Carolina RN to BSN Online
N490
Conceptual Bases of Professional Nursing Practice
The  Seven Steps of Planning--Plus One
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

 


Introduction

Effective teaching-learning interactions rarely just happen. Contrary to what some seem to think, teaching isn't magic; effective teachers plan carefully. There are a number of models one can use for developing teaching-learning interactions. One of these is the nursing process, but, since we use the nursing process all the time, I thought we'd look at another model, just for variety. The model we'll use is Jane Vella's model, called the Seven Steps of Planning. Vella is an adult educator with extensive experience in developing countries as well as in this country. She has written about her experience, describing her use of the seven steps of planning in a variety of settings.

So, what are those seven steps?

Step 1, Who?  arrow  Step 2, Why? arrow  Step 3, What For? arrow  Step 4, What?    Step 5, When? arrow  Step 6, Where?  
Step 7         

And, what's this in the title about "plus one" ?

I've added a step to Vella's model to emphasize the importance of planning for and conducting evaluation. Vella addresses evaluation in Step 3, as you'll see when we talk about objectives and outcomes, but it's been my experience that evaluation is often overlooked, particularly in short-term, non-classroom situations. So, the table gets another box.

Step 1, Who?  arrow  Step 2, Why? arrow  Step 3, What For? arrow  Step 4, What?    Step 5, When? arrow  Step 6, Where?  
Step 7    PLUS   

 

Step 1 is about understanding the learner(s), and planning to best meet their needs. All the learner variables discussed in the previous section should be considered in step 1. These include: culture; developmental readiness; knowledge and skills relevant to the teaching-learning interaction being planned; motivation; physical and mental ability; and learning style. If you need to review any of these learner variables, return to the previous section.



Step 2 is about identifying learning needs. A simple way to approach this is to consider two types of learning needs: felt needs and analyzed needs.

Felt needs are needs identified by the learner.

Analyzed needs are needs identified by the teacher based on his/her expertise.

Both felt needs and analyzed needs are legitimate, and both should be considered in most teaching-learning interactions. The relative weight of felt needs versus analyzed needs in shaping the interaction will vary, as will the degree of congruence between them.

Thinking about your experience ...

Thinking about your experiences as a learner ...

  • Identify at least one situation in which you were asked to identify your learning needs. How did it feel? How effective was it?
  • Identify at least one situation that was based almost entirely on analyzed needs. How did it feel? How effective was it?
  • When do you think greater emphasis on felt needs works best for you as a learner?
  • When do you think greater emphasis on analyzed needs works best for you as a learner?

Thinking about your experiences as a teacher ...

  • Identify at least one situation in which you asked learners to identify their learning needs. How did it feel? How effective was it?
  • Identify at least one situation in which you based the session almost entirely on analyzed needs. How did it feel? How effective was it?
  • When do you think greater emphasis on felt needs works best for you as a teacher?
  • When do you think greater emphasis on analyzed needs works best for you as a teacher?

It's important to remember that felt needs can be expressed directly and indirectly. Asking questions is the most common method of expressing felt needs directly. This is why it's so important to welcome questions and listen to them carefully. An effective teacher is also attuned to indirect communication of felt needs. This may take the form of indirect questions (I have a friend who needs some information about…) or non-verbal communication-voice tone, facial expression, behavior.

Finally, it's important to be aware of conflict between felt and analyzed needs. I've used this example before, but we've all experienced it, and it fits here too. For the majority of unlicensed nursing students, the overwhelming felt need is to learn about diseases and treatment and to learn "hands on" skills. On the other hand, educators analyze other needs like communication skills, application of research as a basis for practice, understanding of professional issues, etc. We all know what happens if content based on the analyzed needs is presented before the students' felt needs for disease knowledge and hands on skills are met.



Step 3 is about outcomes. In step 3 we decide what we want to accomplish through the teaching-learning interaction. Behaviorist theory gives us a good tool for communicating this-the behavioral objective. Since the use of behaviorist theory is so prevalent in nursing, you're familiar with behavioral objectives, but let's review a few key points. There are two sets of objectives involved in any teaching-learning situation, and we sometimes get them confused. One set of objectives is teacher objectives. Teacher objectives are what the teacher wants to accomplish; that is, the teacher's objectives for him/herself.

