STRATEGIES ON HEALTH

EDUCATIONJamie

Rose Q. Cano

CHAPTER 3

PLANNING and CONDUCTING

CLASSES

THE PLANNING SEQUENCE

PLANNING…most formidable task a new teacher may faceFormulate objectivesSelect and organize contentChoose teaching methodsDesign assignmentsDecide how to evaluate learning

DEVELOPING A COURSE OUTLINE OR SYLLABUS

Course outline/syllabus… considered a contract between teachers and learners

FORMULATING OBJECTIVES

THE VALUE OF OBJECTIVES needed to guide selection and handling of course materials

help determine whether people in the class have learned what you have tried to teach

essential from the learner’s perspective

TAXONOMY OF OBJECTIVES

BLOOM (1984)♦ Developed a taxonomy of educational

objectives♦ identified 3 learning domains:a. Cognitive (knowing) – measure knowledge,

comprehension, application, analysis, synthesis, and evaluation by using written or oral tests

b. Psychomotor (doing) – observe what learners are actually doing when they perform a skill.

c. Affective (feeling, valuing) – not so easy to write and measure

Behavioural Verbs Useful for Writing Objects

Cognitive domainKnowledge Define,delineate,describe,identify,list,name,stateComprehension Classify,discuss,estimate,explain,rephrase,summarizeApplication Adjust,apply,compute,demonstrate,generate,proveAnalysis Analyze,compare,contrast,critique,defend,differentiateSynthesis Create,develop,propose,suggest,writeEvaluation Assess,choose,conclude,defend,evaluate,judge

Psychomotor domainArrange, assemble, calibrate, combine, copy,correct, create, demonstrate, execute, handle, manipulate, operate,

organize, position, produce, remove, revise, show, solveAffective domain

Accept, agree, choose, comply, commit, defend, explain,influence, recommend, resolve, volunteer

A COURSE OUTLINE SHOULD…

include the name of the coursename of the instructorone-paragraph course descriptionlist of course objectstopical outlineteaching methods to be usedtextbooks or other readingsmethods of evaluation

SELECTING CONTENT

FACTORS IN SELECTING CONTENT

time that can be devoted to the topic

kind of background the students have

if a textbook has already been selected for the course

SELECTING TEACHING METHODS

WESTON and CRANTON (1986) ♦ believe that selection of teaching

methods is one of the most complex parts of teaching, yet it receives the least attention in instructional planning

♦ they select strategies with which they are familiar and comfortable, without much thought as to whether those strategies are the most appropriate way to teach the material

FACTORS AFFECTING CHOICE OF METHOD

the selection of method depends on the objectives and type of learning you are trying to achieve

course content also dictates methodology to some extent

choice of teaching strategy depends on the abilities and interests of the teacher

compatibility between teachers and teaching methods is important

number of people in the class educator’s instructional options are limited

to the resources of the institution

CHOOSING A TEXTBOOK

TEXTS – provide a stable and uniform source of information for students to use in their individual study, and teachers expect students to use the book extensively

In some academic settings, individual teachers select their own course textbooks; however in others, the text must be reviewed by not only the individual teachers, but by a textbook review committee.

CHOOSING A TEXTBOOK..

evaluate the content scope and quality

credibility of authorshift format ( tables of contents, index, organization, length, graphics )

issues like cost, permanency, quality of print and the like

USING A TEXTBOOK

APPROACHES TOWARD READING ASSIGNMENTS

Assign pages for homework, assume the students have read and understood the material, and carry on the next class

Assume that few people in the class have read or understood the assigned reading, so they rehash it all in the class

Use the information from the assigned reading as a basis for classroom discussion

PESTEL (1977)♦ uses discovery questions to help students get the most out of their reading. Students are assigned short passages to read before class. In class, this author distributes questions that help students to understand and evaluate the material in the text. Students work in groups at the beginning of class to answer the questions, and the questions and answers then guide the rest of the day’s discussion.

CONDUCTING THE CLASS

THE FIRST CLASS introduce yourself communicate your expectations

cover general classroom rules

try to whet the learners’ appetites for what is to come

SUBSEQUENT CLASS gain and control the

attention of the learners

assess the learners to determine their backgrounds and how much they already know about the content of the course

CASE STUDYYou are a community

educator for a large health care system. You are preparing a series of two classes on smoking cessation that will be followed by a support group for people who want to quit smoking.

