Nurse as Educator

Nurse as Educator

Principles of Teaching and Learning for Nursing Practice

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Nurse as Educator: Principles of Teaching and Learning for Nursing Practice, Fifth Edition drives comprehension through various strategies that meet the learning needs of students, while also gen- erating enthusiasm about the topic. This interactive addresses different learning styles, making this the ideal text to ensure mastery of key concepts. The pedagogical aids that appear in most chapters include the following:

The Pedagogy

Chapter Highlights Chapter high- lights provide a quick-look over- view of the content presented in each chapter.

Key Terms Found in a list at the be- ginning of each chapter, these terms will create an expanded vocabulary.

© Helaine Weide/Moment/Getty

Overview of Education in Health Care Susan B. Bastable Kattiria M. Gonzalez



■ Historical Foundations for Patient Education in Health Care ■ The Evolution of the Teaching Role of Nurses ■ Social, Economic, and Political Trends Affecting Health Care ■ Purposes, Goals, and Benefits of Patient and Nursing Staff/Student Education ■ The Education Process Defined ■ The Contemporary Role of the

• Nursing Education Transformation • Patient Engagement • Quality and Safety Education in Nursing • The Institute of Medicine Report: The Future of Nursing

■ Barriers to Teaching and Obstacles to Learning • Factors Affecting the Ability to Teach • Factors Affecting the Ability to Learn

■ Questions to Be Asked About Teaching and Learning ■ State of the Evidence


education process teaching/instruction learning

patient education staff education

barriers to teaching obstacles to learning


Objectives These learning objectives provide instructors and students with a snapshot of the key information they will encounter in each chapter. They serve as a checklist to help guide and focus study.

Evaluation is defined as a systematic pro-cess that judges the worth or value of some-thing—in this case, teaching and learning. Evaluation can provide evidence that what nurses do as educators makes a value-added difference in the care they provide.

Early consideration of evaluation has never been more critical than in today’s healthcare en- vironment, which demands that “best” practice be based on evidence. Crucial decisions regard- ing learners rest on the outcomes of learning. Can the patient go home? Is the nurse provid- ing competent care? If education is to be jus- tified as a value-added activity, the process of education must be measurably efficient and must be measurably linked to education out- comes. The outcomes of education, both for

the learner and for the organization, must be measurably effective.

For example, the importance of evaluating patient education is essential (London, 2009). Patients must be educated about their health needs and how to manage their own care so that patient outcomes are improved and healthcare costs are decreased (Institute for Healthcare Im- provement, 2012; Schaefer, Miller, Goldstein, & Simmons, 2009). Preparing patients for safe dis- charge from hospitals or from home care must be efficient so that the time patients are under the supervision of nurses is reduced, and it also must be effective in preventing unplanned read- missions (Stevens, 2015). Monitoring the hos- pital return rates of patients is not a new idea as a method to evaluate effectiveness of patient


After completing this chapter, the reader will be able to

1. Define the term evaluation . 2. Discuss the relationships among evaluation, evidence-based practice, and practice-based evidence. 3. Describe the differences between the terms evaluation and assessment. 4. Identify the purposes of evaluation. 5. Distinguish between five basic types of evaluation: process, content, outcome, impact, and program. 6. Discuss characteristics of various models of evaluation. 7. Explain the similarities and differences between evaluation and research. 8. List the major barriers to evaluation. 9. Examine methods for conducting an evaluation.

10. Explain the variables that must be considered in selecting appropriate evaluation instruments for the collection of different types of data.

11. Identify guidelines for reporting the results of evaluation. 12. Describe the strength of the current evidence base for evaluation of patient and nursing staff



evaluation evidence-based practice

(EBP) external evidence internal evidence practice-based evidence

assessment process evaluation

(formative evaluation) content evaluation outcome evaluation

(summative evaluation)

impact evaluation total program evaluation evaluation research reflective practice

596 Chapter 14 Evaluation in Healthcare Education

Review Questions Review key con- cepts from your reading with these exercises at the end of each chapter.

The importance of evaluation as internal evidence has gained even greater momentum with the movement toward EBP. Perhaps the most important point to remember is this: Each aspect of the evaluation process is important, but all these considerations are meaningless if the results of evaluation are not used to guide future action in planning and carrying out ed- ucational interventions.

Review Questions 1. How is the term evaluation defined? 2. How does the process of evaluation differ

from the process of assessment? 3. How is evidence-based practice (EBP)

related to evaluation? 4. How does internal evidence differ from

external evidence? 5. What is the first and most important step

in planning any evaluation? 6. What are the five basic components

included in determining the focus of an evaluation?

7. How does formative evaluation differ from summative evaluation, and what is another name for each of these two types of evaluation?

8. What are the five basic types (levels) of eval- uation, in order from simple to com plex, as identified in Abruzzese’s RSA evalua- tion model?

9. What is the purpose of each type (level) of evaluation as described by Abruzzese in her RSA evaluation model?

10. Which data collection methods can be used in conducting an evaluation of educational interventions?

11. What are the three major barriers to conducting an evaluation?

12. When and why should a pilot test be conducted prior to implementing a full evaluation?

13. What are three guidelines to follow in reporting the results of an evaluation?

results. Process, content, and outcome evalu- ations also are more frequently conducted as research projects, however, underscoring the importance of evidence as a basis for making practice decisions. Sinclair, Kable, Levett-Jones, and Booth (2016) conducted a systematic re- view of randomized clinical trials to determine the effectiveness of e-learning programs on health professionals’ behavior and patient out- comes. After screening articles initially iden- tified for review, the authors found 12 process and outcome RCTs worthy of further appraisal and 7 articles worthy of inclusion in the final systematic review. This is just one example of the increase in level of rigor in evaluations of healthcare education.

