This paper examines how Bloom's Taxonomy of learning applies to nursing education, with particular focus on patient teaching in the context of chronic disease management. The paper walks through all three domains of learning—cognitive, affective, and psychomotor—explaining each hierarchical level within those domains and illustrating how nurses use these principles both in their own professional development and when educating patients and caregivers. Examples drawn from diabetes care and other chronic conditions ground the theoretical framework in practical clinical scenarios.
Bloom's Taxonomy of learning suggests that there are different levels of mastery when a student first confronts a topic. There are also three domains of learning: the cognitive domain, which pertains to mental skills and the acquisition of knowledge; the affective domain, which relates to emotional growth; and the psychomotor domain, which pertains to physical skills (Clark, 2015, "Original cognitive"). This taxonomy is not only applicable to students learning in the classroom but also to patients. Nurses can act as teachers, particularly for patients and their families managing chronic disease, who must assume many of the healthcare-related tasks performed by nurses in hospital settings.
On a cognitive level, Bloom arranges the levels of learning from simplest to most complex in a hierarchy. The first level, knowledge, refers to conveying factual information to the individual — such as the fact that he or she has diabetes, heart disease, or an understanding of the basic mechanics of the illness. The nurse must have foundational knowledge about the illness, which she then transmits to the patient. However, this is only a first step. There must also be comprehension: can the patient restate what the illness means in layperson's terms, in a manner that is meaningful and understandable to him or her?
Once comprehension has taken place, application becomes possible — that is, applying this understanding to making meaningful changes such as dietary modifications and adhering to a medical regimen of drugs and other therapies. The nurse must know how to apply her knowledge to the patient's specific condition, and the patient must do the same. The next level, which not all patients may attain, is analysis: does the nurse, and does the patient, understand why the illness occurred? For example, a patient with diabetes might reflect, "I gained weight after I graduated from college, took my first job, stopped playing my college sport, and my poor dietary habits combined with my family history of diabetes caught up with me." The nurse must likewise identify triggers of the illness in order to develop a treatment plan that minimizes future risks posed by the progression of the disease.
At the level of synthesis, the patient can independently take new information provided by the nurse and use it to create new knowledge — for instance, recognizing that lifestyle changes may be important to adopt before pursuing more intensive interventions such as medication. Nurses can also learn from their patients, synthesizing information from prior experience to make that knowledge useful beyond a purely anecdotal level. The highest level is evaluation: reflecting accurately on the degree to which an intervention worked and determining whether it was successful. If not, the patient may need to make further changes — losing more weight, introducing additional dietary modifications, or trying a new medication. By evaluating the progression of the patient's health, the nurse can draw conclusions about how to refine her nursing approach, and generalize lessons from individual patient experiences to broader assumptions about nursing practice.
On an affective level, from the simplest to the most complex, the hierarchy includes: receiving phenomena, responding to phenomena, valuing, organizing, and internalizing values in order to make independent decisions (Clark, 2015, "The affective domain"). Nursing is not simply about intellectual decisions — nurses are also called upon to empathize with patients. The nurse must be open to receiving patient information and must respond in a manner that genuinely honors the patient's emotional needs.
Nurses must understand patient values and what constitutes wellness and a meaningful life when making health-related decisions. For example, some older patients view knee surgery as a necessity so they can continue to be physically active, while other patients who place less priority on running or sports may be less inclined to accept the risks of surgery. The nurse can help the patient organize these values. At times, the nurse may need to set aside her own values in order to understand those of the patient; at other times, she may need to help the patient reorganize his or her own values in light of medical knowledge — as with a patient who is emotionally resistant to vaccinating a child.
Ideally, over the course of a nurse's education, she develops a personal value system that supports nursing practice. As Clark (2015) notes, a nurse "has a value system that controls their behavior. The behavior is pervasive, consistent, predictable, and most important characteristic of the learner. Instructional objectives are concerned with the student's general patterns of adjustment (personal, social, emotional)" ("The affective domain").
It is also important to recognize that nursing has a hands-on, physical component. Psychomotor components of learning include perception, readiness to act, guided response, mechanism, complex overt response, adaptation, and origination (Clark, 2015, "The psychomotor domain"). Nurses must learn to perform physical tasks themselves — such as administering injections — but must also teach patients and caregivers to do so, particularly for chronic illnesses that depend heavily on self-care.
The learner progresses from observation and imitation to being able to replicate an action, and then to more creative and adaptive use of learned skills. For instance, a patient with diabetes might learn how to monitor his or her vital signs and self-administer insulin at appropriate times, and then, through careful self-observation, adapt the treatment and timing to his or her specific needs and circumstances.
Clark, D. (2015). Bloom's taxonomy: The affective domain. Retrieved from http://www.nwlink.com/~donclark/hrd/Bloom/original_cognitive_version.html
Clark, D. (2015). Bloom's taxonomy: The original cognitive domain. Retrieved from http://www.nwlink.com/~donclark/hrd/Bloom/original_cognitive_version.html
Clark, D. (2015). Bloom's taxonomy: The psychomotor domain. Retrieved from http://www.nwlink.com/~donclark/hrd/Bloom/psychomotor_domain.html
You’re 97% through this paper. Sign up to read the full paper.
Sign Up Now — Instant Access Already a member? Log inAlways verify citation format against your institution’s current style guide requirements.