1

Unit:

#6

Topic:

Effecting Change

Audience:

4th year BScN Student Nurses (NCU)

Date:

February, 2015

Time:

8-9:15 am

Duration:

1:15 mins.

Venue:

Lecture Room (The Annex) Kingston Campus

Methodology: Lecture Discussion

Number of participants: 90
Learning Theories:

Ausubel: Emphasized the use of advance organizers which he said was

different from overviews and summaries. His use of an advance organizer acted to bridge the
chasm between learning material and existing related ideas. The advanced organizer used; sought
to bridge new knowledge with what was known (sometimes what is known is uncertain and not
concrete). Though he specified that his theory applied only to reception learning in schools, it
was utilized because it introduced the topic and aided the sequence of the information to be
imparted. (Ormrod & Rice, 2003).
Rogers: Dealt with the adult learner, he posited that learning is student centered and
personalized and the educators role is that of a facilitator. Affective and cognitive needs are
central and the goal is to develop self-actualized persons in a cooperative, supportive
environment. This theory was used because all the participants were adult learners, thus they

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were responsible for their learning experience and the teacher sought to guide them through this
experience. (Quinn, 2006).
Bruner: Believed that learners were not blank slates but brought past experiences to a new
situation, he also stated that new information was linked to prior knowledge, thus mental
representations are subjective. Bruners Discovery learning is an inquiry-based, constructivist
learning theory that takes place in problem solving situations where the learner draws on his or
her own past experience and existing knowledge to discover facts and relationships and new
truths to be learned. (Quinn, 2006). Students interact with the world by exploring and
manipulating objects, wrestling with questions and controversies, or performing experiments. As
a result, students may be more likely to remember concepts and knowledge discovered on their
own (in contrast to a transmissionist model). (Quinn, 2006). Models that are based upon
discovery learning model include: guided discovery, problem-based learning, simulation-based
learning, case-based learning, incidental learning, among others. The advantages of this theory
are: it encourages active engagement, promotes motivation, a tailored learning experience, and
promotes autonomy, responsibility, independence, the development of creativity and problem
solving skills. (Quinn, 2006) Bruners theory was used because it encouraged active engagement,
promotes motivation, a tailored learning experience, and promotes autonomy, responsibility,
independence and the development of creativity and problem solving skills for this presentation.
Vygotsky: Posited that individuals learn from each other through social interaction and the
teacher and the learner collaborate in a reciprocal relationship where each learns from each other
through the same process of social interaction (Quinn, 2006). This theory was chosen since it
lays the overall foundation for human behaviours that of interaction, where students learn from

3
the more knowledgeable other (MKO) it coincides with the topic and the overall mode of
delivery of the topic.
Aim of the activity: To educate nursing students on the importance of change in health care
organization
Scientific Principle:
Resources:
Objectives:

Nurse Instructor, lap top computer, multimedia, white board, markers,

At the end of 1 hour and 15 mins interactive session students should be able
to:
1. Define change as explained by Jones (2007)
2. Outline factors that necessitates change in the work place according to
Marquis & Huston (2014)
3. Explain the stages of Lewins theory as cited by Marquis & Huston (2014)
4. Describe the effects of driving and restraining forces on the change
process according Marquis and Huston (2014)
5. Explain three strategies used in the change process as reasoned by
Marquis and Huston (2014); Jones (2007); Quinn, Spreitzer, and Brown,
(2000).
6. Discuss resistance to change according to Marquis & Huston (2014);
Kalisch (2007); Tappen et al (2010)

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7. Explicate planned change as cited by Marquis and Huston (2014)
Evaluation:

Formative and Summative. Questions will be asked before and after each
objective as well as discussion followed by a short quiz at the end

References:
Ormrod, J & Rice, F. (2003). Lifespan development and learning. Boston MA: Pearson
Publishing.
Quinn, F. (2006). The principles and practice of nurse education. London: Stanley Thornes
design guide. (2nd ed.). New Jersey: Educational Technology Publications, Inc.

