A portfolio of evidence and in-depth critical reflection on the planning, preparation, delivery and evaluation of a teaching session.
The title of the teaching session chosen was: “Pressure Ulcer Risk Assessment.” I have performed an in-depth critical reflection of the whole process of undertaking the teaching session and the details of this are presented below. I reflected upon factors (personal, interpersonal, contextual) that might have influenced the effectiveness of the teaching and learning utilising support and evidence from the literature. In particular I incorporated theories of teaching and learning including learning styles.
The purpose behind this exercise was primarily for me, as a teacher, to become a more effective teacher. An added benefit was the teaching session provided which supplemented nurse education on an important topic which is likely to make a difference to the students (Clark 2005) and one which is incorporated into the process of clinical governance.
There are a variety of learning styles and one of these – activist (Honey, 1982) – learns most effectively from actually performing the task. However performance of the task is relevant as a learning exercise for individuals with different learning styles. To improve the benefit gained, to me as a learner, from the teaching episode I have identified the key areas integral to the teaching session and have then reflected upon them. I have read and reflected upon theories of education with particular focus on how adults learn and have utilised some of this theory to enhance the usefulness of my reflection into how the teaching session took place.
The portfolio of evidence follows in appendices. These are copies of the actual documents used. These are referenced within the reflective elements of the exercise presented below.
The process follows a flexible but focussed teaching plan through the delivery of the teaching episode to feedback culminating in refection on feedback and subsequent plans for improvement in subsequent sessions.
Rationale for choice of teaching session
The topic was “Pressure Ulcer Risk Assessment.” This was chosen for the following reasons:
- It is an important area
- It has a high incidence. In a study in 1991 4.03% of admissions developed pressure sores. In orthopaedic wards 10.3% developed sores (Clark and Watts, 1994). Patients also develop pressure sores in the community; a study by Richardson (1993) found 284 patients out of 1 021 presented with a sore on admission to hospital.
- Once a pressure ulcer develops it is difficult to treat and care is costly both within medical and surgical specialities (Beckrich and Aronovitch 1999). In the Netherlands the cost of treating pressure sores is third after cancer and cardiovascular disease (Health Council of the Netherlands, 1999).
- Pressure ulcers are distressing to patients.
- They adversely influence length of stay which is one of the clinical governance outcome measures
- Increasing length of stay blocks beds and has the ultimate effect of lengthening waiting times for elective surgical procedures
- This has financial implications for the Trust
- Scare NHS resources are diverted away for treating pre-existing diseases
- The are medico legal effects (Moody, 1997)
- Pressure sore are largely preventable (Stephen-Haynes). Nursing on pressure relieving mattresses can be effective (Hofman et al, 1994)
- However treating everyone prophylactically can incur greater financial cost than treating the sores themselves (Touche Ross 1993)
- We can effectively predict which patients are at high risk although the Waterlow score does not perform well in the community (Edwards M (1996) and there are also concerns about its performance within the hospital setting (Schoonhoven,2006).
- We can target preventative treatment at those at high risk
- Prevention measures in the high risk group can make a difference (Cooper and gray, 2002)
- The risk factors need to be understood by all nursing staff on the ward (Moody et al, 1988).
- It is important to keep up to date with new ideas in the topic
Planning – based on a Teaching Plan (Quinn 2000)
The purpose of the teaching plan is to be of assistance to the students. It helps to ensure that important information is not omitted. The teaching plan is different from the teacher’s notes. A copy of the teaching plan is presented in appendix 2.
The aim of the teaching session was “to develop an understanding of the principles of pressure ulcer risk assessment.” The learning outcomes were “At the end of this teaching session students should be able to:
- Define the term ‘pressure ulcer’ and explain rationales for risk assessment.
- Understand the importance of clinical governance in relation to pressure ulcer risk assessment.
- Understand principles of presure ulcer risk assessment tool (Waterlow scale) (Waterlow, 1985, 1988, 2005).
The seven learners were student nurses from the first to the third year of study.
A written plan was set out as shown in appendix 2. This detailed the sequence and process of the session. Approximate timings were given in the first column. The content column detailed six items for teaching. The two remaining columns detailed teacher and student activity for each of the six items. For the first two items; definition of pressure ulcer and rationale for risk assessment consisted of teacher activity questioning students. The teacher, according to the session plan, explained and read from handouts the relationship between pressure ulcer risk assessment and Clinical Governance. For the Waterlow risk assessment scale the teacher activity planned was questioning the students and clarifying subsections and reading from handouts. In the conclusion the teacher activity according to the plan was summarising.
The sequencing of the teaching points loosely corresponded to the Herbatian (Quinn, 2000) principles whereby the simplest concepts are dealt with first and there is progress on to newer more complex material.
