Ptlls Assignment 1
Assignment 1: Teach a new staff on arterial line care
Introduction
The writer is working in a medical intensive care unit (MICU) in a structured hospital. Every year, there is a group of fresh graduated polytechnic students coming to her unit as new staff. As a senior staff nurse, she was assigned to be a student’s preceptor, to guide the new staff during the probation period.
In this assignment, the writer is going to use the E skill teaching model framework (Studdy et al, 1994), to create a best teaching plan suits the new staff base on their learning styles (Refer to appendix 1). Different learning theories will be applied to facilitate the leaning process, and help the new staff maximize their learning ability to learn the skills required …show more content…
in ICU. The new skill will be taught on how to perform arterial line care and some of the hospital protocol related to this skill (Refer to appendix 2).
Teaching plan
The new staff named Ellen is an active student. She seemed to be very interested in all the equipment that she never saw before. At staff lounge during the tea break, they introduced themselves to each other with a friendly opening. The preceptor then gave her a brief orientation about the ward discipline and the ward layout. A meeting should be conducted between preceptor and student to promote an effective learning experience, and show the welcome to student. It is important to build the rapport between the preceptor and student. The initial teaching started in a procedure room, where a quite room and a lot of teaching equipment were available. The preceptor locked the door to minimize others come in to disturb, and Ellen also felt more relax because she did not need to face the crowd. It helped to create a conducive learning environment, which can facilitate the student’s learning motivation (Mulholland et al, 2007).
The E-teaching skills model used to guide Ellen through out the new skills teaching period. E teaching skills model includes 4 stages, exposure, exploration and elaboration, experimentation and evaluation (Studdy et al, 1994).
Exposure
Ellen as an adult learner, firstly her preceptor asked about her learning objectives. Knowles (1984) had mentioned that adult learning in terms of Andragogy requires the learner need to know why they need to learn this skill before they put in any effect to the skills. They are responsible for their own decision and clear about their individual role and responsibility (Atherton, 2011). Adult learners can be motivated by past experiences or if they feel the skill is necessary and relevant to their working (Knowles, 1984). It is different from pedagogy which is usually used with children. Grow (1991) mentioned that children are passive learners; they usually learn what the teacher teaches them without critical thinking and initiative.
During the discussion with Ellen, the preceptor told Ellen that the goals she set must be specific, measurable, attainable, realistic and timely, to avoid wasting time on unrelated works. Ellen told the preceptor that she saw most of the ICU patients were on arterial line monitoring, and she wanted to learn about the arterial line care.
Learner has some prior knowledge of the skills may benefit the learning (Gijlers& Jong, 2005).The preceptor then gave Ellen an overview why ICU patients need arterial line monitoring. Critically ill patients required arterial lines to monitor blood pressure trends, titrate drug therapies and obtain blood samples. The infection control protocol was emphasized to minimize the blood stream infection to patients (Refer to appendix 2).
In order to accelerate and maximize Ellen’s learning ability before she commenced the skill, her prefer learning styles was established. Different students have a different learning style. By identifying the learner’s learning styles, it help the teacher develop appropriate teaching plan to maximize the learner’s learning ability (West,Clark,& Jasper, 2009). Hence, the initial discussion is important, it not only build the rapport but also help the preceptor understand student’s learning styles and learning objective during the clinical posting.
Fleming and Mills created a learning styles framework which consists of visual, auditory, and kinesthetic (VAK) learning styles (Fleming, 2006). Visual learners like to use diagrams and charts to help them memorize the knowledge they learned, auditory learners learn best when they are listening and involve in discussion, whereas kinesthetic learners like to move around and do some hands on activities (West, Clark, &Jasper, 2009). Ellen was therefore shown VAK chart to identify her learning styles with the preceptor observing her usual learning behavior. It was noticed that Ellen like to draw picture or diagrams in her note book, and she always referred to her note book whenever she need to refresh her knowledge. When shown her the medical equipment and devices, Ellen liked to have some hands on to familiarize the machine’s function. She told her preceptor that by hands on activities, she can learn things faster and remember easier. From here, we can see Ellen was combining of both visual and kinesthetic learning styles. Most of us have elements of more than one learning styles. Based on her learning styles, a teaching plan to suit her styles was developed.
