Learning Domains
Learning occurs in three domains: cognitive, psychomotor, and affective. Some learning sessions will involve only one domain, whereas others may involve all three. The cognitive domain is very important, because it will address the knowledge that a patient needs regarding his or her illness and how to manage it. The psychomotor domain addresses the skills that the patient will need to acquire to perform specific treatment modalities (e.g., the use of metered-dose inhalers). The affective domain involves teaching patients about the necessary attitudes and motivations for successfully living with their diseases.
Cognitive Domain
The cognitive domain is probably the easiest to translate into learning objectives because it involves the facts and concepts that the RT wants the patient to know and apply by the end of the education session. Objectives for the cognitive domain might include the following:
Any factual information that you expect the patient to understand and apply falls under the cognitive domain. Action verbs for the cognitive domain are included in Table 49-1.2
TABLE 49-1
Verbs for the Cognitive Domain
Purpose | Example Verbs |
1. Knowledge | Cite, define, read, identify, list, label, name, outline, recognize, select, state |
2. Comprehension | Convert, describe, defend, explain, illustrate, interpret, give examples of, predict, paraphrase, summarize, translate |
3. Application | Apply, compute, construct, demonstrate, change, calculate, use, estimate, modify, present, prepare, solve, proceed, relate, utilize |
4. Analysis | Analyze, associate, compare, contrast, determine, diagram, differentiate, discriminate, distinguish, outline, illustrate, separate |
5. Synthesis | Categorize, combine, compile, compose, create, design, develop, devise, integrate, modify, organize, plan, propose, rearrange, reorganize, revise, rewrite, translate, write |
6. Evaluation | Appraise, assess, compare, conclude, contrast, critique, discriminate, make a decision, support, evaluate, judge, weigh |
Modified from French D, Olrech N, Hale C, et al: Blended learning: an ongoing process for Internet integration, Victoria, Canada, 2003, Trafford Publishing.
Psychomotor Domain
Repetition and active involvement are important when teaching a psychomotor skill. RTs who teach new skills to patients need to provide plenty of opportunity for the patient to practice the activity. Simple demonstration of the skill to the patient is not enough. To confirm performance in the psychomotor domain, have your patients provide a return demonstration. Be sure to provide help and encouragement as needed. Be patient; not everyone develops skills at the same rate.
Examples of action verbs for the psychomotor domain are included in Table 49-2.2
TABLE 49-2
Verbs for the Psychomotor Domain
Purpose | Example Verbs |
1. Perception: prepares and recognizes sensory cues to want to respond | Detect, distinguish, differentiate, identify, isolate, relate, recognize, observe, perceive, see, watch |
2. Ready to act and respond | Begin, explain, move, react, show, state, establish a body position, place, posture, assume a stance, sit, stand, position |
3. Guided response: imitate and practice; rough sequencing of events | Copy, duplicate, imitate, manipulate, operate, try, practice, dismantle |
4. Efficiency: smooth sequencing of events | Assemble, calibrate, construct, display, fasten, fix, grind, manipulate, measure, mix, sketch, demonstrate, execute, increase speed, improve, make, show dexterity, pace, produce |
5. Perform alone: modifies, responds as needed | Act habitually, advance confidently, control, excel, guide, manage, master, organize, perform quickly and more accurately |
6. Creates a new or original model | Adapt, alter, rearrange, reorganize, revise |
Modified from French D, Olrech N, Hale C, et al: Blended learning: an ongoing process for Internet integration, Victoria, Canada, 2003, Trafford Publishing.
Affective Domain
The patient’s attitudes and motivations influence his or her ability to learn. It is important to remember that, with patient education, timing is everything. Patients who have recently been given a poor prognosis or who are in pain are not in an optimal position to learn. Maslow suggested a hierarchy of needs, and he identified physiologic needs as the most basic of human needs, followed by safety, love, esteem, and self-actualization.3 Lower-level needs must first be satisfied before moving on to higher-level needs. For example, if a patient is dyspneic or in pain, he or she will probably not be receptive to learning the steps that are involved in cleaning a small-volume nebulizer. It is important for RTs to assess a patient’s readiness to learn by talking with the patient and his or her family and by listening to the patient’s concerns. It is important to develop a relationship of trust and to be empathetic with the patient.
The RT should begin with easy-to-master facts and skills. After the patient conquers these, motivation should increase, and the patient will have a feeling of accomplishment. Motivation is also enhanced by presenting material clearly with the use of a variety of teaching methods and by relating the facts and skills to practical applications. Getting patients to see how these skills will benefit them is the key to motivation. Communicating to the patient that there is something that he or she can do to maintain or improve his or her health and sense of well-being is important.
Objectives in the affective domain—using the oxygen therapy example mentioned earlier—might include the following:
Affective domain action verbs are included in Table 49-3.2
TABLE 49-3
Verbs for the Affective Domain
Purpose | Example Verbs |
1. Receive: becoming aware of | Accept, acknowledge, alert, choose, give, attend, notice, perceive, tolerate, select |
2. Respond: interested in or doing something about something | Agree, assist with, aid, answer, assist, comply, conform, communicate, consent, label, obey, cooperate, follow, read, report, visit, volunteer, study |
3. Value: concerned about, developing an attitude | Adopt, assume, behave, choose, demonstrate, commit, desire, initiate, join, exhibit, express, prefer, seek, share |
4. Organize: arranging systematically, confirming | Adapt, adjust, arrange, classify, conceptualize, group, rank, validate, verify, strengthen, substantiate, corroborate, confirm |
5. Characterize: internalizing a set of values, championing | Demonstrate a change in lifestyle, discriminate, defend, influence, invite, listen, preach, qualify, question, serve, act upon, advocate, devote, expose, justify, support |
Modified from French D, Olrech N, Hale C, et al: Blended learning: an ongoing process for Internet integration, Victoria, Canada, 2003, Trafford Publishing.