Choose Problem Solving In Nursing Education

 Problem Solving In Nursing Education

 Components Choose Problem Solving ,Settings for Teaching,Sharing Resources Among Settings.

Components Choose Problem Solving 

Activities

    Whether the learners are staff members or patients, the nurse educator must recognize that learners need to be immersed in activities to help them develop problem solving skills. In today's world, professionals must have the ability to identify both patient and system needs by searching and sorting data, uncovering problems, and finding solutions. 

    Increasingly, they are expected to work within interdisciplinary teams to determine and implement solutions to healthcare problems. Learning activities, in turn, must be designed to help nursing staff members and students develop critical thinking and collaborative skills.

    Patients, especially those with chronic conditions, also need problem-solving skills to know how to respond to the flexibility demanded by their condition. What should they do differently on a sick day? What constitutes an emergency? Patients and their families need more than just low level cognitive information to make the needed adjustments in their lives. 

    To help them develop the necessary problem-solving skills, the educator must devise and orchestrate opportunities that challenge learners to critically analyze situations as well as support learners in exploring possible alternative solutions to meet their needs.

Serve as a Role Model

    Educators should constantly seek out new information by keeping abreast of current research, theories, and issues in clinical practice for application relevant to the teaching situation. By expanding their own knowledge base, educators give credence to what they teach and gain the confidence of learners in the educator's expertise. 

    A commitment to lifelong learning transmits an important value to regarding others their own need to pursue continuous personal or professional development.Educators are viewed as credible role models when they are actively engaged in scholarly activities, are experienced in the field, and have advanced credentials to teach complex skills. 

    The believability of a role model is greatly affected by the values displayed and the congruence demonstrated between what the educator says and does (Miller & Stoeckel, 2016). If the learners regard the behavior of the creative educator as desirable, they will likely imitate that behavior, which they perceive as eliciting positive effects.

Use Anecdotes and Examples

    The creative educator uses stories and examples of incidents and episodes to illustrate points. Anecdotes, whether amusing, alarming, sad, or anger provoking, may be valuable in driving a point home, clarifying a topic under discussion, or helping someone better relate to an issue. The educator can reinforce the learning principle that simple representations can assist the learner to grasp complex ideas by using examples relevant to past experiences. 

    The knowledge base of learners helps them identify and connect in a concrete way with the material being taught. For example, using the analogy of police cells (lymphocytes) fighting against outlaw cells (bacteria) can help a child with a serious infection understand in concrete terms how his body is working to heal itself. 

Use Questions

    Questioning is a means by which both the educator and the learner can elicit feedback about performance. If the educator is skillful in the use of questioning, it serves multiple purposes in the teaching-learning process. Questions may help to clarify concepts, assess what the learner already knows about the topic, stimulate interest in a new subject, or evaluate the learner's mastery of the predetermined behavioral objectives. 

    Miller and Stoeckel (2016) identify three types of questions that can be used to elicit different types of answers:

1. Factual or descriptive questions begin with words such as who, what, which, where, how, or when and ask for recall-type responses from the learner. Factual questions such as “Which foods are high in fat?” “Who should you call if you run out of medication?” or “How often on average do you use your inhaler?” elicit straightforward facts. 

    Descriptive questions take a more open ended approach, such as “Which kinds of exercise do you get daily?” “What problems do you have with activities of daily living?” or “What are the signs and symptoms of infection?” These questions require a more detailed and organized response from the learner.

2. Clarifying questions ask for more information and help the learner to convey thoughts and feelings. Such questions might include “What do you mean when you say...?” or “When do you feel most anxious?”

3. Higher order questions require more than memory or perception to answer. They ask the learner to draw conclusions, establish cause and effect, or make comparisons. Examples include “Why does a low-salt diet help to control blood pressure?” “What do you think will happen if you don’t take your medication?” and “What do you see as the advantages and disadvantages in following the treatment plan?”

    After asking questions, a period of silence may occur. This gap can be uncomfortable for both the educator and the learner. Educators can reduce anxiety over silence by encouraging the learner to think about the answer before responding. In a group, this strategy also allows all participants to have a chance to think through their responses to the questions, which gives them the opportunity to make more thoughtful and deliberate responses. 

    How long an educator should wait for a response depends on many variables, such as how complex the question is, who the learners are, and what they are expected to know. Wait time is a matter of judgment on the part of the educator. 