Exploration and elaboration
Before the start of teaching the skill, the preceptor had ensured that the information she provided must be relevant to the skill and at the student’s understanding level.
As a preceptor, it is important to integrate the learning theories into practice, to develop student’s cognitive, psychomotor and affective domains based on Bloom’s taxonomy (Bloom, 1956). In this stage, different theories were involved, such as cognitive learning theory, behavioral learning theory and social learning theory. Cognitive learning theory focuses on the thought processes and learning is viewed as the acquisition of new information (Goldstein, Naglieri & Devries, 2011). The individual learns by listening, watching, touching, reading, or experiencing and then processing and memorizing the information (Schunk, 2010). However, behavioral learning theory learn though a continual process of stimulating and reinforcing a desired response, eventually the behavior is changed to match the desired response (Bower &Hilgard, 1981). Behavioral learning theory recognizes that learning has taken place by a change in behavior; it regards all behavior as a response to stimulus (Hand, 2006). Behavioral learning theory involves positive and negative reinforcement, which reflects in operant conditioning. Operant conditioning developed by Skinner, emphasized on using positive reinforcement to enhance good performance, or using negative reinforcement to eliminate bad behavior, which leads to achievement of learning …show more content…
outcomes effectively (Nevid, 2012). While classical conditioning developed by Pavlor, conclude that behavior can be associated with a particular stimuli (Hand, 2006).
During face to face discussion with Ellen, PowerPoint presentation was provided to show her the content. The slides combined some pictures and diagrams since Ellen was a visual learner. She was also shown some poster charts about the arterial line. At this point of learning, the initial phase to teaching arterial line care was using the cognitive approach based on expanding on the student’s existing knowledge she explored previously. By cognitive approach, it encouraged Ellen to build on the knowledge and understanding she had gained during exposure stage. Ellen was told to bring up questions to clarify any doubts, which facilitate to promote understanding and critical thinking.
After discussion, the preceptor showed her what was the equipment need to be prepared, and then demonstrated to her step by step in a normal speed with little explanation given. Second time she repeated the skill with full explanation, rational was provided for each step. The whole teaching session was broken into component parts which included preparation of equipment, priming steps, bed-side monitor connecting and zeroing phase. Ellen paid full attention to the demonstration to familiarize with the equipment and steps. After demonstration, Ellen tried on her own to have a return demonstration, repeated the steps what she was taught just now. Operant conditioning was used when Ellen having the hands on activities. When she repeated the steps correctly, a positive feedback was given to praise her. When she demonstrated wrongly on certain steps, punishment was carried out. Eventually, the objective was met. Since Ellen is a kinesthetic learner, hands on activities would benefit her as well.
Ellen was highlighted for other skills that related to this skill, such as communication and empathy. Whatever procedure we did on the patient, we need to know how to communicate with patient to reassure them. While communicating with patients, it is conveying the concerns and care simultaneously, and learner was displaying the affective domain (Bloom, 1956). Affective domain, the third component of Bloom’s taxonomy of learning, includes attitudes, feelings and values (Bloom, 1956).
Experimentation
Learners should be given the opportunity to practice the skill they learnt and practice the skill under supervision in a safe environment (Curtis & Christian, 2012). Safe environment is to ensure student competent without risk of injury to the patients. By practicing, it allows the students to apply the theory and observation into practice, strengthen their memory and skills, and build up the confidence level.
Ellen practiced on the teaching set for few times.
If there were new patients coming to ICU, Ellen was told to prime the arterial line on her own with the preceptor’s supervision. The demonstration was started from the preparation of the equipment, to priming process and connecting to patient. This recalling and practicing behavior co -responded to the cognitive and psychomotor skills in bloom’s taxonomy of learning (Bloom, 1956). Correction was provided by preceptor when necessary. Ellen appeared nervous and not confident for her first time priming on a real set. She kept on ask whether the step was correct. Praise was given if the steps were correct, such as verbal praise “well done” or “excellent”. Behavior was strengthened by positive reinforcement, which would enhance her confidence and morale. Ellen was observed how she communicated with patient regarding the whole procedure and taxonomy’s affective domain was reflected. In order to build Ellen’s experience of this skill, the preceptor encouraged her to observe other nurses’ practices as role model. Bandura’s social learning theory enable Ellen meet the objective through observation and imitation (Bandura,
1977).
