The process of learning is never ending. We as human beings begin this process at a very young age and continue to learn throughout our lives. Learning is a process we practice in our daily lives, even those associated in the teaching profession. This can also be seen in the nursing profession, nurses in their everyday practice, come across several patients while teaching health maintenance or preventive measures. Some of the teaching experiences are unforgettable, not only does it provide a chance to improve practice, but it is also very enlightening and informative. This paper critically examines and reflects the story of a nurse client during a client teaching session and demonstrates how this teaching experience turns into a learning experience for the nurse involved in the situation. The paper also closely observes the teaching-learning approaches that nurses can use to improve their practice as a teacher and make it easier for patients to understand the information they need to take better care of themselves. The story described here is a real situation that happened to me, while I was shadowing a staff nurse for the day. Pseudonyms have been used to keep the information confidential.
It was early winter, during my placement for obstetrics at the District Hospital in Greater Toronto Area. I was paired with a staff nurse and was instructed to follow her for the day. I was excited to embark a new day full of experiences and learning opportunities. I followed the staff nurse starting from 07:00 O’ clock and helped her do the tasks that she asked me to do. In the afternoon, we had orders for a patient’s discharge. The patient Ms. Kareem was a 39 year-old lady who had been a third time mother of a baby boy. She had a girl of the age of five and a boy of three years-old. She had a normal delivery and was breastfeeding her baby. The staff nurse and I went to the patient’s room to teach her about self-care and care for the newborn at home. The staff nurse had a clipboard full of information regarding clients’ teaching of patients’ discharge. Upon entering the patient’s room we greeted her and she replied in a friendly manner.
The staff nurse informed the patient about her discharge from the facility and started teaching the client about self-care and care for the newborn. I felt as if the nurse wanted to get the work done and move over to the next task. She was reading every piece of information that was provided on the card from her clipboard. Though the client was nodding her head, demonstrating that she understood the information, I felt as if she wanted the staff nurse to stop reading to her as if these are tasks needed to be done. In the middle of this teaching session, the client started talking to her newborn and did not pay much attention to whatever we were trying to teach her. This session took about 25 minutes, after completing the session, it was charted in the nursing notes that the patient has been taught about the required information. Half an hour later, we received a call from Ms. Kareem. The staff nurse requested me to respond to the patient’s inquiry. Following a short conversation, I had come to the conclusion that she appeared dissatisfied with the staff nurse, particularly her instruction session for the new born care; although she did appreciate her nursing care.
Reflecting upon Teaching-Learning Approach in the Situation
Many times in healthcare facilities, patients and their families ask questions regarding specific to enhance their quality of life. However, sometimes patients are reluctant or feel embarrassed to ask questions; it is nurses’ responsibility to understand their patients’ concerns and respond to them accordingly (Oberle & Bouchal, 2009). Canadian Nurses Association (2008), codes of ethics point out a nurse’s ethical responsibility of informing their clients, and helping them make informed decisions. This is only possible when nurses have the ability to understand and have the competence to respond appropriately. Nurses need to understand patients’ needs to provide them with relevant, complete, and accurate information (Oberle & Bouchal, 2009).
Critically reflecting upon the situation in the light of teaching-learning approaches; it would be accurate to say that teaching-learning is an interactive process that needs the learner and the teacher to be in an engagement of learning activity. Telling approach was used to transfer the information to the client, which was an inappropriate choice for Ms. Kareem. Teaching is not about passing on the facts and figures to patients. Teaching sessions are more effective when proper approaches are used that include the learning needs, learning style, learning capacity, learner’s age group and background information on the previous exposure to the situation (Hall, 2009). Ms. Kareem was a 39 years-old patient who had previously taken care of two children before and after birth for the past five years. The staff nurse used an approach that did not consider age group, previous exposure to the situation, and learning capacity of the client. The nurse wanted to complete the job and move on to the next patient rather than taking the time to understand.
The Role of Teaching-Learning Theories in Clients’ Teaching
All the teaching-learning theories have equal significance when it comes to clients’ teaching. However, constructivist and humanist offer more practical approach to teaching and learning. According to Brandon and All (2010), learning is a process that involves active participation of both the learner and the teacher, which incorporates previous knowledge to develop new understanding. In constructivism, the learner acquires knowledge with active involvement and applies it to daily life. The role of teacher is modified as a facilitator, which focuses more on what patients need to learn rather than what a teacher wants to teach. The constructivist encourages clients to ask questions for their active participation and provides an opportunity for a lifelong learning (Brandon & All, 2010). The humanistic and constructivist approaches both can go together for effective clients’ teaching.