Examples of teacher objectives 

  • get the students to like me
  • maintain order in the classroom.
  • stimulate discussion.
  • become more skilled at leading small groups.
  • use multimedia technology in presenting content on leadership styles

Teacher objectives are often overlooked, and may creep into the list of learner objectives. It's important that you, as a teacher, recognize your objectives and separate them from the learner objectives for the teaching-learning interaction.

The second set of objectives is learner (or learning) objectives. Learner objectives identify what the learner is to accomplish, or, put another way, outcomes of the educational activity to be demonstrated by the learner

Learner objectives may be identified by the teacher, the learner, or both.

Components of behavioral objectives
A behavioral objective has three components:

Performance
What is the learner to do?

The key to writing a clear objective is the choice of verb used to describe the performance. If you use a vague, general verb like "know" or "understand", you will probably have trouble writing the third component, criteria. It's very difficult to tell when someone knows or understands. On the other hand it's much easier to tell whether someone can identify, describe, apply, or evaluate.

Conditions
Under what conditions will s/he do it?

Conditions include things like time allowed, resources (help) permitted, real versus simulated situations, etc.

Criteria
How will we know when s/he has accomplished it?
How well must it be done?

Behavioral objectives must include criteria to judge when the learner has accomplished whatever s/he is to do. In some cases this is enough. An example from the area of health or physical fitness is, "Tom will finish a 5 K race". In this example, the only criterion is whether or not Tom finishes the race.

In other situations, just "yes" or "no" isn't enough. To return to the 5K race example, it might be important to include how well the individual must do. For example, "Tom will finish the 5K race within 40 minutes. In this case, just finishing isn't good enough, Tom must finish in 40 minutes or less to achieve the objective.

One final comment about behavioral objectives ...
Remember, behavioral objectives are supposed to be a useful tool. Sometimes we get so caught up in trying to write perfect objectives that we lose sight of their purpose and allow them to become more trouble than they're worth. Robert Mager, who some consider to be the father of behavioral objectives, says:

You don't work on an objective until it demonstrates these characteristics; rather you work on it until it clearly communicates one of your intended educational outcomes.

Just in case you'd like a different format ...
Although behavioral objectives having Mager's three components are a classic, there are other formats. One of these is the Anderson formula. This formula calls the outcome a learning goal rather than a learner or learning objective, but you can see that it includes Mager's components.

Anderson Formula
Learning Goal = Who + What + How + When



Step 4 is about content. This is where you identify content to address identified learning need(s) and facilitate desired outcomes. Then you organize and sequence it for delivery.

When you set out to identify content, it's important to consider potential content from all 3 domains of learning:

Cognitive-deals with information, knowledge, understanding

Affective-deals with attitudes, values and beliefs

Psychomotor-deals with "hands on" skills

Example

Let's use a newly diagnosed diabetic for this example. Examples of his/her learning needs in each domain are:

Cognitive

  • how diabetes affects the body
  • signs and symptoms of complications
  • how Insulin (or whatever medication) works

Affective

  • coping with implications of chronic illness
  • accepting responsibility for own care

Psychomotor

  • giving Insulin injection
  • blood glucose monitoring
  • foot care

All teaching-learning sessions do not include content from all 3 domains. While it is often useful to include content from two, or even all three domains in one teaching-learning session, be careful about overwhelming or confusing the learner. In the case of the newly diagnosed diabetic, it would probably be both overwhelming and confusing if you tried to teach the disease treatment, pharmacology of Insulin and Insulin injection all in one session.

One pitfall often encountered by "nurse teachers", both in clinical practice and nursing education, is trying to teach too much. We know a lot about this stuff, and we usually find it interesting, so we try to teach everything we know. I'm sure most of you have heard this rule before, but here it is again. You must differentiate between the "need to know" and the "nice to know". No matter how much you love teaching stuff in the "nice to know" category, give it up unless:

  • your learner has conquered the "need to know"
  • your learner demonstrates readiness
  • you have the time and the resources to effectively teach the "nice to know"

Now that you've settled on the content, you need to break it into manageable units, and you need to sequence it. Sequencing should take into account both prerequisite information and skills and prerequisite levels of cognitive processing-if necessary, go back and review the section on cognitive learning theories and levels of cognitive processing.




In this step you'll need to think about the learner(s), you as the teacher, and the environment.

Considering the learner ...

  • Is s/he more alert at certain times of the day?
  • Has s/he just had a tiring procedure or therapy?
  • Is s/he in pain?
  • Is the patient the only learner, or do you need to plan for a time when family/caregivers can be there?

Considering yourself as the teacher ...