Evaluation
Evaluation is the stage when instructor provides both formal and informal feedback, and is an integral part of every adult education program.
As pointed by Erven (2012), “feedback is the key to determination by the sender of whether or not the message has been received in the intended form”. Feedback is crucial in nursing practice for helping students achieve their clinical posting goals and explore their maximum potential. Credible and trustworthy information regarding performance standard and student’s performance should be given for maximum impact (Clynes & Raftery, 2008). Again, feedback should be specific, objective, consistent, and timely in a supportive environment (Sachdeva, 1996).
At the end of the teaching session, Ellen and the preceptor had an open dialog in a quiet place regarding her goals achievement. Ellen had a self-reflection on her own performance. Encourage self-evaluation related to the skill is essential. By self-evaluation, Ellen knew her competent level of this skill and weakness, and the instructor was able to assess if the student is over-rating or under-rating herself. SWOT (strength, weakness, opportunity and threat) analysis developed by Philip Selznick in 1957 was conducted to check Ellen’s strength and weakness. Competence checklist was given to assess Ellen’s competent level of this skill. Ellen was informed that she did well in her communication skills, in which she provided proper explanation and reassurance to patient throughout the whole procedure. But she was still short of confidence in the practical, as she was hesitated about the steps. She was reassured that it is common to feel nervous and lack of confidence at the initial stage, but she need to practice more to make herself familiarize with the whole procedure. Besides that, the preceptor was open to Ellen to receive any feedback from her, so preceptor can do adjustment accordingly.
In this feedback session, “sandwich” technique was used, which involves inserting a negative feedback between positive feedbacks (Dohrenwend, 2002). This technique enables the instructor to praise the achievement and criticize the weakness without destroying learner’s confidence (Hallenbeck, 2003). In order to help Ellen establish her current level of competence in the chosen skill, based on the feedback, the preceptor developed another action plan for Ellen for the future allowing her to become proficient at this skill. The action plan included catching every opportunity to practice more and learn from other nurses.
Introduction
The writer is working in a medical intensive care unit (MICU) in a structured hospital. Every year, there is a group of fresh graduated polytechnic students coming to her unit as new staff. As a senior staff nurse, she was assigned to be a student’s preceptor, to guide the new staff during the probation period.
In this assignment, the writer is going to use the E skill teaching model framework (Studdy et al, 1994), to create a best teaching plan suits the new staff base on their learning styles (Refer to appendix 1). Different learning theories will be applied to facilitate the leaning process, and help the new staff maximize their learning ability to learn the skills required …show more content…
in ICU. The new skill will be taught on how to perform arterial line care and some of the hospital protocol related to this skill (Refer to appendix 2).
Teaching plan
The new staff named Ellen is an active student. She seemed to be very interested in all the equipment that she never saw before. At staff lounge during the tea break, they introduced themselves to each other with a friendly opening. The preceptor then gave her a brief orientation about the ward discipline and the ward layout. A meeting should be conducted between preceptor and student to promote an effective learning experience, and show the welcome to student. It is important to build the rapport between the preceptor and student. The initial teaching started in a procedure room, where a quite room and a lot of teaching equipment were available. The preceptor locked the door to minimize others come in to disturb, and Ellen also felt more relax because she did not need to face the crowd. It helped to create a conducive learning environment, which can facilitate the student’s learning motivation (Mulholland et al, 2007).
The E-teaching skills model used to guide Ellen through out the new skills teaching period. E teaching skills model includes 4 stages, exposure, exploration and elaboration, experimentation and evaluation (Studdy et al, 1994).
Exposure
Ellen as an adult learner, firstly her preceptor asked about her learning objectives. Knowles (1984) had mentioned that adult learning in terms of Andragogy requires the learner need to know why they need to learn this skill before they put in any effect to the skills. They are responsible for their own decision and clear about their individual role and responsibility (Atherton, 2011). Adult learners can be motivated by past experiences or if they feel the skill is necessary and relevant to their working (Knowles, 1984). It is different from pedagogy which is usually used with children. Grow (1991) mentioned that children are passive learners; they usually learn what the teacher teaches them without critical thinking and initiative.