Preparation – of self, subject material, students & environment Self
I ensured that I had no other commitments at the time of the teaching session and no other commitments in the session immediately before that could overrun. I ensured that my colleagues knew this portion of my time was committed to teaching. I ensured that there would be no interruptions for myself and also that I was not working the night before the teaching session. My advance preparation utilised time management skills. I went over the teaching material the day before the session.
I was aware of the policy within the hospital about screening for pressure sore risk and subsequent management so that the contents of the presentation were likely to be appropriate in the day to day working context.
I had thoroughly read up about the subject from a variety of resources including paper backed and electronic journals, National Electronic Library for Health and Internet websites. I had predicted some questions and formulated some draft answers to them.
I already knew who they were and at what stage in their training they were. In advance of the teaching session I asked a number of them about what they already knew about the topic, what teaching they had already had on it and what they felt their learning needs were.
I advertised the teaching session to the students beforehand. I choose a time and location which was convenient for the students as well as for myself. I considered how much preparation the students might do beforehand and I chose not to give out detailed information ahead of the teaching session in case only a proportion of the students would have more detailed knowledge and it would then make the group less homogenous which I thought would be more difficult to teach – some students may not follow what was going on whereas others may be bored.
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A teaching room was obtained. The chairs were arranged in a semi-circular pattern in order for students and mentor to sit and face the teacher and overhead projector. I ensured that there was a clock an overhead projector and I took acetates and a portable table. I also ensured that there was no telephone in the room which might interrupt the session. I checked the temperature of the room beforehand and the means available of adjusting the temperature in the room during the teaching session. The room seemed overly hot and so I took a portable fan to the session.
Delivery – the process of undertaking the session
The total time allocated for this teaching session was 20 minutes. The delivery of the teaching session was largely interactive although some of the students did not participate in the discussion.
I utilised presentation skills (Power presentation info) and was already aware that appearance and body language affect the audience much more that does speech tone which in turn affects an audience more than the particular words spoken. I was already aware that the audience judges a speaker very early on in the presentation. I took account of the attributes of a good teacher (gp-training.net) incorporating the following aspects;
- Clarity of objectives and priorities
- Knowledge of the subject
- Knowledge of educational theory
- Communication skills
The teaching was interactive because I asked the students questions whilst teaching to assess their knowledge and understandings about the topic. I used my awareness of what constitutes a good questioning style by asking open questions, starting at a more basic level and going onto questions which were reflective and probing. I tried to be clear and succinct in my explanations avoiding repetition. Overall I had in mind to make the session learner-centred.
I used cue cards so that I did not need detailed notes. I gave out and used handouts in such a way that the students would not be distracted by looking at them.
The process was not a lecture since I spent some time explaining the contents of some of the handouts. Some of the questions were combinations of closed and open questions such as, “what is …..?”, “can anybody explain or tell me what this….. means please?”, “what do you understand by the term ……?” I spent a preponderance of the available time asking questions, explaining and clarifying.
Some students responded accurately to most of the questions whilst others just kept quiet or just watched me.Most of the time, they either responded to questions, studying their handouts, whispering or listening. I spent one occasion on one to one interaction with one of the students trying to explain how to calculate the BMI whilst others worked in pairs during this time. I was surprised that only one or two questions were asked by the students.
Evaluation – decisions relating to the process of evaluation and preparing evaluation materials
I prepared beforehand an evaluation form. At the end of the session I gave each student an evaluation form and asked if they would complete it and then put them all together in a pile. I explained to the students that the purpose of the evaluation form was to get feedback from them which would be used to improve future teaching. In doing this I planned to convey my enthusiasm and trust in the process that it is the valued feedback from the students that is a very powerful driver for the continuous improvement in education.
In advance I had already considered that it would be important to try and get a completed feedback form from all of the students. If students did not complete and return a form it might be because they did not gain anything from the teaching session and it would be the views of these people that it would be important to obtain. My strategy for achieving 100% return of the forms was to wait until the forms were handed back (I counted them) before giving out the attendance register to sign. I explained to the students that the session would be finished once the feedback forms and attendance register had been dealt with.
The summary of the completed forms is shown in the appendix. The forms included an area for free text comments.
However I appreciated that the feedback form was just one aspect of the feedback from this session (de Cossart and Fish, 2005). Once the session was drawing to a close and the feedback forms were being completed it was really too late to utilise any feedback from the forms for that session. The students would therefore give their feedback in such a way that they knew that they were not so likely to be taught me again in the near future therefore they could not make specific requests of me. This may lead to their feedback being of a much more general nature and hence less immediately useful for enhancing my own personal teaching style. To try and counteract this I attempted to gain some feedback during the session itself. I observed the body language of the students and also asked them whether they felt what they were learning was relevant and which aspects they would to concentrate on, I then tried to modify someway towards this without detracting too widely from the session plan.
