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Instructional materials in teaching or resources are available from many
sources. Modern education faces lots of problems. The attempts at
solvingthese problems, which involve the use of, organized combination
utilization of people, materials, facilities, equipment and procedures to
achievethe desired instructional materials in teaching, instructional media
and educational media virtually mean the same thing.They all involve
media materials derived from communication revolution, which can be
used to promote teaching learning process.According to Agu Okogbuo
(2000) instructional materials in teaching could be classified into:1. Visual
material - such as picture, diagrams buildings, projectors, teachers
themselves, chart, real objects (realia) studies etc. these materialssuch as
books, newspapers journals, magazines, pamphlets, handout or modules
were also involved.2. Audio materials

such as tape recording, cassette, radio, teleconferencing, language
laboratories, teachers voice. They appeal to the sense ofhearing.3. Audio-
visual materials - which include the television, video recording motion
pictures with sound tracks, slide and films trips projection withsound tapes,
films and multimedia. They appeal to both sense of hearing and
sight.4. Materials/software - include graphic materials, printed materials,
slide, filmstrips, overhead transparency, cassette tapes, and
motion pictures.5. Equipment/hardware: examples include: black boards,
tape recorders, projectors and video recorders. They are used in presenting
materials,static or display such as chalkboard, flannel graph, flip
charts, magnetic board are also used in presenting materials or
lectures.6. Electronics - this comprises of radio,
, e-mail, multimedia. These teaching materials makes teaching and learning
process more easyand concrete.7. Non-projected media include books and
other printed materials, objects, specimens. Models mock-up graphical
materials, bulletin boards thatexhibits, black boards, field trips, simulation
and games.8. Two-dimensional instructional materials in teaching - include
flat pictures, graphs, chart, diagrams posters, comics, cartoons, slides,
films trips.They are also non-projected materials with characteristics of
being flat and light and may be either in opaque or transparent form.They
have length but no height, hence they are 2 dimensional aids.9. Three-
dimensional institutional materials - include models, mock up
objects, specimens, laboratories, simulation and games (toys). They
arenon-projected materials. Characteristically, they have length, width,
height, hence they are called 3 dimensional.Instructional materials in
teaching generally make the teaching process easier. However in order to
appreciate the importance of instructionalmaterials in teaching -learning
process, Rhert Heinich

et al (2001) consider the reasons for using them. They include to
help:1. Gain and hold the attention of the learner2. Provide visual aspects
to a process or techniques3. Focus attention on highlight
of key points4. Create impact5. Facilitates the understanding of abstract ex
planations.6. Provide a common experience to a large number of
learners7. Stimulate realityWith this, instructional materials in teaching
help to concretize the learning process.Words only convey little or no
concreteness in the teaching-learning process. In effect, the type of
instructional materials in teaching used dependson what the teacher wants
to demonstrate; for instance, the reasons for media is to create clear idea of
something e.g. real object (realia) modelsas follows:1. To give visual access
to something which may be inaccessible to clarity abstract information
which may be difficult to communicate verbally.Examples are model
picture, photo, posters and diagrams.2. To condense large qualities
of information e.g. diagram and handout3. To promote mental activities
of students; examples are handout, textbooks, films and
picture4. To teach language pronouncement e.g. audiotapes.5. To support
work of the teachers e.g. sound recordingsThey make learning more
interesting, more real and lively. At all level of education, instructional
materials in teaching are very important in theattainment of desired goal
and objectives. The traditional chalkboard method of teaching involves only
the learning sense of hearing and theyeasily loose of interest after some
time. However, the utilization of instructional materials in teaching and
learning situation involves not only thesense of hearing but also the sense
of sight and touch, looking at educational practices, the Chinese proverb
conclude that:I hear

I forgetI see

I rememberI do

I understandKindler (1993) stated that people generally remember;10% of
what they read20% of what they hear30% of what they see50% of what they
hear and see70% of what they say and90% of what they say as they do
a thing.For this reason, it was concluded that instructional materials in
teaching ensure more effective learning since the leaner not only hears but
alsosees and does. Instructional materials in teaching play a very big role in
teaching and learning process as enumerated below:a. It helps the
teacher to provide his students with meaningful sources
of information.b. Helps the teacher by providing him with means of
wildering his students of informationc. Being experts with learning
resources in the classroomd. Allow members of a group or class to
share equally the same teaching experience.e. Provides the teacher means
of exposing the students to a wide range of learning activities.Berkey (1996)
wrote that rational selection of instructional materials in teaching is a
necessary step for effective teaching. He further added thatthe ability to
select and utilize methods and materials are important qualities of a
professional teacher. He outlines the criteria for selectingresources are as


Three Major Components of Instructional Materials

Delivery System
Delivery System
A component of an instructional material where both the physical form and the hardware
are used to present materials

EX: slides with projector

computer software w/ computer
A component of an instructional material wehre actual info is told to the learner

EX: Accuracy
Appropriateness for skill determination
A component of an instructional material that is the form most important for selecting
instructional materials

