teaching material: ways to enhance visual aids in staff development programs

FEBRUARY 1990, VOL. 51, NO 2 A O R N J O U R N A L

Teaching Material WAYS TO ENHANCE VISUAL AIDS IN STAFF DEVELOPMENT PROGRAMS

Margaret E. Kuhn, RN

ith today’s rapidly advancing technology, there is little doubt that periop- W erative nursing is a highly complex and

dynamic area. Recent innovations in surgical equipment and techniques have contributed to high quality patient care. The need for periop- erative nurses to maintain state-of-the-art knowledge and skills presents a considerable challenge to staff development personnel.

Media resources can be particularly helpful in providing concrete representations for highly technical or abstract information. Resources such as printed illustrations and diagrams, programmed instruction packages, transparencies, films, slides, and videos frequently are used in staff development programs.

Adult learners in particular need and want instruction to meet their individual learning needs and work situations.’ This article presents one model for systematic instructional design that may help staff development instructors use available media resources effectively to meet the needs of adult learners.

Systematic Instructional Design

taff development educators can individual- ize teaching programs by using a systematic S approach to instructional design. The

importance of systematic instructional design becomes evident when the many variables inherent in any educational encounter are considered. These variables may be related to the instructor, the learner, or the educational task itself. Adult learners have diverse backgrounds and expe-

riences, and therefore, may differ in learning needs, style, preferences, motivation, prerequisite knowledge, and skills. Instructors themselves may have preferences for certain teaching strategies and methods. They also may have different philos- ophies of nursing, education, and evaluation, which influence instructors’ presentation styles and approaches to educational programs. Teaching strategies also will vary among facilities because of available resources and the time that is allotted to implement educational programs.2

Instructors can determine the objectives and content of the program by assessing learning needs of the group. Program objectives and content should meet individual learning needs, and be consistent with the needs of the institution, the profession, and the clients.3

The ASSURE model is one example of systematic instructional design that may be applied to staff development. This model provides guidelines that effectively use media resources. The acronym ASSURE represents six steps in selecting and using media for instructional purposes: (1) analyze learner characteristics, (2) state objectives, (3) select, modify, or design materials, (4) use materials, (5) require learner response, and (6)

Margaret E. Kuhn, Rh? MSN, was a graduate student at the University of plttsburgh School of Nursing when this article was written She received a bachelor of science degree in nursing from Saint Mary’s College, Notre Dame, In4 and a master of science degree in nursing from the University of Pittsburgh School of Nursing.

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evaluate! These guidelines are intended to follow a thorough needs assessment to determine appropriate areas of content and target audience.

Analyzing Learner Characteristics

efore developing objectives, the instructor should determine how familiar the audience B is with the content. This information might

be available from the needs assessment or from the instructor’s knowledge of the group. If the group includes new employees or those from other departments, the instructor should use other techniques of assessing the audience such as developing a pretest or skills inventory, conducting surveys or interviews with staff members and supervisors, or reviewing available training records.

If a wide variation of knowledge is noted, the instructor may divide participants into more homogeneous groups and adapt the teaching methods accordingly. Heterogeneous groups, however, can facilitate learning when participants are encouraged to share their diverse backgrounds and experiences.

The attitudes of the group toward the content also should be considered when selecting instructional media. When showing films on potentially sensitive or controversial subjects (eg, acquired immune deficiency syndrome, organ harvesting), the instructor should prepare the audience either beforehand in the introduction or through discussion. Conversely, routine material that generates learner apathy should be taught by using a more active or dramatic strategy?

Stating Objectives

nstructional objectives should state what the learner will be able to do as a result of the I instruction. How a learner perceives the

agreement between his or her own goals and objectives and those of the educational offering influences the success of the instruction.6 If the instructor predetermines the learning objectives, he or she is responsible for relating the established goals and objectives to a student’s goals and objectives.

The objectives influence the instructor’s selection of teaching strategy and medium. The teaching aids selected should contribute to success in meeting the objectives? For example, if the objective is to identify the parts of an electrocautery unit, the instructor could present a diagram of that unit. If, however, participants will be required to demonstrate the safe use of an electrocautery unit, the instructor should demonstrate how the device works and give the students time for hands- on experience.

In addition, instructional objectives are the basis for evaluation of the learning experience. Therefore, the objectives must be specific to the desired outcomes and serve as measurable indicators of achievement.

Selecting Instructional Materials

n selecting instructional materials, the instructor bases his or her decision on the I knowledge of learners, instructional objectives

and methods, and available resources, personnel and equipment. Many appropriate audiovisual materials are available commercially and may be obtained through catalogues, professional organ- izations, and drug and equipment companies.