    Questioning helps the educator appropriately pace the material being presented. Also, answers to questions allow the educator to arrive at an evaluative judgment as to the progress the learner is making in the achievement of the behavioral objectives. 

Use the Teach Back or Tell Back Strategy 

    Many patients who have been taught about their health problem, how to prevent disease, or how to follow recommended treatment regimens to promote or maintain their health do not always fully and accurately understand the information that has been given to them. 

    When patients are asked to explain what they have been told by their nurse or other health care provider, it becomes evident that for various reasons there are many gaps and errors in the information they interpreted and remembered (Floyd, Lang, McCord, & Keener, 2004; Kessels, 2003; Ley, 1972, 1979).

    Thus, nurses who teach patients using various teaching methods and instructional materials must assess how well and how much patients understood the information given to them before they are expected to independently care for themselves. It is important that educators ask patients to restate in their own words what they learned to confirm their retention of information and the effectiveness of the patient educational interventions. 

    A key strategy to determine the extent of patients' understanding following each patient education encounter is known as the teach back, tell back, closing the loop, or show me approach to evaluate learning.

    This specific teaching method is patient and family centered and results in improved nurse-patient communication, increased patient satisfaction with care, improved quality of care, decreased healthcare costs, and the opportunity to assess patient health literacy (Fidyk et al., 2014; Jager & Wynia, 2012; Kandula, Malli, Zei, Larson, & Baker, 2011; Nigolian & Miller, 2011; Xu, 2012). 

    It also has been shown to decrease average lengths of hospital stay and readmission rates (Fidyk et al., 2014). Multiple studies have demonstrated that patients prefer and perceive the teach-back, tell-back, or show me strategy because they find it most effective for learning (Hyde & Kautz, 2014; Kemp et al., 2008).

Know the Audience

    The effectiveness of teaching can be severely limited when the choice of teaching method is based only on the interest and comfort level of the educator and not on the assessed needs of the learner. Educators must use methods that match the topic rather than their own personality (Glenn, 2009).

    Most educators have a preferred style of teaching and tend to rely on that approach regardless of the content to be taught. Nurses skilled at teaching, however, adapt themselves to a teaching method appropriate to the subject matter, setting, and various styles of the learners. Flexibility is their hallmark in tailoring the instructional design to the unique needs of each population of learners. 

    All educators should be willing to use a variety of teaching methods to provide the best possible experience for achievement of objectives. Because different styles of teaching exist, it is possible for teachers to conduct a personal inventory (self evaluation) of a teacher's strengths and weaknesses so that a specific teaching style can be integrated with effective classroom management skills. 

    In that way, teachers can determine what fits best with their personalities, the content to be taught, and their learner population. 

Use Repetition and Pacing

    Repetition, when used in the right amount, is a technique that strengthens and reinforces learning by aiding in the retention of information (Willingham, 2004). If overused, however, repetition can lead to boredom and frustration because the educator is repeating what is already understood and remembered. If used carefully, it can assist the learner in focusing on important points and can help to keep the learner on track.

    Repetition is especially important when presenting new or difficult material. The opportunity for repeated practice of behavioral tasks is called skill inoculation. Repetition can take the form of a simple reminder, a review of previously learned material, or the continued practice of a skill. Assessing if the learner understands helps educators use repetition effectively.

    Pacing refers to the speed at which information is presented. Some self-instruction methods of teaching, such as programmed instruction, allow for individualized pacing so that learners can move along at their own speed, depending on their abilities and style of learning. Other methods, such as group learning, require the educator to take command of the rate at which information is presented and processed.

Many factors determine the optimal rate of teaching, such as the following:

• Learner's previous history with learning attention span of the learner
• The domain and level of domain in which learning is to take place The learner's eagerness and determination to obtain a reward or achieve a goal The degree of progress in learning
• The learner's ability to cope with frustration and discomfort.
• Keeping in touch with the audience helps educators pace their teaching. It should be slow enough to allow learners to absorb the information presented yet fast enough to maintain their interest and enthusiasm.

    Summarizing information at the completion of the teaching-learning session gives a perspective on what has been covered, how it relates to the objectives, and what the educator expects the learner to have achieved. Summarizing also reviews key ideas to instill information in the mind and helps the learner to see the parts of a whole. 

