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the extent to which an individual's behavior (for example taking medications, following diets, or making lifestyle changes) coincides with medical or health advice; commitment or attachment to a regimen
Adherence
known as the "feeling" domain is divided into categories that specify the degree of a person's depth of emotional response to tasks; includes feelings, emotions, interests, attitudes, and apreciations
Affective domain
the art and science of helping adults learn
Andragogy
includes the careful indentification of what is to be taught and the immediate identification of and reward for correct repsonses
Behaviorist Theory
the "thinking"domain, includes six intellectual abilities and thinking processes beginning with knowing, comprehending, and applying to analysis, synthesis and evaluation
Cognitive domain
intellectual skills that include problem solving decision making, critical thinking, and creativity
Congnitive theory
the extent to which an individual's behavoir coincides with medical or health advice
Compliance
the term used to describe the process involved in stimulating and helping elderly persons learn
Geragogy
ablility to read, understand, and act on provided health information
Health literacy
learning that focuses on the feelings and attitudes of learners, the importance of the individual in identifying learning needs and taking responsibility for them, and the self-motivation of the lerners to work toward self reliance and independence
Humanism
Copying behaviors and attitudes of another person
Imitation
a change in human disposition or capability that persists over a period of time and cannot be solely accounted for by growth
Learning
a desire or a requirement to know something that is currently unknown to the learner
Learning need
observing the behavior of people who have successfully achieved a goal that one has set for oneself and, through observing, acquiring ideas for behavior and coping strategies
Modeling
the desire to learn
Motivation
the discipline concerned with helping children learn
Pedagogy
giving rewards such as praise for a learner's achievements
Positive reinforcement
the "skill" domain; includes motor skills such as giving an injection
Psychomotor domain
behaviors or cues that reflect a learners's motivation to learn at a specfic time
Readiness
a system of activities intended to produce learning
Teaching
Importance of teaching role
- major aspect of nursing practice
-independent nursing function
-the american hospital association's patient's bill of rights
-state nurse practice acts (the JCAHO's standards)
Attributes to learning
- experience that occurs inside the learner
discovery of the personal meaning and relevance of ideas
-consequence of experience
-collaborative and cooperative process
- process that is both intellectual and emotional
Andragogy (Teaching adults)
-more independent in learning situations
-previous experiences can be used as a resource for learning
-readiness to learn is often related to a development task or social role
-immediate application of material is important
Pedagogy (teaching children)
-alerting
-instructing
-performing
-reinforcing
Geragogy (Teaching elders)
- Material must be practical and meaningful
-set achievable goals with client/family
-increase time for teaching
-incorporate rest periods
-reduce distractions
-accomodate for sensory alterations
-use positive reinforcement and ongoing evaluation
Behaviorism
-learning is based on the learner's behavior
-stimulus and response
-conditioning
-positive reinforcement
-observational learning and instruction (immitation and modeling)
Nursing using behaviorism will
-provide sufficient practice time
-provide immediate and repeat testing and redemonstration
-provide opprotunity for trial and error problem-solving
-select teaching strategies that avoid distracting information and evoke desired response
-praise correct behavior and positive feedback
-provide role models of desired behavior
Cognitvism
-learning is complex cognitive activity
-learner structures and processes information
-perception chosed by learner
-personal characteristics impact perceptions
-social, emotional, and physical contexts
Nursing using cognitivism will
-provide social, emotional, physical environment conductive to learning
-encourage positive teaching-learning relationships
-select mulitsensory teaching strategies
-recognize personal characteristics have impact on how cues are percieved
-develop appropriate approaches to target different learning styles
-assess developmental and inddividual readiness to learn
-adapt teaching to developmental stage
-select behavioral objectives and teaching strategies that encompass cognitive, affective and psychomotor learning
Humanism
- learning is self-motivated, self-initiated, and self-evaluated
-focus on cognitive and affective qualitites of learner
