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Certificate Program for Surgical Services Educators

Learning Module

Instructional Design


Terri Goodman, PhD, RN, CNOR Consultant, Terri Goodman and Associates Dallas, Texas

Contributor: Kathleen Wagner, MSN, EdD Lecturer, Education Consultant College of Nursing University of Kentucky Lexington, Kentucky Reviewers: Heather Burrell, BSN, RN, CNOR Clinical Education Specialist, Surgical Services Olean General Hospital Olean, New York Christine Kennedy, BSN, MA, RN, CNOR Clinical Educator Lawrence and Memorial Hospital New London, Connecticut



Copyright 2010 by Competency & Credentialing Institute, Denver, Colo. ISBN: 978-0-9842595-2-6 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means (electronic, mechanical, photocopying, recording, or otherwise) without the prior written permission of the copyright owners. Printed in the United States of America


Learning Module

Table of Contents


Unit 1: Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Objectives ANCC Accreditation Statement Unit 2: Instructional Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Needs Assessment Evidence-based Literature Creating Behavioral Objectives Unit 3: Learning Styles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Development of an Outline Physical Setting Unit 4: Teaching Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Didactic/Lecture Group Work and Team Work Case Studies Role Play/Simulation One-on-One Learning Panel of Experts Videotapes/DVDs/Movie Clips Web-based Learning Algorithms Games Unit 5: Presentation Skill Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Teaching Tools/Support Materials Digital, Electronic, and Audiovisual Expertise Communication Rules of Engagement Personal Resources -- Your Own "Bag of Tricks" What Happens When Your Plans Get Foiled Glossary of Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

learning Module 3 -- Instructional design


Table of Contents


. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Appendices: Appendix 3-A: Bringing Learning Styles Into Balance . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Appendix 3-B: Outline for Malignant Hyperthermia In-service Program . . . . . . . . . . . . . 34 Appendix 3-C: Suggested Scenarios for Role Play/ Critical Thinking Exercises: Fire in the OR . . . . . . . . . . . . . . . . . . . . . . . 36 Appendix 3-D: Preparing a Power Point Presentation . . . . . . . . . . . . . . . . . . . . . . . . . . . 37


learning Module 3 -- Instructional design

Unit 1:

Learning Module



An activity that leaves both the learner and the educator energized, enthusiastic, and motivated is the result of careful planning. Even though educational content and goals may be diverse, all staff members are adult learners. Integrating adult learning principles, learning styles, teaching strategies, the judicious use of resources, and the talents and expertise of the nurse educator are all components of instructional design. It is not unusual for the responsibility to educate others to fall on those who have no academic preparation for teaching, but any nurse willing to dedicate the time and effort to learning to teach well can become an effective educator. This module will enable the nurse educator to apply the principles of instructional design to develop successful educational offerings, whether it is a day-long workshop or a 10-minute, just-in-time in-service.


Upon completion of this module, the participant should be able to: 1) Develop components of an effective teaching outline.

2) Construct behavioral objectives that reflect measurable achievement of designated outcomes. 3) Employ teaching methods that address varied learning styles.

ANCC Accreditation Statement

This continuing nursing education activity has been approved by the Association of periOperative Registered Nurses (AORN), an accredited approver by the American Nurses Credentialing Center's (ANCC) Commission on Accreditation. Activities that are approved by AORN are recognized as continuing education for registered nurses. This recognition does not imply that AORN or the ANCC Commission on Accreditation approves or endorses any product included in the presentation. Information on completing the Certificate Program for Surgical Services Educators and receiving continuing education may be found at, and in the Certificate Program packet located in the inside pocket of the binder. Note: Credit will not be awarded unless activities for all seven modules are completed.

learning Module 3 -- Instructional design


Unit 4:

Learning Module

Teaching Methods


Choosing the most appropriate teaching method in any learning situation is based on the type of material to be covered, the characteristics of the learners, and the resources available to the educator. Because nurses are adult learners and vary significantly in background, experience, and personality, it is wise to incorporate a variety of teaching methods; no single approach will meet the needs of all adult learners. A program developed and presented addressing all learning styles will benefit the maximum number of attendees. Whatever teaching method(s) are used, adult learners should understand expectations at the beginning of the session. Active participation will enhance the learning process. Providing the same information using a variety of platforms will reach the greatest number of staff, and should be incorporated into the design of the activity.

