Behavioral Objectives and Psychomotor Domain Levels and Taxonomy In Nursing Education
Levels of Behavioral Objectives and Examples in the Psychomotor Domain
Perception level: Ability of the learner to show sensory awareness of objects or cues associated with some tasks to be performed. This level involves reading directions or observing a process with attention to steps or techniques in developing a skill.
Example: After a 10-minute teaching session on aspiration precautions, the family caregiver will describe the best position to place the patient in during mealtimes to prevent chocking.
Set level: Ability of the learner to exhibit readiness to take a certain kind of action as evidenced by expressions of willingness, sensory attending, or body language favorable to performing a motor act (perception is a prerequisite behavior).
Example: Following a demonstration of how to do proper wound care, the patient will express a willingness to practice changing the dressing on his leg using the correct procedural steps.
Guided response level: Ability of the learner to exert effort via overt actions under the guidance of an instructor to imitate an observed behavior with conscious awareness of effort. Imitating may be performed hesitantly but with compliance to directions and coaching (perception and set are pre-requisite behaviors).
Example: After watching a 15-minute video on the procedure for self-examination of the breast, the patient will perform the exam on a model with 100% accuracy.
Mechanism level: Ability of the learner to repeatedly perform steps of a desired skill with a certain degree of confidence, indicating mastery to the extent that some or all aspects of the process become habitual. The steps are blended into a meaningful whole and are performed smoothly with little conscious effort (perception, set, and guided response are prerequisite behaviors).
Example: After a 20-minute teaching session, the patient will demonstrate the proper use of crutches while repeatedly applying the correct three-point gait technique.
Complex overt response level: Ability of the learner to automatically perform a complex motor act with independence and a high degree of skill, without hesitation and with minimum expenditure of time and energy; performance of an entire sequence of a complex behavior without the need to attend to details (perception, set, guided response, and mechanism are prerequisite behaviors).
Example: After three 20-minute teaching sessions, the patient will demonstrate the correct use of crutches while accurately performing different tasks, such as going up stairs, getting in and out of the car, and using the toilet.
Adaptation level: Ability of the learner to modify or adapt a motor process to follow the individual or various situations, indicating mastery of highly developed movements that can be suited to a variety of conditions (perception, set, guided response, mechanism, and complex overt response are prerequisite behaviors).
Example: After reading hands outs on healthy food choices, the patient will replace unhealthy food items she normally chooses to eat at home with healthy alternatives.
Origination level: Ability of the learner to create new motor acts, such as novel ways of manipulating objects or materials, as a result of an understanding of a skill and a developed ability to perform skills (perception, set, guided response, mechanism, complex overt response, and adaptation are prerequisite behaviors).
Example: After simulation training, the parents will respond correctly to a series of scenarios that demonstrate skill in recognizing respiratory distress in their child with asthma.
Taxonomy of Behavioral Objectives and Psychomotor Domain
Another taxonomic system for psychomotor learning proposed by Dave (1970) is based on behaviors that include muscular action and neuromuscular coordination. Dave's system recognizes that levels of skill attainment can be achieved and refined over a period of months depending on the frequency with which the learner uses certain skills in practice.
These taxonomic criteria for the development of psychomotor skill competency suggest that accuracy should be stressed rather than the speed at which a skill is acquired (Reilly & Oermann, 1990). Dave's levels will apply when considering aspects of the learning curve, discussed later in this chapter.
Nevertheless, the levels of psycho-motor behavior, no matter which taxonomic system is used, require the general and orderly steps of observing, imitating, practicing, and adapting
Teaching of Psychomotor Skills
Different teaching methods, such as demonstration, return demonstration, simulation. and self-instruction, are useful for the development of motor skills. Also, instructional mate rials, such as videos (DVDs), audiotapes (CDs), models, diagrams, and posters, are effective approaches for teaching and learning in the psychomotor domain (Oermann, 2016; Ross, 2012; Salyers, 2007).
When teaching psychomotor skills, it is important for the educator to remember to keep skill instruction separate from a discussion of principles underlying the skill (cognitive component) or a discussion of how the learner feels about carrying out the skill (affective component). Psychomotor skill development is very egocentric and usually requires a great deal of concentration as the learner works toward mastery of a skill (Oermann, 1990).
