The Need for the Diabetes Nurse to be a Professional Educator by Prof. Morsi Arab University of Alexandria

1. The Need for the Diabetes Nurse to be a Professional EducatorbyProf. Morsi ArabUniversity of Alexandria

2. Causes of Failure of Patients Education 1- unqualifiededucators 2- pourresources3-patientuncompliance

3. The Education TriangleObjectives Evaluation Strategy( Tests ) ( Methods of teaching )

4. Teachingand Education * a gift ?* Teaching competence is a science, with rules to be learned and skills to be acquired…….?.

5. Adjusting the Education to the Community Needs : 1. The community needs certain jobs.2.In each job certaintasks have to be performed .3. To perform each task we need specific : knowledge,skills and attitudes (Task analysis) 4. Accordingly, we design a curriculum with specific objectives5. At the end we evaluate achievement of objectives.

6. Example : The Job: “ A Diabetes Foot Care Nurse”: Tasks : 1- Examine feet: 2- Diagnose problems 3- Manage care 4- Educate patients

7. Education objectives for the tasks of a Diabetes Foot Care Nurse

8. Objectives

9. The selection of objectives depends on what the learner needs to knowand is going to do i.e. (tasks) during the job , and at which level of competence

10. In an Education Course :N.B.: You can not teach everything,… So, stick to some “selected” priorities :1- obligatory to learn2- useful to learn3- if possible learn

11. ObjectivesGeneral Considerations1- Set clear-cut objectives………. So , 2- Describe in behavioral terms what the learner ultimately will be able to do) : 1- If cognitive : e.g. enumerate causes of..... 2- In skills : e.g. examine pulse, cut nails…. 3- In attitudes : demonstrate punctuality , sympathy , etc….-

12. Objectives ( cont.):3- The education Faculty: (team work) … ( to avoid contradictions )4- Different objectives to different learners 5- Different teaching methods to suit different objectives.

13. Objectives ( cont.):6- Different objectives at different stages of the disease. 7- Overloading leads to confusion , depression and hopelessness.8- Only achievable objectives .

14. Some variables that define different patient objectives:1- Their existing Knowledge about DM.2- Their general educational competences (e.g. if illiterate?).3- Their belief, perception of their illness, misconceptions., etc.4- Readiness to learn acc. to psychol. stage 5- State of illness : controled ? complicated, ? handicapped ?,etc.5- Socioeconomics: cost , feasibility , etc.

15. STRATEGY

16. To prepare for an educational presentation : 1- identify the needs of the learners 2- identify their background (what they already know). Repetition? Revision ? Re-enforcement ? 3- select the content , and never “tell all” 4- focus objectives to the outcome: (what they can do, think , believe and know, at the end of the lecture, which they could not do before ).

17. The Big Group PresentationThe start ( Introduction) :- to gain attentionand interest : e.g. by a question , a story ,problem, case presentation, etc….. (or)- provide a skeleton of the contents to be covered

18. The Flow of the presentation:I- To keep capturing attention : 1- repeat significant points. 2- checkperceptionof the main points. 3- have reasonable sense of humor . 4- face audience and distribute eye contact. 5- keep logical sequence: .

19. The flow of the presentation ( cont.) 6- changemethods. 7- avoid unclear expressions , sophisticated words and long complicated sentences. 8- avoid monotony , mannerism. 9- ensure that everybody sees and hears well.

20. The flow of the presentation ( cont.)10- Use properly selected A.V. aids11- Be aware of the time allowed .12- Prepare for the unexpected mishaps

21. The Audience :1- show respect : ( punctuality , dress?) 2- be concerned with negative responses: ( yawns , expressions of perplexity , whispering questions, looks of unbelief or disapproval, etc. )…Don’t ignore !!3- do not be angered or intimidated , but react by re-shapingthe presentation.4- get final feedback

22. The End :1- Draw conclusions , …or invite independent conclusions.2- Make end flows naturally from introduction (e.g. answering the questions , solve the problem …). 3- Simple summary…. (pin point important aspects.)4- Tie up loose points, to make the whole presentation as one unit ..5- Suggest ways for applicationand benefits.6- suggest ways for continued learning.

23. Small Group Education- Select suitable size of the group ? - Educate, not teach (active participation).- Monitor Group behaviour dynamics at different stages.- Control individual dynamics: *positive behaviors…(encourage) * negative behaviors. .(checked )

24. The One-to-One Education1- Listen. 2- Motivate. 3- Individualize (quality) according to * stage of disease. * educational level…etc. 4- Not too much (quantity). 5- Reward, more than blame.

