Learning Objectives
By the end of this section, you will be able to:
- Describe different evaluation methods for teaching and learning
- Understand the importance of analyzing and interpreting evaluation methods
The evaluation step of the nursing process allows nurses to determine whether goals were met using the interventions created. Similar to the nursing process, the education of patients and families must also be evaluated for its efficacy. Without this essential step, there is no way to determine that the teaching session was successful.
It is also important for the nurse to analyze results and interpret how they influence the next steps for the patient. If goals have been achieved, the education on a topic or topics may be concluded. If goals are unmet, however, the process continues with reassessment. Subsequent findings from the patient’s updated needs assessment will indicate the need for further education, typically with revisions to the goals, the teaching methods, or both.
Evaluation Methods
Teaching may take place separate from learning; an educator can present information and concepts, yet learning may not be effective and established goals may not be achieved. Patients and family members may respond to teaching with head nods or smiles, but those reactions could be attempts at being polite rather than a demonstration of actual understanding. Nonverbal responses like nodding or shaking the head may contribute to the evaluation of learning, but specific and objective measures, such as direct observation of actions, demonstration of an acquired skill, verbalization of comprehension, and use of a checklist, offer more reliable corroboration of learning.
Direct Observation of Actions
Observing the learner in normal setting for actions and behaviors illustrating learning acquisition is referred to as direct observation of actions. There are similarities of this evaluation method with return demonstration and verbalization of understanding, because the nurse is engaged in visual and/or auditory observation of a skill or body of information. Direct observation is different from the other listed methods because the observation is done surreptitiously, or not in such an overt manner as the other evaluation methods.
Direct observation is frequently combined with checklists as a way to minimize subjectivity and maximize objectivity in observational evaluation (Nayyeri et al., 2021). Checklists provide clear descriptions of criteria for the actions under evaluation. Some direct observations are formalized through a process called direct observation of procedural skills, which are particularly helpful for evaluation of step-by-step psychomotor tasks. For patient education, this could be exemplified by a nurse watching a family member changing the patient’s wound dressing and listening to the description of the appearance of the wound, incision, and how much drainage is noted in the dressing during the procedure.
It can be helpful to observe that patients are following suggestions they were taught, even when they don’t realize they’re being watched (Fix et al., 2022). Examples of direct observation include surveying a patient’s actions while they are eating a meal and drinking a beverage. This often does not include a formal tool like a checklist, but it is during such activities that the nurse can monitor whether a patient who has been taught careful mastication and swallowing techniques is using those techniques for safety and aspiration prevention. Another example of informal evaluation is watching a patient ambulating with a family member, observing for correct application and use of a gait belt or assistive device such as a cane or walker.
Direct observation of actions may be a valuable method for evaluating literacy or health literacy skills. An example might be a nurse who hears a patient describe their medical diagnosis and related testing that is scheduled, or a parent explaining to a child why there is no breakfast tray on the morning of their surgery. In the next section, return demonstration of skills is explored, which has some overlap with direct observation.
Return Demonstration of Skills
A patient or family member’s ability to demonstrate a psychomotor skill (or multiple skills) after having it is presented by the nurse is referred to as a return demonstration, which has the patient showcase the ability to complete the task by performing it back to the educator. This evaluation method involves the nurse educating the patient and/or family with a combination of verbal explanation and showing the process of a particular skill. The description and task may be exemplified separately, or the nurse may illustrate the steps of the procedure and simultaneously narrates. After the primary demonstration, the learner is offered an opportunity to ask questions and practice before evaluation of return demonstration.
Mastery varies depending on the complexity of the skill, abilities of the learners, and expectations as to how many teaching and learning sessions required. It is also expected that learners approach a new skill in a linear, stepwise fashion. At different stages, acquisition of a skill may take longer. While putting the pieces together, most learners are not able to multitask by speaking while doing. Asking for a description of the procedure before requesting a demonstration is a common way to approach a task that involves multiple, coordinated actions.
When a patient or family member can demonstrate a newly acquired skill with precision, this is known as skill acquisition. The learner can not only correctly perform the skill but do so more rapidly while maintaining accuracy. At this stage, proficiency is being developed. The ability of the learner to not only accomplish the skill properly but do so promptly and to converse at the same time, illustrates full understanding of the task. All three of the learning methods discussed earlier are incorporated into this demonstration. The patient shows an understanding of both the cognitive and psychomotor processes, the fluency involved in multitasking, and comfort in holding a conversation at the same time—all of which supports the affective component of learning.
Verbalization of Understanding
Another method for evaluation of teaching and learning is for the learner to verbalize understanding. Asking open-ended questions that require more than one-word answers can illustrate acquisition of learning. Giving patients and family members an opportunity to describe what they comprehend at various intervals provides the nurse with insight about how much they know and understand. Allowing time for questions offers the nurse a chance to determine understanding or confusion about topics that have been taught. Verbalization of understanding may be used as an independent evaluation method or in combination with another method, such as discussion with a patient after a return demonstration.
Patient Conversations
Education: A Lot to Swallow
Nurse: Mr. Alvarez, I saw you eat breakfast while I was setting things up for your shower. I noticed that since the speech therapist gave you some tips, your swallowing has improved. I didn’t see you hesitate between chewing and swallowing, as was happening before. How do you feel about eating and swallowing today?
