Teaching Nurses to Teach: Peritoneal Dialysis Training

How do patients learn the skills that they need?
Video: What contributes to a training programs success?Patients learn through practicing a skill and receiving feedback or guidance. It is easy to understand how patients need practice when performing a procedural skill, yet practice activities are important with cognitive skills too. Having patients practice allows you to check whether they can demonstrate if they have learned what you have intended (whether it is following a sequence of instructions, explaining their understanding, recognizing symptoms of peritonitis, or other skills). When patients first begin to practice new skills, you can expect to be involved in providing much guidance and help, even in familiar activities such as washing their hands.

Practice activities must be related to the intended learning outcome for the patient. If the outcome has many steps to remember, try to develop smaller practice activities to help the patient learn the larger goal. Your entire training program is made up of smaller lessons. The following chart illustrates the direct link between a learning outcome and a practice activity

To inspect the solution fluid prior to using it. “Here’s a bag of solution. Show me what you would do before you would use this bag, and tell me the steps as you go through them.”
To identify and describe the role of the peritoneum. “Here’s a picture of the body. Can you show me where the peritoneum is and describe how the fluid replacement works?”
To differentiate cloudy and clear solution bags “Here are two different bags of fluid; can you tell me which one of them is clear? Here is another example a bit more difficult – can you point out the difference now?”
To solve a potential problem. (Pose problems that might occur). “What would you do if you accidentally dropped the cap onto the floor?”
To connect tubing. “Now that I’ve shown you how to do this, try reading the directions aloud as you connect the tubing to the machine.”

How can I increase the value of practice activities?
Practice activities are most effective if they occur right after new information has been presented. If you are teaching a patient how to connect to a machine, you would first demonstrate making the connection, then immediately have the patient attempt or practice that same activity under your supervision.

Practice activities are more effective if integrated in small steps throughout the lessons rather than having patients try to remember large amounts of information on a daily basis.

Once a skill is learned, you will want to reinforce it with further practice. You can strengthen previous learning by asking patients to recall specific information, particularly if that information is important to the next skill that they must master. For example, you might ask your patients to summarize the importance of the aseptic technique prior to teaching them how to make connections. This type of practice further strengthens the idea that maintaining a sterile field is important as they learn the new procedures.

Finally, practice should progress from easy to hard. If you want patients to tell the difference between cloudy and clear bags, present two bags that are easily differentiated. Then present another bag where it is harder to tell the difference. Presenting easier questions first builds confidence in your patients, and allows you to assess whether a basic understanding is achieved.

Watch the patient as he goes through the following sequence of practice activities:

Beginning the procedure

1. Beginning the procedure
Mary has already simplified the initial process of warming the bag and preparing the supplies. The patient is expected to begin the tasks of checking the quality of the bag, putting on a mask, and disinfecting his hands.

Unwrapping the bag and tubing

2. Hanging the bag and untangling the tubing
When working with new materials, patients are not familiar with the products and could be worried about breaking the tubing or bag. Unless the patient is very frustrated, confine your corrections to verbal guidance and nurturing and resist the urge to physically help the patient. This is how patients learn to work with the supplies.

Maintaining the sterile field

3. Maintaining the sterile field
Connecting and disconnecting correctly are vital to the health of the patient. When the patient is performing these small tasks, Mary is vigilant as to how and what the patient touches. It is essential that this skill must be learned and demonstrated correctly in order to avoid future contamination.


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Program Planning
1. Introduction
Lesson Planning
2. Presenting New Information
Procedural Skills
Cognitive Skills
Responding with Feedback & Guidance
Preparing for Training
3. Building in Practice
Lesson Planning - Building in Practice
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