Role of Nurses/Caregivers as a Teacher, Facilitator, Coordinator and a Learner

Nurses have a broad range of responsibilities in today’s health care. The complexity of the role has changed from bedside assistance to nurses as teachers, facilitators, educators, nurse managers, coordinators, learners, and nurses as role models for patients. Regardless of specialty or work settings, the importance of the teaching role of nurses is extremely significant. Teaching plays a major role in the development of a nation, especially in the nursing profession. The practice of teaching helps nurses to update their knowledge and develop a healthy nation; this healthy nation later can come up with innovative ideas that can further develop a country’s economy and provides a basis for advancements in the technologies for every walk of life. For effective teaching-learning in the nursing profession, nurses need to understand the basic domains of learning and the criteria for teaching-learning; this includes learning needs, developmental stages of a person, learning ability, learning style, and motivation to learn. This paper explicitly reflects on learning goals set in the beginning of this course and how these goals have evolved and progressed over time (See Appendix A for learning goals and objectives). The paper also includes personal experiences, a personal teaching-learning philosophy, and personal learning about the process of teaching.

The most significant learning over the course of the semester has been the three domains of learning and the use of VARK (Visual Auditory Read/Write Kinesthetic) principles for the teaching-learning process. I have found these domains of learning and VARK principles helpful for healthcare professionals. They can use these domains to find out patients’ learning needs, and the VARK principles can be used to help meet patients’ learning style preferences, which would make the learning process even more effective (Hall, 2009).

Over the semester, I have met most of my learning goals. The lack of direct patients’ contact however, was a barrier against the fulfillment of all my desired objectives. In regards to my first learning goal, I have learned the humanistic learning theory, which would help me communicate effectively with my patients. From this theory, I have learned that effective communication needs more listening than talking; body language and repeating statements make communication clear and concise. Similarly, working on the group assignment as a team to develop a presentation was a good exercise to build effective communication skills. I have been communicating well with my peers for the development of our presentation. I have been using a plural noun “we” for the group work. My second goal has been achieved during the development of our group presentation. Working collaboratively to provide research based interventions to a certain age group for better sun protection has helped me in achieving my goals and exceeding my potential. I was accountable for the assigned task to develop group presentation and follow the rules set by our group members, which I consider equivalent to working in an institution. I have updated my nursing knowledge, knowledge of human anatomy, physiology, and pathophysiology to be a professional and knowledgeable nurse. To meet my set objectives for the third goal, I have been reflecting on my practice as a student nurse for the past 3 years. Reviewing daily individual and group work is an asset in accomplishing this goal. Reflection has helped me understand how to improve my practice in order to be a good teacher and a learner.

Evolution is a continuous revision of goals and objectives, which provide a basis for personal growth and development. As time passes, human needs tend to change, they move in the direction of higher sophistication, which trigger the evolution and revision of goals. This is specifically evident in the nursing profession, where nurses provide healthcare services to a wide variety of people with different cultural backgrounds (Lee, 2010). The uniqueness of the needs of individuals’ and healthcare professionals’ also play an important role for the evolution of personal learning goals. For example, like medicine nursing proposed the biomedical model of care in the past, which has been shifted to the biopsychsocial model of care to meet aesthetical needs of patients. My first personal learning goal has evolved with the passage of time. I need to incorporate cultural competence into my communication skills. I have added two words, “culturally competent” to my first goal, which would make an immense difference, if learned and practiced appropriately (Lee, 2010).

Teaching-learning is a continuous process and a part of everyday life. Thus, in nursing; teaching is exceedingly important, because it plays a major role in the well-being of a person. All of my previously set learning goals are worth carrying forward towards my nursing praxis, because these are the fundamental features of nursing. The new learning goals that I would like to add for the future planning of nursing could be “to develop true understanding of three domains of learning in actual practice settings”, which plays an important role in the teaching-learning process and allows healthcare professionals to plan accordingly (Hall, 2009). For example, teaching an elderly diabetic client about the use of the glucose meter, which involves psychomotor learning; the true understanding of the domains of learning would help professionals to select the most appropriate method of teaching for that elderly diabetic patient. Also, finding out the affects of aging on learning abilities of a person, will help nurses plan accordingly for teaching sessions.

