . . . . . . . . . . . . . . . 95 Motor Learning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 Common Principles of Learning . . . . . . . . . . . . . . . . 106 State of the Evidence . . . . . . . . . . . . . . . . . . . . . . . . . . 108 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 PART 2 Characteristics of the Learner 117 Chapter 4 Determinants of Learning . . . 119 Sharon Kitchie The Educator’s Role in Learning . . . . . . . . . . . . . . . . 121 Assessment of the Learner . . . . . . . . . . . . . . . . . . . . . 121 Assessing Learning Needs . . . . . . . . . . . . . . . . . . . . . 122 Methods to Assess Learning Needs . . . . . . . . . . . . 127 Readiness to Learn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 Learning Styles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139 Learning Style Models and Instruments . . . . . . . . 140 Interpretation of the Use of Learning Style Models and Instruments . . . . . . . . . . . . . . . 159 State of the Evidence . . . . . . . . . . . . . . . . . . . . . . . . . . 161 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 Chapter 5 Developmental Stages of the Learner . . . . . . . . . . . . . 169 Susan B. Bastable and Gina M. Myers Developmental Characteristics . . . . . . . . . . . . . . . . . 171 The Developmental Stages of Childhood . . . . . . 172 The Developmental Stages of Adulthood . . . . . . 192 The Role of the Family in Patient Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210 State of the Evidence . . . . . . . . . . . . . . . . . . . . . . . . . . 212 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215 Chapter 6 Compliance, Motivation, and Health Behaviors of the Learner . . . . . . . . . . . . . . . 219 Mary Ann Wafer Compliance and Adherence . . . . . . . . . . . . . . . . . . . 221 Motivation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225 Selected Models and Theories . . . . . . . . . . . . . . . . . 235 Models for Health Education . . . . . . . . . . . . . . . . . . . 244 The Role of Nurse as Educator in Health Promotion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247 State of the Evidence . . . . . . . . . . . . . . . . . . . . . . . . . . 248 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 248 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250 Chapter 7 Literacy in the Adult Client Population . . . . . . . . . . . . . . . . 257 Susan B. Bastable, Gina M. Myers, and Leigh Bastable Poitevent Definition of Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . 262 Scope and Incidence of the Problem . . . . . . . . . . . 266 Trends Associated with Literacy Problems . . . . . . 269 Those at Risk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 270 Myths, Stereotypes, and Assumptions . . . . . . . . . . 272 Assessment: Clues to Look For . . . . . . . . . . . . . . . . . 274 Impact of Illiteracy on Motivation and Compliance . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275 Ethical, Financial, and Legal Concerns . . . . . . . . . . 277 Readability of Printed Education Materials . . . . . 279 Measurement Tools to Test Literacy Levels . . . . . 281 Formulas to Measure Readability of Printed Education Materials . . . . . . . . . . . . . . . . . . . . . . . . . 282 Tests to Measure Comprehension of Printed Education Materials . . . . . . . . . . . . . . . . . . . . . . . . . . . 284 Tests to Measure General Reading Skills and Health Literacy Skills of Clients . . . . . . . . . . 286 Simplifying the Readability of Printed Education Materials . . . . . . . . . . . . . . . . . . . . . . . . . 289 Teaching Strategies to Promote Health Literacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297 x Contents Assistive Technologies . . . . . . . . . . . . . . . . . . . . . . . . . 409 State of the Evidence . . . . . . . . . . . . . . . …