Cognitive Teaching to Nurses

Teaching & Learning the Cognitive, Affective, & Psychomotor Domains

Janice is a 28-year-old financial advisor. She is now 7 months pregnant with her first child. She is complaining of many symptoms including fatigue, shortness of breath, dizziness, leg cramps and mouth/tongue sores. She is diagnosed with iron-deficiency anemia. Write learning objectives to guide your teaching about how diet modification could improve her health and well-being.

In nursing, patients who are pregnant represent a category that can be especially complex given the fact that there are a range of various implications due to the prenatal needs of the expecting mother. The fetus is especially vulnerable in the early stages of development and symptoms that the mother has could potentially cause a lifetime full of health issues if the symptoms are sufficiently problematic. Research has even confirmed data that supports the efficacy of certain kinds of prenatal stimulation and the future child starts to move at about seven and a half weeks and his repertory of spontaneous and provoked movements is nearly complete around the fifteenth week; pregnant women who participated in a program to use music to provide prenatal stimulation were observed to have fetus that were more advanced that their control group counterparts which can illustrate the full extent of the sensitivity involved with this developmental stage (Lafuente & Grifol, 2001). Therefore, such patients such as Janice can represent a significant challenge to nurses that have yet to acquire experience in working with expecting mothers.

Currently in the literature relative to teaching and learning in health care, there are a range of various concepts that are the target of a considerable amount of debate and confusion that can be largely attributed to the natural progress of scientific understanding. For example, there are many scientific theories that are constantly being tested, evaluated, and often refined to reflect the latest advancements in science. However, there still remains a large portion of teaching health related matters that can still be largely considered an art. There are many cultural and interpersonal skills that tend to mediate a nurse's ability to effectively communicate with their patients about important health related matters.

Knowledge and communication skills are improved with simulation use, as are interdisciplinary teamwork and interpersonal and psychomotor skills, and because of increasing patient acuity in inpatient settings, students must come to the clinical site better able to deal with rapidly changing situations and greater technological intervention so that there can be improved decision-making abilities and greater awareness of patient safety in this environment (Wolfgram & Quinn, 2012). There are many different strategies to impart the basic skills that nurses need to be successful at this level and there are a variety of different perspectives and competencies that are needed for strategies to develop a program and have the program development succeed. Cultural humility is proposed as key factor in multicultural medical education and it incorporates a lifelong commitment to self-evaluation and self-critique, to redressing the power imbalances in the patient-physician dynamic, and to developing mutually beneficial and nonpaternalistic clinical and advocacy partnerships with communities on behalf of individuals and defined populations (Tervalon & Murray-Garcia, 1998). This perspective allows teachers the ablility to change with a changing landscape of scientific knowledge and new evidence-based practices.

The actual training transfer that can instill cultural competencies can take many forms. One model, Campinha-Bacote's model of cultural competence in health care delivery is defined as process of Cultural Competence in the Delivery of Healthcare Services (Campinha-Bacote, 2002). This model views cultural competence as the ongoing process in which the health care provider continuously strives to achieve the ability to effectively work within the cultural context of the client (individual, family, community) which is an ongoing process involves the integration of cultural awareness, cultural knowledge, cultural skill, cultural encounters, and cultural desire (Campinha-Bacote, 2002). Other sources also propose that it is best to define cultural competence as a nonlinear and dynamic process that is never ending and ever expanding in its quest for increasing knowledge and developing skills (Burchum, 2002). This perspective views the complex combinations of knowledge, skills, and attitudes from a holistic perspective that is never ending.

Nursing Objectives for Teaching along Three Domains

Cognitive

The cognitive demands on nursing students has steadily increased with the increased complexity that is found in the modern day health care environment. As a result of these increasing demands, the need for optimal learning environments and strategies has also increased. For example, Witkin's empirically supported measure of field dependent/independent cognitive style assesses the manner in which students perceive and process information which can in turn help them learn in the most effective and efficient manner by meeting their individual learning preferences (Noble, Miller, & Heckman, 2008). One specific cognitive tool that could be taught is to teach how to make a cognitive map regarding to case study. Cognitive/concept mapping is an educational strategy that can help students understand the larger questions and problems in their assignments and to avoid focusing on simply assimilating data rather than learning on a deeper and more meaningful level (All & Havens, 1997). Therefore, the students will be expected to develop a concept map of how to proceed with the treatment of the patient in the case.

Affective

The affective domain of learning, which encompasses attitudes, beliefs, values, feelings, and emotions and depends heavily on the instructor's ability to create creative lesson plans that connect on a higher level; while this is one of the most difficult aspects of teaching for some, it can also be the most important (Neumann & Forsyth, 2008). Since the case deals with an expecting mother that is presenting many symptoms, there could be many different strategies to reach students on an affective dimension that build off of this requirement. For example, the values regarding the mother's responsibilities to her unborn child could be foundation of such a discussion as well as the nurse's responsibilities to providing relevant health information about those responsibilities.