CHAPTER 13

Evaluation in
Healthcare
Education
● Evidenced-Based Practice, Practice-Based Evidence, and Implementation Science
● Evaluation Versus Assessment
a. Determining the Focus of Evaluation
● Evaluation Models
b. Process Evaluation
c. Content Evaluation
d. Outcome Evaluation
e. Impact Evaluation
f. Total Program Evaluation
● Designing the Evaluation
a. Design Structure
b. Evaluation Methods
c. Evaluation Instruments
d. Barriers to Evaluation
● Conducting the Evaluation
● Analyzing and Interpreting Data Collected
● Reporting Evaluation Results
a. Focus on the Audience
b. Stick to the Evaluation Purpose
c. Use data as Intended
 Scope of the Problem (cont’d)
• Not all disabilities are readily visible.
• Individuals with disabilities are more
likely than those without them to
– Have more illnesses and greater health needs
– Be less likely to receive preventive health
care and other social services
– Be more likely to suffer from poverty
 Models and Definitions
• Models/perceptions of disabilities that
influence how disabilities are addressed
in society:
– The moral model
– The medical model
– The rehabilitation model
– The social model
 Models and Definitions (cont’d)
1. The moral model
– Views disabilities as sin
– Old model that persists in some cultures
– Individuals and their families may
experience guilt, shame, denial of care.
– United Nations established Standard Rules
on the Equalization of Opportunities for
Persons with Disabilities specifying
fundamental right of access to care.
 Models and Definitions (cont’d)
2. The medical and
3. Rehabilitation models view disabilities as
problems requiring intervention to cure.
– The belief that people with disabilities must
be “cured” has been criticized by advocates.
– Medical model: disability as defect/sickness
– Rehabilitation model: disability as deficiency
 Models and Definitions (cont’d)
• The disabilities model (social model) is
most influential on current thinking.
– Embraces disability as a normal part of life
– Views social discrimination, rather than the
disability itself, as the problem
 Models and Definitions (cont’d)
• Disability
– “A complex phenomenon, reflecting an
interaction between features of a person’s
body and features of the society in which he
or she lives.” (WHO, 2016)
– U.S. Social Security Administration defines
disability in terms of an individual’s ability to
work.
Americans with Disabilities Act
(ADA)
• Enacted in 1990, this legislation has
extended civil rights protection to
millions of Americans who are disabled.
• The ADA defines a disability as a physical
or mental impairment that substantially
limits one or more of the major life
activities of the individual.
 The Language of Disabilities
• Since the late 1970s, disabilities
advocates and the government have
encouraged people- or person-first
language, which “puts the person before
the disability” in writing and speech.
– Recently, has become controversial because
some prefer identity-first language, which
affirms what they see as an identity
characteristic
 The Language of Disabilities
(cont’d)
• Additional considerations
– Use “congenital disability,” not “birth defect.”
– Avoid terms with negative connotations such
as “invalid” or “mentally retarded.”
– Speak of the needs of people with disabilities
rather than their problems.
– Avoid phrases like “suffers from,” “victim of.”
– When comparing groups, avoid phrases such
as “normal” or “able bodied.”
 Roles and Responsibilities of
Nurse Educators
• Focus on wellness and strengths of the
individual, not weaknesses
• Teaching skills to maintain or restore
health and maintain independence
– Habilitation
• Teaching skills to relearn or restore skills
lost through illness or injury
– Rehabilitation
 Roles and Responsibilities of
Nurse Educators (cont’d)
• Carefully assess the degree to which
families can and should be involved.
• Interdisciplinary team effort is often
required.
• Nurse should serve as mentor to patient
and family in coordinating and facilitating
multidisciplinary services.
 Roles and Responsibilities of
Nurse Educators (cont’d)
• Assessment always done before teaching
– Nature of problem/needs
– Short-/long-term consequences or effects of
disability
– Effectiveness of their coping mechanisms
– Type of extent of sensorimotor, cognitive,
perceptual, and communication deficits
– Knowledge of and readiness to learn about a
new disability
 Types of Disabilities
• Sensory disabilities
• Learning disabilities
• Developmental disabilities
• Mental illness
• Physical disabilities
• Communication disorders
• Chronic illness
 Sensory Disabilities: Hearing
Impairments
• Total or partial auditory loss (complete loss
or reduction in sensitivity to sounds),
etiology related to either a conduction or
sensory–neural problem
• Incidence increases with age.