Questions to consider in selecting the kind of equipment to use include: Is the audiovisual aid necessary? Does the environment allow for its proper use? What is the time needed to obtain and use the materials? Are purchase or rental costs involved ?

To be effective, some materials may have to be modified by editing unnecessary segments, adding supplementary materials, or providing narration. Adapting available media resources can be cost-effective and save time in obtaining instructional materials; however, instructors should be aware of copyright laws and restrictions as they relate to commercially produced materials.

Audio visual Aids

udiovisual production firms or commercial printing and graphics businesses can A assist instructors in producing high quality

audiovisual materials from master copies or ideas


Computer hardware and software have been developed to reproduce images from

a computer screen onto slide film.

alone. Commercial production may be expensive, but the cost should be weighed against the time, money, and expertise required to produce and use the material in-house, including the initial outlay for the equipment. Commercial production may be justified for items that will receive long-term use or for special projects that require highly technical production techniques.

If new materials are not available, instructors can design them by using available resources such as medical photography and illustration personnel. Materials that can be produced in-house include photographs, diagrams, posters, drawings, graphics, flip charts, bulletin board displays, models, and realia (ie, the actual object or piece of equipment). Many of these items can be viewed as a group or circulated among individuals during a presentation or included as part of a self-learning package. Conversely, photographic slides and overhead transparencies are visual aids that are well-suited to large audiences, but they are more expensive.

Slides, Slides can be produced using a camera and slide film; slides produced from print film will be of lesser quality. Skill is needed to compose an image that is visually appealing and presents the subject clearly. The picture should be framed to eliminate irrelevant elements in the background to focus only on the subject.

One method of producing high-quality slides of a still subject is to use a copy stand. A copy stand provides a flat surface on which to stage the material to be photographed. Additional overhead brackets are provided for lighting and the camera itself. The camera holder usually can be adjusted for height. The camera can then be raised or lowered to frame the subject in the viewfinder. Irrelevant background also can be masked out by making a frame for the subject with paper or poster board.

Computer hardware and software have been developed to reproduce images from a computer

screen onto slide film. This new technology allows the image to be previewed and edited before printing. It also is an easy way to modify color and design as desired.

The instructor also may wish to produce gray or black slides for the beginning, end, or lengthy narrative segments of the presentation. This eliminates distractions caused by slides that are irrelevant to the narration or a glaring white screen.

After slides are produced, they should be stored carefully to prevent damage from bending, warping, or surface soiling from dust and fingerprints. Slides should be marked to indicate the right side up and the intended sequence. This will allow the instructor to quickly reorganize them if dropped or shuffled.

Overhead transparencies. When using transparencies, the instructor can prepare the material ahead of time or draw it in view of the audience during the presentation using black or colored markers or wax pencils. “Write-on” transparency film is specially manufactured for this purpose. Blue-tinted film also is available to help reduce glare.

Overhead transparencies can be quickly and inexpensively produced using one or several methods. They can be constructed to help illustrate ideas developed in a sequence. The base transparency represents the first idea or step to be presented. The base transparency is taped to a frame made from poster board. Other transparencies are then created to illustrate subsequent steps or ideas in the series and are laid over the base transparency and taped to the frame on one side only, creating a hinge. The transparencies can be flipped onto the projector stage as needed.

Another method used to produce overhead transparencies is the thermal film process. This method requires a thermal copy machine and specially treated thermal acetate film which is available in a variety of colors. The master copy must be prepared with lettering and markings of

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Do

Fig 1 Do’s and Don’ts of Legibility

PRINCIPLES

OF ASEPSIS

I I

Use lettering that is all capitals, double spaced, and at least three eights of an inch (slides) and three sixteenth of an inch (transparencies).

MANAGEMENT

OF ORTHOPEDIC

IN JURIES Use typeface that is large.

TO BE, OR NOT TO B E

THAT IS THE QUESTION

Hamlet William Shakespeare

Keep the message simple.

Don’t

G

Don’t use a poor quality typewriter ribbon. Any imperfections will be magnified. Lettering should be dark and as uniform as possible.

I I

Don’t use standard-sized typeface generally because it is too small to read.

To be, or not to be: that is the question: Whether ’tis nobler in the mind to suffer The slings and arrows of outrageous fortune, Or to take arms against a sea of troubles, And by oppositng end them? To die: to sleep; No more; and, by a sleep to say we end The heartaches and the thousand natural shocks That flesh is heir to, ‘tis a consummation Devoutly to be wished. To die, to sleep;

Don’t use copy that is longer than seven lines.

d) 543


a carbonaceous substance (eg, soft lead pencil, India ink, black printer's ink, photocopier ink or carbon typewriter ribbon) or it will not transfer onto the film.

