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Teaching psychomotor Skills

are those skills that you have done so often that you don't think about how to do them while you are doing them. As well as tying shoelaces, riding a bike is another example. At first, you really have to concentrate on the steps, later your brain takes over. the development of physical skills

 Independent Learning vs. Teacher Instruction Demonstration

Simulations

Independent Learning - refer to a concept where learners are involved in their own learning process. Teacher Instruction - refers to the policies and procedures designed to equip prospective students with the knowledge, attitudes,behaviors and skill s they require to perform their tasks effectively in the classroom, school and wider community.

A syllabus must be developed with instructions for how learners should proceed.
Background reading material must be identified and made available Hardware and software must be selected and prepared for use . Supplies must be ordered and made available.

Haukenes and halloran (1984) - describe college laboratory in which self instruction Is the primary teaching method.
Snyder, fitzloff, fiedler, lambke (2000) - describe a college laboratory in which a combination of audiovisuals and supervised practice is structured around a belief that learners must focus on the context of the skill as well as the skill itself.

The trend today is to rely more on self instruction in skills lab and to rely less on instructor demonstrations.

 Way of learning that most students prefer to do by

the instructor.
New teachers sometimes find it anxiety provoking Research has shown the effectiveness of it as a

teaching strategy for learning skills that are entirely new to learner

 Banduras social learning theory best explains

why demonstration is an effective pedagogical method for teaching skills.

The Learner observes and attends to

observation and retains a mental model (type of schema).

Assemble all equipments ahead of time Make sure all equipment is in working order Do a dry run of the procedures and time the demonstration Arrange the environment to be as realistic as possible Perform a procedure step by step, explaining as you go along

When appropriate, give the rationale of your actions. Refer to handouts or textbooks to show fine points that may not be visible to the audience Be sure to adhere to all relevant principles of good nursing care Consider performing the skill a second time without explanations to show the flow of the skill

Can be a real help in teaching psychomotor skills. Practicing a skill with equipment is a simulated experience The idea is to make the practice setting and conditions like the real world. Elaborate scenarios may be planned in which the learners apply skills to simulated hospital or home care situation to help learners apply skills and knowledge learned in the classroom.

Are common means of organizing skill learning and assessment Checklists describe the step by step progression of skill activity needed to achieve the goal.

Checklist used by the teacher while demonstrating a skill to be sure nothing is forgotten. Teacher also use them to evaluate skill performance Learners use them during self instruction to provide guidance and feedback

contains a number of items that are checked off when completed May contain a rating scale with descriptors such as Adequate, Good, and Excellent or Poor, Fair and Good, or it may be a number scale.

Without an accurate assessment, it is difficult to determine the competency of the learner.

Clinical Teaching

Is a complex enterprise It is the complexity of clinical setting that makes research so difficult Consist of variables that are difficult to control

is a place where consequences for ones action are readily apparent and accountability is demanded.

Learners should have the opportunity to apply the theoretical concepts, rules and proposition they have learned in the classroom. Learners not only test the proposition but learn when to apply it, and they practice the techniques of implementation. Learners see how this one piece of information fits into the whole picture of a patient care in a more realistic way than they ever could in a classroom.

1.) Complex psychomotor skills Learners can practice but will never be a expert until they work with a variety of patients using variety of equipment. 2.) Skill of observation - the opportunity of observation is an essential elements of clinical learning.(Infante,1985)

but learners needs repeated experience observing patients in changing circumstances so that they know what to look for in changing situations.

3.) Problem-Solving and Decision-Making Skills Learners need practice using these cognitive skills under the guidance of an educator and other professional staff in a real settings.

4.) Organization and Time Management Skills Learners finds how to organize all data that bombards them, all the request made of them, and all the intellectual and psychomotor tasks that they must perform.
5.) Skill of Delegation - is the assignment of authority and responsibility to another person to carry out specific activities.

Learn to set priorities by having repeated practice in doing so in complex situation.

6.) Cultural Competence Learners may know a lot of theory about how to approach clients from different cultures, but they become comfortable and more expert with cross-cultural care when they care for culturally diverse patients.

