What are the main ideas to remember when training patients?
Always prepare the learner with what he or she is going to learn, what the trainer will be doing, what the learner will do, and how both of you will know that learning has occurred. In the self efficacy theory of learning, the patient must believe he is capable of performing the required skills. This is accomplished with simple task repetition at each step of a procedure. It can be enhanced by encouragement (“Good, you are doing that correctly.”) or support (“Be careful where you place your fingers.”) or fear (“This kind of mistake could cause peritonitis.”).
Restrict the educational content to three or four key messages per hour of instruction.
Structure and ritual in procedures give security to both the learner and the teacher.
Role playing is an effective way to rehearse new skills or rehearse for future difficulties. Nurses may role play with one another when trying out techniques for training. Patients may role play with the use of the practice catheter to practice procedures.
In developing a problem solving approach in the training program, the patient needs help to define the problem, then to list possible solutions. The patient should select a solution, try it, and evaluate the results. If this solution does not work, the patient should be allowed to try another solution or seek advice from the nurse about other solutions.
Practice is very important to the learner. This is how the learner accomplishes correct movements so that the muscles become “programmed.” Practice allows the brain to recognize errors and give feedback. Mistakes must be acknowledged as a fact of life and something to enhance learning.
The patient does not perform an exchange using his or her own catheter until he or she can demonstrate the skills independently using a training apron. This increases the likelihood that the patient can safely and successfully perform the exchange without contamination or error and will increase patient confidence in the ability to achieve the goals of learning the procedure.
The teacher can check the learner’s progress by asking “Tell me again the steps…” In giving feedback to the learner, be careful not to get ahead of what he or she is doing because the teacher then will be telling the learner rather than the learner processing the information. Questions from the teacher are a powerful learning tool. They allow evaluation of the learning process, help the learner to think, and guide the learner. Positive questions (“What do you need to do next?”) take less time for the learner to process than negative questions (“What do you need to avoid doing now?”). When asking a question, the teacher should allow some silence while the learner is processing the answer, particularly for more complicated, negative questions.
Teaching concepts such as peritonitis requires understanding what is sterile, what is clean, what is contaminated, and what are the signs of infection. Avoid repetitive listing of symptoms because this will cause the learner to only memorize the list. Recognition of symptoms can be presented by the teacher as “I will describe symptoms, and you guess which might be peritonitis.” Using pairs, initially describe one symptom very likely to be peritonitis, such as swelling and tenderness, and one very unlikely to be peritonitis, such as belly pain and headache. If the patient guesses correctly, proceed with other pairs more difficult to differentiate to help him or her understand the concept. Cloudy bags can be shown to the learner in the same pattern of pairs, one very cloudy versus one crystal clear, then one very cloudy versus somewhat cloudy, then one very cloudy versus slightly cloudy.
The learner needs time to have information embedded into memory before going to the next set of learning tasks. Although information memorized is the hardest to learn, it is the easiest to forget. This is an important point for the teacher regarding retraining, as learners often simply forget. Thus learning about the signs of peritonitis during training may be long forgotten if the learner never develops peritonitis until two years later.
There should be no teaching of “whys” during the motor skill learning. This should be done either before or after motor skill learning. If the learner asks why, the teacher can say, “Good question, we’ll get to that after we finish with this.”
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