During the discussion with Ellen, the preceptor told Ellen that the goals she set must be specific, measurable, attainable, realistic and timely, to avoid wasting time on unrelated works. Ellen told the preceptor that she saw most of the ICU patients were on arterial line monitoring, and she wanted to learn about the arterial line care.
Learner has some prior knowledge of the skills may benefit the learning (Gijlers& Jong, 2005).The preceptor then gave Ellen an overview why ICU patients need arterial line monitoring. Critically ill patients required arterial lines to monitor blood pressure trends, titrate drug therapies and obtain blood samples. The infection control protocol was emphasized to minimize the blood stream infection to patients (Refer to appendix 2).
In order to accelerate and maximize Ellen’s learning ability before she commenced the skill, her prefer learning styles was established. Different students have a different learning style. By identifying the learner’s learning styles, it help the teacher develop appropriate teaching plan to maximize the learner’s learning ability (West,Clark,& Jasper, 2009). Hence, the initial discussion is important, it not only build the rapport but also help the preceptor understand student’s learning styles and learning objective during the clinical posting.
Fleming and Mills created a learning styles framework which consists of visual, auditory, and kinesthetic (VAK) learning styles (Fleming, 2006). Visual learners like to use diagrams and charts to help them memorize the knowledge they learned, auditory learners learn best when they are listening and involve in discussion, whereas kinesthetic learners like to move around and do some hands on activities (West, Clark, &Jasper, 2009). Ellen was therefore shown VAK chart to identify her learning styles with the preceptor observing her usual learning behavior. It was noticed that Ellen like to draw picture or diagrams in her note book, and she always referred to her note book whenever she need to refresh her knowledge. When shown her the medical equipment and devices, Ellen liked to have some hands on to familiarize the machine’s function. She told her preceptor that by hands on activities, she can learn things faster and remember easier. From here, we can see Ellen was combining of both visual and kinesthetic learning styles. Most of us have elements of more than one learning styles. Based on her learning styles, a teaching plan to suit her styles was developed.
Exploration and elaboration
Before the start of teaching the skill, the preceptor had ensured that the information she provided must be relevant to the skill and at the student’s understanding level.
As a preceptor, it is important to integrate the learning theories into practice, to develop student’s cognitive, psychomotor and affective domains based on Bloom’s taxonomy (Bloom, 1956). In this stage, different theories were involved, such as cognitive learning theory, behavioral learning theory and social learning theory. Cognitive learning theory focuses on the thought processes and learning is viewed as the acquisition of new information (Goldstein, Naglieri & Devries, 2011). The individual learns by listening, watching, touching, reading, or experiencing and then processing and memorizing the information (Schunk, 2010). However, behavioral learning theory learn though a continual process of stimulating and reinforcing a desired response, eventually the behavior is changed to match the desired response (Bower &Hilgard, 1981). Behavioral learning theory recognizes that learning has taken place by a change in behavior; it regards all behavior as a response to stimulus (Hand, 2006). Behavioral learning theory involves positive and negative reinforcement, which reflects in operant conditioning. Operant conditioning developed by Skinner, emphasized on using positive reinforcement to enhance good performance, or using negative reinforcement to eliminate bad behavior, which leads to achievement of learning …show more content…
outcomes effectively (Nevid, 2012). While classical conditioning developed by Pavlor, conclude that behavior can be associated with a particular stimuli (Hand, 2006).
During face to face discussion with Ellen, PowerPoint presentation was provided to show her the content. The slides combined some pictures and diagrams since Ellen was a visual learner. She was also shown some poster charts about the arterial line. At this point of learning, the initial phase to teaching arterial line care was using the cognitive approach based on expanding on the student’s existing knowledge she explored previously. By cognitive approach, it encouraged Ellen to build on the knowledge and understanding she had gained during exposure stage. Ellen was told to bring up questions to clarify any doubts, which facilitate to promote understanding and critical thinking.