    Closure should be achieved at the end of one lesson before proceeding to a new topic. Summary reinforces retention of information. It also provides feedback as to the progress made, thereby leaving the learner with a feeling of satisfaction with what has been accomplished. 

Settings for Teaching

    Traditionally, the primary focus of nursing practice has been on the delivery of acute care in hospital settings. In recent years, however, the practice of nursing in community based settings has experienced tremendous growth. The reasons for the shift in orientation of nursing practice from inpatient to outpatient care sites relate to the trends affecting the nation's healthcare system in its entirety. 

    These trends include public and private reimbursement policies, changing population demographics, advances in healthcare technology, an emphasis on wellness care, and increased consumer interest in health. In response to these trends, nursing practice has broadened its focus to include a greater emphasis on the delivery of care in community settings, such as homes, clinics, health maintenance organizations, doctors' offices, public schools, and the workplace.

    With the increased focus on prevention, promotion, and independence in self-care activities, today's newly emerging healthcare system mandates the education of consumers more than ever before. Opportunities for client teaching have become increasingly varied in terms of the types of learners encountered, their specific learning needs, and the settings in which healthcare teaching occurs. 

    Because health education has become an increasingly important responsibility of nurses in all practice environments, it is important to acknowledge the various settings were clients, well or ill, may be consumers of health care.

    Settings for teaching are classified according to the need for health education in relationship to the primary purpose of the organization or agency that provides health instruction. These settings are defined as any place where nurses engage in teaching for disease prevention, health promotion, and health maintenance and rehabilitation. 

    They comprise any environment in which health education takes place to provide individuals with learning experiences to improve their health or reduce their risk for illness and injury. O'Halloran (2003) identified three types of settings for the education of clients:

1. A healthcare setting is one in which the delivery of health care is the primary or sole function of the institution, organization, or agency. Hospitals, visiting nurse home care associations, public health departments, outpatient clinics, extended care facilities, health maintenance organizations, doctors' offices, and therapist owned and managed centers are some examples of organizations whose primary purpose is to deliver health care, Health education is a part of the overall care delivered within these settings. Nurses function to provide direct client care in this setting, and their role encamp passes the teaching of clients as part of that care.

2.A healthcare related setting is one in which healthcare-related services are offered as a complementary function of the agency. Examples of this type of setting include the American Heart Association, the American Cancer Society, the American Arthritis Association, and the Muscular Dystrophy Association. 

    These organizations provide client advocacy, conduct health screenings and self-help groups, distribute health education information and materials, and support research on disease and lifestyle issues for the benefit of consumers within the community. Education on health promotion, disease prevention, and improving the quality of life for those who live with an illness or disability is the key function of nurses within these agencies.

3. A nonhealthcare setting is one in which health care is an incidental or supportive function of an organization. Examples of this type of setting include businesses, industries, schools, and military and penal institutions. The primary purpose of these organizations is to produce a manufactured product or offer a non-health-related service to the public. 

    Industries, for example, are involved in health care only to the extent of providing health screenings and non emergency health coverage to their employees through a health office within their place of employment, making available instruction in job related health and safety issues to meet Occupational Safety and Health Administration (OSHA) regulations, or providing opportunities for health education through wellness programs to reduce absenteeism or improve employee health status and morale.

    Classifying teaching settings in which the nursing functions as educator provides a frame of reference through which to better understand the interrelationship between the components of the organizational climate, the target audience, and the resources within the environment influencing the educational tasks to be accomplished. The role and functioning of the nurse are affected differently by these components in each of the identified settings.

    Nurses must recognize the numerous opportunities available for the teaching of those individuals who are currently or potentially consumers of health care. Given that teaching is an important aspect of healthcare delivery and that nurses function as teachers in a multitude of settings, they will inevitably encounter clients of different ages and at various stages along the wellness to illness continuum. 

    Wherever and whenever teaching takes place, nurses need to recognize the importance of consciously applying the principles of teaching and learning to these encounters for maximum effectiveness in helping clients to achieve and maintain optimal health. 

Sharing Resources Among Settings

    Professional involved nurses in client health education should use available opportunities to share resources among the three identified settings. Many already perform this service, as printed or audiovisual materials are borrowed, rented, or purchased for small fees from area institutions, organizations, or agencies; nurse educators from healthcare or healthcare related settings are contracted for or voluntarily provide health education programs to small and large groups in another setting; and nurses from each category of setting collaborate on individual client situations or on major community health projects. 

