Teaching Strategy: Return Demonstration

1. Teaching Strategy: Return Demonstration Lori Couch RN, BSN, CDE Christina Jilek, RN, BSN, CNOR

2. Broad overview of strategy • Return demonstration is effective strategy when learning a psychomotor domain • This strategy is effective when combined with a demonstration, the learner should return demonstration as close to demonstration as possible • Gives the learner an opportunity to show what they have learned in a comfortable non-intimidating environment

3. Educational theories • Self Efficacy theory: theory based on performance accomplishments. The learner is taught a skill and then given the opportunity to demonstrate the skill learned. • According to Albert Bandura, self-efficacy is “the belief in one’s capabilities to organize and execute the courses of action required to manage prospective situations” (Bandura, 1994).

4. Educational Theory:Self Efficacy Defined • People with strong self efficacy • View challenging problems as tasks to be mastered • Develop deeper interest in the activities in which they participate • Form a stronger sense of commitment to their interests and activities • Recover quickly from setbacks and disappointments (Bandura, 1994) • People with weak self efficacy • Avoid challenging tasks • Believe that difficult tasks and situations are beyond their capabilities • Focus on personal failings and negative outcomes • Quickly lose confidence in personal abilities (Bandura, 1994)

5. Usages of the strategy • Demonstration of blood glucose testing, explained and the learner is given the opportunity to demonstrate this to the instructor. Best used with individualized instruction. • Other examples: • Dressing Change • Injections • Blood Pressure Measurement • Medication Administration • Hand washing • Donning Sterile Gloves

6. Pros of strategy • Effective for learning in the psychomotor domain • Engages the learner using visual, auditory and tactile senses • Repetition of movement and constant reinforcement increases confidence, competence, and skill retention • Provides opportunity for over learning to achieve goal

7. Cons of strategy • Best completed with 1:1 instruction • Can be costly • Need to limit the size of instruction • Requires plenty of time to be set aside for teaching and for learning • Extra space and equipment may be necessary for certain skills

8. Evaluation • Return demonstration is beneficial in making patients comfortable with new skills. • This strategy permits the nurse to document patient’s progress and any areas they need improvement. • Evaluator/Coach can use a checklist to make sure the learner is mastering each step, and which steps require more practice

9. Summary • Can increase the knowledge base for health promotion practices. • Accurately reflects both what was taught and how the patient is able to demonstrate the skill. • Teacher should remain silent except for offering cues • Practice should be supervised until the learner is competent

10. References • Bastable, S. B. (2008). Nurse as educator (3 ed.). Sudbury, MA: Jones and Bartlett. • Cirone, N. (2010). Documenting return demonstration. Nursing 2010. Retrieved May 24, 2010 from www.journal.lww.com. • Finkelstein, E., Wittenborn, J. & Farris, R. (2004). Evaluation of public health demonstration programs: The effectiveness and cost effectiveness of wise woman. Journal of Women’s Health. Retrieved May 24, 2010 from ebscohost. • London, F. (1997, February). Return Demonstration: How to validate patient education. Nursing 97, 32.

11. References Continued • Bandura, A. (1994). Self-Efficacy. New York, New York: Academic Press. • Bastable, S. (2008). Nurse as educator: principles of teaching and learning for nursing practice. Sudbury: Jones and Bartlett. • Mantik Lewis, S., & Heitkemper, M. (2004). Medical-surgical nursing: assessment and management of clinical problems. Mosby.