1)What resources might you use to help you with content for classes?

2)Write objectives for the course in all three learning domains. Indicate how you plan to measure each of them.

3)Write objectives for the first class, with one at each of the six levels of the cognitive domain.

4)What teaching methods would you use in these classes? What resources would you need for these methods?

CRITICAL THINKING EXERCISES

1. You are responsible for selecting a medication computation workbook for an RN refresher course you are going to teach. A friend has recommended a book to you, but you want to be sure that it is the best book for your course. Which of the following factors might make this book appropriate or inappropriate for your course, and why?

a.It reviews basic math like addition, multiplication, and working with fractions.

b. Conversions between metric and apothecary systems are included.

c.Intravenous rate calculations are included.

d. Dimensional analysis is used as an approach instead of the desired/have method.

e. Formulas are given for titrating drugs used in critical care units.

f. A computer disk with tutorials and sample quizzes is included with each book.

2. An experienced teacher one said that it can be good if learners feel a little confused during class. How can it be a good thing? If there is some merit to that thought, why should we work hard at

organizing our content delivery in order to avoid confusion?

3. How could you design an experiment to test the effectiveness of a new teaching method that would minimize some of the pitfalls of educational research?

CHAPTER 13

CLINICAL TEACHING

PURPOSE OF THE CLINICAL LABORATORY

Infante ( 1985 )

♦ noted that the opportunity for observation is an essential element of clinical learning. The skill of observation can be taught in stimulated situations.

Fothergill-Bourbonnais & Higuchi, 1995

♦ learners need practice using these cognitive skills under the guidance of an educator and other professional staff in real-life settings.

Gaberson & Oerman, 1999♦ learners also gain organization

and time management skills in clinical settings

♦ cultural competence is a skill that can be learned well in the clinical laboratory

Chan, 2002♦ learners of nursing become

socialized in the clinical laboratory

MISUSE OF THE CLINICAL LABORATORY

• Nursing students have been sent to the clinical setting to gain work experience rather than to achieve educational objectives.

• Novices are given too much responsibility for patient care

• Learners are supervised and evaluated more than they are taught

MODELS OF CLINICAL TEACHING

INFANTE♦ developed a model that relies

heavily on keeping nursing students in a skill laboratory until they are proficient with skills.

PACKER♦ contends that more

information about clinical practice should be taught in the classroom before learners go to the clinical area

MORE ON PRECEPTORSHIP

PRECEPTORSHIP…♦ increase clinical experience for students and expose them to more of the realities of the work world, which should reduce reality shock.♦ potentially increase the learning during clinical time♦ allow students to learn from practitioners with a high skill level while still being guided by faculty who have a wealth of knowledge

The role of preceptor is that of orienting students to the agency assigning students to patients, teaching patient care, asking questions to be sure learners understand what they are doing, and evaluating student learning

COMPONENTS OF A COMPREHENSIVE ORIENTATION FOR PRECEPTORS1. Purpose and expected outcomes of the

clinical education of learners.2. Overview of the school curriculum as it

relates to the clinical experience.3. Skills that can be expected of learners

entering the preceptorship.4. Principles of adult learning.5. Common errors made by students and

common misconceptions.6. Roles and responsibilities of the preceptor,

the educator, and the student.

7. Interactions with learners and relationship with educators.

8.Introduction to course syllabi.9.Planning and learning

experiences.10. Clinical teaching strategies.11. Overview of evaluation

procedures and measuring instruments.

12. Legal implications of working with learners.

PREPARATION FOR CLINICAL INSTRUCTION

contracts must be drawn up between the school and the clinical agency

educator should set-up a meeting with the agency staff that will be involved with the education process

make specific assignments for learners on a weekly or daily basis.

GOLDENBERG and IWASIW (1988)♦ conducted an investigation of the criteria used by the educators in selecting students’ clinical assignments.

3 MOST IMPORTANT CRITERIA USED IN THE SELECTION PROCESS:

○ students’ individual learning needs,

○ patients’ nursing care needs, and

○ matching of patients’ needs with students’ learning needs.

CONDUCTING A CLINICAL LABORATORY SESSION

PRECONFERENCES♦ planning of patient care continues♦ tentative nursing diagnoses are discussed♦ assigned learner can discuss possible nursing interventions with the other learners and the instructor♦ answer students’ questions about their assignments and to try to alleviate their anxieties♦ help learners organize their day and prioritize the care they must give.