 Sensory Disabilities: Hearing
Impairments (cont’d)
• Hearing loss described by type, degree,
and configuration
• Types of hearing loss
– Conductive (usually correctable, loss in
ability to hear faint noises)
– Sensorineural (permanent, damage to
cochlea or nerve pathways)
– Mixed
 Sensory Disabilities: Hearing
Impairments (cont’d)
• Modes of Communication to Facilitate
Teaching/Learning:
a. American Sign Language (ASL)
b. Lipreading
c. Written materials
d. Verbalization by client
e. Sound augmentation
f. Telecommunication devices for the deaf
(TDD)
 Learning Disabilities
• Heterogeneous group of disorders of
listening, speaking, reading, writing,
reasoning, or mathematical abilities
• Approximately 20% of the American
population is affected.
• The majority have language, integrative
processing, or memory deficits.
• Multiple definitions exist; controversial
area of debate
 Learning Disabilities (cont’d)
• Varied and often unclear causes
• Most individuals have normal or superior
intelligence.
• Disorders include:
– Dyslexia
– Auditory processing disorders
– Dyscalculia
 Developmental Disabilities
• A severe chronic state that is present
before 22 years of age, is caused by mental
and/or physical impairment, and is likely
to continue indefinitely
• Include:
– Attention-deficit/hyperactivity disorder
– Intellectual disabilities
– Asperger syndrome/autism spectrum
disorder
 Developmental Disabilities
(cont’d)
• Public laws providing for special
education needs
– Developmental Disabilities Assistance and
Bill of Rights Act of 2000
– Education of All Handicapped Children Act
1975
– Individuals with Disabilities Education Act of
1990 (IDEA)
– Updated in 2004
 Mental Illness
• Estimated to affect 20% of adult Americans
• Advances in mental illness care since 1950s
• Teaching guidelines
– Begin with comprehensive assessment.
– Be aware of communication and learning
challenges.
– Teach using small words, repeating information.
– Keep sessions short and frequent.
– Involve all possible resources, including client and
family.
Physical Disabilities: Traumatic
Brain Injury
• Falls are leading cause
– Greater awareness with combat and sports
• Includes closed and open head injuries
• Treatments
– Acute care
– Acute rehabilitation
– Long-term rehabilitation
• Ultimate goal of independent living
 Physical Disabilities: Memory
Disorders
• Causes include:
– Brain injury
– Amnesia
– Alzheimer’s disease
– Parkinson’s disease
– Multiple sclerosis
– Brain tumors
– Depression
• Short-term or long-term memory deficits
 Communication Disorders
• Deficits affect perception and/or language
production abilities.
• Most common residual communication
deficits
– Global aphasia
– Expressive aphasia
– Receptive aphasia
– Anomic aphasia
– Dysarthria
 Chronic Illness
• Leading cause of death in U.S.
• Permanent condition lasting three plus months,
often a lifetime
• May cause a disability but is not a disability itself
• Affects every aspect of life—physical, social,
psychological, economic, and spiritual
• Successful management is a life-long process.
• Development of good learning skills is matter of
survival.
• The learning process must begin with illness onset.
• There is often a conflict between feelings of
dependence and the need for independence.
 Chronic Illness: Problem Areas
for Patients and Families
• Prevention of medical crises and management of
problems once they occur
• Control of symptoms
• Carrying out prescribed regimens
• Prevention of or living with social isolation
• Adjustment to disease changes
• Keeping interactions with others normal and
maintaining one’s lifestyle
• Funding
• Confronting related psychological, marital, and
family problems
 The Family’s Role in Chronic
Illness or Disability
• Families are usually the care providers
and support system.
• Their reactions and perceptions influence
adjustment.
• Note what learning needs the family
considers important.
• Communication between family is key.
• Consider family strategies for coping.
• Denial may be present.
 Assistive Technologies
• Technological tools (computers and
communication devices) available to persons
with disabilities to live more independently
– Provide access to education, employment,
recreation, communication
• Impact
– Has liberated people with disabilities from social
isolation and feelings of helplessness
– Increases feelings of self-worth, independence
– Useful tool for health promotion
 Assistive Technologies (cont’d)
• Advocacy role of nurses
– Recommend that clients use computer
technology
– Assist in obtaining appropriate equipment and
training, possibly with multidisciplinary team