Patient: So much was going on in my brain! Remembering what the therapist said and trying to chew more than I used to. And not to swallow too soon! I was really nervous!
Nurse: I know it can be a lot. You have many therapies to think about since your stroke, but you’re working very hard to recover! I want you to know, you felt nervous, but you did all the steps the speech therapist told you, and I didn’t notice you were nervous.
Patient: Thank you. I’m going to try just as hard with walking when I see the physical therapist later.
Nurse: Excellent, Mr. Alvarez. I’ll plan to watch you walk later and see how you do.
The teach-back method is a commonly used technique in health care whereby the patient or family member is asked to repeat, in their own words, the information they received through education. As mentioned earlier, when patients are first presented with new information, they may understand and retain only a portion of it. By asking the patient to recall information and explain it in their own words, the nurse can get a better understanding of what information was retained and what information needs to be retaught or clarified.
Link to Learning
The teach-back method is an evidence-based intervention used to improve patient–healthcare provider communication and health outcomes. Explore the Teach-back Toolkit and how you can incorporate it any time important information is being shared.
The use of teach-back in discharge education reduced rates of hospital readmissions and improved patient satisfaction (Yen & Leasure, 2019). Patients also have a higher ability for self-care, greater understanding of their diagnosis, and compliance with their medication and treatment regimen (Yen & Leasure, 2019). Teach-back may also be used in conjunction with return demonstration after the teaching of a psychomotor skill.
Unfolding Case Study
Unfolding Case Study 3: Part 5
Refer to Unfolding Case Study 3: Part 4 for a review on the patient data.
| Nursing Notes | 1630: Assessment The palliative care team has met with the patient and family and addressed all concerns. They all agreed for the patient to be discharged immediately and receive care at home. The patient’s daughters were taught how to safely reposition their mother in bed and how to administer her medications. |
Checklist
Checklists can serve as an independent evaluation or provide documentation of evaluation, such as direct observation of actions, return demonstration of skills, and verbalization of understanding. Checklists can be simple or complex, depending on what is being evaluated. More complicated psychomotor skills, such as those that require multiple steps, a combination of evaluation methods, or illustration of acquisition of a skill in more than one learning domain, require a checklist that reflects the patient’s various achievements.
A checklist also helps objectify the evaluation process, which can be valuable for complex skills or processes, which have different levels of achievement and acquisition. Checklists permit the educator-evaluator to make notations for listed skills, as well as levels of performance. Spaces can also be included for initials and/or signatures of both the teacher(s) and learner(s). Space may be allotted for comments, which is helpful when there is the possibility of a note being vague or inconclusive without explanation (Figure 17.10).
Analyzing and Interpreting Teaching and Learning
Evaluation also involves analyzing the teaching and learning process to determine whether the teaching was effective and successful. Teaching efficacy is reflected by whether the patient learned what was taught and if the learner’s goals were achieved. If evaluation of the data indicates one or more goals set prior to the educational intervention were not met, the care plan may be modified to meet the goals for the patient. This involves reassessing the patient’s educational needs, revising patient goals, and revising teaching methods.
Reassessment of Patient’s Educational Needs
Reassessment is key to identifying changing learning interests and priorities, as well as causes for why teaching was successful or unsuccessful. If the educational session was successful, the patient acquired the correct knowledge or skill, and the goals were achieved. When an education session is unsuccessful, reassessment of the patient’s educational needs can determine what interventions need to be adjusted to meet education goals. For example, a patient who is unable to complete a return demonstration on how to inject insulin may need another interactive demonstration by the nurse. They may also have a fine motor function deficit that makes it difficult for them to draw insulin into a syringe and so be a better candidate for an insulin pen instead. During reassessment, a nurse can discover unmet needs and adjust the education being given to meet those needs.
Revision of Patient Goals
There are many reasons why patients’ healthcare goals change. Considering the patient’s physical and emotional status, the nurse assesses, intervenes, and evaluates continuously while providing patient care. Awareness of changes allows the nurse to understand factors that influence learning. For example, if a patient is anxious or in pain or physiologically compromised, then their mental state is not optimal for taking in new information.
Patient goals can also change based on external factors, such as ambient temperature or environmental distractions. Creating an environment free of distraction to facilitate learning can help set the patient and family up for success with learning. It is important for the nurse to recognize and accommodate changes in the patient’s goals and work with the patient to produce goals that meet the needs of the patient, family, and care team. Learning goals and techniques may be affected by a teaching technique that was expected to be successful but was ultimately ineffective for the patient.
Revision of Teaching Methods
If the patient’s goals have not changed but a teaching session was determined to be unsuccessful, it may be worth exploring a revision of the teaching method. Perhaps during assessment of the patient’s needs, the patient shared a preference for verbal delivery of information “because I learn best by listening.” However, in asking the patient for verbalization of understanding after an explanation of a new medication, it was discovered that much of the information was misunderstood, including the drug’s classification, the dose prescribed, and what time of day it should be taken. Through further reassessment, and with additional input from the patient’s adult child, the nurse may determine that a combination of verbal information with written information would be more effective. The nurse may revise the teaching method and use a whiteboard and markers, writing the name of the drug, what type of drug it is, the dose, and a drawing of a clock face with the time to take it to offer the patient multiple ways to learn the information.