Didactic Approach/Lecture

The most traditional teaching method is the in-service, in which a lecture verbally transmits information to an audience of learners. This approach is familiar to most educators as it was the way most staff were taught in school. It is an effective way to impart information quickly (Fitzgerald, 2003) to a large number of people. Lectures are often easier for educators to prepare than the more creative and interactive approaches to teaching. Lectures appeal to auditory learners and those who prefer a more passive approach to education. Careful lecture preparation, at a minimum, includes attention to graphics, visual representation of materials, and handouts to appeal to visual learners, breaks in lecturing for questions, discussion to stimulate involvement and small group activities to clarify and reinforce concepts and break the monotony of "just listening." The educator's two primary challenges in preparing lectures/ in-services for staff nurses are engaging the audience and fitting the material into the time allotted. The key to capturing the attention of adult learners is a combination of relevance and varying teaching methods. In-service material that the audience perceives as important or that will enhance their performance in the clinical setting (e.g., new technology) will capture their attention. Keeping their attention is a function of the quality of the presentation. An engaging presentation would include visual materials to accompany the lecture and an opportunity for questions to reinforce understanding of the material. When the topic of the in-service is not new (e.g., an annual review of basic material), design a different approach to delivering the material. Use a game or puzzle that involves the audience, or a different style of presentation, such a movie clip or panel of experts. Very little time may be available for in-services. Prioritizing what is the most important "take away" from the in-service, as opposed to a historical narrative or "nice to know" information, can often shave minutes off a presentation and allows staff to focus on what is most important. Typically, learning is most effective during learning Module 3 -- Instructional design


Unit 4:Teaching Methods

the first 10 minutes of a presentation, so front-loading the most important information will encourage retention. Whenever possible, follow the in-service with opportunities for the staff to review the material on their own. Some material lends itself to a poster presentation that can be placed in the nurses' lounge or other central location for a period of time. A pamphlet or handout can be reviewed at a later date. If the in-service can be videotaped, staff can watch it again at their leisure. A video also permits staff who did not attend the original in-service (e.g., those who may be working other shifts or off duty) to participate in the learning activity.

Group Work and Team Work

Some venues (e.g., orientation, new nurse or refresher courses), in which multiple staff are involved, lend themselves nicely to group work. A group of nurse learners most often represents different age groups, different backgrounds, and a wide variety of experiences. In a group learning setting, individual nurses contribute differently to the learning process. The nurses learn a great deal from one another, and have the potential to achieve a greater learning experience than if each nurse were working alone. Discussion encourages the sharing of ideas and strategies. It stimulates active thinking, engagement with the topic, and can promote the application of previous learning. It also provides an opportunity to develop social ties and networking opportunities, both of which are needed for job satisfaction. Effective group work is the outcome of good planning. The educator must focus on material that is relevant to all members of the group. Decision-making and critical-thinking strategies can be very effective when presented in a group setting, where skills can be developed that will be applied in the clinical setting. Instructions to the group must be clear, and resources must be accessible. The educator should provide questions or an outline to guide the group work; the role of the educator is to facilitate, rather than dominate, the learning process. The group may need to be encouraged to stay on task and to utilize all members' talents and skills. Group participants have the potential to achieve a greater understanding of material, increased mastery of skills, and increased enthusiasm for self-directed learning.

Case Studies

Case studies and simulation are excellent tools for learning to function effectively in the clinical setting. Using real life situations emphasizes that learning is relevant to clinical practice. A case study is a "chunk of reality" -- a story that usually involves a patient in a situation that provides an opportunity for nurses to seek an effective solution to a problem. The patient care example may be a challenging, difficult, or unusual case, or one in which less than optiEDUCATOR'S PEARL mum outcomes were observed. Professional journals also provide examples for case studMedscape offers a variety of patient care situations in an ies. Collaboration among staff shifts the focus from assigning blame or responsibility, to easy-to- use electronic format. Passing a test at the end of the problem-solving through the identification of scenario will award continuing education credits. It's free, and all the relevant information available and investigating a variety of options for achieving a available at solution.


