Learner-Centered Instruction for Congestive Heart Failure Self-Care
This paper presents a learner-centered lesson plan designed to teach patients with congestive heart failure how to manage their own care and reduce hospital readmissions. Grounded in humanistic learning theory and supplemented by computer-assisted instruction, the plan addresses four core self-care objectives: adhering to a medication regimen, following a low-sodium diet, restricting fluid intake, and recognizing when to seek medical help. The paper outlines the rationale, learner demographics, educational philosophy, goals, behavioral objectives, instructional strategies, learning activities, and evaluation methods. One-to-one instruction, demonstration, and role-playing are emphasized as strategies that fill identified gaps in heart failure self-care education.
- Introduction and Rationale: Need for CHF self-care education and project purpose
- The Learner and Learning Needs: Learner demographics and physical, emotional, cognitive needs
- Educational Philosophy and Theory: Essentialism, humanistic theory, and computer-assisted instruction
- Goals and Objectives: Four core self-care objectives with supporting sub-objectives
- Teaching Plan and Instructional Strategies: One-to-one instruction, demonstration, and role-playing per objective
- Learning Activities and Evaluation Methods: Session structure, learning activities, and pass-fail evaluation
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What makes this paper effective
- Grounds every instructional choice in cited research, demonstrating that strategy selection (role-playing, one-to-one instruction, demonstration) directly addresses documented gaps in heart failure self-care education.
- Clearly differentiates between main objectives and supporting objectives, giving nurse educators a realistic, step-by-step implementation roadmap with time allocations for each session component.
- Connects educational philosophy (Essentialism), learning theory (Humanistic), and supplemental theory (computer-assisted instruction) into a coherent, justified framework rather than treating each in isolation.
Key academic technique demonstrated
The paper exemplifies behavioral objective writing: each objective specifies a condition ("Following a 20-minute teaching session…"), a measurable learner behavior ("the learner will list…"), and the relevant learning domain (cognitive, psychomotor, affective). This precision makes evaluation straightforward and is the hallmark of sound instructional design in health education.
Structure breakdown
The paper is organized in three sequential parts that mirror the instructional design process. Part 1 establishes context — rationale, setting, learner profile, learning needs, and theoretical framework. Part 2 translates that context into specific goals and behaviorally stated objectives with supporting sub-objectives. Part 3 operationalizes the plan through instructional strategies, structured learning activities, and a dual evaluation method (direct observation and self-assessment), closing with narrative justification that ties each choice back to the literature.
Teaching patients how to care for themselves when they have a diagnosis of congestive heart failure has been shown to be "effective in improving self-care and reducing readmissions" (Stromberg, 2005). This project provides a lesson plan that nurses can implement using a learner-centered instruction approach in order to help patients with congestive heart failure properly and effectively apply self-care.
Currently there is a need for better self-care among patients with congestive heart failure, as shown by Dickson and Riegel (2009) and Harkness, Spaling, Currie, Strachan, and Clark (2015), as self-care can help to empower patients to provide more effective relief and management of their own health. Moreover, Tsai, Wang, Lee, Tsai, and Chen (2015) show that self-care can help reduce readmission rates and prevent patients from misapplying treatments on their own. As congestive heart failure is responsible for "11 million physician visits each year, and more hospitalizations than all forms of cancer combined," it is imperative that steps to help patients better cope with this health issue be taken (Emory Healthcare, 2018). To achieve that aim, Tsai et al. (2015) conclude that "establishment of heart disease educators and professional consultation services may be helpful to improve patient education" (p. 1101). This paper aims to provide a first step in that process by developing a lesson plan for heart disease educators.