Learners of nursing become socialized in the clinical laboratory As a nursing students, we can expressed the belief that developing a sense of team membership was one of their most important goals in the clinical laboratory. Students also learn how to relate to patients professionally and gain a patients perspective of illness that leads to more caring behaviors.

Misuse of the Clinical Laboratory

Infante (1985) Points out clearly,

The clinical laboratory has historically been misused at all levels of nursing

education.

Clinical Objectives should be as clear and specific as those for the classroom or skills

laboratory.

Misuse of the clinical setting also occurs when novices are given too much responsibility for patient care.

Learners should not be functioning independently in situations with relatively high levels of risk.

Objectives for beginning learners should be quite limited, focusing on specific processes of care.

A third way in which the clinical laboratory is

misused is when learners are supervised and evaluated more than they are taught

They may be expecting learners to

perform rather than practice.

One study conducted by wilson (1994) found that nursing students were constantly aware that the instructor was evaluating them.

 Best

known model in nursing education. The educator provides the instruction and evaluation for a small group of nursing students and is on site during clinical experience. Instructor accompany groups of 8 to 12 learners to a clinical agency and assign the learners to Pt.

1. 2.

3.

Some learners get minimal attention on a particular day The educator is employed by a college or university, she or he is a guest in the agency. Agency staff can feel overwhelmed with having so many learners on a unit atone time.

Started in1985 is based on theory of the use of the clinical laboratory in nursing education. A model that relies heavily on keeping nursing students in a skills laboratory until they are proficient with skills. They are sent to the clinical area to practice specific psychomotor and other skills

1.

The clinical agency must be willing to accept students when the educator is not present.

 Started

in 1994 She contends that more information about clinical practice should be taught in the classroom before learners go to clinical area

 is

a set of planned experiences designed to help students acquire skills, attitudes, & knowledge by participating in the work setting

To ensure a positive learning experience for learners:

educators

must do a lot of planning before clinical instruction begins

You must consider the learning experiences available: Will it be possible to obtain clinical experiences that correlate with theoretical content? Will learners have a variety of experiences? Is there enough room around the nurses station or office for learners to use patients charts?

What are the educational credentials & experience levels of the staff who will serve as these role models, & are they receptive to having learners on their unit? -An often overlooked aspect of the learning experience is the availability of role models for learning. -Research has demonstrated that clinical educators are role models for learners. (Wiseman, 1994)

Step 1: If the college or university is not part of the health care system, written contracts must be drawn up between the school & the clinical agency.

Data to be included in the written contract: availability of the clinical unit for certain days & weeks availability of conference space parking locker space Maximum student-faculty ratio Evidence of completion of health records for student & faculty Evidence of malpractice & general liability insurance for students & faculty

If the educator is part of the staff development department in an agency, clinical units within the agency must be identified. -selection of clinical sites must be done methodically

Step 2: Once arrangements have been made for clinical units, the educator should set up a meeting with the agency staff (staff development educator, unit manager, or head nurse) that will be involved with the education process.

expectations of both parties can be discussed actual implementation of the learning experience can be worked out This is the appropriate time to share clinical learning objectives with the manager or head nurse. If the staff are familiar with the learning objectives, they can assist learners in meeting them.

Step 3: the educator can proceed with the final preparation for clinical instruction. involves making specific assignments for learners on a weekly or daily basis educators & learners together may choose assignments

Goldenberg & Iwasiw (1988) conducted an investigation of the criteria used by educators in selecting students clinical assignments.

3 criterias: 1. Students individual learning needs 2. Patients nursing care needs 3. Matching of patients needs with students learning needs

Planning of patients care continues Assigned learner can disscuss possible nursing interventions with other learners and educator This is a good time to answer students question and try to alleviate their anxieties

Help

learners organized their day

Educator

discuss the patients with the learners

Learners begin their practice for the day

Learners should be acquainted with the place Scavengers hunts are sometimes used to help orient learners to the clinical unit

COMBINATION OF STRATEGIES:

demonstration with explanations, asking and answering questions and coaching techniques can be used. Questioning can be used to assist learners in developing problem solving and decision making

Coaching techniques can be used to help learners to set goals for themselves, to guide learners through psychomotor skills, to help them refine their thinking process.

