Transcript The Need for the Diabetes Nurse to be a Professional Educator by Prof. Morsi Arab University of Alexandria.

The Need for the
Diabetes Nurse to be a
Professional Educator
by
Prof. Morsi Arab
University of Alexandria
1
Causes of Failure of Patients
Education
1- unqualified educators
2- pour resources
3- patient uncompliance
The Education Triangle
Objectives
Evaluation
( Tests )
Strategy
( 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
objectives
5. 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
Knowledge
- Anatomy
- Factors-> foot vuln.
- Mechanics of
walking
- Circulation
- Pain sensation…etc
Skills
Attitudes
-Foot examination - - Show respect
- cutting nails
- Accuracy
- dressing wounds- - Show care &
--------------------sympathy…etc.
- Debridement ?
..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 learn
2- useful to learn
3- if possible learn
Objectives
General 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 Skills
Step 2Demonstration:
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)
0
1
2
3
4
5
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
Tasks
Trainee
A
(B)
1
X
2
X
3
X
4
X
5
X
X
(6)
X
C
D
X
X
X
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