AORN education
How to write objectives for education programs Fulfill asinine approval requirementsDecipher the crazy jargon-Complete bureaucratic paperwork-ldentify objectives. Let's forget about sponsoring a workshop; it is not worth all the trouble of completing AOFiN's approvalapplication. Besides, National should tnrst our good intentions. Have you had similar negative thoughts about AORN's approval process for educational offerings? In most instances, the issue does not seem to be disagreement with the necessity for an approval process, for members want AORN to monitor the quality of continuing education for OR nurses. Most concur that it is imperative that continuing education should be subject to a thorough system of appraisal. However, members often have an attitude of resignation when required to list the objectives for their workshop. Feelings of inadequacy generate anger which generalizes to the entire approval process. They blame National for an ineffectual system. The difficulty, however, is not with the system, but with developing effective objectives that state learning outcomes in behavioral terms. The Education Department staff must admit they, too, are distressed when they receive broad objectives that are ambiguous and unmeasurable. Poorly stated objectives
illustrate the fallacy of the assumption that chapter members intuitively know why they are offering a specific educational workshop. Furthermore, belief or trust in the constructive motives of the sponsor is not reinforced by such objectives. Approval cannot be given to a workshop, or other educational program, when objectives are inadequate. Global, idealistic promises on the part of a chapter are not enough. Potential participants expect to know the learning outcomes of educational activity. Chapters must justify the merit of educational offerings by clearly identifying their intentions within the context of written objectives. What should the learner be able to do upon completing the workshop? The answer to this provides rationale for sponsoring a workshop as well as a framework for evaluation. Because members of the National Committee on Education, which currently approves AORN's educational undertakings, and Education Department staff members became increasingly aware that members needed assistance in writing objectives, guidelines were developed. The following guidelines are not a panacea but should aid in formulating meaningful objectives. Definition of an objective An objective consists of a statement that clearly and concisely describes a measurable change in the behavior of the leamer/participant as a result of involvement in a learning activity. Purpose of objectives Objectives state desired learning outcomes of an educational activity. They
AORN Journal, November 1975, Vol22, No 5
693
define precisely what behaviors the participant can be expected to demonstrate as a result of exposure to a given educational offering. Objectives identify, for the learner and the teacher, the terminal behaviors expected on the part of the learner upon completion of the instruction. 0 Characteristics of objectives 1. focus upon learner behavior rather than teacher behavior 2. tell exactly what a learner will be able to do upon completion of a given educational offering 3. contain only one expected learner behavior per statement 4. emphasize one of three realms or domains of behavior a. Cognitive objectives describe thinking or intellectual activities associated with acquiring knowledge, eg, to write, discuss, compare, contrast, analyze, differentiate. b. Psychomotor objectives describe the acting behaviors associated with performing skills, eg, to collect, scrub, circulate, open, cut, demonstrate. c. Affective objectives describe feeling behaviors associated with the formulation of attitudes, values, interests, appreciations, sensitivity, eg, to empathize, actualize, experience, feel, accept, contribute, volunteer. 5. communicate to the learner what he can reasonably expect to gain from particular educational offering 6. determine the selection of specific program content, speakers, and teaching methodologies 7. provide the basis for evaluating the effectiveness of the educational offering. 0 Cautions Although objectives can be classified into these domains for convenience of comparison, there is no pure cognitive, psychomotor, or affective objective. Usually, every objective contains some aspects of the three; but there is primary emphasis on one domain.’ Many objectives stress cognitive outcomes because they are easier to identify, write, and measure. Although the other two domains are equally important, members may prefer to develop expertise in writing objec-
694
tives by emphasizing cognitive objectives. Six broad levels encompassed within the cognitive domain are: knowledge, comprehension, application, analysis, synthesis, and evaluation.2 The mastery of manipulative and motor skills is essential for operating room nurses. If the workshop design allows an opportunity for participants to actually demonstrate certain skills, then psychomotor objectives should be delineated. Affective objectives are the most difficult to write because affective behavior is often internalized and, therefore, difficult to mea~ure.~ Still, this domain is critically important, for part of the educational process is usually aimed at changing a participant’s values or attitudes. The situation with respect to affective objectives is primitive, that is, few individuals know how to write or measure Objectives. An attempt has been made to develop a continuum that would order affective behavior: receiving, responding, valuing, organization of a value system, and characterization by a value or value com~lex.~ Chapter members may want to read the references or seek advice from an educator in their area when identifying affective objectives. Pitfalls to avoid when writing objectives 1. Refrain from overly wordy objectives. Such statements confuse the issue and confound the reader. For example, “to be able to apply principles of asepsis” is an overly wordy psychomotor objective. More clearly stated, it might read “apply principles of asepsis in establishing a reverse isolation unit.” 2. Avoid loaded words that are easily misinterpreted or contain a multiplicity of behaviors. The classic example is the commonly employed “to understand.” Understanding is a complex cognitive behavior composed of several levels of more explicit behaviors. “To internalize” and “to motivate” are two other examples of compound, value-loaded action words. One method of avoiding the use of such words is to ask, “How will the learner display his mastery of content if he is motivated or understands?” 3. Avoid global statements or those which bunch several behaviors within one objec-
AORN Journal, November 1975, Vol22, No 5
void including program content for which no objectives are written.
