In order for Nurses to be able to learn new information and skills, to enable them to confidently support their patients, the following points have been identified:

1. A positive learning environment will enhance quality of care.

2. It is imperative that training programmes reflect the learning styles and preferences of individuals in order for them to be effective.

3.Organisational leaders must be aware of factors that can impede effective learning, and be proactive in creating positive learning environments.

4. Nurses must seek opportunities to practise new skills in a safe and supportive environment, with structured supervision and mentorship. (Frankel, 2009)

Four stages of learning have been identified:

1. Activist - Active experimentation (simulations, case study, homework)

2. Reflector - reflective observations (logs, journals, brainstorming)

3. Theorist - abstract conceptualisation (lectures)

4. Pragmatist - concrete experience (observations, application to practice) (Frankel, A. 2009, Source: Kolb 1984)

Most adult learners develop a preference for learning that is based on childhood learning patterns (Edmunds, Lowe, Murray, & Seymour, 1999). Several approaches to learning styles have been proposed, one being based on the senses that are involved in processing information. An assessment of the persons learning style is a fundamental step prior to beginning any educational activity. Determining the learning style will help identify the preferred conditions under which instruction is likely to be most effective (Richardson, 2005).

The most frequently used method of delineating learning styles is in describing visual, auditory, and kinesthetic learners.

1. Visual learners prefer seeing what they are learning. Pictures and images help them understand ideas and information better than explanations (Jezierski, 2003). A phrase you may hear these learners use is "The way I see it is." The teacher needs to create a mental image for the visual learner as this will assist in the ease of holding onto the information. If a visual learner is to master a skill, written instructions must be provided. Visual learners will read and follow the directions as they work and will appreciate it even more when diagrams are included.

2. Auditory learners prefer to hear the message or instruction being given. These adults prefer to have someone talk them through a process, rather than reading about it first. A phrase they may use is "I hear what you are saying." Some of these learners may even talk themselves through a task, and should be given the freedom to do so when possible. Adults with this learning style remember verbal instructions well and prefer someone else read the directions to them while they do the physical work or task.

3. Kinesthetic learners want to sense the position and movement of the skill or task. These learners generally do not like lecture or discussion classes, but prefer those that allow them to "do something." The phrase this group of people will often use is "I feel like …" These adults do well learning a physical skill when there are materials available for hands-on practice. (Russell 2005)

A 2003 study published in "Diabetes Care" on the effect of nurse-directed diabetes care in a minority population, shows specially trained nurses who follow detailed protocols and algorithms under the supervision of a diabetologist can markedly improve diabetes outcomes in a minority population. This approach could help moderate the increased morbidity and mortality seen in minority populations. (Davidson 2003)

Staff members' ability to learn and then apply learning to practice has a significant impact on delivering effective clinical care. A skilled and competent workforce ensures patient safety, and they will be able to recognise and respond to clinical need more appropriately. It is believed that the knowledge and application of a range of learning theories, concepts and approaches is the foundation for building and managing effective learning environments.

An eclectic model is therefore suggested, which combines the individual's learning needs with the organisation's practice requirements. Consideration for individual learning styles is fundamental in designing effective training programmes. Study results highlight that most health professionals prefer a visual learning style (Frankel, 2009).

A podcast by Teresa Doran, Diabetes Nursing Lecturer, E.I.T. Taradale, as reviewed in course Learning Resources highlights learning styles for adult learners, as Andragogy. (as opposed to children's learning styles; Paedagogy)

1. Need to know the reason for learning

2. Learners Self concept

3. Role of the learners experience, these can be barriers and preconceived ideas

4. Readiness to learn

5. Orientation to learning, its relevance to career and health etc


The Peter Principle outlines stages of learning concepts:

1. Not aware they don't know

2. Become conscious of a deficit in knowledge

3. Aware of need to do something about it, and capable of doing this.

4. Become an expert: auto action

As Nurses, we must recognise that our current practice does not always reflect best practice. We need to integrate best research evidence with clinical expertise. (Di Censo, A., Guyatt, G., and Ciliska, D., 2005) With the evidence-based information before us on the consequences of modern diets consisting of an excess starch, refined sugars and flours, we can no longer tolerate complacency, we firstly owe it to ourselves to become competent nutritionists.

We need to enlighten the whole nation to the dangers of a highly refined diet and discourage its consumption, we need to promote a wholesome diet around the principals of the Mediterranean Diet and lobby the government to review health promotional literature.

Nurses are recognised as change agents (Wright 1989) as they are ideally positioned to implement new ideas and engage others. Be it a one-on-one consultation with a patient, a discussion with a peer or colleague, as leader taking a group study session, a keynote speaker at a conference, or writing for publication.
New Zealand has an aging population and our health system is already over burdened with escalating costs, so it is imperative that we try to mitigate the effects of the five major inflammatory ailments which are diabetes, cardiovascular disease, obesity, arthritis and cancer. They are all associated with poor dietary practices that make our bodies into a pro-inflammatory mode, thereby accelerating the disease process. (Karl 2010)

As nurses we are in a pivotal position to roll out revised and innovative nutritional information, especially to our ethnic minority groups such as the Asian Indians.

Many patients with a chronic illness have to endure physically debilitating and psychologically challenging treatments and most chronic illnesses require self-management that entails ongoing motivation. Motivation is a state of readiness or eagerness to change. Motivational interviewing (MI) is a relatively new cognitive-behavioural technique that aims to help patients identify and change behaviours that may be placing them at risk of developing health problems or may be preventing optimal management of a chronic condition.

It is a relatively simple, transparent and supportive talk therapy based on the principles of cognitive-behaviour therapy.

These principles are to help the patient:

1. To understand their thought processes related to the problem

2. To identify and measure the emotional responses to the problem

3. To identify how thoughts and feelings interact to produce patterns in behaviour

4. To challenge his or her thought patterns and implement alternative behaviours. (Bundy 1997)

Motivational Interviewing has developed from the theoretical aspect of the Transtheoretical Model (TTM) which is based on the premise that people are at different stages of motivational readiness for engaging in health behaviours and that intervention approaches are most useful when they are matched to a person's current stage of change. (Ruggiero 2000)

The stages of change most commonly used:

Precontemplation-not intending to change to the goal level of a behaviour in the near future;

Contemplation-intending to change to the goal level in the foreseeable future (next 6 months), but not the immediate future (next 30 days);

Preparation-intending to change to the goal behaviour in the immediate future and taking behavioural steps in the direction of the change required;

Action-has made a change to the goal level of the behaviour in the recent past (6 months);

Maintenance-has been at the goal level of the behaviour for 6 months or longer. (Ruggiero 2000)

Much of the evidence base for MI comes from literature around addictions, but is beginning to be applied to the fields of chronic illness management, when it has been shown to help people with heart disease quit smoking and people with diabetes to achieve better control of blood glucose. (Bundy 1997)

Patients need to be aware that their current situation has consequences. Goals should be generated by the patient and not imposed on them. The exercise of getting the patient to outline their goals gives the therapist valuable insight into how realistic these goals are and what the priority for change is. (Bundy 1997)