1. Demonstration & Return Demonstration Courtney Crannell, Erin A. Eckhart, Geraldine Keeley, & Tiara Reid MSN7750 Teaching & Learning Wilmington University

2. Overview of Strategy Demonstration: done by teacher to show learner how to perform task/skill Return Demonstration: done by learner, attempts to perform task/skill, with cues from instructor Both: –Require different skill sets from teacher & learner –Effective in teaching psychomotor domain skills –May enhance cognitive & affective domains of learning Cognitive processes necessary for skill development Learner must correctly perceive & interpret stimuli from environment (cognitive & affective), then choose & control appropriate motor responses (psychomotor) Braungart & Braungart, 2008; Fitzgerald, 2008; Gaberson & Oermann,1999

3. Overview of Strategy Educational Theory: Behaviorist Learning Theory Both theory & teaching strategy: –Focus on directly observable behaviors –Observe learner behaviors/responses to stimuli & manipulate environment to create desired change Principles of Operant Conditioning Model directly applicable to return demonstration –Increase desired behaviors: Positive reinforcement: pleasant stimulus (i.e. compliments) Negative reinforcement: removal of unpleasant stimulus –Escape conditioning: applied unpleasant stimulus creates desired learner behavior –Avoidance conditioning: learner expects unpleasant stimulus, performs desired behavior to avoid unpleasant event –Decrease undesired behaviors: Non-reinforcement: no response from teacher Punishment: unpleasant teacher response Braungart & Braungart, 2008; Fitzgerald, 2008

4. Usages Application Prior to Demonstration: –Inform learners of purpose, sequential steps, equipment, & expected actions –Provide detailed proficiency check-list –Insure equipment is available & functioning Demonstration: –Passive activity for learners –Enhance learning: Slow timing Exaggerate steps Break lengthy procedures into smaller parts –Explain whys & sequencing of each step –Work with exact equipment learner will use Braungart & Braungart, 2008; Fitzgerald, 2008; McGovern-Billings & Halstead, 2005

5. Usages Application Return Demonstration: –Should occur close to time of demonstration –Reduce learner anxiety: Reinforce teacher’s role: coach not evaluator Stress perfection not expected on initial performance Explore alternative approaches –Incorporate games music, posters, etc. –Create relaxed, flexible atmosphere –Teacher’s role: Should remain silent; offer cues when necessary, briefly answer questions Avoid casual conversation & asking questions, these interrupt learner thought processes; inhibit retention & learning Praise learner – reinforces behavior & increases confidence Emphasize how to do correctly, rather than mistakes or how not to do Braungart & Braungart, 2008; Fitzgerald, 2008; McGovern-Billings & Halstead, 2005

6. Usages Application Return Demonstration: –Practice should be supervised until learner masters performance –Practice high-risk skills on model/simulator prior to clinical setting –Learners require varying levels of practice to become proficient –Compensate for individual learner differences Left-handed versus right-handed: –Same handed as learner? Sit on same side of table –Different handed from learner? Sit on opposite sides of table Sensory deficits: –Ensure learner has resources available to address (i.e. glasses, hearing aids, additional time for learning disabilities, etc.) –Provide learner with opportunity for mental rehearsal Associated with improved performance & retention Braungart & Braungart, 2008; Fitzgerald, 2008

7. Usages Settings May be used in any setting Frequently seen in clinical & learning lab Requires: –Small groups –All necessary equipment on hand –Limited interruptions –Repetition & Reinforcement Fitzgerald, 2008

8. Pros & Cons Pros of the Strategy Effective for learning in psychomotor domain –Skill acquisition: giving IM/IV injections or dressing changes) Creates active learner –Stimulates all senses Increases learner confidence, competence, & skill retention through repetition & constant reinforcement Provides over-learning to achieve goal Cons of the Strategy Requires small teacher-student ratios –Ensures learner able to visualize demonstration –Ensures adequate learner practice –Competency evaluation requires 1:1 teacher-student ratio Extra space & equipment needed depending on task/skill Extra costs for purchasing & replacing equipment Requires precise time allotment for both learner & teacher Braungart & Braungart, 2008; Fitzgerald, 2008

9. Pros & Cons Strategy Adaption General: –Provide teaching content & examples prior to return demonstration (i.e. case studies) Reinforces cognitive & affective domains Ties to Adult Learning Theory: makes it relevant to the learner, if they know why they’re learning it, they pick it up quicker Speeds learning, decreasing necessary class time commitment For Nurse Learners: –Offer course at multiple times to ensure small groups, makes return demonstration more beneficial & manageable –Re-use materials when possible to reduce costs Patient Education: –Return demonstration ensures mastery of new task/skill Fitzgerald, 2008; Hodson-Carlton & Worrell-Carlisle, 2009

10. Evaluation Determining Effectiveness Demonstration: –Is effective if learner able to reproduce task/skill accurately Return Demonstration: –Initial return demo may be done with peer/partner supervising task/skill Use of peers or videotaping of return demo to obtain feedback –Video replay allows students to evaluate themselves –Advantages: »Self-paced learning »Student must think about the necessary skills needed in order to critique »Reinforces learning; gives more opportunities to create mental images & procedural knowledge »Self-critique provides more ownership of evaluation & less antagonism toward faculty; & some research says is less stressful –Final Evaluation must be performed by an expert: ensures accuracy of learning Braungart & Braungart, 2008; Fitzgerald, 2008

11. Conclusion Demonstration & return demonstration are separate, but related functions –Demonstration is teaching –Return demonstration is a measure of learning Successful learning is: –A measure of psychomotor skill acquisition –Involves repetition of movement & constant reinforcement Benner’s Novice to Expert –Stages of clinical competence depend on skill acquisition & development 3 general aspects of skilled performance; the learner: –Moves from abstract principles to concrete experience –Changes perception; focus shifts from pieces to the whole –Changes from detached observer to an involved performer Benner, 1984; Braungart & Braungart, 2008

12. References Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Menlo Park, CA: Addison-Wesley. Braungart, M. M., Braungart, R. G. (2008). Applying learning theories to healthcare practice. In S. B. Bastable (Eds.), Nurse as educator: Principles of teaching and learning for nursing practice, (3rd ed., pp. 93-146). Sudbury, MA: Jones & Bartlett. Gaberson, K. B., & Oermann, M. H. (1999). Clinical teaching strategies in nursing. New York: Springer. Hodson-Carlton, K. E., & Worrell-Carlisle, P. J. (2009). The learning resource center. In D. Billings & J. Halstead (Eds.), Teaching in nursing, (3rd ed., pp. 349-376). St. Louis, MO: Saunders Elsevier. Fitzgerald, K. (2008). Instructional methods and settings. In S. B. Bastable (Eds.), Nurse as educator: Principles of teaching and learning for nursing practice, (3rd ed., pp. 429-471). Sudbury, MA: Jones & Bartlett. McGovern Billings, D., & Halstead, J. A. (2005). Teaching in nursing: A guide for faculty, (2nd ed.). St. Louis, MO: Elsevier Health.