The story does not actually depict the application of any teaching-learning perspectives; however, humanistic and constructivist theories could be used accordingly to facilitate communication and make the learning process more effective. Humanistic approach plays a major role in developing therapeutic relationship, which would ultimately help explore patients’ needs. Proper identification of Ms. Kareem’s needs could help the staff nurse plan accordingly and her previous experience could be considered an asset in developing new information, which could improve her quality of life according to her own wishes and would also help her to take good care of the newborn. The staff nurse ought to have prepared enough evaluation and assessment in planning strategies to actively involve Ms. Kareem in the teaching session. Also, the patient should have been provided with the required information, rather than flooding with unwanted information. The patient must be encouraged to ask questions to clarify any concerns.
Teaching Strategies with a new Vision
Hall (2009) has considered participating approach as one of the best approaches for clients’ teaching-learning, where nurses and patients actively get involved to set mutually acceptable objectives for the learning process. Clients’ help nurses decide the material and sequence of information they need to learn about and in addition nurses facilitate them to get the required resources. This teaching-learning approach provides an opportunity for clients to offer feedback and further queries (Hall, 2009). In the light of humanistic and constructivist theories, there is a series of steps that nurses have to consider before starting a teaching session. These processes include nursing assessment, diagnosis, planning, implementation, and evaluation. The whole clients’ teaching cycle starts with humanistic approach, when nurses come into the now moment with their clients and explore their needs (Hall, 2009). Based on the three basic domains of learning that includes cognitive, behavioural, and affective learning; nurses need to develop learning objectives, identify learning needs and client’s priorities, identify preferred teaching method, work in partnership with client on teaching plan, consider patient’s developmental stage, learning environment, and client’s motivation to learn.
Using constructivist approach to actively involve the patient in teaching sessions; consider patients’ prior experience to the situation, ask patients to provide feedback and encourage them to ask questions. Feedback will provide a chance for the teacher to evaluate the teaching plan and make some amendments to the teaching plan if necessary. Ms. Kareem prior experience is a plus point for her learning; however, nurses may have to modify the teaching plan to make it congruent with her mental status; meaning linking new information with already learned knowledge (Brandon & All, 2010).
Healthcare has evolved and will continue to evolve to meet the increased demand from the public and the advancements in technology. Nursing paradigm is shifting from biomedical care to a more biopsychosocial model of care. Everyday, scientists come along new research and information that is evidence based. Teaching-learning theories have also been changing and will continue to change with passage of time; scientists learn more and more about certain topics and these are a few reasons for the evolution of theories.
Nursing Standards of College of Nurses of Ontario (CNO)
The standards set by College of Nurses of Ontario (2008) that includes professional responsibility and accountability, knowledge based ethical practice, service to the public and self regulation; all are equally important and worth making them a part of our daily practice as nurses. However, in relation to the teaching-learning experience that we had with our client, it is important to talk about a few standards, such as service to the public, ethical practice, and knowledge based practice (CNO, 2008). From nursing perspective, we are out there for the public to provide with information that is required to enhance the quality of life of our patients. Providing the required and accurate information will be a true service to the community and ultimately improve the quality of life. In regards to the ethics of nursing practice, nurses are obligated to understand and consider patients’ wishes in nursing process. Clients’ teaching would be highly effective and long lasting if nursing ethics of clients’ teaching are implemented. This is how nurses can be true to their profession. However, everything can be considered and implemented, only if nurses are knowledgeable, aware of learners’ capabilities, actively involved in and facilitate teaching-learning process.
Knowledge is the key to success that leads nurses to conquer peoples’ mind and place them on an approach to improve quality of life. As described by Chinn and Kramer (2008), there are certain ways of knowing, such as empirical, personal, ethical, aesthical, and emancipatory knowing. These ways of knowing help nurses understand their patients’ needs intuitively and scientifically, and respond to them appropriately. Also these combinations of resources facilitate clients’ teaching and learning by knowledgeable nurses (Chinn & Kramer, 2008).
