State the learner behavior or performance, not nurse behavior. For example, “The learner will choose her own diet as instructed” (client behavior), not “Teach the client about his diet” (nurse behavior).

Guidelines for Learning and Teaching The following guidelines for effective learning/teaching may be helpful to nurses:

• Teaching activities should help a learner to meet individual learning objectives. These objectives should be mutually determined by the client (learner) and the nurse (teacher). If selected teaching strategies do not assist the learner, they need to be reassessed and other strategies used. For example, oral explanation alone may not be sufficient to teach a client how to handle a syringe. Demonstrating the use of the syringe, allowing the client to practice manipulating the syringe, providing feedback based on the observation, and allowing further practice will be much more effective.
• Rapport between teacher and learner is essential. A relationship that is both accepting and constructive is the best way to assist learning. The nurse should take time to establish rapport with the learner before teaching.
• The teacher who uses the client’s previous learning in the present situation encourages the client and facilitates learning new skills. For example, a person who already knows how to cook can use this knowledge when learning to prepare food for a special diet.
• The nurse teacher must be able to communicate clearly and concisely. The words the nurse uses need to have the same meaning to the learner as to the teacher. For example, a client who is taught not to place water on an area of skin may think a wet wash-cloth is permissible for washing the area. In effect, the nurse needs to explain that no water or moisture should touch the area. This is especially important when teaching a client/family that is not proficient in the language of instruction.
• The nurse should have knowledge of the learners and the factors that affect their learning before planning teaching. For example, when teaching a group of senior citizens at a community center, the nurse should ensure frequent breaks that allow the seniors to use the restrooms (increased frequency of urination is a physiological change associated with aging) and high-contrast instructional materials (decreased visual acuity and color discrimination is a physiological change associated with aging).
• Learning is enhanced when the patient/client is involved in planning the instruction.
• Teaching that involves multiple senses often enhances learning. For example, when teaching about changing a dressing, the nurse can tell the client about the procedure (hearing), demonstrate how to change the dressing (sight), and allow the learner to manipulate the equipment and practice the dressing change (touch).
• The anticipated behavioral changes that indicate that learning has taken place must always be within the context of the client’s lifestyle and resources. For example, it would probably not be reasonable to expect a client to soak in a tub of hot water four times a day if he or she does not have a bathtub and has to heat water on a stove.

Client/patient teaching is valuable in that it generally provides better healthcare outcomes and is cost-effective; that is, the cost of the nurse’s time spent in teaching a client/family is less than the cost of treating problems that occur when clients do not follow recommended treatments, fail to take medications correctly, or do not adapt their lifestyle to their changing health needs. See the accompanying box for characteristics of effective teaching. Assessing Learning Needs The first step in teaching others is to assess their learning needs and the factors that may affect their learning. These factors include the learner’s (1) age and developmental level, (2) health beliefs and practices, (3) cultural and spiritual factors, (4) economic factors, (5) learning styles, (6) readiness to learn, (7) motivation, and (8) reading level. Characteristics of Effective Teaching Effective teaching:

• Is accurate and current, gathering information from reliable sources.
• Holds the learner’s interest.
• Involves the learner in the learning process. Makes partners of the learner and the teacher.
• Fosters a positive self-concept in the learner: The learner believes learning is possible and probable.
• Sets realistic goals.
• Is directed toward helping the learner meet learning objectives.
• Supports the learner with positive reinforcement.
• Is appropriate for the learner’s age, condition, and abilities.
• Is optimistic, positive, and nonthreatening.
• Uses several methods of teaching to accommodate a variety of learning styles and provides learning opportunities through hearing, seeing, and doing.

