Module 19 – Domain III: Assessment & Planning, Implementation & Evaluation

After reviewing Module 19 lecture, you should be able to:

  1. Describe interviewing techniques.
  2. Discuss counseling of individuals and groups.
  3. Describe education and training considerations.

Assessment and Planning

Goals and objectives

  • when setting goals – be sure to include realistic short-term and long-term goals
  • goals are based on problem list
  • consideration should be given to socioeconomic, family, occupation, and ethnicity

Education/literacy level

  • literacy – client’s ability or skills to read
  • SMOG test – evaluates readability; focus is on number of syllables per word

Types of Learning (Bloom’s Taxonomy of Learning?)

  • Cognitive – (knowledge) focus on gaining and using knowledge or information
  • Affective– (attitude) internalize information involves changes in beliefs, attitudes, and interests
  • Psychomotor– (skills) development of manual skills

Cognitive Domain – the cognitive domain involves knowledge and the development of intellectual skills; this includes the recall or recognition of specific facts, procedural patterns, and concepts that serve in the development of intellectual abilities and skills; there are six major categories, which are listed in order below, starting from the simplest behavior to the most complex; the categories can be thought of as degrees of difficulties - that is, the first one must be mastered before the next one can take place.

  • Bloom’s Taxonomy or Hierarchy of Cognitive Objectives - six levels of learning from simplest to difficult (KCAASE)
  • knowledge – recall of knowledge
  • Recall data or information
  • Key Words: defines, describes, identifies, knows, labels, lists, matches, names, outlines, recalls, recognizes, reproduces, selects, states
  1. comprehension – low level of understanding
  2. Understand the meaning, translation, interpolation, and interpretation of instructions and problems. State a problem in one's own words
  3. Key Words: comprehends, converts, defends, distinguishes, estimates, explains, extends, generalizes, gives Examples, infers, interprets, paraphrases, predicts, rewrites, summarizes, translates
  4. application– use of information
  5. Use a concept in a new situation or unprompted use of an abstraction. Applies what was learned in the classroom into novel situations in the work place
  6. Key Words: applies, changes, computes, constructs, demonstrates, discovers, manipulates, modifies, operates, predicts, prepares, produces, relates, shows, solves, uses
  7. analysis – breakdown information into parts
  8. Separates material or concepts into component parts so that its organizational structure may be understood. Distinguishes between facts and inferences
  9. Key Words: analyzes, breaks down, compares, contrasts, diagrams, deconstructs, differentiates, discriminates, distinguishes, identifies, illustrates, infers, outlines, relates, selects, separates
  10. synthesis – assembling parts to make whole
  11. Builds a structure or pattern from diverse elements. Put parts together to form a whole, with emphasis on creating a new meaning or structure
  12. categorizes, combines, compiles, composes, creates, devises, designs, explains, generates, modifies, organizes, plans, rearranges, reconstructs, relates, reorganizes, revises, rewrites, summarizes, tells, writes
  13. evaluation – judge the value of part or whole
  14. Make judgments about the value of ideas or materials
  15. Key Words: appraises, compares, concludes, contrasts, criticizes, critiques, defends, describes, discriminates, evaluates, explains, interprets, justifies, relates, summarizes, supports.

Affective Domain – This domain includes the manner in which we deal with things emotionally, such as feelings, values, appreciation, enthusiasms, motivations, and attitudes. The five major categories are listed from the simplest behavior to the most complex (RRVOC)

  • Receiving – willing to receive information; awareness, willingness to hear, selected attention
  • Responding– willing to be involved and learn information; active participation on the part of the learners; attends and reacts to a particular phenomenon
  • Valuing– student has belief in information; the worth or value a person attaches to a particular object, phenomenon, or behavior; valuing is based on the internalization of a set of specified values, while clues to these values are expressed in the learner’s overt behavior and are often identifiable
  • Organizing - Organizes values into priorities by contrasting different values, resolving conflicts between them, and creating a unique value system; the emphasis is on comparing, relating, and synthesizing values
  • Characterization (Internalizing values) – values have been internalized; has a value system that controls their behavior; the behavior is pervasive, consistent, predictable, and most importantly, characteristic of the learner