25. Teaching of SkillsTypes of Skills1- Psychomotor skills 2- Communication skills 3- Cognitive skills ___________________________________________How to Teach Skills ( 3 steps) :( Describe - Demonstrate - Exercise)___________________________________________Step 1- Describe : importance, indications, tools, steps of performance , pitfalls & precautions…etc.

26. Teaching of SkillsStep 2- Demonstration:a) every one should be able to see the demonstration. b) may have to be repeated c) describe again what you are doing during the performance ( to explain) d) support by AV aids

27. Teaching of SkillsStep 3 :Exercising ( Training) a) everybody exercises. b) Feed back ,to correct mistakes and advise for better performance. c) use helping methods :e.g. play role , simulation equipment , etc. d) give sufficient time for the training. e) initiate training in groups or projects

28. Teaching AttitudesAttitude = Tendency to behave in specific way.? * Could they be acquired by educational methods?

29. Ways to teach, develop and encourage behaviours1- Provide relevant information. ……………..(to know ? ) 2- Give example results of good behavior…( to inspire ?).3- Long observation on results of negative(bad) behaviors. .. ……………………………. ( to warn ?)4- From close contact e.g. working or living with individuals with positive or negative attitude (camps..).( all the above)5- Finally ,discuss in small groups; every one must share in the discussion and should be free to express. (to finally convinvce)

30. Evaluation

31. Evaluation by judgment :A- Expert judgment by trained observers: * the expert Judge determines “ how well” is the candidate …., without having to define the concept of “well”

32. Evaluation by judgment :( cont.)B- In Judging by the use of tests and scales : - The concept “well” has to be defined “ before hand”. - This standardization ensures objectivity .

33. How to ensure” reliability” of the judgement ? By using objectivetests : e.g. MCQ s, check lists, rating scales and similar methods , ( We help the examiners to unify their judgments and under different personal i.e. subjective conditions ) .

34. To ensure “validity”, be sure that evaluation is testing for the true requirements of the job: So,1- Discard Qs onsophisticated Knowledge ( not needed in performing the required tasks in the job). 2- Do not ignore theskills and attitudesneeded ( as defined in the task analysis and job description.)

35. Long Essay Questions : They have minimal advantages ( uncommonly used in patient education )1- Easy to prepare ( for the examiner). 2- Tests ability to construct an article (poor validity) 3- Poor reliability .

36. Multiple Short Essay Questions 1- covers a large part of the curriculum 2- less unreliable 3- answered and marked in shorter time 4- Still tests simple knowledge

37. MCQ Test - scored in a short time and precisely. - if numerous , covers widely the syllabus. - can be used for self assessment. - high reliability, very objective But,………………. - difficult to prepare good MCQs. - usually test only knowledge (rarely skills e.g. in decision making ).

38. Oral Examination- Few advantages : vivid, can probe increasing depth of knowledge (escalate).- Disadvantages: - induces anxiety (stress not existing in practical life). - consumes long time. -very subjective and unreliable - can not test skills - does not give good FB to the education process.Conclusion : better avoided

39. Evaluation of performance by Check Lists (very useful for testing skills). observe steps: well done 1-……………………………………………… √ 2-……………………………………………… √ 3-………………………………………………(X) 4-……………………………………………… √ 5-……………………………………………… √ 6-……………………………………………… √ 7-……………………………………………… √ 8-……………………………………………… √ 9……………………………………………… √ 10……………………………………………… √. Score = 9/10 - Has high reliability - Gives good feed-back .

40. Check List / Rating scale, for measuring attitudes (behaviours) of a person during his training or working (job) 0: strongly lacking…………5: strongly agree / evident

41. The Follow-up Record of Proper Performance during a training course for a group * The Record contains a number of tasks enlisted (1,2,3 …). * Each individual (A,B,C,…) should fulfill the performance of all tasks. * Satisfactoryachievement of each task ( separately ) is monitored. * Unsatisfactory performance indicates repeat training for a specific individual or the whole group

43. General Considerations in Evaluation: - There is no oneideal method for evaluation . - The choice of one method depends on : 1- is it reliable? 2- is it valid? 3- time consumed? 4- availability of its tools . 5- its FB (feed-back) value to the learning process 6- comprehensive testing of knowledge ,skills and attitudes.

44. Alexandrie – Palais du Montazah Thank You