As a teacher and a learner, I have learned that knowledge is the key to success, especially in the nursing profession. If nurses are knowledgeable, they will provide competent care to their patients and prevent many complications. Nurses need to have knowledge of all “ways of knowing”, which includes empirical, aesthetical, personal, ethical, and emancipatory knowing to offer better care to their patients (Carper, 2008). I am a kinesthetic learner; I was stunned to know that I am an impatient teacher. Listening with patience is an art that is the core of the nursing profession. I need to develop listening skills to be a good teacher and a learner.

We are learning everyday as human beings from our peers, elders, children, teachers, and in some cases from our students. This process can be a lot easier if we are aware of the learning and teaching process. The idea of “learning about learning and learning about teaching” is something that stood out for me, while I was doing the weekly readings in my second or third week of the semester. This idea stood out for me because it provides the extract and in itself is the explanation of the whole teaching-learning process, which proves the importance of learning about learning and learning about teaching. Researchers have found that for effective teaching-learning, it is very important to know about the learner and the teaching methods to be used (Robertson, Smellie, Wilson, & Cox, 2011). Learning about the learner includes knowing about the learner’s learning style preferences, motivation to learn, ability to learn, and learning needs; while learning about teaching, emphasizes the role of a teacher in the teaching-learning process, which includes finding ways to engage learners to learn more effectively (Robertson et al., 2011). The idea of learning about learning and learning about teaching has great importance for healthcare professionals, especially for nurses, because it would be much easier and effective to teach if we knew our clients’ learning habits, learning needs, and their motivation to learn.

While working as a teacher in a practicum setting, I would be most concerned about knowing my students in relation to their learning style preferences. Robertson and her colleagues (2011) have reported that poor awareness of a learner’s learning style can lead to misunderstandings about a learner’s motivation to learning; hence the teacher would not be able to provide the appropriate learning environment. Not providing the suitable learning environment would ultimately hinder learners’ capability to learn; and would also cause frustration for the teacher. Scientists have suggested that teachers should ask their students to fill out a learning style inventory, so that they can be taught more efficiently (Robertson et al., 2011).

All the teaching-learning theories whether in nursing or in psychology are developed for the betterment of human beings. Yet, some of these theories provide a more practical approach for the teaching-learning process. As a nursing student, I am a true believer of the humanistic and the constructivist perspectives. These two theories are unique in nature because the humanistic offers me to get close to patients, be in the now moment to explore patients’ needs. On the other hand, the constructivist offers me to utilize patients’ previous exposure to the situation and develop new learning for patients. The humanistic approach is also congruent with nursing standards, which is to provide patients with freedom of choice (CNO, 2008). The humanistic perspective takes care of individuals based on their uniqueness. The most important aspect of the humanistic perspective that influences me to use this theory as a student nurse and carry it forward is that it gives me a chance to listen to my patients as a facilitator rather than a dictator. The constructivist approach enables me to get better use of patients’ previous experiences and not flood information that one cannot digest. This theory is worth carrying forward because it will save my time that I can spend for the well-being of other patients.

The teaching of clients’ is a major part of the nursing practice, every time nurses encounter patients, there is teaching-learning involved. However, in concern to the question of rewards found in the teaching-learning, an experience comes to mind. I remember, during one of our peer presentations in the class about teaching-learning, it was said that we learn more when we teach someone. Nursing is the profession in which nurses need to update their knowledge on a regular basis (CNO, 2008). I find it rewarding if I learn something while teaching a client. This is as the case of a teacher who goes to the class with full preparation and can expect any questions from students. Teaching someone can improve my knowledge and would also provoke me to study; this would give me a chance to update my knowledge. I can recall of a patient asking me a question during my placement at a hospital, feeling the discomfiture of not being able to answer their question, I was determined to update my knowledge. I find it rewarding, when I can make a difference in peoples’ lives by providing them with required information and reducing the number of their visits to a facility.