Used routinely in clinical education

Supported by social cognitive theories

Learners may be assigned to observe nurses that perform various aspects of health care that learner usually cannot perform Learners can be paired off with nurses whom they can both observe and questions

Use nursing round as a pedagogical strategy Involves a group of learners and their instructor to visit patient whom they were assigned Instructor may point out the use of certain equipment or procedures

Expose learners to additional nursing situations Encourage learners to consult each other in planning, and evaluating care

Provides many opportunities to apply classroom theory to patient situation

Compare and contrast patient care

Make sure to ask permission from the patient for a group visit Keep the patient information confidential

Shift report is a unique time for learning (Yurkovich and Smyer) Shift report is a way for students to learn the uniqueness of nursing communication A means of professional socialization

- Learning contracts are a useful way to structure and guide learning in the clinical setting - Can be defined as a written agreement between instructor (or supervisor)and learner spelling out the learners outcome objectives(Chan & Wai-tong,2000)

- The learning resources needed to achieve them, the learning experiences planned, a timeline, and an evaluation plan are included (Renner, Stritter, & Wong, 1993) - Learning contracts have been used successfully in undergraduate and graduate education, for RN and BSN students, for new staff during orientation, for staff on a clinical ladder and for patient education (Hiromoto & Dungan,1991, Kreider & Barry,1993;Lowry,1997;Waddell & Stephens,2000)

- Each nurse develops a learning contract with the staff development educator, it includes learning objectives related to organizational abilities, communication skills, psychomotor skills, pharmacology, disease-related knowledge, patient teaching or nursing skill

- Validation may be done by observing skill performance (live or videotaped), evaluating written work or oral presentations or validating attendance at meetings. - When used in academic settings, validation may result in a grade being given.

Learning Objectives Improve communicatio n skills with families of dying patients.

Resources Needed 1. Literature search 2. Assignments of terminally ill patients

Activities and Accomplishments 1. Analyze the essential elements of communication in this scenario. 2. After talking with families, recount the conversation with the preceptor.

Means of Validation Instructor will evaluate the therapeutic adequacy of the conversation.

Correctly perform colostomy care

1. Procedure 1. Perform the skill in 1. Instructor will manual the skill lab. evaluate 2. Practice in skill performance lab 2. Perform the skill on in the skill lab 3. Assignment to a patient with the 2. Preceptor will patient with a supervision of the evaluate colostomy preceptor. performance with the

The individualized nursing care plan is a standard teaching device.

- Care plans help learners think like a nurse. - Writing journals in clinical placements is one way in which the students can create dialogue which these experiences occur (Holmes,1997)

- Learners use the reflection process to relate their clinical learning to prior learning

- Journals should be used as graded assignments is a controversial issue

- (Armstrong and Dieranunzi 2000) describe a Critical Thought Paper that they required of students in psychiatric rotation.

- A mundane assignment that is used frequently is the student generated drug card (Morgan,1991)

- Postconferences are often unstructured seminars that allow for creativity but that can dissolve into meaningless - The conference is usually held at the end of a physically and emotionally draining practice session

- A few learners in each clinical group seem to believe that they learned everything that could possibly be learned during their practice time and feel that a postconference is just a boring postmortem session

- Postconferences time is an ideal opportubity for pointing out application of theory to practice, for analyzing the outcome of hypothesis testing, for group problem solving and for evaluating nursing care (Letizia, 1998 )

- The primary topic for discussion should fit in with the laboratory objectives. - (Rossignol, 2000) suggests that educators should take the role of coaches for cognition during conferences, monitoring the thinking level of the learners and attempting to raise it through higher-order questions.

- Postconferences

are means to help socialize learners into the world of nursing and are another opportunity to get them to think like a nurse

THANK YOU GODBLESS !! >