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To measure the effectiveness of teaching, goals must be set at the very beginning of the educational session. "You can’t teach unless you have a goal," says Linda Kocent, RN, MSN, coordinator for patient-family education at Children’s Hospital of Philadelphia. Everyone involved in the education needs to know what the goal is and who is responsible for what portion of the teaching, she says.
At Children’s Hospital, there are teaching plans for most diagnoses and procedures so that the goals for teaching already are established. For example, if a patient is a newly diagnosed diabetic, the teaching plan for basic survival and safety skills would be implemented, and patient and family members would be taught such skills as how to give insulin, says Kocent.
"It is always important to set goals before beginning a teaching session," agrees Mary Szczepanik, MS, BSN, RN, manager of cancer education, support, and outreach at Grant/Riverside Methodist Hospital in Columbus, OH. Goals can be established according to topic areas. For example, does the patient need to learn about medications, self-care at home, rehabilitation, or community resources?
Goals also are based on the patient’s readiness to learn, which is measured by several factors, including the stage of adaptation to the illness the person has, the home situation, and the sensory or cognitive deficits, says Szczepanik. (To learn about assessing learning readiness, see the second part of article series on teaching published in Patient Education Management, April 2002, p. 40.)
To determine whether or not the goals for teaching are met, the patient’s understanding of the lesson must be evaluated. For example, if a newly diagnosed diabetic is learning to use a blood glucose monitor at Children’s Hospital, the parent first would be sent to the learning center for basic teaching. The educator would demonstrate the procedure and then have the parent return demonstrate. "In the learning center, we would document that we demonstrated the procedure, and they demonstrated for us either successfully or not," says Kocent.
The teaching record is returned to the nursing unit and the nurse documents as parent’s practice the procedure on their child during the hospital stay. "If it is a skill that was taught, parents need to be able to demonstrate that they can perform it, they can trouble shoot when something goes wrong, and they know when to ask questions and call for help. If it is about a diagnosis or medication, they need to just be able to verbalize their understanding of it," says Kocent.
The best way to know if a learner can apply what he or she learned is to watch him or her try to do it if the task involves psychomotor skills, says Szczepanik. At home, patients may need to refer to written instructions or a video to complete the task, and it’s OK for them to use a diagram during a return demonstration.
To evaluate learning, listen to their conversation to see how comfortable they are at doing the procedure. "The more successful people think they will be, the more successful they will actually be," says Szczepanik.
Also watch for mistakes that could be a problem. For example, if it’s a sterile procedure, watch to see if people break the sterile field to check their directions.
If verbal understanding is warranted, have the patient describe a medication regimen or treatment in his or her own words, says Szczepanik.
There are three learning domains to evaluate during the education process to make sure that learning is taking place, says Szczepanik. The following is a list of questions that can help determine if learning is taking place in these domains:
• Cognitive domain
— Can the person recall information?
— Can the person understand information well enough to draw conclusions?
— Can the person adapt rules to specific problems?
— Can the person distinguish between facts and myths?
— Can the person use food exchange lists to develop weekly menu plans?
— Can the person evaluate the effectiveness or value of the information?
• Psychomotor domain
— Can the person assemble the necessary equipment and environment for the task?
— Can the person do the task under supervision?
— Can the person do the task without instruction or intervention from the instructor?
— Is the person accurate? For example, can he or she read a thermometer to within 0.2°?
— Can a person adapt procedure to add a new step or adapt to a new piece of equipment (such as going from a disposable colostomy pouch to a reusable one)?
• Affective domain
— Is the person paying attention?
— Is the person reacting to stimuli the teacher provides?
— Is the person making definitive plans for how to do the procedure at home?
— Can the learner tell the educator where and how he or she will do the required activity or procedure or make the behavioral change?
"Good education is based on realistic learning outcomes being set at the start, on evaluating and constantly reevaluating the patient’s readiness and ability to learn, and then measuring the patient’s progress toward those goals," says Szczepanik.
For more information about evaluating teaching, contact: