1

The Need for the Diabetes Nurse to be a Professional Educator

by

Prof. Morsi ArabUniversity of Alexandria

Causes of Failure of Patients Education

1- unqualified educators 2- pour resources

3- patient uncompliance

The Education Triangle

Objectives

Evaluation Strategy

( Tests ) ( Methods of teaching )

Teaching and Education * a gift ? * Teaching competence is a science, with rules to be learned and skills to be

acquired.?.……

Adjusting the Education to the Community Needs : 1. The community needs certain jobs.2.In each job certain tasks have to be performed .3. To perform each task we need specific : knowledge, skills and attitudes (Task analysis) 4. Accordingly, we design a curriculum with specific objectives5. At the end we evaluate achievement of

objectives.

Example :

The Job: “ A Diabetes Foot Care Nurse”:

Tasks :

1- Examine feet: 2- Diagnose problems 3- Manage care

4- Educate patients

Education objectives for the tasks of a Diabetes Foot Care Nurse

KnowledgeSkillsAttitudes

-Anatomy

-Factors-> foot vuln.

-Mechanics of

walking

-Circulation

-Pain sensation…etc

--Foot examination - cutting nails

- -dressing wounds---------------------

- Debridement ? ..etc

-Show respect

-Accuracy

-Show care &

sympathy…etc.

Objectives

The selection of objectives depends on what the learner needs to know and is going to do i.e. (tasks) during the job , and at which level of

competence

In an Education Course :

N.B.: You can not teach everything,… So, stick to some “selected” priorities :

1- obligatory to learn2- useful to learn3- if possible learn

ObjectivesGeneral Considerations 1- Set clear-cut objectives………. So , 2- Describe in behavioral terms what the learner ultimately will be able to do) : 1- If cognitive : e.g. enumerate causes of..... 2- In skills : e.g. examine pulse, cut nails…. 3- In attitudes : demonstrate punctuality ,

sympathy , etc.…

-

Objectives ( cont.):

3- The education Faculty: (team work) … ( to avoid contradictions )4- Different objectives to different learners 5- Different teaching methods to suit different objectives.

Objectives ( cont.):

6- Different objectives at different stages of the disease. 7- Overloading leads to confusion , depression and hopelessness.

8- Only achievable objectives.

Some variables that define different patient objectives:1- Their existing Knowledge about DM.2- Their general educational competences (e.g. if illiterate?).3- Their belief, perception of their illness, misconceptions., etc.4- Readiness to learn acc. to psychol. stage 5- State of illness : controled ? complicated, ? handicapped ?,etc.5- Socioeconomics: cost , feasibility , etc.

STRATEGY

To prepare for an educational presentation : 1- identify the needs of the learners 2- identify their background (what they already know). Repetition? Revision ? Re-enforcement ? 3- select the content , and never “tell all”

4- focus objectives to the outcome: (what they can do, think , believe and know, at the end of

the lecture, which they could not do before ) .

The Big Group Presentation

The start ( Introduction) :

- to gain attention and interest : e.g. by a question , a story ,problem, case presentation, etc….. (or)- provide a skeleton of the contents to be covered

The Flow of the presentation:

I- To keep capturing attention : 1- repeat significant points.

2- check perception of the main points.

3- have reasonable sense of humor .

4- face audience and distribute eye contact.

5- keep logical sequence . :

The flow of the presentation ( cont.) 6- change methods.

7- avoid unclear expressions , sophisticated words and long complicated sentences. 8- avoid monotony , mannerism.

9- ensure that everybody sees and hears well.

The flow of the presentation ( cont.)

10- Use properly selected A.V. aids

11- Be aware of the time allowed .

12- Prepare for the unexpected mishaps

The Audience :

1- show respect : ( punctuality , dress?)

2- be concerned with negative responses: ( yawns , expressions of perplexity , whispering questions, looks of unbelief or disapproval, etc. )…Don’t ignore !!

3- do not be angered or intimidated , but react by re-shaping the presentation.

4- get final feedback

The End :1- Draw conclusions , …or invite independent conclusions.

2- Make end flows naturally from introduction (e.g. answering the questions , solve the problem …). 3- Simple summary…. (pin point important aspects.)

4- Tie up loose points, to make the whole presentation as one unit ..

5- Suggest ways for application and benefits.

6- suggest ways for continued learning.

Small Group Education

- Select suitable size of the group ? - Educate, not teach (active participation).- Monitor Group behaviour dynamics at different stages.- Control individual dynamics: *positive behaviors…(encourage) * negative behaviors. .(checked )

The One-to-One Education 1- Listen. 2- Motivate. 3- Individualize (quality) according to * stage of disease. * educational level…etc. 4- Not too much (quantity). 5- Reward, more than blame.