A
tive. “To increase operating room nurses’ knowledge and promote effective communication between staff, patients, and family” is an example of both problems. How will the program planners know whether or not the learners have increased their knowledge unless they are given a pretest and a posttest? The statement is exceedingly broad and more appropriate as a purpose for sponsoring an educational activity. “Effective communication” establishes such a broad content base that years of formal schooling can be devoted to it. Exactly what is effective communication? In addition, the statement violates two cardinal principles of objective writing: it contains two action words, increase and promote, and it is not written in terms of the learners’ behavior. 4. Refrain from espousing personal opinion or chapter philosophy. “To encourage nurses to accept personal responsibility for continuing education” contains a philosophical belief to which learners conceivably may not subscribe. Every learner is entitled to make up his own mind on a subject without being brainwashed. The objective also is a global statement more appropriate for identifying the purpose for sponsoring the offering. A cognitive objective derived from such a purpose could be stated “to discuss the advantages and disadvantages of mandatory continuing education requirements for nurses.” 5. Avoid using nonmeasurable terms. Such terms include to appreciate, recognize, guide, know, believe, enjoy, encourage, increase, understand, motivate, promote. 6. Avoid including program content for which no objectives are written. Large
696
categories of content should have at least one objective Written for each to defend their inclusion in the offering. Program planners take a large subject matter heading, subdivide it into designated content areas, and write objectives for each of those areas. It is not necessary to have an objective for every detail of content, nor is it tenable to write one or two broad objectives for a one or two-day educational activity. The reality lies somewhere in the middle. Sample objectives 1. Discuss the concept of nursing accountability. (cognitive) 2. identify the principles of surgical asepsis as applied in the operating room. (cognitive) 3. Describe ways that operating room nurses utilize the concept of quality assurance in providing care to patients having surgery. (cognitive) 4. State the advantages and disadvantages of mandatory continuing education requirements for nurses. (cognitive) 5. Construct a budget for a particular operating room suite. (psychomotor) 6. Prepare supplies and equipment for use on the sterile field. (psychomotor) 7. Manage personal anxiety in a constructive manner within a crisis situation in the operating room. (affective) 8. Assert one’s self as a patient’s advocate. (affective) Initially, objectives may not reflect each of the specified characteristics. For example, it is hard to write an objective that focuses on one expected outcome. Often, we clump several expected outcomes together. Some of us write teacher objectives rather than
AORN Journal, November 1975, Vol22, No 5
student objectives; therefore, we fail to state what the learner will be able to do upon completion of our workshop. It takes practice using the above guidelines before the process becomes easy. Yet, the final product, behavioral objectives, will enable the planners of a workshop to be selective in choosing specific program content, speakers, and teaching methodologies. They can also develop an evaluation tool designed to measure the achievement of stated objectives, thus facilitating a meaningful evaluation of the effectiveness of their workshop. Ideally, the workshop will be more successful because both instructors and learners know the expected outcomes and are motivated to achieve the desired results. Ultimately, members can readily accept the praise from participants because they know the workshop was soundly designed upon educational principles.
Carol J Alexander, RN, MS Director of Education Gwen H Dodge, RN, MS Ass ’t Director of Education Bernice McPhee, RN, EdM NCE Representative Region I Notes 1. Thomas E Cyes, Working with Performance Objectives in Nursing and Allied Health Sciences (Massachusetts: Educational Development Associates, 1975). 2. Benjamin S Bloom, ed. Taxonomy of Educational Objectives: The Classificationof Educatlonal Goals: Handbook I; Cognitive Domain (New York: David McKay Company Inc, 1956). 3. Cyes, Working with Performance Objectives. 4. David R Krathwohl, Benjamin S Bloom, B e rtram B Masia, Taxonomy of Educational Objectives: The Classification of Educational Goals: Handbook /I; Affective Domain (New York: David McKay Company Inc, 1964). References Gronlund, Norman E. Stating Behavioral Objectives for Classroom Instruction. New York: Macmillan Co,1970. Harrow, Anita J. A Taxonomy of the Psychomotor Domain: A Guide for Developing Behavioral Objectives. New York: David McKay Company Inc, 1972. Mager, Robert F. Preparing Objectives for Programmed Instructlon. San Francisco: Fearon Publishers, 1962.