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Time

Objectives

Contents

5mins Ice-breaker
The advanced
organizer used;
sought to
bridge new
knowledge
with what was
known
(sometimes
what is known
is uncertain
and not
concrete)
12
Define change Change means to be different, to cause to be different, or to alter.
as explained by It may be personal or organizational and can occur suddenly or
mins Jones (2007)
incrementally. It may be planned or unplanned. Unplanned
change, or reactive change, usually occurs suddenly and in
response to some event or set of circumstances (Jones, 2007).
For example, an unanticipated rise in patient census may
precipitate the need for a change in patient assignments.
Decisions are madeand change followsas a reaction to an
event. Planned change, however, entails planning and application
of strategic actions designed to promote movement toward a
desired goal. Planned change is deliberate and proactive. It
responds to anticipated events in the environment or community
(Jones, 2007).

Teacher
Activity
Students will be
asked to view the
pictures and
determine the
topic to be
discussed

Learners
Activity
Students will
view picture and
attempt to
determine the
topic to be
discussed

Teacher will
randomly ask
students to say
what the terms
distance
education and elearning are in
their own words.

Students will
randomly say
what the terms
distance
education and elearning are in
their own words.

Teacher will
discuss distance
education and elearning with the
use of
PowerPoint
according to the
content.

Students will
listen attentively
and ask questions
where necessary
as they follow on
PowerPoint as
distance
education and elearning are

Evaluation
Students will
correctly
identify
topic
subsequent
to viewing
pictures

Students will
be able to
correctly
discuss
terms
distance
education
and elearning
according to
the content
using terms
such as
distance
education
means that
the teacher
and the

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discussed
Teacher will ask
two students
seated at the
back of class to
briefly outline
one of the two
terms according
to the content

Two students
seated at the back
of class will
outline one of the
two terms
discussed
according to the
content

learner are
separated
from one
another or
are simply in
separate
places
and
Involves
the use of
technologybased tools
and
processes to
provide for
customized
learning
anytime or
anywhere.
The
emphasis in
e-learning is
on outcomes,
with the goal
of providing
an individual
with the
information
or practice

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7mins Outline factors
that
necessitates
change in the
work place
according to
Marquis &
Huston (2014)

Institutions undertake a number of projects as part of change

efforts directed at organizational restructuring, quality
improvement, and employee empowerment.
Many things drive change in contemporary health care, among
them are increasing technology, information availability,
economics and growing populations.
The integrated leadermanager is well grounded in change
theories and applies such theory appropriately. Regardless of the
type of change, all major change brings feelings of achievement,
loss, pride, and stress

Teacher will ask

three students
whose surname
begin with the
letter B to
explain the
nursing
informatics

Three student
whose surname
begins B will
attempt to explain
the term nursing
informatics

Teacher will
explain the term
nursing
informatics with
the aid of
PowerPoint

Students will
follow on white
board and on
PowerPoint
presentation and
ask questions
where necessary

Teach will ask

two students
whose surname
begin with the
letter W to
explain the term
nursing
informatics
according to the
contents

Two students
whose surname
begin with the
letter W will
explain the term
nursing
informatics
according to the
contents

Students will
correctly
explain the
term nursing
informatics
according to
the contents
using key
terms such
as The
integration
of nursing
science,
computer
and
information
science, and
cognitive
science to
manage
communicati
on and
expand the
data,
information,
knowledge,
and wisdom
of nursing
practice.
It functions
as
translators
between

15
mins

Describe the
concepts,
literacy and
health literacy
as cited by
Bastable
(2008, 2013)
and Websters
Collegiate
Dictionary
(1999);
Winslow
(2001); Fisher
(1999); Fetter,
(1999); Fleener
et al (1992);
Duffy et al
(1999); Doak
et al (1998)

Literacy is an umbrella term used to describe socially required and

expected reading and writing abilities.
The word literate is defined in Websters Collegiate Dictionary
(1999) as an educated person, one who is able to read and
write (p. 680). More specifically, literacy has been thought of as
the relative ability to use printed and written material commonly
encountered in daily living (Bastable, 2008).Others have defined
literacy based on the number of grade levels of school completed
or the equivalent of achievement tests. Many researchers have
found, however, that the reported number of years of schooling
attended is an inadequate predictor of a persons reading and
writing skills (Winslow, 2001).