Psychomotor Domain - The psychomotor domain includes physical movement, coordination, and use of the motor-skill areas; the seven major categories are listed from the simplest behavior to the most complex (PSGMCA)

  • Perception – aware of objects via senses; the ability to use sensory cues to guide motor activity
  • Set – willingness to learn/readiness to act; it includes mental, physical, and emotional sets (mindsets)
  • Guided response – student is guided through activity; the early stages in learning a complex skill that includes imitation and trial and error; adequacy of performance is achieved by practicing
  • Mechanism – displays beginning level of skill due to practice; this is the intermediate stage in learning a complex skill; learned responses have become habitual and the movements can be performed with some confidence and proficiency
  • Complex overt response – skill over time; the skillful performance of motor acts that involve complex movement patterns; proficiency is indicated by a quick, accurate, and highly coordinated performance, requiring a minimum of energy. This category includes performing without hesitation, and automatic performance
  • Adaption/origination – using skill in new situations;
  • Adaptation: Skills are well developed and the individual can modify movement patterns to fit special requirements
  • Origination: Creating new movement patterns to fit a particular situation or specific problem. Learning outcomes emphasize creativity based upon highly developed skills

Learning Principles

  • Conditioning– stimuli which normally does not cause a behavior, over time produces the behavior
  • Reinforcement– a kind of strategy which motivates change; the point of reinforcement is to increase the frequency or probability of a response occurring again
  • positive: (rewards) present a positive stimulus when the desired behavior is made; motivator which reinforces particular behaviors
  • negative: motivator in which something bad is removed; take away something unpleasant when the desired behavior response is made
  • Punishment– the premise of punishment is to decrease the frequency or probability of a response occurring again.
  • Positive – present something negative to decrease the probability of an undesired response from occurring again. For example, a child reaches for a cookie before dinner, and you slap his hand.
  • Negative - the removal of something pleasant to decrease the probability of an undesired response from occurring again. For example, each time a child says a curse word, you remove one dollar from their piggy bank
  • Hierarchy of Needs (Maslow)– associates motivation with an individual’s desires
  • physiological needs - bottom of the pyramid; these are biological needs (oxygen, food, water, and a relatively constant body temperature)
  • safety and security – physical safety, economical security
  • social needs and affection – acceptance, belonging to a group, friendship, family
  • esteem and status – recognition from others, confidence
  • self actualization - top of the pyramid; learning at a high level, challenging work, creativity

Implementation and Evaluation

Interviewing

Techniques of questioning

  • open-ended questions – broad questions to allow the client to express more freely; generally these questions begin with what or how to avoid a yes or no response
  • close-ended questions – questions lead to brief response, usually yes or no
  • leading questions– may aid in the clients ability to answer or may show the R.D.’s bias towards an issue ie: "How many times a week do you exercise?" affects the clients response assuming they exercise

Response techniques

  • attributing - describing strengths to motivate a client
  • clarifying - confirms the accuracy of perception of the client's answer
  • empathy – demonstrates to the client you understand concerns or feelings
  • directive – encourages a client to discuss a concern which seems to be unacknowledged or avoided
  • interpreting - provides a possible connection between behaviors
  • non-directive – invites the client to proceed with their concerns or feelings; beneficial when the client contacts the counselor for help
  • paraphrasing - rephrasing a client's response for clarity
  • probing - attempt to gain the most information possible; used to obtain more information from the respondent - often used on open-ended questions

Counseling

Four parts of nutrition counseling include nutrition assessment, plan for treatment, intervention for change, and evaluation.