From the patient's point of view, it is important that they understand what they need to know and how to apply self-care effectively. Based on their assessment of patients with heart failure, Dickson and Riegel (2009) showed that "skill-building tactics, such as role-playing in specific situations, are needed" when teaching patients with heart failure how to care for themselves. This approach gives patients a better sense of what to do, how to do it, and when. Role-playing in particular provides a concrete example for patients to follow rather than relying on traditional teaching methods in which information is simply relayed by the teacher and passively received by the patient. Role-playing facilitates active learning, which helps lessons to be more deeply understood by the learner (Jensen, 2005). Additionally, in their follow-up study, Riegel, Dickson, and Faulkner (2016) show that situation-specific heart failure self-care can help patients identify their own symptoms and make better decisions. This situation-specific approach aligns with the findings of Harkness et al. (2015), who show that individualized care is essential for patients seeking to better manage their own health.
The setting for this project can be the hospital facility where congestive heart failure patients receive primary care from physicians and nurses and training in self-care from a health educator, or it can be a non-hospital setting such as a nursing home or the patient's own home, provided the nurse is able to make a home visit. Because this project focuses on learner-centered instruction, the recommended setting is wherever the patient-learner is most comfortable so that care can be truly individualized. The audience for this project consists of the health educator who provides the self-care instruction and the heart failure patient who receives it.
The learner in this case is the congestive heart failure patient. Approximately 6 million Americans are affected by heart failure, which is the leading cause of hospitalization among the elderly population (people aged 65 and older). However, the demographic for congestive heart failure is broader than that: it affects people of all ages, from children to the elderly. Approximately 1.4 million individuals under the age of 60 have congestive heart failure, while 2% of individuals between the ages of 40 and 59 suffer from heart failure — a percentage that rises to 5% among persons between the ages of 60 and 69. Heart failure is equally frequent among men and women, but African Americans are 1.5 times more at risk of developing heart failure than Caucasians (Emory Healthcare, 2018). Since virtually anyone can be a learner for this type of self-care, there are also varying levels of education among likely learners — from elementary levels to post-graduate. For the purposes of this project, the learners chosen represent the most common demographic: elderly patients.
Physical needs. Learners must be physically able to care for themselves and must have "gross motor movements, sensory acuity, adequate strength, flexibility, coordination, and endurance" (Bastable, 2014, p. 126). The tasks must not be too complex to be mastered and must not conflict with the learner's environment. For elderly patients, instructors must allow "more time to react and respond to stimuli" (Bastable, 2014, p. 126). For the elderly population, these conditions must be present or self-care instruction cannot proceed effectively.
Emotional needs. As Bastable (2014) notes, learners must also be "emotionally ready to learn" — that is, they must not be excessively anxious; they must have a secure and stable support system; they must be motivated; they must not be prone to excessive risk-taking; their frame of mind must be balanced; and their developmental stage should be advanced enough that they are mature enough to take on the responsibility of self-care (p. 127). The elderly learner must meet these emotional conditions or self-care instruction cannot be effectively taught.
Experiential needs. Learners should be encouraged to incorporate aspects of their cultural background or beliefs into the learning process and even into the self-care practice itself, as this helps to individualize the learning. The elderly learner is most likely to want to incorporate some element of cultural background — such as religious devotion or music — into the self-care process.
Knowledge needs. Learning should build on prior knowledge that the learner already possesses. Instructors should make an effort to assess the learner's prior understanding and educational level so that instruction can be pitched appropriately. The elderly learner is most likely to have achieved some level of education but is also most likely to benefit from clear, simple instruction, and should be approached accordingly unless the learner indicates otherwise.
The educational philosophy for this project is Essentialism, which focuses the instructor on the essence of teaching — enabling the learner to acquire a needed skill. The aim of this philosophy is to help the learner achieve mastery of the subject being taught. This philosophy aligns with the theoretical approach used for this project: the humanistic approach.
The primary theory employed is the Humanistic Learning Theory. The humanistic theory of learning places the recipient of the learning at the center of the learning process — the individual is the focus, rather than the environment, the nurse, or the situation. This stems from the person-centered approach that Rogers (1951) developed, describing it as: "the best vantage point for understanding behavior is from the internal frame of reference of the individual" (p. 495).
