Information Delivery and One To One Instructions In Nursing Education
Whats Are One to one Instructions
One-to-one instruction, which may be given either formally or informally, involves face-to-face delivery of information specifically designed to meet the needs of an individual learner. Teaching methods such as one-to-one instruction have a positive effect on patient education and compliance (Martin, Williams, Haskard, & DiMatteo, 2005; Vermeire, Hearnshaw, Van Royen, & Denekens, 2001).
Formal one-to-one instruction is a planned activity, whereas informal one-to-one instruction is an unplanned interaction, such as capitalizing on a teach-able moment that occurs unexpectedly when the patient demonstrates a readiness to learn (Miller & Stoeckel, 2016).
Such instruction offers an opportunity for both the educator and the learner to communicate knowledge, ideas, and feelings primarily through oral exchange, although nonverbal messages can be conveyed as well. Thus, this method of teaching is a process of mutual interchange between the patient and the health professional.
It requires inter-personal skill and sensitivity on the part of the educator and the ability to establish rapport with the learner (Falvo, 2010; Gleasman De Simone, 2012).
Pros and Cones of One to One Instruction Methods In Healthcare and Nursing Education
One-to-one instruction should never be a lecture delivered to an audience of one to meet the educator's goals. Instead, the experience should actively involve the learner and be based on his or her unique learning needs. Ideally, a one-to-one teaching session should be 15 to 20 minutes in length, and the educator should offer information in small, bite-sized portions to allow time for processing (Haggard, 1989).
Research shows that the more information that is given at any one time, the less it is remembered and correctly recalled (Martin, Williams, et al., 2005). Thus, effective communication depends more on the quality of the information presented than on the quantity to increase adherence to, and patient participation in, a recommended plan of care (Kessels, 2003).
One-to-one teaching can be tailored to meet objectives in all three domains of learning. It begins with an assessment of the learner and the mutual setting of objectives to be accomplished (Burkhart, 2008). As part of the assessment process, it is very important to determine whether any problem behaviors exist, such as smoking, and at which stage of change the person is with respect to dealing with such behaviors.
Once this information is determined, the educator can tailor educational interventions to that stage (Prochaska, Di Clemente, Velicer, & Rossi, 1993).The stages of change model can be generalized across a broad range of behaviors, including but not limited to smoking cessation, weight control, avoidance of high-fat diets, safer sex, and exercise initiation (Prochaska et al., 1994).
Interactions and Stages Help in One To One Instructions
The following describes how educators can focus their interactions to help a learner through the stages of change (Saarmann, Daugherty, & Riegel, 2000):
Precontemplation stage Provide information in a nonthreatening manner so that the learner becomes aware of the negative aspects or consequences of his or her behavior. Contemplation stage-Support decision making for change by identifying benefits, considering barriers to the change, and making suggestions for dealing with these obstacles.
Preparation Stage Support a move to action by contracting with the learner in establishing small, realistic, and measurable goals; providing information on effective ways to achieve the desired change; and giving positive reinforcement.
Action Stage Encourage constant practice of the new behavior to instill commitment to change by pointing out the benefits of each step achieved, providing rewards and incentives, and assisting the learner to monitor his or her behavior through the implementation of such strategies as keeping a food diary.
Maintenance Stage Continue encouragement and support to consolidate the new behavior and prevent relapses.
For example, the patient with a chronic problem such as obesity must consider the options available for weight control; only then can he and the nurse educator mutually design an action plan that they think can be accomplished. This patient's confidence level can be assessed by asking on a scale of 0-10 how certain he is of achieving this goal.
Mutual setting goal is a very important first step to be undertaken between the educator and the learner. Contracting, which clearly spells out the roles and expectations of both educator and learner, is one effective way to facilitate mutual goal setting. Contracts should be written in specific terms and planned and evaluated by both participants in the teaching-learning process.
Whenever teaching is done on a one-to-one basis, instructions should be specific and time should be given for an immediate response from the learner, followed by direct feedback from the educator. Giving learners the opportunity to state their understanding of information allows the educator to evaluate the extent of learning.
The teach-back or tell-back strategy that asks learners to restate in their own words what they understood should always be used by the educator to be sure patients heard and interpret the information correctly and completely (Fidyk, Ventura, & Green, 2014 ; Hyde & Kautz, 2014; Jager & Wynia, 2012; Kemp. Floyd, McCord-Duncan, & Lang, 2008).
So often educators ask learners “Do you understand what I just taught you?” A question that is closed ended and requires only a “yes” or “no” response does not provide information for the educator to confirm that the message was, in fact, received as intended. This type of question should almost always be avoided.