698
Relationship between pill, breast carcinoma “There is no evidence that breast carcinoma increases when taking the pill. There is no study that relates the pill to the cause of breast cancer,” according to Nathan G Kase, MD, professor and chairman of the department of obstetrics and gynecology, Yale University Medical School, New Haven, Conn. Speaking at a symposium on “Current concepts in oral contraceptive treatment,” Dr Kase stated that once cancer of the breast is present, however, it is an absolute contraindication to the use of the pill. Dr Kase pointed out that clinicians sometimes have trouble differentiatingbreast carcinoma from benign cystic hyperplasia of the breast, a condition that “may actually improve in a small percentage of women on the pill.” Noting that the uncertain physician may take the worried well patient off the pill because he feels he cannot distinguish benign breast disease from a malignancy, Dr Kase emphasized that cystic hyperplasia is not a premalignant disease. “There appear to be at least two types of endometrial carcinoma,” Or Kase explained. “One type develops in the woman who has few or none of the constitutional stigmata that can be seen with the disease. For her, it is a serious problem involving a lesion that is extensive and associated with reduced cure rates. The second type of endometrial cancer, with hypertension and obesity, plycystic ovaries, or functioning ovarian tumors, is associated with chronic anovulation. This lesion is preventable by the use of birth control pills; it is curable by simply hysterectomy.” In his discussion of the premenopausal woman, Dr Kase maintained that, as a woman nears the end of her reproductive years, her benefits from taking oral contraceptives decrease while her risk of developing major side effects increase. In his own practice, he recommends that oral contraceptives be discontinued by age 38 to
40.
AORN Journal, November 1975, Vol22, No 5
How to write objectives for education programs Fulfill asinine approval requirementsDecipher the crazy jargon-Complete bureaucratic paperwork-ldentify objectives. Let's forget about sponsoring a workshop; it is not worth all the trouble of completing AOFiN's approvalapplication. Besides, National should tnrst our good intentions. Have you had similar negative thoughts about AORN's approval process for educational offerings? In most instances, the issue does not seem to be disagreement with the necessity for an approval process, for members want AORN to monitor the quality of continuing education for OR nurses. Most concur that it is imperative that continuing education should be subject to a thorough system of appraisal. However, members often have an attitude of resignation when required to list the objectives for their workshop. Feelings of inadequacy generate anger which generalizes to the entire approval process. They blame National for an ineffectual system. The difficulty, however, is not with the system, but with developing effective objectives that state learning outcomes in behavioral terms. The Education Department staff must admit they, too, are distressed when they receive broad objectives that are ambiguous and unmeasurable. Poorly stated objectives
illustrate the fallacy of the assumption that chapter members intuitively know why they are offering a specific educational workshop. Furthermore, belief or trust in the constructive motives of the sponsor is not reinforced by such objectives. Approval cannot be given to a workshop, or other educational program, when objectives are inadequate. Global, idealistic promises on the part of a chapter are not enough. Potential participants expect to know the learning outcomes of educational activity. Chapters must justify the merit of educational offerings by clearly identifying their intentions within the context of written objectives. What should the learner be able to do upon completing the workshop? The answer to this provides rationale for sponsoring a workshop as well as a framework for evaluation. Because members of the National Committee on Education, which currently approves AORN's educational undertakings, and Education Department staff members became increasingly aware that members needed assistance in writing objectives, guidelines were developed. The following guidelines are not a panacea but should aid in formulating meaningful objectives. Definition of an objective An objective consists of a statement that clearly and concisely describes a measurable change in the behavior of the leamer/participant as a result of involvement in a learning activity. Purpose of objectives Objectives state desired learning outcomes of an educational activity. They
AORN Journal, November 1975, Vol22, No 5
693