learning Module 3 -- Instructional design

Unit 4:Teaching Methods

Role Play/Simulation

Role-playing and simulation can be excellent When time is of the essence, a stopwatch can be used methods for engaging nurses and developing skills that are important in the practice setting. Simuto underscore the importance of time-sensitive decision lation refers to creating a hypothetical experience that closely models the environment in which the making (e.g., mock codes and Malignant Hyperthermia nurse is expected to demonstrate competence. crisis drills). Role play places the nurse in a defined position within that environment and provides an opportunity to use imagination to explore the experience from that person's perspective. Both role play and simulation are frequently used together in the popular skills lab format typically used when orienting new nurses to the OR. Clinical skills are taught largely through demonstration and return demonstration using simulation with mannequins, artificial body parts, or fellow nurses who emulate live patients. In a simulated environment, clinical skills and behaviors can be developed and strengthened through repetitive practice without fear of harmful consequences. The nurse can practice a technique, ask questions, test critical thinking, and validate judgment without endangering the patient in an actual situation. Simulation is an excellent tool for teaching nurses to participate effectively in challenging situations that have the potential for an adverse outcome (e.g., an intraoperative arrest, a patient with malignant hyperthermia, or a fire during a surgical procedure). Appendix 3-C lists scenarios for role play about fire situations in the OR. To be effective, a simulation must be relevant to the nurses' learning needs; it must represent the environment in which they are preparing to work, and it must engage them in a realistic practice situation. In order for learning to be completely transferable the simulation must mirror the real environment and the staff must react as if the events were actually occurring (Fitzgerald, 2003). When the clinical skill is non-invasive, using another student as the "patient" has the added benefit of live feedback. A good example is teaching positioning for surgical procedures. When a student is being positioned on the OR table, it is very reinforcing for the need for good technique when the "patient" expresses discomfort when arms are hyper-extended, knees don't have a pillow to support them, or heels rest directly on the mattress. Hands-on practice for the clinical setting most often requires supplies ­ gowns and gloves, sponges for counting, packs for opening a case, etc. These can be expensive and are often in short supply. The educator should ask colleagues in the OR and in Central Supply to save anything that is clean but would otherwise be discarded. The perioperative educator should also have a relationship with the hospital education department as well as local universities. These relationships might provide access to such practice settings as simulation labs. An overlooked benefit of simulation and role play is that both can amplify the importance of working cohesively with multidisciplinary teams and serve as an avenue for attitude change. Participants can appreciate the feelings and pressures associated with being in someone else's shoes, and can develop an effective approach


learning Module 3 -- Instructional design


Unit 4:Teaching Methods

to interacting with colleagues in that position. Understanding another person's perspective and the challenges he or she faces can lead to more productive and acceptable behavior (DeYoung, 2003). Make sure to factor in enough time for a debriefing session after a simulated experience. The information gleaned from the participants' observations are often as useful as the content of the simulated experience, and can be used for improving future activities (Rowles & Brigham, 2005).

One-on-One Learning

Do not underestimate the power of one-on-one teaching. Although time-consuming for the educator, observing an individual provides important information on learning styles and needs. It also provides an opportunity to evaluate progress without the contributions of peers. Teaching one-on-one requires the same level of preparation and the same teaching skills that make group learning successful. This model is used frequently by preceptors and mentors; however, consider utilizing one-on-one teaching for other situations, including the following. · · · · · · Thestaffmemberneedsadditionalsupportinachievingcompetenceoranidentifiedoutcome. Smallfacilitieswithlownumbersofstaff. Workloads/schedulesthatpreventnursesfromattendinganeducationalsessionandwhoneed to be "caught up" on the content. Orientingagroupofnurseswhowillbeassignedtodifferentclinicalspecialties. Orientingagroupofnewnurseswithvastlydifferentexperiencesrelatedtoperioperativenursing. "Front-loading"contentfornewlygraduatednursesbeforebeginningpatientcareintheoperating room.