    Nurses from each of these settings can establish a health education committee in their community to coordinate health education programming, ensure effective use of all resources, and reduce duplication of efforts. The members of this committee can develop standardized health education content, delineate roles and services for each of the teaching settings, and share resources to provide a well planned, comprehensive community program of health education for a wide spectrum of clients.

    Education of patients and their families is very complex. They present with a wide variety of chronic and acute illnesses, financial resources, developmental stages, cultural values, reading abilities, learning styles, motivation levels, and social support. Nursing students and staff differ widely in terms of their own educational and experiential backgrounds and also are influenced by generation gaps. 

    This reality makes it difficult to generalize the results of research studies. In addition, it is difficult in some of the literature to analyze the cause-and-effect relationship between the teaching method used and the outcomes achieved. This, in turn, comes more challenging when the goal is to compare studies.

    Cooper et al. (2001) critically reviewed 12 meta analysis studies concerning patient education for people with chronic diseases where the treatment regimen required behavior change. In their review, they sought to determine which types of educational interventions produced the most benefit for these clients. The determination of effects by type of educational intervention was hampered by inadequate descriptions of the interventions. 

    Another problem was the fact that the interventions included more than one educational method. Cooper et al.'s conclusion was that effect by educational approach could not be differentiated. Some evidence suggested that didactic and psychosocial strategies produced smaller outcome effects than a combination of behavioral, cognitive, and affective therapies.

    Deakin et al. (2005) systematically reviewed 11 studies of group-based, patient centered educational programs for people with type 2 diabetes to assess the effects on clinical, lifestyle, and psychosocial outcomes. This review provided evidence that group-based diabetes education programs for adults with type 2 diabetes resulted in improvements in glycated hemoglobin, fasting blood glucose , and diabetes knowledge when monitored at 4-6 months and at 12 months.

    In addition, Deakin et al. (2005) recommended more research on the theoretical models underpinning the educational programs. Some of the studies suggested that group education is more effective if based on adult learning principles, patient empowerment, and participation. 

    The authors also commented on the need for more research to determine whether this type of program is appropriate for all ethnic backgrounds, Cost-effectiveness was included under their implications for future research, which is an especially important factor to be considered in the current resource-constrained health-care environment.

    The difficulty with measuring the effectiveness of different teaching methods is that many studies do not make a distinction between teaching methods and instructional materials (tools), such as the study conducted by Dougal and Gonterman (1999) and Friedman et al. (2011). 

    Instead, the authors treat them as one and the same which means that the studies' findings cannot be compared or applied as evidence in this chapter, which deals exclusively with methods of teaching.

    Many empirical studies and expert reviews have focused on the effectiveness of the various teaching methods available to educate different patient, student, and staff populations, and this chapter discusses selected reports. 

    Further research needs to be conducted on specific populations in relation to effectiveness of teaching methods for reaching various audiences about selected topics they need to learn. For example, what is the most effective and efficient method to teach healthcare consumers about important safety behaviors for optimal self-care management? 

    This chapter presented an in depth review of the various teaching methods and compared the advantages and limitations of each approach. Also, it briefly addressed the settings in which teaching takes place. Emphasis was given to the importance of taking into consideration the learner characteristics, the behavioral objectives, the educator's characteristics, and available resources prior to selecting and using any of the vast array of methods at the educator's disposal. 

    In many instances, guidelines were put forth to assist educators in planning and developing their own teaching activities. In addition, the major questions to be considered when evaluating the effectiveness of teaching methods were assessed in detail. Finally, some general principles to increase the effectiveness of all teaching methods were discussed.

What must be stressed are the qualities specific to each method and the fact that no one method is better than another. The effectiveness of any method depends on the purpose for and the circumstances under which it is used. Nurses in the role of teachers are urged to take different approaches to teaching rather than rely on any one method. 

    Varying the teaching methods or using methods in combination with one another can assist educators in accomplishing the objectives for learning while meeting the different needs and styles of every learner.

    Multisensory stimulation is best for increasing the acquisition of skills and the retention of information. Research regarding patient, staff, and student education is increasing. It is imperative that nurse educators demonstrate a willingness to make decisions about choosing and using teaching methods based on the evidence that is emerging as to the most effective ways to teach in relation to learner and situational variables.