After discussion, the preceptor showed her what was the equipment need to be prepared, and then demonstrated to her step by step in a normal speed with little explanation given. Second time she repeated the skill with full explanation, rational was provided for each step. The whole teaching session was broken into component parts which included preparation of equipment, priming steps, bed-side monitor connecting and zeroing phase. Ellen paid full attention to the demonstration to familiarize with the equipment and steps. After demonstration, Ellen tried on her own to have a return demonstration, repeated the steps what she was taught just now. Operant conditioning was used when Ellen having the hands on activities. When she repeated the steps correctly, a positive feedback was given to praise her. When she demonstrated wrongly on certain steps, punishment was carried out. Eventually, the objective was met. Since Ellen is a kinesthetic learner, hands on activities would benefit her as well.
Ellen was highlighted for other skills that related to this skill, such as communication and empathy. Whatever procedure we did on the patient, we need to know how to communicate with patient to reassure them. While communicating with patients, it is conveying the concerns and care simultaneously, and learner was displaying the affective domain (Bloom, 1956). Affective domain, the third component of Bloom’s taxonomy of learning, includes attitudes, feelings and values (Bloom, 1956).
Experimentation
Learners should be given the opportunity to practice the skill they learnt and practice the skill under supervision in a safe environment (Curtis & Christian, 2012). Safe environment is to ensure student competent without risk of injury to the patients. By practicing, it allows the students to apply the theory and observation into practice, strengthen their memory and skills, and build up the confidence level.
Ellen practiced on the teaching set for few times.
If there were new patients coming to ICU, Ellen was told to prime the arterial line on her own with the preceptor’s supervision. The demonstration was started from the preparation of the equipment, to priming process and connecting to patient. This recalling and practicing behavior co -responded to the cognitive and psychomotor skills in bloom’s taxonomy of learning (Bloom, 1956). Correction was provided by preceptor when necessary. Ellen appeared nervous and not confident for her first time priming on a real set. She kept on ask whether the step was correct. Praise was given if the steps were correct, such as verbal praise “well done” or “excellent”. Behavior was strengthened by positive reinforcement, which would enhance her confidence and morale. Ellen was observed how she communicated with patient regarding the whole procedure and taxonomy’s affective domain was reflected. In order to build Ellen’s experience of this skill, the preceptor encouraged her to observe other nurses’ practices as role model. Bandura’s social learning theory enable Ellen meet the objective through observation and imitation (Bandura,
1977).
Evaluation
Evaluation is the stage when instructor provides both formal and informal feedback, and is an integral part of every adult education program.
As pointed by Erven (2012), “feedback is the key to determination by the sender of whether or not the message has been received in the intended form”. Feedback is crucial in nursing practice for helping students achieve their clinical posting goals and explore their maximum potential. Credible and trustworthy information regarding performance standard and student’s performance should be given for maximum impact (Clynes & Raftery, 2008). Again, feedback should be specific, objective, consistent, and timely in a supportive environment (Sachdeva, 1996).
At the end of the teaching session, Ellen and the preceptor had an open dialog in a quiet place regarding her goals achievement. Ellen had a self-reflection on her own performance. Encourage self-evaluation related to the skill is essential. By self-evaluation, Ellen knew her competent level of this skill and weakness, and the instructor was able to assess if the student is over-rating or under-rating herself. SWOT (strength, weakness, opportunity and threat) analysis developed by Philip Selznick in 1957 was conducted to check Ellen’s strength and weakness. Competence checklist was given to assess Ellen’s competent level of this skill. Ellen was informed that she did well in her communication skills, in which she provided proper explanation and reassurance to patient throughout the whole procedure. But she was still short of confidence in the practical, as she was hesitated about the steps. She was reassured that it is common to feel nervous and lack of confidence at the initial stage, but she need to practice more to make herself familiarize with the whole procedure. Besides that, the preceptor was open to Ellen to receive any feedback from her, so preceptor can do adjustment accordingly.
In this feedback session, “sandwich” technique was used, which involves inserting a negative feedback between positive feedbacks (Dohrenwend, 2002). This technique enables the instructor to praise the achievement and criticize the weakness without destroying learner’s confidence (Hallenbeck, 2003). In order to help Ellen establish her current level of competence in the chosen skill, based on the feedback, the preceptor developed another action plan for Ellen for the future allowing her to become proficient at this skill. The action plan included catching every opportunity to practice more and learn from other nurses.