Type of intervention required

  • knowledge – may include education program or individual program to aid in meeting goals
  • skills – may include practice of a task to ensure goals are met
  • attitudes – behavior modificationincludes changing previous behavior or habits to new behaviors to achieve goals; includes specific realistic goals, positive reinforcement, self-monitoring eating habits, and visual imagery

Techniques

  • motivation– what leads a person to learn, make a change, etc.
  • contracts– focus on specific behaviors, put in writing and based on an understanding between client and R.D.; includes agreed upon goals and reinforcement
  • feedback– may be positive – useful as a motivator for desirable behavior
  • rewards– as a result of behavior; may aid to reinforce goals

Evaluation of educational outcomes

  • formative evaluation– occurs during design, plan, or implementation of program; aid in improving programs by identifying weaknesses; Formative evaluation is a process of ongoing feedback
  • summative evaluation– evaluates results of program after it is completely underway; analyze the achievement of program
  • qualitative evaluations –subjective, descriptive evaluation; looks for detail
  • quantitative evaluations –produce numerical results; questionnaires or tests

Now that you have read the lecture, consider the following:

  1. Describe interviewing techniques. Include techniques of questioning.
  2. Discuss counseling of individuals and groups. Include:
  3. setting goals
  4. education/literacy level
  5. type of intervention required
  6. motivational techniques
  7. consultative process
  8. Using the psychomotor domain, describe set versus perception. At what step of this domain would you begin teaching a child with diabetes?

1. "How are your meals prepared?" Is an example of which of the following types of questioning?

a. close-ended

b. leading

c. attributing

d. open-ended

2. "Do you like vegetables?" Is an example of which of the following types of questioning?

a. close-ended

b. leading

c. attributing

d. open-ended

3. "How many times per week do you exercise?" Is an example of which of the following types of questioning?

a. close-minded

b. leading

c. attributing

d. open-minded

4. A patient with high cholesterol levels is feeling discouraged. You encourage the patient by reminding them of their work to increase fiber and exercise. This is an example of which type of response?

a. interpreting

b. clarifying

c. probing

d. attributing

5. A patient who is overweight states she is feeling discouraged with her weight loss. Your respond saying "You feel you've worked very hard to lose the pounds you've lost." This is an example of which type of response?

a. attributing

b. interpreting

c. clarifying

d. probing

6. A patient who is overweight is skipping breakfast to lose weight and notices he is overeating in the evening. You respond saying "There may be a connection between skipping meals and overeating late in the day." This is an example of which type of response?

a. interpreting

b. attributing

c. probing

d. clarifying

7. When setting goals it is important to:

a. set realistic goals

b. all of these

c. include long-term goals

d. include short-term goals

8. A client meets with you and sets the goal of losing 25 pounds over the next year. What is missing from this goal agreement?

a. long-term goals

b. realistic goals

c. short-term goals

d. all of these

9. Which of the following focuses on sentence length and number of syllables per word?

a. SMOG test

b. Reading test

c. Knowledge test

d. Fry test

10. A client chooses to garden instead of snack when she is stressed. What is this an example of:

a. skills

b. rewards

c. behavior modification

d. knowledge

11. Which of the following may include an educational program to aid in meeting goals?

a. rewards

b. skills

c. behavior modification

d. knowledge

12. A patient contacts you for help with weight loss. Which of the following would be the best response technique?

a. directive

b. probing

c. non-directive

d. empathy

13. Which of the following learning principles is a motivator that reinforces particular behaviors?

a. reinforcement

b. rewards

c. punishment

d. conditioning

14. A client receives a compliment on her weight loss from a co-worker. What is this an example of?

a. reinforcement

b. conditioning

c. punishment

d. reward

15. A client’s spouse suggests they go for a walk after dinner. This occurs 3 times a week for months. Thereafter, walking after dinner occurs several times a week without requiring suggestion. This is an example of:

a. conditioning

b. reward

c. punishment

d. reinforcement

16. Food is an example of which level of Maslow’s Hierarchy of Needs?

a. safety and security

b. social needs

c. self actualization

d. basic physiological needs

17. Focusing on eating a variety of well balanced foods for general health is an example of which level of Maslow’s Hierarchy of Needs?

a. basic physiological needs

b. social needs

c. safety and security

d. self actualization

18. Listing foods found in the bread group of the Food Guide Pyramid is an example of which level of the Hierarchy of Cognitive Needs or Bloom’s Taxonomy?

a. comprehension

b. knowledge

c. analysis

d. application

19. Categorizing a list of foods into food groups is an example of which level of Hierarchy of Cognitive Needs or Bloom’s Taxonomy?