Age and Developmental Level Age provides information about the learner’s developmental status that may indicate specific health teaching content and teaching approaches. Simple questions to school-age children and adolescents will elicit information about what they know. Observing children in play provides information about their motor and intellectual development as well as relationships with other children. For some elderly persons, conversation and questioning may reveal slow recall, limited psychomotor skills, decreased sensory capacities, diminished cognitive function, or learning difficulties. The age of learners also affects the duration of instruction. Young children have a short attention span; therefore, instruction of children should be of shorter duration. Older adults may be uncomfortable sitting for long periods of time or may require more frequent bathroom breaks. Health Beliefs and Practices A learner’s health beliefs and practices are important to consider in any teaching plan. However, even if a nurse is convinced that a particular learner’s health beliefs should be changed, doing so may not be possible because of the many factors that are involved in a person’s health beliefs. Values and beliefs related to people’s life experience and education, culture, and religion often influence their decisions regarding their willingness to accept specific treatment plans. Cultural and Spiritual Factors People of specific cultural groups or religions may have specific beliefs and behaviors related to health and healing; a number of them are related to diet, health, illness and healing, and lifestyle. Some of these cultural and spiritual healing practices may be in conflict with accepted health and healing practices in the United States. It is therefore important to know how the practices and values held by learners influence their health learning needs. RESEARCH CURRENT Patient Education of Children and Their Families: Nurses’ Experiences The purpose of this qualitative study by Kelo, Martikainen, and Eriksson was to “describe significant patient education sessions and explore nurses’ empowering and traditional behavior in the patient education process of children and their families.” The participants in the study were 47 nurses. The study included tape-recorded interviews that lasted from 10 to 40 minutes. Participants were asked to recollect one significant (positive or negative) patient education session of a child and his or her family over the previous month. Topics used to guide the interviews were (1) context of the patient education session, (2) nurse’s knowledge of the family, (3) nurse’s knowledge of the child, (4) assessment of educational needs, (5) planning of patient education (preparation and objectives), (6) implementation of patient education (content, methods, and interaction), and (7) evaluation of patient education. The participants described 32 positive and 13 negative patient education incidents. Two categories were identified: challenges with children and their parents, and challenges with resources. Challenges with children and their parents included the child’s condition worsened, the child had learning difficulties, the child had fear of injections, the family had a different cultural or language background, the parent had a negative attitude or was not involved, and the parent had difficulties managing the treatment. Challenges with resources included a lack of nurses, nurse’s lack of experience, education could not be provided step-by-step before discharge, no time for preparation, no quiet room for counseling, and not enough time for providing education. Educational outcomes that reflected empowerment of the family included parents expressed that they managed with the treatment, parents left the hospital with confidence, the parents’ fears had subsided, a problem was solved unusually quickly and the family continued their life normally, and the family was not dependent on professionals as they managed the medication themselves. Aspects of nurses’ sense of empowering versus traditional nursing included professional success, professional development experience, and professional learning. Examples of professional success were “when parents were completely satisfied with care” or “parents noticed the changes in their child’s condition.” An example of professional development experience was when the nurse “had to consider ethical issues, offer all options, and not state her own opinion.” An example of professional learning was “the nurse learned that she had to consider the education methods carefully to ensure that clients understood the counseling.” The authors stated that “more training for nurses is needed in hospitals to enhance the empowering education of children and their families.” Source: “Patient Education of Children and Their Families: Nurses’ Experiences,” by M. Kelo, M. Martikainen, and E. Eriksson, 2013, Pediatric Nursing, 39(2), pp. 71–79. Cultural and spiritual beliefs may also affect learning. Although the learner may readily understand the health information being taught, this learning may not be implemented in the home where folk healing practices prevail. For example, if the client holds the belief that the oldest male in the family (father, husband, brother) makes health decisions for all family members, a female client may not be willing to receive health information without permission of her male decision maker. Economic Factors Economic factors can also affect learning. The nurse must consider the economic ability of the learner to follow through on learning goals that are related to treatment plans. For example, a learner who cannot afford to purchase prescribed medications or medical supplies may not get them. In such a situation, the nurse should either consult with social services to assist the learner with the purchase of the needed medications or supplies or contact the physician to determine if a different medication or generic medication can be substituted. Learning Styles Considerable research has been done on people’s learning styles. The best way to learn varies with each individual. Some people are visual learners and learn best by having printed material to refer to or by watching demonstrations. Other people do not visualize an activity well; they learn best by actually manipulating (psychomotor) equipment and discovering how it works. Other people can learn well from reading printed material presented in an orderly fashion. Still other people learn best in groups, relating to other people. For some, stressing the thinking (cognitive) part of a skill and the logic of something will promote learning. For others, stressing the feeling (affective) part or interpersonal aspect motivates and promotes learning. When material is presented in more than one learning domain and uses multiple senses (e.g., sight, hearing, touch), the chances for learning and retaining information are greatly increased. The nurse seldom has the time or skills to assess each learner, identify the person’s particular learning style, and then adapt teaching accordingly. What the nurse can do, however, is to ask learners how they have learned best in the past or how they like to learn. Many people know what helps them learn, and the nurse can use this information in planning teaching. Using a variety of teaching techniques and varying activities during teaching are good ways to match learners with learning styles. One technique will be most effective for some learners, whereas other methods will be suited to learners with different learning styles. Readiness to Learn People who are ready to learn often behave differently from those who are not. A learner who is ready may search out information, for instance, by asking questions, reading books or articles, talking with others, and generally showing interest. Today people have access to information with computers and the Internet. The person who is not ready to learn is more likely to avoid the subject or situation. In addition, the unready learner may change the subject when the nurse brings it up or ask to postpone health learning activities to a better time. In assessing readiness to learn, the nurse observes for the following:

• •Physical readiness. Is the learner able to focus on things other than his or her physical status, or is fatigue, pain, or disability using up all the learner’s energy?
• •Emotional readiness. Is the learner emotionally ready to learn? People who are extremely anxious, depressed, or grieving are not ready to learn.
• •Cognitive readiness. Can the learner think clearly? For example, a client who has an altered level of consciousness is not cognitively ready to learn. Developmental level will also affect cognitive readiness. For example, a young child may not be cognitively ready to perform complex self-care requirements. An older client with memory impairment may also have difficulty learning about self-care activities. In these cases, parents, spouses, or other caregivers must be taught to perform the care requirements.