Teacher will two

students who
surname begin
with the letter
G to explain
the concepts
literacy and
health literacy or
call on someone
of their choice to
assist them

Teacher will
describe the
terms literacy
CATEGORIZATION OF LITERACY
Literacy can be categorized into three general kinds of tasks:
and health
1. Prose tasks, which measure reading comprehension and the literacy using
ability to extract themes from newspapers, magazines,
PowerPoint
poems, and books
presentation

Two students
whose surname
begin with the
letter G to
explain the
concepts literacy
and health
literacy or call on
a classmate to
assist them

Students will sit,

listen and follow
on PowerPoint
presentation as
well as ask
questions where
necessary as the
concepts literacy

nurse
clinicians
and
information
technology
personnel to
ensure that
information
systems
capture
critical
nursing
information
Students will
be able to
correctly
describe the
concepts of
teaching
using key
words such
as the
relative
ability to use
printed and
written
material
commonly
encountered
in daily
living
health
literacy

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2. Document tasks, which assess the ability of readers to
interpret documents such as insurance reports, consent
forms, and transportation schedules
3. Quantitative tasks, which assess the ability to work with
numerical information embedded in written material such
as computing restaurant menu bills, figuring out taxes,
interpreting paycheck stubs, or calculating calories on a
nutrition checklist (Bastable, 2008).
HEALTH LITERACY
This refers to how well an individual can read, interpret, and
comprehend health information for maintaining an optimal level of
wellness (Fisher, 1999).
As managed care requires individuals to take more responsibility
for self-care and symptom management, health literacy is
becoming an important determinant of health status. Poor health
literacy may lead to serious negative consequences, such as
increased morbidity and mortality, when a person is unable to read
and comprehend instructions for medications, follow-up
appointments, diet, procedures, and other regimens. Patients
cannot be expected to be autonomous and self-directed in
navigating the healthcare system if they do not have the ability to
follow basic instructions (Fetter, 1999). Therefore, health
knowledge, health status, and the use of health services are all
related to literacy levels. (Bastable, 2013).
Illiteracy has been portrayed as an invisible handicap that affects
all classes, ethnic groups, and ages (Fleener & Scholl, 1992, p
740). Illiteracy knows no boundaries and exists among persons of
every race and ethnic background, socioeconomic class, and age
category (Duffy & Snyder, 1999).

and health
literacy are
presented
Teacher will
specifically ask
two male
students to
describe one
concept each
according to the
concept

Two male
students
specifically asked
will describe one
concept each
according to the
concept

refers to how
well an
individual
can read,
interpret,
and
comprehend
health
information
for
maintaining
an optimal
level of
wellness.

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It is true; however, that illiteracy is rare in the higher

socioeconomic classes. According to Winslow (2001) populations
that have been identified as having poorer reading and
comprehension skills than the average American include the
following: The economically disadvantaged, older adults,
immigrants (particularly illegal ones), racial minorities, high
school dropouts, the unemployed, prisoners, inner-city and rural
residents and those with poor health status due to chronic mental
and physical problems.
ASSESSMENT CUES TO ILLITERACY
Persons (particularly our patients who are our focus) who are
illiterate when reacting to complex learning situations will
withdrawal, completely avoid, or being repeatedly noncompliant.
They will often Use the excuse that they were too busy, too tired,
too sick, or too sedated with medication to maintain attention span
when given a booklet or instruction sheet to read. Claiming that
they just did not feel like reading, that they gave the information to
their spouse to take home, or that they lost, forgot, or broke their
glasses. Often, Camouflaging their problem by surrounding
themselves with books, magazines, and newspapers to give the
impression they are able to read (Bastable, 2013).
Still others, Circumvent their inability by insisting on taking the
information home to read or having a family member or friend
with them when written information is presented. Some will even
ask you to read the information for them under the guise that their
eyes are bothersome, they lack interest, or they do not have the
energy to devote to the task of learning.
Some will show a great deal of frustration and restlessness when