  • Are you more alert at certain times of the day?
  • Are some times in your schedule better for teaching than others?

Considering the environment ...

  • Do you need uninterrupted time?
  • Are there times that are quieter and less frantic in your setting?


You can probably think of other factors to consider when choosing a time to teach in your practice setting.


 
In this step, as in step 5, you'll need to consider the learner, yourself as the teacher, and the environment. Take a minute to identify a few examples of the kinds of things you should consider as you plan for where to conduct a teaching-learning session. Of course, sometimes you have no choice about the location, so the challenge is how to best use what you've got, if it's less than ideal.

 
This step is about teaching strategies. The term "teaching strategy" is teacher focused; if you prefer a learner focus, you might prefer the term learning activities. I will use "teaching strategies" here to underscore the fact that, in this case, you are the teacher. There are many teaching strategies available, ranging from more traditional strategies like lecture and print materials to less traditional strategies like gaming. The first step in choosing teaching strategies is to match the strategy to the domain of learning involved. The following table gives examples (not a comprehensive list) of teaching strategies best suited to each domain. Note that some strategies are appropriate for more than one domain. It's also important to remember that no strategy is inherently creative or effective-the design and implementation of a strategy in large part determines its creativity and effectiveness.


Teaching Strategies by Domain

COGNITIVE DOMAIN

AFFECTIVE

DOMAIN

PSYCHOMOTOR DOMAIN

Lecture
Demonstration
Discussion
Testing
Simulation
Audio-visuals
Print material
Games

Role Play
Discussion
Values Clarification Exercises
Simulation
Games

Demonstration
Practice
Simulation
Game


Once you've identified appropriate potential strategies for each domain included in your session, there are other factors to consider. These are particularly helpful when you have several appropriate strategies from which to choose. Paying attention to these additional factors when choosing teaching strategies will increase the effectiveness of the teaching-learning interaction.

  • Learner's learning style
  • Teacher's comfort and skill with the strategy
  • Time available
  • Resources available (media, equipment, etc.)
  • Physical Setting


This is the step Debbie added, and it's about evaluation. We are often guilty of assuming that if we taught it, learning occurred. This is like assuming in other aspects of practice that if we did an intervention, the desired outcome happened --if we gave pain medication, the patient's pain was relieved. Well, maybe yes, maybe no. Evaluation involves collecting evidence. We must look for evidence that learning happened. There are two steps involved: identifying what evidence to collect, and deciding how to collect that evidence. Although behaviorism isn't my favorite learning theory, I must admit that good, clear learner objectives make the first step much easier. If you've written a good objective, it will tell you what evidence to look for to see whether that objective has been met.

Example

Objective: The patient will be able to list the signs and symptoms of infection. In this case, the evidence you need is the learner's list of signs and symptoms.

Objective: The patient will report signs and symptoms of infection to the health care provider. (You could be more specific about who this is in each situation.) In this case you're looking for a higher level of processing-application. The fact that the patient can list the signs and symptoms as in the first example tells you nothing about whether or not s/he can recognize signs and symptoms and take appropriate action. The only way you'll know about this one is if the patient does report signs and symptoms (objective met) if they occur, or if infection is rampant at the follow-up visit or an emergency visit (objective not met). Obviously, if the patient doesn't develop infection, there's no opportunity (or need) to evaluate this objective.

The second step involves deciding how you will collect the evidence you need to determine whether or not the objective is met. In general, it is easier to collect evidence when the objective deals with lower level cognitive processes in the cognitive domain and/or can be achieved in a short time. The first objective in the example above illustrates this. The only decision you have to make is whether you want the learner to list the signs and symptoms verbally or in writing.

When meeting an objective requires some time and/or a change in setting, planning for how to collect the evidence becomes more challenging. The second objective in the example above illustrates this. In that example you have to decide whether you want/need to know whether or not your teaching was effective. If you do, you'll have to figure out a way to get information from those who follow-up with the patient (if it's someone other than you). In health care, we may often start teaching that won't come to fruition until the learner is in another setting and time has passed. In these situations it's particularly important to communicate clearly with providers who may be working with the patient in other settings.

Thinking about evaluation in your practice ...

  • Look at some learner objectives readily available to you (from courses, from patient education materials, etc) and practice identifying what evidence you need to collect for evaluation and how you might collect that evidence.
  • Do you evaluate learning outcomes effectively as part of your teaching in practice? If not, what could you do to include effective evaluation?


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