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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?
♥♥♥END♥♥♥