Nurses can promote readiness to learn by providing physical and emotional support before and during learning activities. Motivation Motivation relates to whether the learner wants to learn and is usually greatest when the learner is ready, the learning need is recognized, and the information being offered is meaningful to the learner. Nurses can increase a learner’s motivation by doing the following:

• •Relating content to something the learner values and helping the learner see the relevance of the content
• •Making the learning experience pleasant and non-threatening
• •Encouraging self-direction and independence
• •Demonstrating a positive attitude about the learner’s ability to learn
• •Offering continuing support and encouragement as the learner attempts to learn (i.e., using positive reinforcement)
• •Creating a learning situation in which the learner is likely to succeed
• •Rewarding the learner for his or her success

Reading Level The nurse should not assume that a learner’s reading level is equal to the highest grade or level of formal education the learner has completed. Most patient education literature is written above the 8th-grade level, the average level being between the 10th and 12th grades. However, as described previously, 22% of adults performed at Below Basic levels of literacy on the National Assessment of Adult Literacy, which means that their functional level of literacy (reading) is at the most simple and concrete level. Most current computer word-processing programs will determine the reading level of a document. A variety of instruments exist to assess the readability of patient education materials. The most commonly used instruments to assess readability are the Flesch formula, Gunning’s FOG formula, the Fry Readability Graph, and McLaughlin’s SMOG (Simple Measure of Gobbledygook) formula. Several of these formulas can be used for both English and Spanish documents. The Flesch, FOG, and SMOG formulas can be used with documents less than 300 words and measure reading from 4th-grade level through college reading ability. The Fry Readability Graph should be used with documents longer than 300 words. Planning Content and Teaching Strategies Developing a teaching plan (see a sample teaching plan for wound care in Table 8–4) is accomplished in a series of steps. Involving the learner at this time promotes the formation of a meaningful plan and stimulates learner motivation. The learner who helps formulate the teaching plan is more likely to achieve the desired outcomes. Determining Teaching Priorities Learning needs must be ranked according to priority. The client and the nurse should do this ranking together, with the client’s priorities always being considered. Once a client’s priorities have been addressed, the client is generally more motivated to concentrate on other identified learning needs. For example, a man who wants to know all about coronary artery disease may not be ready to learn how to change his lifestyle until he meets his own need to learn more about the disease. Nurses can also use theoretical frameworks, such as Maslow’s hierarchy of needs, to establish priorities. Setting Learning Objectives or Outcomes Outcome-based learning is prevalent in education today. Learning objectives can be considered the same as outcome criteria for other nursing diagnoses. They are written in the same way. Like client outcomes, learning objectives do the following:

• •State the learner behavior or performance, not nurse behavior. For example, “The learner will choose her own diet as instructed” (client behavior), not “Teach the client about his diet” (nurse behavior).
• •Reflect an observable, measurable behavior. The performance may be visible (e.g., walking) or invisible (e.g., adding a column of numbers). However, it is necessary to be able to deduce whether an unobservable activity has been mastered from some performance that represents the behavior. Therefore, the performance of an objective might be written: “Writes a meal plan for the day” (observable), not “Considers a daily meal plan” (not observable). Avoid using words such as knows, understands, believes, and appreciates; they are neither observable nor measurable. Some verbs that can be used for measurable objectives are shown in Table 8–5.
• •May add conditions or modifiers as required to clarify what, where, when, or how the behavior will be performed. Examples are “Walks to the end of the hall and back without crutches (condition).” “Irrigates his colostomy independently (condition) as taught,” or “States three (condition) factors that affect blood glucose level.”
• •Include criteria specifying the time by which the learning should have occurred. For example, “The client will state three things that affect blood glucose level by the end of the second diabetes class.”

CRITICAL THINKING EXERCISE Assess the readability of an example of patient education material from your healthcare setting using the Flesch, FOG, Fry, and SMOG formulas. All formulas are available on the Internet. What are the readability levels of the patient education material you selected? Based on your findings, what recommendations do you have about the education materials you selected? If you have a large population of Spanish-speaking clients, assess both the English and Spanish versions of the same educational document. How do they compare in readability? What recommendations do you have for the English and Spanish versions of the document you assessed? Therefore, the objective “The client will state three things that affect blood glucose level by the end of the second diabetes class” has a behavior (“will state”) that is observable and includes conditions (“three things”) and a time criterion (“by the end of the second diabetes class”). (Blais 156-159) Blais, Kathleen, Janice Hayes. Professional Nursing Practice: Concepts and Perspectives, 2nd Edition. Pearson Learning Solutions, 06/2015. VitalBook file. The citation provided is a guideline. Please check each citation for accuracy before use

ANSWER. PAPER DETAILS
Academic Level	Masters
Subject Area	Nursing
Paper Type	Case Study
Number of Pages	3 Page(s)/1650 words
Sources	2
Paper Format	APA
Spacing	Single Spacing

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