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Introduction
Part
1: Variables Influencing Teaching and Learning
System Variables
Teacher
Variables
Learner
Variables
Part 2: The Seven Steps of Planning --Plus
One
Weekly
Assignment 1
Evaluating
Learning
Weekly
Assignment 2
Analyzing Experiences
Feedback
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Laws and
standards governing nursing practice
determine whether we teach, and, to some extent, what we teach. Our
shared assumptions, beliefs, and values have a powerful impact on how
we teach. We'll look briefly at how teaching-learning in nursing
practice is influenced by:
- Nurse Practice Acts
- Standards of Practice
- The prevailing model guiding patient/consumer education
Nurse Practice Acts
Since nurse practice acts define the scope of nursing practice, they
determine whether or not teaching is a part of professional nursing
practice. As you know, nurse practice acts differ from state to state,
and they change over time. While many of you assume that teaching is a
part of nursing practice, it wasn't always so. We older nurses can
remember when nurses were not allowed to share information about a
patient's "condition" with him/her. For example, a nurse couldn't tell
a patient his/her blood pressure or temperature, or the name of his/her
medications. Instead we might respond to questions with vague comments
like, "This pill is something your doctor ordered to help you
relax."-usually followed by, "Ask your doctor." So, while the impact of
nurse practice acts on teaching and learning (or any other aspect of
practice) doesn't change from day to day, it does change over time, and
it behooves us to pay attention to proposed changes. If you don't know
what your Nurse Practice Act has to say about teaching, you might want
to review it at
Nursing
Practice Acts -- Click on "Law and Rules", then roll over
"Laws and Rules" on the submenu to click on "Nurse Practice Act".
Standards of Practice
Standards of practice have been developed by a number of nursing
organizations ranging from ANA to specialty organizations. Standards of
practice, as the label implies, outline the recommended standards of
practice in general and specialized nursing practice. While standards
of practice are not law as are nurse practice acts, they are often used
to define the "standard of practice" in malpractice cases. The
following link provides a list of standards available from the
ANA-while the standards themselves aren't available at this site, you
can see that there are standards available for many nursing
specialties.
ANA
on Standards
You might also want to check the
standards for your particular
specialty-these may be available at your workplace or on your specialty
organization's web site.
The Prevailing Model
Guiding Patient/Consumer Information
Our work is guided by broad models or frameworks that include shared
assumptions, attitudes, beliefs, and values about some aspect of our
practice. Often these models or frameworks are borrowed from other
disciplines, or are modified versions of models used by other
disciplines. There is usually a prevailing model guiding practice or
specific aspects of practice, and it may change over time as
assumptions, attitudes, beliefs, and values change. For many years the
prevailing model guiding patient/consumer education has been what some
call the compliance model. This model will be very familiar to many of
you, particularly those who have been in nursing for some time.
However, in recent years there have been changes in assumptions,
attitudes, beliefs, and values as well as changes in the health care
system which have led to movement away from the compliance model. We've
begun to move toward another model that some call the cooperation
model. Both models will be presented here because they are opposites in
many ways, demonstrating the extent to which models can differ, and the
potential impact of these differences on approaches to practice. In
reality, nurses today use a number of models to guide teaching-some use
a compliance model, some use a cooperation model, and many use a model
that lies somewhere between these two, incorporating some aspects of
each.
Perhaps the most important
thing to remember is that neither
of these models (or other models we might use) is inherently good or
bad. The model guiding teaching is only one element affecting the
character and quality of the interaction, and any model can be used
effectively or ineffective.
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Prevailing
Models
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Compliance
Model
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Cooperation
Model
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Goal
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To provide the
knowledge and skills the patient needs to carry out the treatment plan
designed by the health care team
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To provide the information
and skills patients need to make informed choices
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Educator's
Role
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- Provide patients with knowledge and skills
needed to manage continuing care without daily supervision
- Motivate patients to accept treatment
plans as valuable in attaining health or controlling illness
- Encourage patients to change behavior
patterns to fit the requirements of the treatment regimen
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- Provide a framework for creative thinking
- Assist the patient to raise questions such
as Why? How? Who?
- Establish an environment in which genuine
dialog can occur
- Encourage the chosen actions and evaluate
their results with the patient
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More about the compliance model ...
I
probably don't need to say
much more about the compliance model, since it's been the prevailing
model in health care for many years. I'll just offer a few questions to
stimulate your thinking about using this model in your practice:
- Is this model likely to be more effective in some
situations than others? What kinds of situations are likely to be a
good fit with this model?
- What problems might you encounter as you use this model to
guide teaching and learning?
- What do you see as the pros and cons of this model?
More
about the cooperation
model
...
Since this
model may be less
familiar
to some, I'll add a bit of information about a key concept in the
cooperation model-empowerment. Empowerment has become a buzz word, but
understanding it is key to understanding this model.
Empowerment
is defined as the
ability
of the individual to have control over his/her life. It includes the
following components:
- Sufficient knowledge to make rational informed decisions
- Sufficient control and resources to implement decisions
- Sufficient experience to evaluate the effectiveness of
decisions
If you look
back at the goal of
the cooperation
model
and the educator's role in this model, you can see that each component
of empowerment is addressed. The educator provides information and
facilitates skill development, facilitates decision making about goals
and ways to work toward those goals, and assists with evaluating the
effectiveness of decisions. In short, the educator is a
facilitator-facilitating the patient's work as s/he sets goals,
identifies and takes action to achieve those goals, and evaluates the
effectiveness of actions taken. In the compliance model
the health care professional sets the goals, prescribes actions to
achieve goals, and evaluates the effectiveness of actions taken. By
contrast, in the cooperation model the
patient takes responsibility for these activities, with the health care
professional serving as a facilitator and expert resource.
The Pellino article (link
below) describes a study comparing an empowerment approach (basically a
cooperation model) with a more traditional approach to pre-op teaching
for patients undergoing total joint replacement. This is a good example
of using different models to guide teaching in nursing practice.
Pellino, Theresa et al., Increasing Self-Efficacy Through Empowerment:
Preoperative Education for Orthopaedic Patients, Orthopaedic
Nursing, July-Aug 1998
Think about applying the
cooperation model using the same questions you used to think about
applying the compliance model:
- Is this model likely to be
more effective in some situations than others? What kinds of situations
are likely to be a good fit with this model?
- What problems might you encounter as you use this model to
guide teaching and learning?
- What do you see as the pros and cons of this model?
Thinking about models
in your practice ...
Now that you've reviewed information about two models that can be used
to guide teaching-learning, think about the model(s) guiding
teaching-learning in your practice. Ask yourself the following
questions:
- What model do I use most of the time to guide
teaching in my practice?
- Do I use different models in different situations?
- Why am I using the model(s) I'm using?
- Does the model(s) I'm using feel like a good fit for
me?
- Am I an effective teacher? If so, how does my guiding
framework contribute to my success? If not, how could my guiding
framework inmprove by effectiveness?
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