This is because, more likely than not, learners will say “yes,” indicating they understood something even when research shows that on average only about half of the information taught the first time is remembered, and only about 20% of it is recalled accurately (Kessels, 2003; Ley, 1972; Martin, Williams, et al., 2005).
Also, communicating to learners what further information is forthcoming allows them to connect what they have just learned with what they will be learning in the future (Falvo, 2010). For example, the educator teaching a patient about hypoglycemia might say, “Now that you understand what causes low blood sugar, we will talk about how to tell when you have it and what to do if you experience it after discharge.”
The process of one-to-one instruction involves moving learners from repeating the information that was shared to applying what they have just learned. In the previous example regarding hypoglycemia, the educator might offer the learner a hypothetical situation similar to what the patient might experience given his lifestyle and have him work through how to respond to it.
In this type of one-to-one exchange, a potentially threatening situation can be presented in a nonthreatening manner (Boyd et al., 1998). For instance, the educator might ask a busy executive who has diabetes how he would respond to feeling shaky and sweaty at 2:00 pm on a day when a meeting runs late and he misses lunch.
Educators should clearly state that these types of scenarios are not meant to be a test but rather a dress rehearsal for real-world situations. They can change the scenarios with further questioning to help learners plan how they could prevent such occurrences in the future. This technique gives learners a chance to use the information at a higher cognitive level and provides an opportunity for the educator to evaluate the client's learning in a safe environment.
With the one-to-one method of instruction, questioning is an excellent technique. It encourages learners to be active participants in the learning process and gives educators important feedback on their progress (Falvo, 2010). Questions can be matched with the behavioral objectives to be achieved.
For example, to determine a client's knowledge level in the cognitive domain, the educator might ask, “What is the next step that you should take?” For the higher level of synthesis in the cognitive domain, the educator might ask a staff nurse to plan for how he or she would respond to an angry family member (Abruzzese, 1996).
Problems With One to One Instruction Questions
Questioning should not be interpreted by learners as a test of their knowledge but rather as a way to exchange information and stimulate thinking. However, two problems can occur with questioning:
(1) questions can be so unclear that the learner does not know what the question
(2) they can contain too many facts to process effectively (House, Chassie, & Spohn , 1990).
The educator should watch the learner's nonverbal reactions and rephrase the question if he or she detects either of these problems. If the learner seems confused, it is helpful to state that perhaps the question was not clear. This technique guards against the learner feeling guilty or becoming discouraged if the answer to a question was incorrect (Falvo, 2010).
Also, it is important to give learners time to process information and respond to questions posed by the educator. Sometimes educators are uncomfortable waiting in silence for an answer or are impatient and attempt to correct an answer before learners complete their responses. Questioning is ineffective as a technique when educators do not give learners enough time to process information.
Preliminary interruption may further interfere with a learner's thinking abilities and create a tense atmosphere.Many nurse educators conduct individualized teaching of other staff nurses or student learners in the skills laboratory and clinical settings. Clinical instruction is not a discrete teaching method but rather can be an extension of one-to-one teaching in a very complex setting for experiential learning.
Educators can use a variety of methods other than one-to-one instruction, such as role model, role play. demonstration, return demonstration, and group discussion. However, one-to-one instruction very well may be involved as a teaching approach during new employee orientation, student preceptorship, or a staff continuing education activity.
The learner is singularly guided in the actual practice setting, and each learning experience requires specific objectives, known to both the educator and the learner, that are tailored to meet the individual's needs (Emerson, 2007; Gaberson, Oermann, & Shellenbarger, 2013; O'Connor, 2015).
Preceptors who assume clinical teaching roles are usually expert physicians but may not necessarily be expert educators. If this is the case, to carry out their roles effectively, they need to be taught how to be educators through workshops and coaching sessions. One-to-one instruction has much strength as a teaching method. However, it also has its drawbacks.
From an economic standpoint, one-to-one instruction is a very labor intensive method and should be thoughtfully tailored to make the expense worthwhile in terms of achieving learner outcomes. One-to-one teaching of patients and their families is often considered an inefficient approach to learning because the educator is reaching only one person at a time.
Clinical teaching of students and continuing education for staff are vital for professional development, but they are costly endeavors when carried out on a one-to-one basis. Also, orientation of new staff is a significant expense to an institution or agency in terms of payroll dollars and the lack of short term productivity of the employee being oriented (Del Bueno, Griffin, Burke, & Foley, 1990) ; hence one-to-one instruction in this scenario is likely to be economically infeasible.
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