THE PRACTICE SESSION♦ learner may be providing some degree of care to one or more patients and may be reporting directly to the educator for all questions and needed help.♦ learners may work closely with staff nurses who answer many routine questions and provide some assistance and supervision, while the educator spends time with those learners who are in situations calling for intense teaching and guidance.♦ preceptorship with several variations of that structure.

OBSERVATION ASSIGNMENTS♦ supported by Social

Cognitive Theory, which expresses the importance of observation in the learning process.

♦ learners may be assigned to observe nurses or other professionals performing various aspects of health care that learners usually cannot perform.

NURSING ROUNDS

♦ use as a pedagogical strategy♦ involves a group of learners and

their instructor visiting patients to whom the learners are assigned

♦ PURPOSE – to expose learners to additional nursing situations and to encourage them to consult each other in planning and evaluating care

♦ provide many opportunities to apply classroom theory to patient situations and to compare and contrast patient care

SHIFT REPORT♦ a unique time for learning♦ a way for students to learn the uniqueness of nursing communication and is a means of professional socialization

LEARNING CONTRACTS♦ useful way to structure and guide learning in the clinical setting.♦ a written agreement between instructor and learner spelling out the learner’s outcome objectives♦ have been used successfully in undergraduate and graduate education, for PN to BSN students, for new staff during orientation, for staff on a clinical ladder, and for patient education

WRITTEN ASSIGNMENTS ♦ nursing care plans – help learners think like a nurse ♦ clinical log or journals – students can create a dialogue

with their teacher and reflect upon and explore their clinical experiences in the context in which these experiences occur

♦ Critical Thought Paper – asks the students to identify key problems and issues for the patient,to identify underlying assumptions that the patient and the student bring to the situation, the meaning of these issues for the patient and student, and therapeutic approaches the students used.

♦Mundane assignment (drug card) – students are required to look up each drug their patient is receiving and to write all the pertinent information on an index card

POSTCONFERENCES♦ unstructured seminars that allow for creativity but that can dissolve into meaninglessness♦ usually held at the end of a physically and emotionally draining practice session♦ ideal opportunity for pointing out applications of theory to practice, for analyzing the outcome of hypothesis testing, for group problem solving, and for evaluating nursing care

EVALUATING LEARNER PROGRESS

Formative evaluation – the ongoing feedback given to the learner throughout the learning experience. This helps the learner identify strengths and weaknesses and meet the learning objectives efficiently

Summative evaluation – a summary evaluation given at the end of the learning experience

Norm-referenced evaluation – a learner is compared with a reference group of learners, either those in the same cohort or in a norm group.

Criterion-referenced evaluation – that which compares the learner to well-defined performance criteria rather than comparing him or her to other learners. It defines the behaviour expected at each level of performance

BEHAVIORS TO BE EVALUATED

• use of the nursing process• use of health-promoting strategies• psychomotor skills• organization of care• maintaining patient safety• ability to provide rationale for nursing care• ability to individualize care planning and

intervention

• therapeutic communication• ability to work with a professional team

• professional behaviors like following policies, being on time, maintaining confidentiality, and being accountable for one’s own actions

• written documentation of care

SOURCES OF EVALUATION DATA

direct observation by instructors

learner self-evaluation data gathered from agency

staff

CLINICAL EVALUATION TOOLS1. The item should derive from the

course or unit objectives.2. The items must be measurable in

some way. It must be possible to collect substantiating data.

3. The items and instructions for use should be clear to all that must use the tool.

4. The tool should be practical in design and length.

5. The tool must be valid and reliable.

3 interesting tools that appear in the literature that have been tested for reliability and validity are the:A. RATING SCALES (Bondy, 1983,1984)

- developed a five-point rating scale. The five points reflect criterion-referenced levels of competency. The beauty of the scale is that it can be applied to any clinical setting with its unique learning objectives.

B. COMMUNITY FAMILY NURSING CLINICAL EVALUATION TOOL

(Hawranik 2000)- contains items on the

nursing process and professional growth and leadership and could be used in evaluating students in most home-health settings

C. CLINICAL EVALUATION TOOL (Krichbaum, Rowan, Duckett, Ryden, and Savik 1994)

- generic enough that it could be used in almost any clinical experience. It covers items on health promotion, nursing process, safety, scientific knowledge, multicultural care, therapeutic relationships, and professional behavior. These tools can be used or adapted for academic or staff development settings.