It is easy to interfere with psychomotor learning if the teacher asks a knowledge (cognitive) question while the learner is trying to focus on the performance (psychomotor response) of a skill. For example, while a nursing student is learning to suction a patient, it is not unusual for the teacher to ask, “Can you give me a rationale for why suction is important?” or “How often should suction be done for this particular patient?”
As another example, while the patient is learning to self-administer parenteral medication, the teacher may simultaneously ask the patient to respond cognitively to the question, “What are the actions or side effects of this medication?” or “How do you feel about injecting yourself?” These questions demand cognitive and affective responses during psychomotor performance.
What the educator is doing in this situation is asking the learner to demonstrate at least two different behaviors at the same time. This approach can result in frustration and confusion, and ultimately it may result in failure to achieve either of the behaviors successfully.
It is essential for the teacher to keep in mind that questions related to the cognitive or affective domain should be asked only before or after the learner practices a new psychomotor skill (Oermann, 1990).
In psychomotor skill development, the ability to perform a skill is not equivalent to having learned or mastered a skill. Performance is a transitory action, whereas learning is a more permanent behavior that follows from repeated practice and experience (Oermann, 1990).
The actual mastery of a skill requires practice to allow the individual to repeat the performance time and again with accuracy, coordination, confidence, and out of habit. Practice does make perfect, so repetition leads to perfection and reinforcement of the behavior. However, once a task oriented skill has been practiced, the teacher can introduce situated cognition.
Within this constructivist perspective, learners are challenged to think critically about what they know and can do in the context of the specific situation in which they are functioning. Teaching learners to actively construct knowledge helps them make sense of their experiences and develop their skills of inquiry (Keating, 2014; Woolfolk, 2017).
Riding a bicycle is a perfect example of the difference between being able to perform a skill and having mastered that skill. When one first attempts to ride a bicycle, movements tend to be very jerky, and a great deal of concentration is required.
Falling off the bicycle is not unexpected in the learning process. Once the skill is learned, however, bicycle riding becomes a smooth, automatic operation that requires minimal concentration.
Some behaviors that are learned do not require much reinforcement, even over a long period of disuse. Yet, other behaviors, once mastered, need to be rehearsed or relearned to perform them at the level of skill once achieved.
Variable of Psychomotor Domain
The amount of practice required to acquire any new skill varies with the individual, depending on many factors. Oermann (1990), Bell (1991), and Mwale and Kalawa (2016) have addressed some of the most important variables:
Readiness to learn: The motivation to learn affects the degree of effort exhibited by the learner in working toward mastery of a skill.
Past experience: If the learner is familiar with equipment or techniques similar to those needed to learn a new skill, then mastery of the new skill can be achieved at a faster rate. The effects of learning one skill on the subsequent performance of another related skill are collectively known as transfer of learning (Gomez & Gomez, 1984; Moursund, 2016).
For example, if a family member already has experience with aseptic technique in changing a dressing room. then learning to suction a tracheostomy tube using sterile technique should not require as much time to master.
Health status: An illness state or other physical or emotional impairments in the learner may affect the time it takes to acquire or successfully master a skill.
Environmental stimuli: Depending on the type and level of stimuli as well as the learning style (degree of tolerance for certain stimuli). distractions in the immediate surroundings may interfere with the ability to acquire a skill.
Anxiety level: The ability to concentrate can be dramatically affected by how anxious someone feels. Nervousness about performing in front of another person is a particularly important factor in psychomotor skill development. High anxiety levels interfere with coordination, steadiness, fine muscle movements, and concentration levels when performing complex psychomotor skills.
It is important to reassure learners that they are not necessarily being tested during psychomotor skill performance. Reassurance and support reduce anxiety levels related to the fear of not meeting expectations of themselves or of the teacher.
Developmental stage: Physical, cognitive, and psychosocial stages of development all influence an individual's ability to master a movement-oriented task. Certainly, a young child's fine and gross motor skills as well as cognitive abilities are at a different level from those of an adult. The older adult, too, likely exhibits slower cognitive processing and increased response time (needing more time to perform an activity) compared to younger clients.
Practice session length: During the beginning stages of learning a motor skill, short and carefully planned practice sessions and frequent rest periods are valuable techniques to help increase the rate and success of learning. These techniques are thought to be effective because they help prevent physical fatigue and restore the learner's attention to the task at hand.