Teaching-Learning Guidelines by Registered Nurses Association Ontario (RNAO)
RNAO has provided nurses with tools required for teaching and learning. In the RNAO guidelines, educators self assessment has been added to the document, which facilitates nurses to gain knowledge in order to be good teachers. Teaching sessions can be successful if nurses are aware of self and have knowledge of learning style preferences of their clients; nurses should have an understanding of patients’ education level, age and patients’ experience (RNAO, 2005). In the situation described earlier, it was lack of knowledge and self assessment as well as the lack of learners’ assessment, which was creating hurdles in a smooth passage of communication. The patient Ms. Kareem had an exposure to the circumstances of taking care of new born for the past five years. She had been a good mother of two elder children, and was an educated lady. The nurse could have taken advantage of her previous experience and linked it to the new one.
Confirmation/evolution of Goals and Objectives
With time and experience we learn new ways of meeting our goals. Nevertheless, goals can be adjusted and modified according to our priorities and precedence. I remember when I was in my first year of nursing program; my objective and aims were different than what they are at the moment. I have grown enough to be a professional nurse and my goals and objectives have also evolved. Although, some of my goals are long living, such as developing communication skills; however, its mode has been changed from simple communication skills to culturally competent skills that includes patients’ cultural values, social norms, and personal values. In relation to the teaching-learning theories, my vision has broadened and I had to change my goals and objectives as well. Humanistic approach is needed to develop communication skills that also involve interactive communication. This would help me understand my patients holistically and clients would also participate in learning objectives.
Setting goals and priorities is not only important; in addition nurses need to have knowledge of teaching-learning theories as well. This would help them plan accordingly for their patients’ well-being and more-being. For example, constructivist allows nurses to use clients’ previous experiences in developing teaching plan, which would prevent repetition of information delivered to patients, save nurses’ precious time, and money. After learning about these theories, my goal “to be a good teacher and a learner” has also evolved. I want to be a teacher, who develops a teaching plan based on clients’ age, learning ability, learning environment, gender, culture, and learning style preferences.
Nursing profession is more than just a job, these days nurses have major roles to play in different disciplines of healthcare, such as a teacher, an administrator, a nurse practitioner, a coordinator, and a caring nurse. However, the role of nurses as teachers is the foundation to a healthy society that prevents community members from diseases, helps them improve quality of life, reduces patients’ pressure on healthcare facilities, and ultimately saves revenue that can be spent on other patients. In regards to my nursing practice in future, I plan to develop myself as a good teacher. For clients’ teaching, I will make sure that I bring teaching-learning theories in my practice. The humanistic approach that provides an insight into patients’ lives, which would help me understand my patients intuitively and scientifically and plan accordingly. I will use participatory approach for clients’ teaching, which ensures clients’ active participation in meeting clients’ set outcomes. Reflection is another effective way to learn and meet all the nursing perspectives, I will reflect on my practice after teaching sessions and ask patients’ feedback about teaching sessions. This would provide me a chance to be a helpful client’ instructor and above and beyond improve my practice in helping me provide quality care to my patients.
Brandon, A., All, A. (2010). Constructivism theory analysis and application to curricula. Clinical Nursing Education, (31)2, 89-92. Retrieved from http://web.ebscohost.com.ezproxy. Library .yorku .ca/ehost/detail?vid=3&hid=126&sid=1 2b850d5-a42b-4190-943c-9f283da40 849%40sessi onmgr114&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ% 3d%3d#db=rzh&AN= 2010635234
Chinn, P., & Kramer, M. (2008). Nursing fundamental patterns of knowing. In Integrated theory and knowledge development in nursing (pp. 1-24). St. Louis, Missouri: Elsevier
College of Nurses of Ontario, (2009). Practice guideline: Supporting learners. Toronto, ON: Author. Retrieved from http://www.cno.org/docs/prac/44034_SupportLearners.pdf
Hall, A. (2009). Client Education. In P. Potter & A. Perry (Eds.), Canadian fundamentals of nursing (pp. 294-311). Toronto: Elsevier Canada. Fundamental of nursing
Oberle, K., Bouchal, S. (2009). Ethics in Canadian Nursing Practice. Toronto: Pearson Canada Inc
Registered Nurses’ Association of Ontario [RNAO]. (2005). Educator’s resource: Integration of best practices guidelines. Retrieved from http://www.rnao.org/Storage/12/65 8_BPG_ educators_resource_complete.pdf
These articles have been written by Nasir Ahmad BSc. (HONS) Nursing, a graduate from York University Toronto, Ontario, Canada. The writer of these articles authorize Peace In-Home Health Care Services Inc to use these articles on their website as an additional resource for their clients. However, any unauthorized copying or distribution of these articles will be dealt strictly by the laws of the state. Please contact author for any queries at 416-648-2717 or email: firstname.lastname@example.org