-learning best when relevant to the learner
-autonomy and self-determination of learner important
-learner is an active participant and takes responsilbity for meeting learning needs
Nurses using Humanism
-convey empathy
-encourage learner to establish goals
-promote self learning
-serve as facilitator, mentor, or resource for learners
-use active learning strategies
-expose the learner to new, relevent information
-ask appropriate questions
-encourage the learner to seek new answers
Domains of learning
-Cognitive
-Affective
-Psychomotor
Cognitive Domain
-"thinking" domain
-knowledge
-comprehension
-application
-analysis
-synthesis
-evaluation
Affective Domain
-"feeling" domain
-feelings
-emotions
-interests
-attitudes
-appreciations
Psychomotor Domain
-"skill" domain
-motor skills
Factors affecting learning
-motivation
-readiness
-active involvement
-relevence
-feedback
-nonjudgmental support
-organizing material from simple to complex
-repitition
-timing
-environment
-emotions
-physiologic events
-culture
-psychomotor ability
Assessment of learning needs
-Nursing history (age, client's understanding of health problem, beliefs and practices, economic factors, motivation ect)
-Physical examination (mental status, energy level, nutrition status, visual ability, hearing ability, muscle coordination)
Nursing diagnosis
Primary problem or etiology for other nursing diagnosis
NANDA diagnoses when used as the primary problem
-deficient knowledge (specify)
-health-seeking behavior
-noncompliance
Nursing Diagnoses
NANDA diagnoses when used as Etiology
-risk for impaired parenting
-risk for injury
-ineffective health maintenance
Learning outcomes
-specify specific knowledge or skills client must aquire
-state in terms of the client
-state in observable, measurable terms
-addconditions or modifiers as needed
-add criteria specifying the time for achievement
Interventions
-selecting content
-selecting teaching strategies
-organizing learning experiences
Teaching plan (should include)
-nursing diagnosis
-goals
-learning outcomes
-contain content that is: accurate, current, based on learning outcomes, adjusted for the learners age, culture, and ability, consistent with information nurse is teaching
-carefully selected with time and resources in mind
Teaching Strategies
-lecture
-one-to-one discussion
-answering questions
-demonstration
-group discussion
-practice
-printed and audiovisual materials
-role-playing
-modeling
-contracting
-group teaching
-computer-assisted learning programs
-discovery/problem solving
-behavior modification
Guidelines for effective teaching
-establish raport
-use client's previous learning to encourage further learning
-choose the best times for learning
-communicate clearly and concisely
-use layperson's vocabulary
-be sensative to teaching pace (too fast or too slow)
-choose the best environment for learning
-use teaching aids to foster learning and focus attention
-involve the senses
-allow learners to discover content for themselves
-use repitition to reinforce learning
- employ "organizers" to introduce material
-choose appropriate anticipated behavioral changes within the context of clien't lifestyle and resources
Teaching clients of different cultures
-obtain teaching materials, pamphlets, and instructions in languages used by client
-use visual aids, such as pictures, charts, or diagrams to communicate meaning
-use concrete rather than abstract words
-allow time for questions
-avoid the use of medical terminology or health care language
-if understanding another's pronunciation is a problem, validate brief information in writing
-use humor cautiously
-do not use slang works or phrases
-do not assume that a client who nods, uses eye contact, smiles is indication an understanding of what is being taught
-invite and encourage questions
-when explaining procedures or functioning related to personal areas of the body, may be appropriate to have a nurse of a the same gender do the teaching
-include family in planning and teaching
-consider the client's time orientation
-indentify cultural health practices and beliefs
Evaluating learning
cognitive learning
-direct observation
-written measurements
-oral questioning
-self-reports or self-monitoring
Psychomotor learning
-observing how well the client carries out the skill
Affective learning
-more difficult to evaluate
-inferred by the following: listening to the client's responses to questions, noting how the client speaks about relevant subjects, observing the clients behavior
Documentation
-provides legal record that the teaching took place
-communicates teaching to other health professionals
-document repsonses of the client and support people to teach activities

Parets of the teaching process that should be documented include:
-diagnosed learning needs
-topics taught
-clent outcomes
-need for additional teaching
-resources provided
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