CASE STUDYAs a clinical supervisor, you are responsible for conducting yearly performance evaluations of your staff. Your agency provides a competency-based measurement tool, but most aspects of the actual conduct of the evaluation are left up to you.

1. What decisions must you make before conducting the evaluation?

2. How will you collect the data you will need for the evaluation?

3. How will you respond if a staff member disagrees with some aspect of the evaluation?

4. If a staff member receives an unsatisfactory evaluation, what are the possible next steps, and how are they determined?

CRITICAL THINKING EXERCISES

1. Should you place learners in a clinical setting that has less than desirable staff role models? What are the risks and how could they be mitigated?

2. Conducting nursing rounds with a large group of learners poses threats to patient privacy and confidentiality. What guidelines could you put in place to protect privacy and confidentiality?

3. What are the sources of learner stress in the clinical setting? How can they be reduced? Can this stress ever have a positive aspect?

4. Some educators believe they should have a collegial relationship with learners in the clinical setting. What would be the benefits and drawbacks of having more than a traditional teacher-learner relationship?

CHAPTER 14ASSESSING AND

EVALUATING LEARNING

CLASSROOM ASSESSMENT

Classroom Assessment Techniques (CATs)

are in-class, anonymous, short, nongraded exercises that provide feedback for both teacher and learner about the teaching/learning process.

PURPOSE – to provide the teacher with quick and timely feedback about the effectiveness of his/her teaching and the state of student learning

ANGELO and CROSS (1993)“Instructors who have

assumed that their students were learning what they were trying to teach them are regularly faced with disappointing evidence to the contrary when they grade tests and term papers.”

ADVANTAGES OF USING CATs gaining insight into student learning while

there is still time to make changes demonstrating to learners that the teacher

really cares if they are succeeding building rapport with learners spending only short amounts of time to gain

valuable information using the flexibility of CATs to adapt to the

needs of individual classes helping learners to monitor their own

learninggaining insight into your own teaching

DISADVANTAGE S OF USING CATs do take some class time away

from other activities can be overused to the point of

frustration of the learners they provide some negative

feedback for the educator they are likely to point

weaknesses in your teaching process or in your style

ONE-MINUTE PAPER♦ this technique is used in the last two or three minutes of the class period

MUDDIEST POINT♦ very popular assessment technique♦ was first used by Mosteller (1989) at Harvard University♦ especially useful for introductory level courses and for totally new content

DIRESCT PARAPHRASING♦ requires learners to put into their

own words something they have just learned

♦ can be used in the classroom, as an out- of-class assignment, or with patient teaching

♦ provides valuable feedback into learner understanding and ability to translate information

♦ especially useful for nurses because in their work they will often have to translate medical information into layman’s terms

APPLICATION CARDS♦ after you have taught an

essential principle, theory, or body of information, and before you talk about how this information can be applied to the real world, ask the learners to take a few minutes and write on an index card at least one possible application of this content

BACKGROUND KNOWLEDGE PROBE♦ used before teaching new content to

discover what the learners already know about the material

♦ it is, in a sense, an ungraded pre-test

MISCONCEPTION/PRECONCEPTION CHECK♦ helps to expose these mistaken ideas that

may hinder learning.♦ learners must be made aware of these

preconceived notions and then led to understand how those notions do not fit with the truth. (Enerson, Plank, & Johnson, 1994)

SELF-CONFIDENCE SURVEYS♦ allow learners to express

their possible lack of confidence in learning certain content or skills

♦ learners may be self-confident in many areas but feel insecure in some

♦ may involve developing a short survey with five or six questions and a Likert-type measurement

GOOD ADVICE ABOUT USING CAT ( ANGELO AND CROSS, 1993)

If a published CAT doesn’t appeal to you or fit with your style, don’t use it.

Don’t make the use of CATs a burden. Use them only when they can enhance the learning process.

Don’t use a CAT in class until you have tried it on yourself.

Allow a little more time than you actually think you will need to administer a CAT.

Be sure to give learners feedback on the CAT results.

