The Craft of Teaching

Question: Have you ever been taught by someone who:

  1. Didn’t care if you understood them or not
  2. Thought the subject so boring or simple that you should already know it
  3. Became impatient or gave up when you didn’t absorb their training right away
  4. All of the above

Would you agree? It wasn’t nice. It didn’t help. It wasted everyone’s time. Maybe even it risked people’s safety, health and happiness. We don’t want to do that. Ever.

Like any craft, if teaching is worth doing, it is worth doing right.

Teaching is integral to nursing, and at the heart of the DD healthcare coordinator’s role. Teaching (should) happen at the bedside, on the phone, at staff team meetings, verbally and in writing. I’ve seen it done beautifully, and I’ve seen it done appallingly badly. This by the same people!

Why does this happen? Because we don’t always think of teaching as a set of skills. Instead, teaching is sometimes done:

  • On autopilot (teaching something the same way to every audience)
  • As an afterthought (something added in at the end without purpose or preparation)
  • As a defense mechanism (“my learners will mess it up, but don’t blame me, I did my job and taught ’em”)

Bad! Ugly! Awful! To avoid this, we must understand teaching as a concept and as a series of essential actions.

What is Teaching?

Teaching is helping someone understand something they didn’t already. Perhaps you need to clarify something that’s confusing (make it simple and easy to grasp). Maybe you need to clear up a misunderstanding (show the difference between two similar things). Maybe it’s an entirely new concept you need to explain, illustrate and apply for your learners. Or perhaps you’ve got to train someone to perform a task correctly.

Example: someone’s diet texture orders changed from regular to mechanical soft.

Regardless of the circumstance, teaching requires that you know the learner. You need to understand his educational background, work experience, life experience, and current level of knowledge/ability. You can’t base this on assumptions; you need to ask questions. You can’t take the answers at face value, either: you’ve got to probe for specifics.

Teacher: Do you know what a mechanical soft diet includes?

Learner: Yes, I do.

Teacher: Tell me, please.

Learner: Well, nothing hard and crunchy.

Off to a good start! But does the learner really grasp the full scope of the definition? What about foods that are chewy, like sirloin steak? What about foods that have hard and soft components, like crusty bread? And how important does your learner think this is, anyway?

What’s The Point?

To teach, you’ve got to spell out the details, but make the main points stand out. I usually try to provide something in writing (which requires some time spent in research/preparation). This isn’t an exhaustive explanation, but bullet points. It can be step-by-step or dos and don’ts. It cannot simply be generic; it has to be person-specific. For example, if the person is allergic to milk, but the diet texture instruction sheet says milk is OK for this person’s mechanical soft diet, I lose my student’s confidence (or worse, I teach someone to hurt this person by giving them something they’re allergic to.)

The Teaching Process

To teach, you’ve got to introduce, train, and review. (Translation: first you tell ’em what you’re going to tell ’em, then you tell ’em, then you tell ’em what you told ’em.) To prevent this essential repetition from getting boring (which means nobody’s listening and everybody’s wasting time) you’ve got to make it relevant. Share a what-if scenario:

Teacher: What if we get this diet texture right? Means no more time lost/suffering from aspiration pneumonias, right? What if we don’t follow it? Next time this person gets pneumonia, we’ll be responsible. We might even make him/her choke! That could cause death.

Feedback Is Essential

Until I require and evaluate feedback, I’m just a talking machine. Feedback tells you if your learner got the point. First, you have to care. If a teacher doesn’t care about the learner getting the point, he should hang it up right now. Second, you have to ask the right questions to draw out the main points and reinforce them. Third, you have to listen carefully to the response. Then go back and re-teach as needed. Maybe verbal feedback is suitable; if the circumstances require it written feedback may be appropriate. Sometimes the only way you’re going to know if you learner understood you is to require hands-on demonstration of a newly-learned skill.

Follow-up

To be effective, teaching has to generate follow-up. This might require future training sessions, or equipping a supervisor to tell the difference between their employees getting it wrong vs. getting it right. My role as healthcare coordinator includes empowerment to visit people’s homes and exercise a healthy curiosity as to whether their supports are being provided as per the orders from the doctor and the training from me.

I have no right to expect that anyone will perform anything better than they’re trained and supervised to perform. This brings me to my last point: training requires that the teacher be the expert. Sometimes, that isn’t me. If my people need training to a skill or concept that I don’t possess, I can’t be the teacher. It’s as simple as that. Not the end of the world; it just means I need to access other resources to get people the knowledge and skills they need to succeed. Accessing other training resources becomes an extension of my responsibility, helping others (and me) to grow into the needs we must fill.

Like any craft, if teaching is worth doing, it is worth doing right.

Why I Love Being a Healthcare Coordinator

If you’re a fireman, or a doctor, or a nurse, people get a pretty clear picture in their heads of what you do as soon as you tell them your job title. As it happens, though, that first impression is usually wrong. The real workplace is far more diverse and specialized than the one on TV.

I have the happy privilege of coordinating healthcare for persons with intellectual disabilities. Some of them live in group homes, others with a caregiver, and still others independently. I’m a nurse, and my training and disposition is to care for my patients. In this role I get to do that and much more.

I’m with my patients for the long term; many months and years in most cases. I get to visit my patients in their homes, meet with their families, and talk with their doctors and therapists. I help make sure their medications make sense and are being taken appropriately. There is often a difference between what people want and what they think their doctor wants. I help a person choose a plan of action. I help make sure their caregivers understand how to meet their needs and why their efforts are beneficial. I get to support staff teams who have been supporting the same individuals for years and are sometimes as close as families. I help ensure that complex needs continue to be met and important needs aren’t overlooked. When trouble strikes, I support and advocate with hospital personnel to help them meet the unique needs of my patients. At the end of a person’s lifespan, I support their families to understand the choices with which they are confronted. I assess, I consult, I confer, I teach, and I care. This is a really neat job.

It’s not all rainbows and unicorns. There have been moments of frustration and grief, fatigue and regret. From this pain have come some of the most important lessons I’ve learned.

When I started in this field in 2003, I had some experience as a nurse, and I had years of experience as a direct-support caregiver in a group home for adults with disabilities. I did not have a clue as to the role of a nurse in a group home, or why healthcare coordination is needed. For bringing me up the steep learning curve, I am forever grateful to my teacher, mentor, and friend Cheryl Deignan. I also enjoy sharing what I’ve learned, in the hopes of improving quality care and quality lives for everyone who relies on healthcare coordinators like me.