Elspeth Raisbeck explains how nurses can fulfil their professional code by using a variety of methods to teach students
The NMC Code of Professional Conduct requires us to “facilitate students of nursing and midwifery and others to develop their competence” (NMC 2002, point 6.4). So from on-the-ward demonstrations, through one-to-ones with patients to formal teaching situations, how can you improve your skills? Here are some practical pointers and dos and don’ts.
A Starting Point
In any educational situation it’s easy to assume that the learner knows nothing and needs to know everything, so you start at the beginning and deliver all you know.
But what about the student on a respiratory ward placement who has had asthma since childhood? She may know all about living with the disease, its medications and treatments (she’s been hospitalised twice) but her inhaler technique needs improvement.
So in teaching adults, always ask about what they’ve read (in books, magazines, journals, press), seen on TV or had experience with on the topic under discussion. Use open questions where appropriate, such as:
• “Tell me what you already know about…”
• “What do you think/feel about…?”
• “How do you like to learn best?” (eg books, TV, leaflets, one-to-one, practical, a combination).
• “Who told you about…?”
• “Why do you feel it’s important to…?”
It may help to write down the answers to some of these questions for future reference.
Getting The Theory Across
Nurses, like many people, tend to be practical or experiential learners (Kolb 1984) – ie they learn best from doing something rather than reading about it. This can make understanding theory or retaining facts more difficult.
• Do relate theory to everyday life.
• Do use practice or real-life scenarios to bring facts and theory alive.
• Do allow people to work in groups (if practical) to pool ideas and learn from each other. They should feed back to the larger group and facilitator so that any anomalies can be corrected.
• Do let learners explore “What if” situations or case histories where a problem can be solved using the information they’ve been learning.
• Do use visual media such as video, pictures and diagrams.
Psychomotor skills like setting up an intravenous infusion through a delivery device, self-injection or making a hospital corner on a bed all take practice while a new neural pathway is formed in the brain.
The “see one; do one; teach on” model of learning is useful insofar as it encourages the student to learn as if she were going to be a teacher. This encourages greater mental involvement in the knowledge-gaining process. So in a group setting it might be advantageous to let learners work in monitored trios, with a teacher, student and observer, each participant taking each role in turn and the observer feeding back.
Here are some things to avoid:
• Don’t demonstrate and not allow the learner to handle the equipment, carry out the action etc.
• Don’t expect the learner to be proficient after only one or two attempts. A safe learning environment must be provided for practise and building confidence.
• Don’t leave mistakes uncorrected, especially in the theory surrounding a practical subject. Theory such as hygiene and health and safety should be integrated to the session.
• Don’t go through the whole demonstration without breaking it down into sections for the learners to digest at their own speed.
• Don’t forget your own first learning experiences and how they were/could have been made easier.
Ask More Questions
It may seem like an odd guideline, but often when teaching adults, questions are much more powerful than answers.
The “What if” scenarios, case histories and problem-solving exercises mentioned above can help learning become real and applicable to reality. Asking questions forces students to actively engage in the learning process and enables them take responsibility for their answers.
Putting learning into practice is one of the end points of being a student. The teacher can facilitate this by providing and discussing an action plan. In learning from peers or other health professionals the trainee can document the answers to questions such as:
• “What were my learning aims?”
• “What are my five most important learning outcomes?”
• “How will I use the information gained today?”
• “How will today’s session change my practice?”
• “How will the change be monitored?”
When teaching patients, disease management plans can be used to demonstrate and reinforce learning.
Nurses are uniquely placed as educators in the clinical and classroom settings because they are able to communicate well with patients and peers. We often underestimate how effective we are in passing on the skills in the things we do every moment of every working day, because someone (student nurse, colleague or patient) is watching and learning.
Tips on Using Microsoft PowerPoint for teaching.
• Make one point/argument on one slide.
• Keep the text big - 26 point or above – so that it’s visible to everyone.
• Use the KISS principle – Keep It Short and Sweet.
• Use pictures as well as or in place of words.
• Use plain font without a distracting slide design.
• Use bullet points and headings that you can expand on from your notes (but preferably from memory) as they’re much easier for the audience to remember and digest.
• In groups, make eye contact as you speak and hold pauses. Ron Hoff (1993) calls this ‘gathering friends’ in the audience.
• Smile as you talk and speak as if you’re addressing each person individually.
• Make your body language confident and relaxed. Up to 55 percent of the message we give will be non-verbal, (38 percent is the tone of voice, 7 percent the actual words, (Mehrabian 1960)).
• Breath and speak more slowly during your talk. It’s easier to project your voice and make it heard when you’re speaking more slowly.
Elspeth Raisbeck, MSc, BA RGN
Hoff R. (1992) I Can See You Naked. Andrews and McMeel, Kansas City, USA.
Kolb, D A (1984) Experiential Learning: experience as the source of learning and development. New Jersey: Prentice-Hall.
Professor Mehabrian’s work 1960s. Accessed 24/3/08 at http://www.businessballs.com/mehrabiancommunications.htm
NMC (2002) Code of Professional Conduct.
Entwhistle N (1996) Styles of Learning and Teaching David Fulton Publishers Ltd.
Leddy S, Pepper JM, (1989) Conceptual Basis of Professional Nursing. Lippincott, Philadelphia. See Chapter 15.