Feedback – response to evaluation feedback (from learners/students) and self-evaluation
Response to feedback from the students
I felt that I had performed well in some areas. I felt I was proceeding at a pace that was appropriate for the students. I did feel slightly nervous whilst teaching although I do not think that this affected my tone of voice by making it too high. I felt that my interaction with the students was probably good. I felt that the topic was an appropriate one for most of the students. I had provided the students with a reference list for further reading and although I felt this was a good idea since according to educational theory adult learners need to be given direction and motivation to seek things out for themselves I felt that I had provided the direction but not so much of the motivation.
I felt that there were some weak areas which could benefit from further action. I felt that the main disadvantage was that the students might not have achieved their learning outcomes due to the time constraint of the session only being 20 minutes and the small size of the room. I felt relieved at the end of the teaching session because the room was too small, the students were beginning to loose concentration, there was so much needing to be covered on the topic but the time was insufficient. Initially I felt strongly that I need to negotiate for a larger teaching room and more time to achieve better outcomes in the future. However on further reflection I now appreciate that I should not have to negotiate for a bigger teaching room I just need to state what the requirements of the room size are for the students. Certain resources are necessary in order for students to be taught. In retrospect it would have probably been advantageous to include on the evaluation form for the students a section on the teaching environment. Deficiencies in the physical space would probably have been highlighted by the students indicating the need for the location problem to be addressed by the allocater of rooms. More time will not necessarily improve effectiveness of teaching it may be necessary to make the subject matter fit the available time.
Feedback from the students
The feedback from the students contains combinations of both negatives and positive remarks.I felt overwhelmed about the large response but had mixed feelings about individual feedbacks.
In addition the assessor gave me positive feedback after the teaching but was more critical about the whole teaching in private.
Reflective practice (Schön, 1987) consists of two elements:
- “reflection in action,” this occurred at the time of the teaching session
- “reflection on action,” occurred following the session and involved thinking about what happened, what contributed to it and whether the actions were appropriate and how they might be improved.
Action plan for future practice – identify key points for future development
- Learn and utilise techniques for dealing with the students who are quiet (e.g. asking a generalised question).
- Assess my own learning style and adapt learning episodes to fit in with this. (Honey, 1982).
- Have a written teaching plan with space for my comments so these can be filled in immediately whilst still fresh in my mind. These notes can then be useful for the reflective process (Quinn, 2001).
- Have a space on the evaluation form for comments on the environment.
- Use photographs and pictures.
- Get the students to actually use the scale.
- Do less reading of handouts.
- Find out at the end what they know. According to Knowles (1984) it is a basic principle that adults learn best if they diagnose their own learning needs and this triggers their motivation to learn.
- Utilising the “andragogy” (Knowles, 1984) which is defined as “the art and science of helping adults learn” but now accepted more as guidance than a theory (Kaufman, 2003) adults value learning that integrates with their every day needs and are more interested in a problem centred approach therefore an interactive problem solving approach will be used for the teaching session in future. Consider a practical basis to the session for instance get the students to actually use the risk scoring system by applying it to examples.
- According to Knowles (1984) it is a basic principle that adult learning is facilitated by encouraging learners to identify resources and ways of using these to fulfil their learning needs. Direct them to how to search the literature for relevant information rather than providing a list of resources.
- Improving performance includes preparing well in advance, ensure appropriate room bookings, or choose a topic that is not too broad but enough to covered within the timeframe.
- Use of electronic resources saves on time, photocopying and subsequent student storage. Explore the use of the intranet for this.
It is now going to be particularly important to repeat the exercise without delay. It would probably be helpful to teach the same group of students for 20 minutes in a larger room on a topic of their choice. I could perhaps invite them to choose from a number of topics that I propose but they could also add suggestions of their own. It is going to be a worthwhile exercise for my own learning experience as a teacher to then perform the same evaluation exercise as done here to plan subsequent improvements since the process of teaching effectively can always be improved. It is going to be valuable to develop some effective means of archiving information with learning points and proposals for change.
It would also be helpful to have some aspects of the teaching readily available at all times on a memory stick when an impromptu ten minute presentation could be given for instance if there is a delay in an audit meeting. Such action would add to my teaching experience and probably be much appreciated by the department.
In the future evaluation of student feedback might be analysed statistically if it is obtained as a continuous variable for instance on a visual analogue scale which can then be converted to percentages. This would enable some measure of, hopefully, improvement to be readily apparent which will further motivate me as a teacher.
Finally this exercise has very clearly demonstrated the cycle of think, plan, do, reflect which is integral to the learning cycle described by Cheek (2005) of a learner centred approach.
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