A sheet of thermal film is placed over the master with the notch in the upper right-hand corner of the master. These sheets are then fed together into the thermal copier. The sheets are separated when received from the machine. The thermal film is ready to be projected, and the master may be reused.

Xerographic or electrostatic copiers also can be used to produce transparencies using specially treated film. Although special film is available for thermal copiers to make color images on transparency film (eg, red on clear, blue on clear), xerographic copiers produce only black images on clear or colored film; however, some advanced copiers can produce color transparencies. Xerographic copiers do have the advantage over thermal copiers of not requiring master copies produced with a carbonaceous material.

Overhead projectors can be adapted with special hardware to project computer screen images. In this way, an instructor could use the computer to change the overhead projection as desired, or to display a program being run by the computer. Computers also can be used to produce color transparencies using ink jet printers with compatible transparency film.

Slides and overhead transparencies are best used to convey a single, visual concept. If extensive wording is required, handouts will be more effective. Some problems that can affect the legibility of projected visuals are illustrated in Figure 1.

Lettering

W 'ord slides can be created using the copy stand by photographing lettering reproduced onto colored paper. To be

legible when projected, the lettering on the master copy should be all capitals, double spaced, and no more than seven lines long. The size of the lettering will vary with the distance of the camera from the master copy. Standard typeface is generally too small for this purpose; however, this

problem can be overcome by using an enlarging copier or a typewriter that can produce an extra- large typeface.

Suitable lettering also can be hand drawn or produced with cutouts, stencils, dry-transfer letters, computers with laser or ink jet printers, or commercial typesetting. Lettering at least three eights of an inch high seems to work well when photographing a master copy produced on 8 x 1 1% inch paper.

Lettering and background should be as dark and uniform as possible because small impedec- tions will become more obvious when magnified by a projector. It is best to avoid white or shiny backgrounds or surfaces because they tend to produce glare.

When making lettering for images to be projected, certain color lettering to background combinations produce the most legible results. Black lettering on a yellow background provides the best legibility (Fig 2). In descending order of legibility, other color combinations are green, red, or blue lettering on a white (clear) background; white lettering (clear) on a blue background; black lettering on a white (clear) backgrow@ and yellow lettering on a black background.8

There should be no more than six words per line and six or less lines per transparency with letters at least three sixteenths of an inch high. A simple way to check for the legibility of an overhead transparency is to place it on the floor with a white background. If it can be read from a standing position, it should be legible when projected.

Stencils and cutouts can be used to trace shapes and lettering that are difficult to reproduce freehand. Color adhesive film can be cut out and applied to transparencies to add high quality color details. Marking pens are available in permanent and nonpermanent varieties; however, not all color markers project in color and not all markers produce dark, uniform markings on acetate transparency film. For the best results, use markers that are labeled for use on overhead transparencies.

Additional notes or details can be temporarily added to a permanent transparency by covering it with another clear sheet of transparency film

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Fig 2 Color Combinations and Legibility

PRINCIPLES

OF ASEPSIS

PRINCIPLES

OF ASEPSIS

Black lettering on a yellow background is the most legible. background is acceptable.

Green, red, or blue lettering on a white (clear)

White (clear) lettering on a blue background is less legible.

PRINCIPLES OF ASEPSIS

Black lettering on a white (clear) background is hard to read.

Yellow lettering on a black background is the most difficult to read.

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Nonprojected

Drawings and illustrations

Table 1 Instructional Media/Learning Objective Matrix

~

Learning facts, Learning visual Theories identifications

Medium High

I Learning Objective I Instructional Medium

Photographic prints Chalkboard

Low High Medium High

Models & mock-ups Simulators (sound & visual) Real objects Exhibits & displays



Programmed material Printed material Audio recordings Projected

I 2" x 2" slides I Medium I High I

High Low High Low High Low

Overhead projection Medium I High I Opaque projection Filmstrips

I I - I

Motion picture (sound) I Medium I Medium 1

Medium High Medium High

Motion picture (silent)

before marking. Although other types of clear plastic can be used instead of acetate transparency film, they may not be as easy to mark and handle.

Although slides and overhead transparencies require additional time and money to produce, they can add a distinctive professional appearance to educational presentations. But even the most spectacular visuals can be ineffective when used inappropriately. The next section will outline guidelines to be applied in making optimal use of media resources.