Aldridge (2017) conducted a qualitative literature review to explore nursing students' perceptions of psychomotor skills learning. He identified six themes as important to learning new skills:
(1) peer support and peer learning are important
(2) practicing on real people is essential to mastery
(3) faculty members matter during the learning experience
(4) conditions of the environment are essential
(5) knowing that patients need good nursing skills
(6) anxiety is never present because of fear of harming patients
These findings are useful in helping faculty to understand students' experiences in the teaching and learning of psychomotor skills.
Performing motor skills is not done in a vacuum; that is, the learner is inevitably immersed in an environmental context full of stimuli. Learners must select those environmental influences that will assist them in achieving the behavior (relevant stimuli) and ignore those factors that interfere with a specific performance (irrelevant stimuli).
This process of recognizing and selecting appropriate and inappropriate stimuli is called selective attention (Gomez & Gomez, 1984). Motor skills should be practiced first in a laboratory setting to provide a safe and non-threatening environment for the novice learner.
Gomez and Gomez (1987) also suggest arranging for practice sessions to take place in the clinical or home setting to expose the learner to actual environmental conditions a technique known as open skills performance learned under changing and unstable environments.
Mental imaging, also referred to as mental practice has surfaced as a helpful alternative for teaching motor skills, particularly for patients who have mobility deficits or fatigue (Page, Levine, & Khourey, 2009, Page, Levine, Sisto, & Johnston, 2001) .
Research indicates that learning psychomotor skills can be enhanced through use of such imagery. Mental practice, which involves imagining or visualizing a skill without body movement prior to performing the skill, can enhance motor skill acquisition (Page et al., 2009).
Another hallmark of psychomotor learning is the type and timing of the feedback given to learners. Psychomotor skill development allows for spontaneous feedback so that learners have an immediate idea of how well they perform. During skill practice, learners receive intrinsic feedback.
This is feedback generated from within the learners, giving them a sense of or a feeling for how they have performed. They may sense that they either did quite well or that they felt awkward and needed more practice. The teacher also has the opportunity to provide augmented feedback.
In this case, the teacher shares information or an opinion with the learners or conveys a message through body language about how well they performed (Oermann, 1990). The immediacy of the feedback, along with intrinsic and augmented feedback, makes it a unique feature of psychomotor learning. In addition, performance checklists can serve as guides for teaching and learning and are another effective tool for evaluating the level of skill performance.
An important point to remember is that making mistakes is an expected part in the process of teaching or learning a psychomotor skill. If the teacher makes an error when demonstrating a skill or the learner makes an error during return demonstration, this occasion is the perfect teaching opportunity to offer anticipatory guidance: “Oops, I made a mistake.
Now what do I do?” Unlike in cognitive skill development where errorless learning is the objective, in psychomotor skill development a mistake made represents an opportunity to demonstrate how to correct an error and to learn from the not-so-perfect initial attempts at performance. The old saying “You learn by your mistakes” is most applicable to psychomotor skill mastery.
The spacing of practice time improves the likelihood that learners will remember new facts, as described by Willingham (2002) earlier in this chapter. The spacing effect seems to apply to the learning of simple as well as complex motor skills. Willingham (2004) also addressed the necessity for practice to be repeated beyond the point of perfection if skill learning is to be long lasting, automatic, and achieved with a high level of competence.
In summary, learning is a very complex phenomenon. It can occur in all three domains simultaneously, can happen formally or informally, and can occur in a variety of settings. Evaluation of learning is equally challenging, especially in the affective domain because affective behaviors are not as obvious and clearly observable as the skills acquired in the cognitive and psychomotor domains.
Clearly the cognitive, affective, and psychomotor domains represent separate behaviors, yet these domains are interrelated. For example, the performance of a psychomotor skill requires cognitive knowledge or understanding of information. Knowledge might be about the scientific principles underlying a practice or the rationale explaining why a skill is important to carry out.
Also, an affective component to performing the skill must be acknowledged. Understanding the feelings and attitudes of learners is essential if the psychomotor behavior is to become integrated into their overall experience. Mastering behavioral objectives in all domains is necessary for the learner to ultimately achieve the goal of competence and independence in self care.
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