define precisely what behaviors the participant can be expected to demonstrate as a result of exposure to a given educational offering. Objectives identify, for the learner and the teacher, the terminal behaviors expected on the part of the learner upon completion of the instruction. 0 Characteristics of objectives 1. focus upon learner behavior rather than teacher behavior 2. tell exactly what a learner will be able to do upon completion of a given educational offering 3. contain only one expected learner behavior per statement 4. emphasize one of three realms or domains of behavior a. Cognitive objectives describe thinking or intellectual activities associated with acquiring knowledge, eg, to write, discuss, compare, contrast, analyze, differentiate. b. Psychomotor objectives describe the acting behaviors associated with performing skills, eg, to collect, scrub, circulate, open, cut, demonstrate. c. Affective objectives describe feeling behaviors associated with the formulation of attitudes, values, interests, appreciations, sensitivity, eg, to empathize, actualize, experience, feel, accept, contribute, volunteer. 5. communicate to the learner what he can reasonably expect to gain from particular educational offering 6. determine the selection of specific program content, speakers, and teaching methodologies 7. provide the basis for evaluating the effectiveness of the educational offering. 0 Cautions Although objectives can be classified into these domains for convenience of comparison, there is no pure cognitive, psychomotor, or affective objective. Usually, every objective contains some aspects of the three; but there is primary emphasis on one domain.’ Many objectives stress cognitive outcomes because they are easier to identify, write, and measure. Although the other two domains are equally important, members may prefer to develop expertise in writing objec-
694
tives by emphasizing cognitive objectives. Six broad levels encompassed within the cognitive domain are: knowledge, comprehension, application, analysis, synthesis, and evaluation.2 The mastery of manipulative and motor skills is essential for operating room nurses. If the workshop design allows an opportunity for participants to actually demonstrate certain skills, then psychomotor objectives should be delineated. Affective objectives are the most difficult to write because affective behavior is often internalized and, therefore, difficult to mea~ure.~ Still, this domain is critically important, for part of the educational process is usually aimed at changing a participant’s values or attitudes. The situation with respect to affective objectives is primitive, that is, few individuals know how to write or measure Objectives. An attempt has been made to develop a continuum that would order affective behavior: receiving, responding, valuing, organization of a value system, and characterization by a value or value com~lex.~ Chapter members may want to read the references or seek advice from an educator in their area when identifying affective objectives. Pitfalls to avoid when writing objectives 1. Refrain from overly wordy objectives. Such statements confuse the issue and confound the reader. For example, “to be able to apply principles of asepsis” is an overly wordy psychomotor objective. More clearly stated, it might read “apply principles of asepsis in establishing a reverse isolation unit.” 2. Avoid loaded words that are easily misinterpreted or contain a multiplicity of behaviors. The classic example is the commonly employed “to understand.” Understanding is a complex cognitive behavior composed of several levels of more explicit behaviors. “To internalize” and “to motivate” are two other examples of compound, value-loaded action words. One method of avoiding the use of such words is to ask, “How will the learner display his mastery of content if he is motivated or understands?” 3. Avoid global statements or those which bunch several behaviors within one objec-
AORN Journal, November 1975, Vol22, No 5
void including program content for which no objectives are written.
A
tive. “To increase operating room nurses’ knowledge and promote effective communication between staff, patients, and family” is an example of both problems. How will the program planners know whether or not the learners have increased their knowledge unless they are given a pretest and a posttest? The statement is exceedingly broad and more appropriate as a purpose for sponsoring an educational activity. “Effective communication” establishes such a broad content base that years of formal schooling can be devoted to it. Exactly what is effective communication? In addition, the statement violates two cardinal principles of objective writing: it contains two action words, increase and promote, and it is not written in terms of the learners’ behavior. 4. Refrain from espousing personal opinion or chapter philosophy. “To encourage nurses to accept personal responsibility for continuing education” contains a philosophical belief to which learners conceivably may not subscribe. Every learner is entitled to make up his own mind on a subject without being brainwashed. The objective also is a global statement more appropriate for identifying the purpose for sponsoring the offering. A cognitive objective derived from such a purpose could be stated “to discuss the advantages and disadvantages of mandatory continuing education requirements for nurses.” 5. Avoid using nonmeasurable terms. Such terms include to appreciate, recognize, guide, know, believe, enjoy, encourage, increase, understand, motivate, promote. 6. Avoid including program content for which no objectives are written. Large
696