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attempting to read, often mouthing words aloud (vocalization) or
silently (sub-vocalization), substituting words they cannot
decipher (decode) with meaningless words, pointing to words or
phrases on a page, or exhibiting facial signs of bewilderment or
defeat. Patients will Stand in a location clearly designated for
authorized personnel only, Listening and watching very
attentively to observe and memorize how things work, failing to
ask any questions about the information they received, revealing a
discrepancy between what is understood by listening and what is
understood by reading (Bastable, 2013).
A few will Demonstrate difficulty with following instructions
about relatively simple activities such as breathing exercises or
with operating the TV, electric bed, call light, and other simple
equipment, even when the operating instructions are clearly
printed on them (Bastable, 2013).
MOTIVATION AND COMPLIANCE
In addition to the fact that poor literacy skills affect the ability to
read as well as understand and interpret the meaning of written,
visual, and verbal instruction, an illiterate or semiliterate person
struggles with other significant interrelated limitations with
communication that negatively influence healthcare teaching
(Doak et al., 1998)

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21
mins

Explicate the
difference
between
evidenced
based practice
and practice
based care as
proffered by
Bastable
(2008);
Cannon et al
(2012); Majid
et al., (2011);
Melnyck, et al
(2005);
FineoutOverholt et al
(2010); Sackett
et al (2000);
Lachance et al
(2006); Jette
et al (2003);
Heater et al
(1988);
Mantzoukas
(2007);
Youngblut
(2001)

Evidenced based practice (EBP) is defined as the conscious use of

current best evidence in making the decisions about patient care
(Melnyk & Fineout-Overholt, 2010). It is a framework for clinical
practice that integrates the best available scientific evidence with
the expertise of the clinician, patients preferences and values to
make decisions about health care (Sackett, Strauss, Richardson,
Rosenberg & Haynes, 2000).
Historically, care of the patient was influenced by the experiences
and opinions of those involved in providing treatment (KaniaLachance, McDonah & Ghosh, 2006). EBP marks a shift among
health care professionals from a traditional emphasis on
authoritative opinions to an emphasis on data extracted from prior
research and studies (Jette, Bacon, Batty, Carlson, Ferland &
Hemingway et al., 2003; Sackett et al., 2000).
A meta-analysis done by Heater et al. demonstrated that nursing
practice based on evidence improves patient care, as compared to
traditional practices. (Heater, Becker & Olson, 1988). Moreover,
as nurses are increasingly more involved in clinical decision
making, it is becoming important for them to utilize the best
evidence to make effective and justifiable decisions
(Mantzoukas, 2007).
Evidence-based practice (EBP) is one such technique and is
quickly gaining popularity due to its potential to effectively handle
clinical issues and provide better patient care. One major objective
behind all these efforts is to help doctors, nurses, and medical
technicians provide the best possible care and treatment to patients
(Cannon & Boswell, 2012).
In addition to using traditional and well-established procedures
and practices, health care practitioners are adopting innovative
interventions that are based on best practices as well as solid

Teacher will ask

students to turn
to the person
next to them and
briefly explain
the difference
between
evidenced based
practice and
practice based
care

Teacher will
explain the
difference
between the
concepts
evidenced based
practice and
practiced based
care utilizing
PowerPoint
presentation,
marker and
white board

Teacher will
randomly ask
two students to
explain the
concepts

students will turn

to the person next
to them and will
attempt to explain
briefly the
difference
between
evidenced based
practice and
practiced based
care

Students will
be able to
correctly
explain the
concepts
evidenced
based
practice and
practiced
based care
utilizing
terms such
as,
Students will sit,
Evidenced
listen ask
based
questions and
practice
follow on
(EBP) is
PowerPoint and
defined as
white board as the the
concepts
conscious
evidenced based
use of
practice and
current best
practiced based
evidence in
care are explained making the
decisions
about patient
care.
Practice
Two students will based care
randomly explain is care that
the concepts
is ongoing, it
evidenced based
is an
practice and
integral and