Medium I High 1

Using Materials

here is not necessarily any one best medium to use in any one teachingAearning T situation-several strategies may be

appropriate for the proposed educational task. Instructional strategy and audiovisual material should be based on the objectives or desired learning outcome. Although instructors cannot know the ultimate results of any instructional program in advance, they should select the medium that is most likely to help this specific

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Comprehending and appbing Performing perceptual Influencing attitudes, facts, principles, concepts motor skills opinions, motivations

High Medium Medium

1

I Medium I Low I Low I

Medium High

~

Medium I Low I Low High LOW

High Low Medium Medium

High

High Low Low Medium Low Medium

~ ~

High Low Medium Low Low Medium

1 I I

I Medium I Low 1 Low 1 I Medium I Medium

I Medium I LOW I Low I

Low

Medium Medium

Medium Low High Medium

group of learners achieve the desired objectives. Table 1 presents some guidelines for the use of various instructional media in accomplishing differing learning objectives.

Available media resources should be carefully previewed and evaluated before they are used. Alternative strategies should be considered in case of equipment failure or last minute changes in the presentation. Whenever possible, a dry run should be presented to avoid unexpected problems with the material. Materials should be examined for damage, flaws, inappropriate content, and

High High

proper sequencing. The instructor should know how to operate the equipment and know some basic troubleshooting techniques.

The instructor also should investigate the classroom or learning environment before the presentation. The area should provide comfortable seating, lighting, and temperature conditions. There should be adequate space and outlets for the equipment. The equipment should be checked to see that it is functioning properly and that the participants will be able to see and hear with relative ease.

High High High High

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Requiring Learner Response

hrough an introduction and program objectives, the instructor can motivate T learners, establish a “need to know,” and

direct learners’ attention to important aspects of the presentation? During and after the presentation, the instructor should seek feedback from the learners. Feedback reinforces learning and gives the instructor some important cues as to the effectiveness of the presentation. Feedback can be obtained through discussions, question and answer periods, or return demonstrations.

Many adults fear making mistakes or appearing incompetent in group learning situations. Instruc- tors can help ease their anxieties by creating a relaxed, nonthreatening learning environment. This can be done, for example, by involving all members of the group in discussions directed at joint problem-solving or sharing relevant experiences.’O Whichever technique is selected, adults will respond best in a nonjudgmental learning environment that protects and promotes their sense of self-esteem. Through learner response, the learner is able to integrate what he or she learned into everyday practice. Knowledge that is not used will be lost over time. Therefore, instruction should include follow-up practice and application whenever possible.

Evaluation

he type of evaluation selected (eg, written test, performance evaluation) will depend T on the purpose of the evaluation. It should

be based directly upon specified learning objectives. Criteria for amptable performance and plans for remediation should be established in advance as necessary. Not all situations call for formal testing, and therefore, alternatives to testing should be considered (eg, supervised practice sessions with formative feedback, providing participants with questions for review, self- evaluation tools).

In addition to learning objectives, the instructor also may evaluate the effectiveness of the instructional media and methods. Staff development instructors often need to repeat educational

programs, and therefore, feedback can help improve future presentations. Instructors can observe the group’s response during the presentation and administer follow-up questionnaires.

Summary

ost nurse educators incorporate some kind of media into their teaching M strategies. The widespread availability

of professionally developed media resources, however, does not guarantee effectiveness. The ASSURE model was presented as one method of selecting these materials on the basis of their suitability for the subject, the adult learner, and the instructor in achieving the desired educational outcomes. Furthermore, it offers guidelines for modifying or designing materials to be used in settings where media resources may be limited. The ASSURE model can help staff development educators provide effective instruction by making the best use of available media through the use of systematic instructional design principles. 0

Notes 1. L D Lanese, “Applying principles of learning

to adult training programs,” Educational Technology 23 (March 1983) 16.

2. A B OConnor, Nursing Staff Development and Continuing Education (Boston: Little, Brown and Co, 1986) 76-77.

3. Ibid, 75. 4. R Heinich, M Molenda, J D Russell, Instructional

Media and the New Technologies of Instruction, second ed (New York City: Macrnillan Publishing Co, 1985) 34-35.

5. Ibid 36. 6. Lanese, “Applying principles of learning to adult

7. Heinich, Molenda, Russell, Instmcriond Media

8. Ibid, 82-83. 9. Ibid, 51.

training programs,” 16.

and the New Technologies of Instruction, 37.

10. Lanese, “Applying principles of learning to adult training programs,” 16.

Suggested reading Amrnon-Gaberson, K B. “Adulting learning principles:

Applications for preceptor programs.” AORN Journal 45 (April 1987) 961-963.

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teaching material: ways to enhance visual aids in staff development programs

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