▸ Summary Conducting evaluations in healthcare educa- tion involves gathering, summarizing, inter- preting, and using data to determine the extent to which an educational activity is efficient, effective, and useful for those who participate in that activity as learners, teachers, or sponsors. Five types of evaluation were discussed in this chapter: (1) process, (2) content, (3) outcome, (4) impact, and (5) program evaluations. Each of these types focuses on a specific purpose, scope, and questions to be asked of an educational activity or program to meet the needs of those who ask for the evaluation or who can benefit from its results. Each type of evaluation also re- quires some level of available resources for the evaluation to be conducted.

The number and variety of evaluation models, designs, methods, and instruments are growing exponentially as the importance of evaluation becomes widely accepted in today’s healthcare environment. Many guidelines, rules of thumb, suggestions, and examples were in- cluded in this chapter’s discussion of how a nurse educator might go about selecting the most ap- propriate model, design, methods, and instru- ments for a certain type of evaluation.

627Review Questions

Case Studies Case studies encour- age active learning and promote critical thinking skills in learners. Students can read about real-life scenarios and then analyze the situation they are presented with.

Ammerman, A., Smith, T. W., & Calancie, L. (2014). Practice- based evidence in public health: Improving reach, relevance, and results. Annual Reviews in Public Health , 35 , 47–63. doi:10.1146/annurev-publhealth-032013-182458

Bahreini, M., Moattari, M., Shahamat, S., Dobaradaran, S., & Ravanipour, M. (2013). Improvement of Iranian nurses’ competence through professional portfolio: A quasi-experimental study, Nursing and Health Sciences , 15 , 51–57. doi:10.1111/j.1442-2018.2012.00733.x

Balas, M. C., Burke, W. J., Gannon, D., Cohen, M. Z., Colburn, L., Bevil, C., . . . Vasilevskis, E. E. (2013). Implementing the ABCDE bundle into everyday care: Opportuni- ties, challenges, and lessons learned for implementing the ICU pain, agitation, and delirium (PAD) guidelines. Critical Care Medicine , 41 (9 Suppl. 1), S116–S127. doi: 10.1097/CCM.0b013e3182a17064

Bates, O. L., O’Connor, N., Dunn, D., & Hasenau, S. M. (2014). Applying STAAR interventions in incremental bundles: Improving post-CABG surgical patient care. Worldviews on Evidence-Based Nursing , 11 (2), 89–97.

References Abruzzese, R. S. (1992). Evaluation in nursing staff

development. In R. S. Abruzzese (Ed.), Nursing staff development: Strategies for success (pp. 235–248). St. Louis, MO: Mosby–Year Book.

Adams, R. J. (2010). Improving health outcomes with better patient understanding and education. Dovepress , 2010 (3), 61–72. Retrieved from /pubmed/22312219

Allen, J., Annells, M., Clark, E., Lang, L., Nunn, R., Petrie, E., & Robins, A. (2012). Mixed methods evaluation research for a mental health screening and referral clinical pathway. Worldviews on Evidence-Based Nursing, 9 (3), 172–185.

American Nurses Credentialing Center, Commission on Accreditation. (2014, September). The importance of evaluating the impact of continuing nursing education on outcomes: Professional nursing practice and patient care. Retrieved from http://www.nursecredentialing .org/Accreditation/ResourcesServices/Evaluating-the -Impact-CNE-Outcomes.pdf

CASE STUDY Having recently completed her master’s degree in nursing, Sharon has accepted a new role as clinical nurse educator for three adult medicine units in the medical center where she has been employed as a staff nurse for the past 6 years. Eager to put her education to practice in a manner that would benefit both patients and staff, Sharon meets with the nurse managers of the three units to learn what they view as priority issues on which she should focus. All three managers agree that their primary concern is teaching their staff how to better prepare patients with type 2 diabetes to care for themselves after they are discharged home. One manager comments, “Half of my nurses are new graduates. I’m not even certain that they know much about type 2 diabetes—how on earth can they teach the patients?” The other two managers nod, agreeing with the first, and chime in: “The patients aren’t being taught what they need to know, they don’t believe what they’re hearing, or they don’t understand what they’re hearing. As a result, I’m being told by ambulatory service nurses that our discharged patients aren’t taking their medications, aren’t making any changes in diet or lifestyle, and seem unconcerned about their hyperglycemia.”

You next meet with Eric, the certifi ed diabetes educator at your hospital, and he reminds you that all nurses are mandated to annually review the patient and family education program for patients with type 2 diabetes and complete the cognitive posttest.

1. Which type of evaluation is being conducted every year when the nurses review the program and complete the cognitive test?

2. Which type(s) of evaluation would be most relevant to the nurse manager’s concerns? 3. Putting yourself into Sharon’s place, describe in detail an evaluation that you would conduct

with the patients as a primary audience. 4. If evaluation is so crucial to healthcare education, what are some of the reasons why evaluation

seems often an afterthought or is even overlooked entirely by the educator?

628 Chapter 14 Evaluation in Healthcare Education

Susan B. Bastable, EdD, RN Nursing Education Consultant

Professor Emerita and Founding Chair Department of Nursing

Purcell School of Professional Studies Le Moyne College

Syracuse, New York

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