a. knowledge

b. comprehension

c. analysis

d. application

20. Which order is the best order to promote learning according to Hierarchy of Cognitive Needs?

a. synthesis, knowledge, comprehension, application, analysis, evaluation

b. knowledge, comprehension, analysis, application, evaluation, synthesis

c. knowledge, application, comprehension, analysis, synthesis, evaluation

d. knowledge, comprehension, application, analysis, synthesis, evaluation

21. All of the following are involved with behavior modification except:

a. Including rewards for desirable behaviors

b. Keeping a food record including cues or reasons for eating

c. Elimination of snacking

d. None of these

22. You are teaching a 7-part diabetes class. You evaluate the course as it is being designed. You also conduct an evaluation after each class in the form of a survey of participants. What type of evaluation is this?

a. formative

b. psychomotor

c. cognitive

d. summative

23. A client is describing weekend eating habits. You intervene with “After eating that, how did you feel?” What type of response is this?

a. Clarifying

b. Passive

c. Probing

d. Directive

24. A client who has learned to prepare low-fat foods at home now asks several questions regarding preparation when dining out. What level of psychomotor skills is displayed?

a. set

b. adaption

c. perception

d. mechanism

25. Which of the following learning domains involves manual skills?

a. cognitive

b. affective

c. mechanism

d. psychomotor

Module 19 – Domain III Quiz
Assessment & Planning, Implementation & Evaluation
1. "How are your meals prepared?" Is an example of which of the following types of questioning? Incorrect
a. close-ended
b. leading
c. attributing
d. open-ended
An open ended question is broad to allow the client to express more freely.
2. "Do you like vegetables?" Is an example of which of the following types of questioning? Correct
a. close-ended
b. leading
c. attributing
d. open-ended
A closed ended question leads to a brief response, usually yes or no.
3. "How many times per week do you exercise?" Is an example of which of the following types of questioning? Correct
a. close-minded
b. leading
c. attributing
d. open-minded
A leading question may aid in the client's ability to answer or may show the RD's bias toward an issue.
4. A patient with high cholesterol levels is feeling discouraged. You encourage the patient by reminding them of their work to increase fiber and exercise. This is an example of which type of response? Correct
a. interpreting
b. clarifying
c. probing
d. attributing
Attributing response describes strengths to encourage a client.
5. A patient who is overweight states she is feeling discouraged with her weight loss. Your respond saying "You feel you've worked very hard to lose the pounds you've lost." This is an example of which type of response? Correct
a. attributing
b. interpreting
c. clarifying
d. probing
A clarifying response confirms a perception of the client's answer.
6. A patient who is overweight is skipping breakfast to lose weight and notices he is overeating in the evening. You respond saying "There may be a connection between skipping meals and overeating late in the day." This is an example of which type of response? Correct
a. interpreting
b. attributing
c. probing
d. clarifying
An interpreting response provides a possible explanation or connection between behaviors.
7. When setting goals it is important to: Correct
a. set realistic goals
b. all of these
c. include short-term goals
d. include long-term goals
When setting goals it is important to be realistic and include short term and long term goals.
8. A client meets with you and sets the goal of losing 25 pounds over the next year. What is missing from this goal agreement? Correct
a. long-term goals
b. realistic goals
c. short-term goals
d. all of these
When setting goals it is important to include long term and short term goals.
9. Which of the following focuses on sentence length and number of syllables per word? Correct
a. SMOG test
b. Fry test
c. Reading test
d. Knowledge test
SMOG test evaluates a client's reading level; focuses on sentence length and the number of syllables per word.
10. A client chooses to garden instead of snack when she is stressed. What is this an example of: Correct
a. skills
b. rewards
c. behavior modification
d. knowledge
Behavior modification includes changing previous behavior or habits to new behaviors to achieve goals.
11. Which of the following may include an educational program to aid in meeting goals? Correct
a. rewards
b. skills
c. behavior modification
d. knowledge
knowledge may include education program or individual program to aid in meeting goals.
12. A patient contacts you for help with weight loss. Which of the following would be the best response technique? Incorrect
a. directive
b. probing
c. non-directive
d. empathy
Non-directive response invites the client to proceed with their concerns or feelings; beneficial when the client contacts the counselor for help.