Computer-assisted instruction theory is also utilized, as it allows learners to use the technology available in the digital age to facilitate their self-care process. As Bartholomew, Gold, Parcel et al. (2000) show, computer-assisted instruction theory is helpful in teaching lessons to students of all ages because it is a tool — like a calculator — that helps make processing problems easier for the learner.
The main advantages of humanistic theory are that: (1) it offers a learner-centered approach that places the needs of the individual learner at the forefront, and (2) it assists in the development of adequate motivation, relationship-building, communication, and self-efficacy (Halstead, 2007).
When individualizing a self-care practice to fit a patient's lifestyle, humanistic theory is especially helpful because it allows the patient's needs to be identified and addressed first. Rather than simply recommending the correct course of action indifferent to the patient's underlying needs, the nurse guided by humanistic theory can help the patient identify issues that may be contributing to unhealthy behaviors — such as depression or anxiety — and address those underlying issues before implementing a care plan. Humanistic theory also facilitates the essentialist philosophy by providing the instructor with the perspective to center the learning process on the individual learner's needs in order to achieve the objective: communicating the knowledge required to master self-care. It can be combined with computer-assisted instruction theory to provide a comprehensive approach that equips the learner with both the confidence and the practical tools needed to conduct effective self-care.
A goal is defined by Bastable (2014) as the "end of the teaching-learning process" (p. 425). Thus, the goal of this project is to empower the learner to become self-actualized. Specifically, the goal is to teach elderly patients how to care for themselves when they have a diagnosis of congestive heart failure.
The main objectives of this project are to provide self-care instruction that focuses on physiological stability and the management of symptoms. Specific objectives include: (1) adhering to the prescribed medication regimen, (2) adhering to a low-sodium diet, (3) restricting fluid intake, and (4) seeking the help of a health care provider when necessary.
Objective 1. Following a 20-minute teaching session on using the personal health record (PHR) system, the learner will list the patient's prescribed medication regimen as posted in the PHR portal. The learning domains for this objective are cognitive and psychomotor.
Objective 2. Following a 20-minute teaching session on identifying the sodium content of a meal using Google, the learner will list the sodium content of the day's meals and identify whether those meals are under or over the prescribed sodium intake levels. The learning domains for this objective are cognitive and psychomotor.
Objective 3. Following a 20-minute teaching session on restricting fluid intake, the learner will identify which fluids are permissible, which are not, and what the prescribed recommended intake levels are. The learning domains for this objective are cognitive and psychomotor.
Objective 4. Following a 20-minute teaching session on when it is necessary to seek medical assistance, the learner will respond to four hypothetical scenarios and indicate whether it is or is not necessary for the patient to seek medical assistance. The learning domain for this objective is affective.
Supporting Objectives 1. (a) Following a 10-minute tutorial on how to use the PHR, the learner will be able to log in, access the patient's medical records, and retrieve the prescribed medication regimen; and (b) following a 10-minute tutorial on when and how to reorder medications, the learner will be able to demonstrate how to ensure that prescriptions never run out. The learning domains for these supporting objectives are cognitive, psychomotor, and affective.
Supporting Objectives 2. (a) Following a 10-minute tutorial on how to use Google, the learner will be able to search for a meal to find its sodium levels; and (b) following a 10-minute tutorial, the learner will be able to compile a notebook of low-sodium meals. The learning domains for these supporting objectives are cognitive, psychomotor, and affective.
Supporting Objectives 3. (a) Following a 10-minute tutorial, the learner will be able to monitor fluid intake levels using a graph and notebook; and (b) following a 10-minute tutorial, the learner will be able to develop a schedule of when to take fluids. The learning domains for these objectives are cognitive and psychomotor.
Supporting Objectives 4. (a) Following a 5-minute tutorial, the learner will be able to use a device that alerts a designated health care provider in the case of emergency; and (b) following a 15-minute tutorial, the learner will be able to role-play correctly a scenario in which medical assistance is required and one in which it is not, taking the correct action in each case. The learning domain for these supporting objectives is affective.
The instructional strategies to be used are: (1) one-to-one instruction, (2) demonstration, and (3) role-playing.
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