Panel of Experts

It may take extra effort to enlist outside sources, but the wise nurse educator will take advantage of the expertise of others. Utilizing the contributions of experts diminishes the amount of time needed to prepare material to present. In addition to enhancing the learning environment with in-depth information and perspectives, experts typically have a broader range of experiences to share with staff on their chosen subject, making the content "come alive." As experts, they have a built-in credibility that the educator may lack. The use of experts is most effective when perspective is as important as the information itself. When considering asking an expert to present, inquire about interactions with the audience and comfort level with answering questions. They should be able to participate in a lively discussion and answer questions easily. The educator's responsibility is to involve invited experts in ways that accentuate their strengths and maximize their benefit to the learners. It is also the educator's responsibility to prepare the expert(s)


learning Module 3 -- Instructional design

Unit 4:Teaching Methods

for exactly what is expected of them, sharing with them the objectives for the activity, the amount of time they will have for the presentation, the number and types of staff attending, and what resources they will need. Key Point 3-3 lists examples of experts who can be utilized for learning activities. Take into account that it may be more effective to take the learners to the experts. A field trip to another department or facility can enhance knowledge, broaden perspectives, and encourage collegiality.

Key Point 3-3

Sources of Expert Speakers

Clincial Service Specialty Leads/Managers: · Sterile Processing · Radiology · Pathology · Perioperative Services · Nuclear Medicine · Infection Control Faculty at Local College Member of Local AORN Chapter Invection Control Nurse Chair of a Facility Committee (e.g., policy and procedure, quality improvement) Surgeons Industry Representatives Chaplain Member of Ethics Committee Clinical Nurse Specialist Wound Care Nurse Case Manager Hospital Education Department

Videotapes/DVDs/Movie Clips

Videotapes, DVDs, or video clips can bring the real world to the classroom. Ideal for visual learners, auditory learners will often create visual images as they listen. Viewing real life scenarios may be a very graphic and focused approach that captures the group's attention. Seeing the situation can be more compelling than hearing a story. This is especially true if the scenario involves many activities occurring simultaneously, such as managing a crisis situation (e.g., a fire in the OR, a cardiac arrest in surgery, or a disaster involving many patients who require surgery). If using this teaching strategy, always view the material first. There is nothing worse then setting up to watch a video and then finding out it was nothing like what was expected.

Web-based Learning

Becoming more popular, computer-based programs have been embraced by institutions as a cost-effective and efficient method of delivering information to a large number of people. In addition, staff in isolated areas of the country or with fewer resources can retrieve the same information as their counterparts in more populated areas. When determining if a web-based program should be included in the instructional design, Berger et al (2009, p. 132) recommend considering the following: · · · · · Thetargetaudiencehassuccessfullyusedweb-basedtraining(WBT)inthepast. Thetargetaudienceislarge. Thecontentwillbetaughtmultipletimes,andtofuturegroups. Thecontentisappropriateforweb-basedteaching. Thenecessaryresources(i.e.,technologyandexpertise)areavailableatareasonablecost. learning Module 3 -- Instructional design


Unit 4:Teaching Methods


Theinformationtechnology(IT)infrastructure(equipmentandaccess)issufficienttosupport the web-based approach.


An algorithm is set of simple instructions ­ a step -by-step plan or logical flow of activities ­ for achieving optimal results in specific situations. The presentation of information in a logical sequence is especially useful for visual, linear thinkers. Algorithms are used when there is little flexibility in the appropriate management of a situation, and each step of the situation can be answered "yes" or "no" with the corresponding action. The steps are done in precise order in every instance. The nursing process is an algorithm: APIE ­ assess, plan, implement, evaluate ­ a step by step guideline for managing patient care.


Game formats can be used to foster competition and fun to reinforce knowledge. To encourage active participation, the educator can enlist the help of the nurses in setting up the game environment, selecting a "show host" and establishing teams. Use games sparingly, more for a "break in the routine" than to teach as it is difficult to determine how much is actually learned with this method. Adult learners may consider games trivial and approach them with a negative attitude. It is the educator's responsibility to introduce a game by identifying its merit in terms of the learners' goals and objectives.