EVALUATION OF LEARNING

TEST BLUEPRINT ♦ a chart that spells out the content

( behaviors, objectives ) and the level of knowledge to be tested

♦ can be highly specific or rather general, according to the teacher’s preference

♦ it should contain the content or objectives to be measured, a taxonomy of levels of learning to be assigned to the content or objectives, and the number of questions or relative weight to be given to each area.

MULTIPLE-CHOICE QUESTIONS♦ easy to score and can be scored

by computer♦ licensure and certification

examinations are multiple-choice tests

2 PARTS:a. STEM – the question itselfb. OPTIONS – the possible answers

or solutions that followa) ANSWER – the correct optionb) DISTRACTERS – the incorrect

options

the stem should be as short as possible while still conveying the ideas clearly

negatively stated stems should be avoided unless they test for important points

distracters should be realistic

the number of options that follow the stem may vary

RULES IN WRITING OPTIONS they should be grammatically consistent

with the stem, both to use good style and to avoid giving unwanted clues

options should be fairly short and about the same length

options should be placed in the logical order, if one exists

avoid the use of qualifying terms, such as always, sometimes, usually, and never.

alter the positions of the correct answers in a series of multiple-choice questions

TRUE-FALSE QUESTIONS♦ designed to test a learner’s ability to

identify the correctness of statements of fact or principle

♦ limited to testing the lowest levels of knowing, knowledge and comprehension, and thus have limited usefulness in tests for nurses or nursing students

♦ may be useful in evaluating patient learning or ancillary staff learning

MATCHING QUESTIONS♦ test knowledge, the lowest level of

knowing♦ useful in determining if learners can

recall the memorized relationships between two things such as dates and events, structures and functions, and terms and their definitions

♦ easy to construct and to score, but because they test only recall, they should be used sparingly

♦ set up as two lists, with the premises usually on the left and the responses on the right

ESSAY-TYPE QUESTIONS♦ time consuming for test takers to

answer thus limiting the amount of knowledge sampling you can accomplish in a short time

♦ also time consuming to score

♦ lend themselves to testing the highest levels of knowing, especially analysis, synthesis, and evaluation

Restricted response♦ short-answer questions♦ place limitations on the type of

response requested♦ fit well with case study formats

Extended response♦ full essay questions♦ permit the test taker to select all

pertinent information, organize it as desired , and express the thesis in a clear manner

TEST ITEM ANALYSISITEM DIFFICULTY♦ the proportion of test takers that answer the question

correctly♦ calculated by dividing the number of people who got

the item right by the number who took the test# correct

Difficulty index = ––––––––––––––# total test takers

The resulting fraction provides an estimate of difficulty, with the higher percentages indicating easier questions

ITEM DESCRIPTION♦ an estimate of the usefulness of an

item in differentiating between learners who did well on the whole test and those who performed poorly

♦ process for calculating item discrimination involves ranking the test papers from highest to lowest scores and choosing the top 25 to 30 percent and the bottom 25 to 30 percent

EVALUATING PATIENT LEARNING

FEEDBACKS ABOUT PATIENT LEARNING: ask the person to read a pamphlet or

fact sheet summarizing what you have taught and to underline the important information

a change in patient behaviour related to health care practices

return demonstration of a taught skill collect physical evidence of the

effectiveness of patient teaching

CASE STUDYYou are teaching a class of 10

infection control nurses from your geographic area on insect-borne diseases. Although these are experienced nurses, this information is quite new to them and you want to be sure they are learning as you go along.

1. What Classroom Assessment Techniques would be most appropriate to use: Muddiest Point, Student-Generated Test Questions, Application Cards, or Self-confidence Surveys?

2. What would be the advantages and disadvantages of using each of these CATs with this population?

3. If you use Application Cards and no one comes up with good applications, what is this feedback telling you?

4. Develop a new CAT that would be appropriate for this class.

CRITICAL THINKING EXERCISES1. What are some things that could go wrong

in using Classroom Assessment Techniques, and how could you prevent them from happening?

2. Compare and contrast two CATs: Misconception/Preconception and Background Knowledge Probe. What are the advantages of each?

3. How might you assess or evaluate problem-solving skills among new graduates?

4. In evaluating patient learning, how can you tell the difference between failure to learn and lack of interest in applying learning?

5. In conducting research, we are taught not to use measurement instruments unless they have demonstrated reliability and validity. Does this principle apply to measuring classroom learning? Why or why not?

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