categories of content should have at least one objective Written for each to defend their inclusion in the offering. Program planners take a large subject matter heading, subdivide it into designated content areas, and write objectives for each of those areas. It is not necessary to have an objective for every detail of content, nor is it tenable to write one or two broad objectives for a one or two-day educational activity. The reality lies somewhere in the middle. Sample objectives 1. Discuss the concept of nursing accountability. (cognitive) 2. identify the principles of surgical asepsis as applied in the operating room. (cognitive) 3. Describe ways that operating room nurses utilize the concept of quality assurance in providing care to patients having surgery. (cognitive) 4. State the advantages and disadvantages of mandatory continuing education requirements for nurses. (cognitive) 5. Construct a budget for a particular operating room suite. (psychomotor) 6. Prepare supplies and equipment for use on the sterile field. (psychomotor) 7. Manage personal anxiety in a constructive manner within a crisis situation in the operating room. (affective) 8. Assert one’s self as a patient’s advocate. (affective) Initially, objectives may not reflect each of the specified characteristics. For example, it is hard to write an objective that focuses on one expected outcome. Often, we clump several expected outcomes together. Some of us write teacher objectives rather than
AORN Journal, November 1975, Vol22, No 5
student objectives; therefore, we fail to state what the learner will be able to do upon completion of our workshop. It takes practice using the above guidelines before the process becomes easy. Yet, the final product, behavioral objectives, will enable the planners of a workshop to be selective in choosing specific program content, speakers, and teaching methodologies. They can also develop an evaluation tool designed to measure the achievement of stated objectives, thus facilitating a meaningful evaluation of the effectiveness of their workshop. Ideally, the workshop will be more successful because both instructors and learners know the expected outcomes and are motivated to achieve the desired results. Ultimately, members can readily accept the praise from participants because they know the workshop was soundly designed upon educational principles.
Carol J Alexander, RN, MS Director of Education Gwen H Dodge, RN, MS Ass ’t Director of Education Bernice McPhee, RN, EdM NCE Representative Region I Notes 1. Thomas E Cyes, Working with Performance Objectives in Nursing and Allied Health Sciences (Massachusetts: Educational Development Associates, 1975). 2. Benjamin S Bloom, ed. Taxonomy of Educational Objectives: The Classificationof Educatlonal Goals: Handbook I; Cognitive Domain (New York: David McKay Company Inc, 1956). 3. Cyes, Working with Performance Objectives. 4. David R Krathwohl, Benjamin S Bloom, B e rtram B Masia, Taxonomy of Educational Objectives: The Classification of Educational Goals: Handbook /I; Affective Domain (New York: David McKay Company Inc, 1964). References Gronlund, Norman E. Stating Behavioral Objectives for Classroom Instruction. New York: Macmillan Co,1970. Harrow, Anita J. A Taxonomy of the Psychomotor Domain: A Guide for Developing Behavioral Objectives. New York: David McKay Company Inc, 1972. Mager, Robert F. Preparing Objectives for Programmed Instructlon. San Francisco: Fearon Publishers, 1962.
698
Relationship between pill, breast carcinoma “There is no evidence that breast carcinoma increases when taking the pill. There is no study that relates the pill to the cause of breast cancer,” according to Nathan G Kase, MD, professor and chairman of the department of obstetrics and gynecology, Yale University Medical School, New Haven, Conn. Speaking at a symposium on “Current concepts in oral contraceptive treatment,” Dr Kase stated that once cancer of the breast is present, however, it is an absolute contraindication to the use of the pill. Dr Kase pointed out that clinicians sometimes have trouble differentiatingbreast carcinoma from benign cystic hyperplasia of the breast, a condition that “may actually improve in a small percentage of women on the pill.” Noting that the uncertain physician may take the worried well patient off the pill because he feels he cannot distinguish benign breast disease from a malignancy, Dr Kase emphasized that cystic hyperplasia is not a premalignant disease. “There appear to be at least two types of endometrial carcinoma,” Or Kase explained. “One type develops in the woman who has few or none of the constitutional stigmata that can be seen with the disease. For her, it is a serious problem involving a lesion that is extensive and associated with reduced cure rates. The second type of endometrial cancer, with hypertension and obesity, plycystic ovaries, or functioning ovarian tumors, is associated with chronic anovulation. This lesion is preventable by the use of birth control pills; it is curable by simply hysterectomy.” In his discussion of the premenopausal woman, Dr Kase maintained that, as a woman nears the end of her reproductive years, her benefits from taking oral contraceptives decrease while her risk of developing major side effects increase. In his own practice, he recommends that oral contraceptives be discontinued by age 38 to
40.
AORN Journal, November 1975, Vol22, No 5