Teaching of Skills

Types of Skills 1- Psychomotor skills 2- Communication skills 3- Cognitive skills ___________________________________________ How to Teach Skills ( 3 steps) : ( Describe - Demonstrate - Exercise)___________________________________________ Step 1- Describe : importance, indications, tools, steps of performance , pitfalls & precautions…etc.

Teaching of SkillsStep 2- Demonstration:

a) every one should be able to see the demonstration. b) may have to be repeated c) describe again what you are doing during the performance ( to explain) d) support by AV aids

Teaching of Skills Step 3 :Exercising ( Training)

a) everybody exercises. b) Feed back ,to correct mistakes and advise for better performance. c) use helping methods :e.g. play role , simulation equipment , etc. d) give sufficient time for the training. e) initiate training in groups or projects

Teaching Attitudes

Attitude = Tendency to behave in specific way.? * Could they be acquired by

educational methods ?

Ways to teach, develop and encourage behaviours

1- Provide relevant information. ……………..(to know ? ) 2- Give example results of good behavior…( to inspire ?).3- Long observation on results of negative (bad) behaviors. .. ……………………………. ( to warn ?)4- From close contact e.g. working or living with individuals with positive or negative attitude (camps..).( all the above)5- Finally ,discuss in small groups; every one must share in the discussion and should be free to express.

(to finally convinvce)

Evaluation

Evaluation by judgment :

A- Expert judgment by trained observers:

* the expert Judge determines “ how well” is the candidate …., without having to define the concept

of “well”

Evaluation by judgment : ( cont.)

B- In Judging by the use of tests and scales :

- The concept “well” has to be defined “ before hand”.

- This standardization ensures objectivity .

How to ensure” reliability” of the judgement ?

By using objective tests : e.g. MCQ s, check lists, rating scales and similar methods , ( We help the examiners to unify their judgments and under different

personal i.e. subjective conditions ) .

To ensure “validity”, be sure that evaluation is testing for the true requirements of the job: So, 1- Discard Qs on sophisticated Knowledge ( not needed in performing the required tasks in the job).

2- Do not ignore the skills and attitudes needed ( as defined in the task analysis and job

description.)

Long Essay Questions :

They have minimal advantages ( uncommonly used in patient education )

1- Easy to prepare ( for the examiner). 2- Tests ability to construct an article (poor validity) 3- Poor reliability .

Multiple Short Essay Questions

1- covers a large part of the curriculum 2- less unreliable 3- answered and marked in shorter time 4- Still tests simple knowledge

MCQ Test - scored in a short time and precisely. - if numerous , covers widely the syllabus. - can be used for self assessment. - high reliability, very objective

But,………………. - difficult to prepare good MCQs. - usually test only knowledge (rarely skills e.g. in decision making ).

Oral Examination

- Few advantages : vivid, can probe increasing depth of knowledge (escalate).- Disadvantages: - induces anxiety (stress not existing in practical life). - consumes long time. -very subjective and unreliable - can not test skills - does not give good FB to the education process.

Conclusion : better avoided

Evaluation of performance by Check Lists (very useful for testing skills). observe steps: well done 1-……………………………………………… √ 2-……………………………………………… √ 3-………………………………………………(X) 4-……………………………………………… √ 5-……………………………………………… √ 6-……………………………………………… √ 7-……………………………………………… √ 8-……………………………………………… √ 9……………………………………………… √ 10……………………………………………… √. Score = 9/10

- Has high reliability - Gives good feed-back.

Check List / Rating scale, for measuring attitudes (behaviours) of a person during his training or working (job)

012345

1 -shows interest

2 -accepts instructions

3 -cares for patients

4 -shows desire to learn

5 -keeps on time

6 ..………………… -

×

×

×

×

0 :strongly lacking…………5: strongly agree / evident

The Follow-up Record of Proper Performance during a training course for a group * The Record contains a number of tasks enlisted (1,2,3 …). * Each individual (A,B,C,…) should fulfill the performance of all tasks. * Satisfactory achievement of each task ( separately ) is monitored. * Unsatisfactory performance indicates repeat training for

a specific individual or the whole group

TraineeTasks

A)B(CD

1X

2X

3XX

4X

5X)6(XXXX

General Considerations in Evaluation: - There is no one ideal method for evaluation . - The choice of one method depends on : 1- is it reliable? 2- is it valid? 3- time consumed? 4- availability of its tools . 5- its FB (feed-back) value to the learning process 6- comprehensive testing of knowledge ,skills

and attitudes.

Alexandrie – Palais du Montazah

Thank You