Effective teaching depends on a variety of factors, these factors include the teaching approach, knowing the learning style, the environment, learner’s ability to learn, motivation to learn, identifying learners’ needs based on three domains of learning, and evaluation of the outcomes after the teaching process is complete. Effective teaching should also be tested through the process of return demonstration for assurance of understanding (Hall, 2009). For example, at my clinical placement, a 53 years-old client asked me to teach her the use of inhaler with a spacing device. I assessed her need based on the three domains of learning, motivation to learn, and taught her the correct use of inhaler with a spacing device. After demonstrating twice, I requested her for the return demonstration to make sure teaching was successful. Thus, inquiring if the patient had any further concerns. Effective teaching also requires patience in order to listen to the learner for appropriate responding. I am working on overcoming this weakness, which would ultimately help me to be an effective teacher.

Knowledge is the key to any teaching-learning session. I see myself as a knowledgeable teacher, as I have a keen interest in updating my information on a regular basis. I research thoroughly before starting any teaching session, to anticipate answers to queries from learners. I look at every aspect of the situation in order to give a broad view of the scenario. For example, when corresponding to diabetic clients; I would inform them about the complications of diabetes if not taken seriously. I would educate them about lifestyle and dietary changes, before things can get worse. As a teacher, I would provide them with resources that would meet their learning needs, learning style, and easy to follow charts about dietary changes for diabetics. I would also educate them on the procedure to checking blood glucose and asking for a return demonstration soon after for self reassurance and for evaluation of the learning process.

Developing a therapeutic relationship is difficult; however, it is the first step towards any nursing intervention or clients’ teaching-learning. This connection can be developed by accepting the meaning of the situation from patients’ perspective, going with the flow of the patients’ desires, and exploring patients’ hopes, and possibilities for the future (Pilkington & Jonas-Simpson, 2009). In order to develop a relationship of trust, nurses must have good communication skills; they must also be truthful to the nursing profession by keeping an eye on their own moral values. I have been using these strategies to develop that relationship of trust with my patients in clinical settings. Although, English is my second language, I am always successful in developing that connection by a means of giving respect to my patients’ wishes, and listening to them without interrupting the rhythm. For example at my placement, a 62 years-old lady with asthma would not take her inhaler before her breakfast to preserve the taste of her food, as it was prescribed by her physician. I respected her wishes and did not pressure her to follow the instructions. However, respecting her wishes at that moment helped me develop a caring relationship, and teaching was successful after this connection.

As healthcare professionals, nurses have to take care of people of different cultural and ethnic background and people of various age groups as well. These people can have different values, beliefs, and cultural norms than a nurse. However, that does not mean that a nurse would try to impose personal beliefs and values on a patient (CNO, 2008). Just as patients have high expectations of nurses; I would not have as high expectations from learners. However, as a teacher or as a student nurse, I would expect patients to have positive attitude towards learning, paying attention to the information being provided and be respectful to the educator as well.

Best practice guidelines regarding teaching-learning from Registered Nurses Association of Ontario (2005) and nursing practice standards from College of Nurses of Ontario (2008) complement each other on various levels. CNO (2008) requires nurses to have knowledge based practice and emphasizes nurses to be truthful to their profession; while providing service to the public. On the other hand, RNAO (2005) guides nursing teachers to pay more attention to the learners and requires nurses to accept and adapt to the learners’ preferred learning style and philosophy of learning for teaching purposes.

The philosophy of teaching-learning in the nursing profession that I own comes under the umbrella of the nursing standards and the best practice guidelines. I have come to realize that the nursing profession is more than just a job; I can pay my services to the community truly, only if I am truthful to my profession. I would be able to serve the community in a better way, if I had knowledge, not only of nursing, but of other related disciplines as well. For example, people have different interests, and hobbies, nurses can use these various interests to break the ice and get close to patients, making them more comfortable and open to communication. Regarding congruence with RNAO, I believe that the humanistic approach is the best to explore patients’ feelings and their perceptions from their point of view. This approach would provide healthcare professionals with a chance to know more about patients’ preferred learning styles, learning environments, learning capacities, and motivations to learn; this would ultimately help in teaching-learning process. However, this is possible only when we develop that trust based therapeutic relationship with our clients.

Hopes as a teacher and a learner can be different and similar simultaneously. As a teacher, I hope that we all reflect on our practice and give a chance for improvement to ourselves, to see how we can utilize our knowledge to develop more well-informed and caring nurses; spending more time on planning for different learners according to their learning styles and meeting their learning needs. I hope that all nurses become truthful to their profession by paying even more attention to learning because the nursing profession requires a continuous growth and knowledge based practice (CNO, 2008). On the other hand, my hopes as a learner include a caring relationship between the learner and the teacher as it is required for nurse-patient relationship. Having a non-judgmental, genuine, respectful, patient, and flexible teacher is vital for the success of this relationship. Good social relationship among teacher-learner would create a comfortable learning environment for the learner and provide them with a chance to reflect on their teaching-learning. This reflection would help these learners to learn more effectively and improve their practice for the future of nursing.

Learning about teaching and learning about learning is like an ocean, which is deep. I find myself to be at the shallows end of this ocean and have to swim deeper. I have to learn a lot more as a teacher as well as a learner. As a teacher, I should reflect on my teaching and request evaluation by peers and learners, to make sure that learners understand whatever they have been taught. As a learner, I need individuals who can understand my feelings, respect my values and beliefs, and not try to impose personal values on me.

At the beginning of this course, I was not sure if I had a philosophy of teaching. However, as time elapsed and twelve weeks of this course came to an end, I have come to realize the change within me; I have become a tremendously better teacher and learner. The philosophy of teaching-learning, which can be summarized through the phrase, “Knowledge is power” that I encompass now is coming from Carper (2008), who describes five different ways of knowing and considers knowing as one of the powerful tools in nursing profession. Carper (2008) differentiated five ways of knowledge including empirical, ethical, personal, aesthetical, and emancipatory knowing. Only scientific nursing knowledge is not sufficient, the modern era of nursing is too complicated and it is difficult for students to offer better care without guidelines. There is a need for nursing students to learn and accomplish “knowing” in their practice from all five directions that has been offered by Carper (2008).

Artistic expressions give words to emotions and feelings that cannot be expressed in words by an artist. It gives a full description of the personal values and beliefs of the author (Bennet, 2010). The piece of art that I have chosen to represent my philosophy of teaching-learning is from Google images. The link to the source has also been provided at the bottom of the art. This piece of art consists of the sun as a source of light as a human hand is holding that beam of light. The open lighted space reveals the universe and piece of cloud that prevents sunlight to come down upon earth. Now, I am going to explain how this piece of art expresses my philosophy of teaching-learning that I have developed from Carper (2008) ways of knowing. This piece of art has been provided in appendix “B,” this picture depicts my philosophy of teaching-learning “knowledge is power” very strongly. The light from the sun represents knowledge as it lights up everything in this universe, it is a source of power for this universe. However, this is up to someone’s capacity to absorb the amount of light; meaning gaining knowledge and application of this knowledge. The human hand in the picture holding that light can be compared to nurses’ mind, trying to consume and carry as much knowledge as possible. The font used for the heading reveals that it has potential energy in it; just as a spring if twisted and released, causing it to expand, transforming into a different form of energy. This light brightens up anything in is distance, just as the power of knowledge has on the human mind.

Just as light has the power to light up everything, nurses who are knowledgeable and know all “ways of knowing” are successful at teaching their clients (Carper, 2008). This knowledge facilitates them to understand their patients holistically, which ultimately helps them develop that therapeutic relationship with their clients, which can then explore learning needs. After this step, nurses can plan accordingly for these patients based on their learning style preferences and learning ability.

Teaching-learning is an important task in the nursing profession that helps nurses to buildup a healthy nation and prevents patients’ from needlessly visiting a facility. Teaching can be successful, when all the aspects of teaching are covered in a teaching session, such as developing therapeutic connection with patient, exploring learning needs, motivation to learn, knowing about the learning style preferences, learning ability of a patient, and developmental stage. A successful teaching session also includes client’s satisfaction upon evaluation of the teaching plan. Responsibilities are expected from dual sides, teachers and learners. A teacher should have knowledge to build up a caring connection with learners, using the humanistic approach to teaching, such as accepting a client’s leadership in learning process, respecting their wishes, and teaching them in a way that they choose. A teacher should ask for teaching evaluation following the completion of the session. On the other hand, learners should pay respect to their teachers by openly sharing their ideas with teachers and providing sincere evaluation of the teaching session.

 

This article has 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 & home health care professionals. 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: 23.ahmad@gmail.com

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