EDUCATOR'S PEARL There are many free downloadable programs on the internet that provide instruction on how to develop computer-based games based on popular game show formats ( has a wide variety of templates), or how to make a crossword puzzle or word scramble (


learning Module 3 -- Instructional design

Learning Module



Anderson, L.W., Krathwohl, D.R., Airasian, P.W., Cruikshank, K.A., Mayer, R.E., Pintrich, P.R., et al. (2001). A taxonomy for learning, teaching, and assessing (Abridged edition). New York, NY: Pearson Education. AORN. (2009). Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc. Berger, J., Topp, R., Davis, L., Jones, J., & Stewart, L. (2009). Comparison of web-based and face-toface training concerning patient education within a hospital system. Journal for Nurses in Staff Development, 25(3), 127-132. D'Alfonso, J., & Moss, R. (2005). Designing competencies that count. Denver, CO: Competency & Credentialing Institute. DeYoung, S. (2003). Activity based teaching strategies. In Teaching strategies for nurse educators (pp. 141-168). Upper Saddle River, NJ: Prentice Hall. Felder, R.M., & Silverman, L.K. (1988). Learning and teaching styles in engineering education. Engineering Education, 78(7), 674-681. Fitzgerald, K. (2003). Instructional methods. In S.B.Bastable (Ed.). Nurse as educator: Principles of teaching and learning for nursing practice. Sudbury, MA: Jones and Bartlett Publishers. Kozier, B., Erb, G., Berman, A., Snyder, S., Lake, R., & Harvey, S. (2004). Fundamentals of nursing: Concepts, process, and practice. Essex, England: Pearson Education Limited. Rowles, C., & Brigham, C. (2005). Strategies to promote critical thinking and active learning. In D. Billings & J. Halstead (Eds.). Teaching in nursing: A guide for faculty. St. Louis, MO: Elsevier Saunders.

Additional References and Resources

Berman, A.J., Snyder, S., Kozier, B.J., & Erb, G. (2007). Kozier & Erb's fundamentals of nursing (8th ed.), Chapter 11: Assessing. Upper Saddle River, NJ: Prentice Hall. Billings, D.M., & Halstead, J.A. (2008). Teaching in nursing: A guide for faculty (3rd ed.). St. Louis, MO: Elsevier Saunders.

learning Module 3 -- Instructional design



Deck, M. (2009). Instant teaching tools. Journal for Nurses in Staff Development, 25(2), 99. [Editor's note: This is a recurring column that focuses on teaching tips; columns in many issues may be valuable to nurse educators.] Haig, J. (2004). Information technology in health professional education: Why IT matters. Nurse Education Today, 24, 547-552. Harton, B.B. (2007). Clinical staff development: Planning and teaching for desired outcomes. Journal for Nurses in Staff Development, 23(6), 260-268. Klingbeil, C.G., Johnson, N.L., Totka, J.P., & Doyle, L. (2009). How to select the correct education strategy: When not to go online. Journal for Nurses in Staff Development, 25(6), 287-291. McCain, C.L. (2008). The right mix to support electronic medical record training. Journal for Nurses in Staff Development, 24(4), 151-154. McKane, C.L. (2004). Clinical objectives: A method to evaluate clinical performance in critical care orientation. Journal for Nurses in Staff Development, 20(3), 134-139. Mind Tools: Essential skills for an excellent career. Retrieved Jan. 8, 2010 from Murray, C., Grant, M.J., Howarth, J.L. (2008). The use of simulation as a teaching and learning approach to support practice learning. Nurse Education in Practice, 8, 5-8. Pape, T.M. (2007). Creating an inviting perioperative learning experience. AORN Journal, 85(2), 354, 356358, 360-362, 365-366. Phillips, N. (2007). Berry and Kohn's operating room technique. St. Louis, MO: Mosby. Phippen, M.L., Ulmer, B.C., & Wells, M.P. (2009). Competency for safe patient care during operative and invasive procedures. Denver, CO: Competency & Credentialing Institute. Rogal, S. M.M., & Snider, P.D. (2008). Rethinking the lecture: The application of problem-based learning methods to atypical contexts. Nurse Education in Practice, 8, 213-219. Rothrock, J. (2007). Alexander's care of the patient in surgery. St. Louis, MO: Mosby. Shanley, C. (2004). Extending the role of nurses in staff development by combining an organizational change perspective with an individual learner perspective. Journal for Nurses in Staff Development, 20(2), 83-89. Smith, S.J. (2009). Looking for simulation resources? Try SIRC! Clinical Simulation in Nursing, 5, e195-e197. Smith-Stoner, M.(2009). Web-based broadcast of simulations: Expanding access to learning. Nurse Educator, 34(6), 266-270.


learning Module 3 -- Instructional design


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