Carolina RN to BSN Online
N490
Conceptual Bases of Professional Nursing Practice
System Variables:  The Nursing Profession
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

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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.

Prevailing Models

 

Compliance Model

Cooperation Model

Goal

To provide the knowledge and skills the patient needs to carry out the treatment plan designed by the health care team

To provide the information and skills patients need to make informed choices

Educator's Role

  • 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
  • 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


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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