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research-based evidence (Majid, Foo, Luyt, Zhang, Theng &
Chang et al., 2011).
IMPORTANCE OF EVIDENCED BASED CARE NURSING
Evidence-based practice has gained momentum in nursing, and
definitions vary widely. Research findings, knowledge from basic
science, clinical knowledge, and expert opinion are all considered
"evidence"; however, practices based on research findings are
more likely to result in the desired patient outcomes across various
settings and geographic locations (Cannon et al., 2012).
The impetus for evidence-based practice comes from pay or and
healthcare facility pressures for cost containment, greater
availability of information, and greater consumer savvy about
treatment and care options. Evidence-based practice demands
changes in education of students, more practice-relevant research,
and closer working relationships between clinicians and
researchers (Majid et al., 2011).
Evidence-based practice also provides opportunities for nursing
care to be more individualized, more effective, streamlined, and
dynamic, and to maximize effects of clinical judgment. When
evidence is used to define best practices rather than to support
existing practices, nursing care keeps pace with the latest
technological advances and takes advantage of new knowledge
developments (Youngblut & Brooten, 2001).

LEVELS OF EVIDENCE
Levels of evidence are a schema for understanding the value of the
information presented to the clinical topic or question under

evidenced based practiced based

practice and
care according to
practiced based
the content
care according to
the content

important
component
of
professional
practice.
Intentional
recognition
of these
findings
about
practice as a
source of
evidence to
guide future
practice
requires that
we critically
think before
acting and
engage in
ongoing
appraisal
during and
after each
nursepatient
interaction

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review. Among the many schema available, there are
commonalities in their hierarchical structure, often represented by
a pyramid or publishing wedge (Haynes, 2005; McKibbon,
Eady, & Marks, 1999)
Level I: evidence rating is given to evidence obtained from
synthesized sources: systematic reviews, which can either, be
meta-analyses or structured integrative reviews of evidence.
Level II: derives from a single experimental study or randomized
controlled trial (RCT).
Level III: A quasi-experimental study such as a nonrandomized
controlled single group pre-posttest time series or matched casecontrolled study (Melnyck & Fineout-Overholt, 2005; FineoutOverholt et al., 2010).
Level IV: evidence is a non-experimental study, such as
correlational descriptive research or case controlled studies.
Level V: A case report systematically obtained and of verifiable
quality or program evaluation data
Level VI: evidence consists of the opinions of respected
authorities based on their clinical experience or the opinions of an
expert committee; including their interpretation of non-research
based information also includes regulatory or legal opinions.
(Melnyck et al., 2005; Fineout-Overholt et al., 2010)

PRACTICE BASED CARE

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Nurses understanding and use of EBP has evolved and expanded
over the past decade, however, they are only now beginning to
understand Practice Based Evidence. Bastable, (2008) suggest that
it could mean evidence derived from practice rather than research.
This includes possibly the results of systematically conducted
evaluations.
It could also mean patients response to care delivered on the basis
of clinical expertise and an understanding of individual patients
values. It may also include results from systematically conducted
quality improvement projects. The results of evaluations, the
outcomes of expert-delivered patient-centered care and the results
of quality improvement projects all comprise internal evidence
gathered by nurses.
Practice based care that is ongoing is an integral and important
component of professional practice. Intentional recognition of
these findings about practice as a source of evidence to guide
future practice requires that we critically think before acting and
engage in ongoing appraisal during and after each nurse-patient
interaction (Bastable, 2008) (reflection in action, reflection after
action)

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QUESTIONS
1. Distance education suggests that the learner and teacher are __________________________.
2. Define the term e-learning
3. Why do nurses need informatics?
4. Explain in your own words the term health literacy
5. State the difference between evidenced based practice and practice based care

ANSWERS
1. Separate from each other/they are not in the same place
2. The use of technology-based tools and processes to provide for customized learning anytime or anywhere.
3. To provide safe, competent, and compassionate care in an increasingly technical and digital environment.
4. This refers to how well an individual can read, interpret, and comprehend health information for maintaining an optimal level
of wellness
5. Practice based care is the use of critical thinking process, acting and engage in ongoing appraisal during and after each nursepatient interaction (reflection in action and after action, where evidenced based care is the use of the best available evidence to
support nursing care and patient outcomes

END OF SESSION

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