EX: Illusionary representations

Instructional Materials
Diane Hainsworth
Kara Keyes
 General Principles
 Choosing Instructional Materials
 The Three Major Components of Instructional Materials
 Delivery System
 Content
 Presentation
 Types of Instructional Materials
 Written Materials
 Demonstration Materials
 Audiovisual Materials
 Evaluation Criteria for Selecting Materials
 State of the Evidence

instructional materials
characteristics of the learner
characteristics of the media
characteristics of the task
delivery system
illusionary representations
symbolic representations
audiovisual materials
multimedia learning
blended learning
After completing this chapter, the reader will be able to
 Differentiate between instructional materials and instructional methods.
 Identify the three major variables (learner, task, and media characteristics)
to be considered when selecting, developing, and evaluating instructional
 Cite the three components of instructional materials required to
communicate educational messages effectively.
 Discuss general principles applicable to all types of media.
 Identify the multitude of instructional materials—printed, demonstration,
and audiovisual media—available for client and professional education.
 Describe the general guidelines for development of printed materials.
 Analyze the advantages and disadvantages specific to each type of
instructional medium.
 Evaluate the type of media suitable for use depending on such variables as
the size of the audience, the resources available, and the characteristics of
the learner.
 Identify where educational tools can be found.
 Critique instructional materials for value and appropriateness.
 Recognize the supplemental nature of media’s role in client, staff, and
student education.
Whereas instructional methods are the approaches used for
teaching, instructional materials are the vehicles by which information
is communicated. Often these terms are used interchangeably and are
frequently referred to in combination with one another as teaching strategies
and techniques. Nevertheless, instructional methods and instructional
materials are not one and the same, and a clear distinction can and should
be made between them. Instructional methods are the way information is
taught. Instructional materials, which include printed, demonstration, and
audiovisual media, are the adjuncts used to enhance teaching and learning.
These multimedia approaches must be examined from a scientific, evidence-
based perspective, grounded in theory on how people learn (Mayer, 2005).
Instructional materials, also known as tools and aids, are mechanisms or
objects to transmit information that are intended to supplement, rather than
replace, the act of teaching and the role of the teacher. These modes by which
information is shared with the learner often are not considered in depth, yet
instructional materials represent an important, complex component of the
educational process. Given the numerous factors affecting both the teacher
and the learner, such as the increase in staff workloads, the decrease in
length of inpatient stays or outpatient visits, the increase in client acuity, the
alternative settings in which education is now delivered, and the shrinking
resources for educational services, it is imperative that the nurse educator
understand the various types of printed, demonstration, and audiovisual
media available to complement teaching efforts efficiently and effectively.
Instructional materials provide the nurse educator with tools to deliver
education messages creatively, clearly, accurately, and in a timely fashion.
They help the educator reinforce information, clarify abstract concepts, and
simplify complex messages. Multimedia resources serve to stimulate a
learner’s senses as well as add variety, realism, and enjoyment to the
teaching-learning experience. They have the potential to assist learners not
only in acquiring knowledge and skills, but also in retaining more effectively
what they learn. Research indicates that a variety of printed, demonstration,
and audiovisual materials do, indeed, facilitate teaching and learning.
This chapter provides a systematic overview of the process for selecting,
developing, implementing, and evaluating instructional materials. Various
types of audiovisual media are examined with an eye toward matching them
to the particular characteristics of learners, the specific topics to be taught,
and the variable situations and settings for teaching and learning. The
advantages and disadvantages of each of the media types are discussed.
Although the choice of instructional materials often depends on availability
or cost, whichever tools are selected should enhance achievement of
expected learning outcomes.
This chapter is intended to inform nurse educators about various media
options so that they can make informed choices regarding appropriate
instructional materials that fit the learner, that affect the motivation of the
learner, and that accomplish the learning task. Whether nurses educate
clients and their families, nursing staff, or nursing students, the same
principles apply in making decisions about the type of materials selected for
Before selecting or developing media from the multitude of available options,
nurse educators should be aware of the following general principles
regarding the effectiveness of instructional materials:
 The teacher must be familiar with the media content before using a tool.
 Printed, demonstration, and audiovisual materials can change learner
behavior by influencing cognitive, affective, and psychomotor
 No one tool is considered better than another in enhancing learning
because the suitability of any particular medium depends on many
 The tools should complement the instructional methods.
 The choice of media should be consistent with the subject content to be
taught and match the tasks to be learned to assist the learner in
accomplishing predetermined behavioral objectives.
 The instructional materials should reinforce and supplement—not
substitute for—the educator’s teaching efforts.
 Media should match the available financial resources.
 Instructional aids should be appropriate for the physical conditions of the
learning environment, such as the size and seating of the audience,
acoustics, space, lighting, and display hardware (delivery mechanisms)
 Media should complement the sensory abilities, developmental stages, and
educational level of the intended audience.
 The messages imparted by instructional materials must be accurate, valid,
authoritative, up-to-date, appropriate, unbiased, and free of any
unintended content.
 The media should contribute meaningfully to the learning situation by
adding and diversifying information.
Nurse educators must consider many important variables when selecting
instructional materials. The role of the nurse educator goes beyond the
dispensing of information only; it also involves skill in designing and
planning for instruction. Learning can be made more enjoyable for both the
learner and the teacher if the educator knows which instructional materials
are available, as well as how to choose and use them so as to best enhance
the teaching-learning experience.
Knowledge of the diversity of instructional tools and their appropriate use
enables the teacher to make education more interesting, challenging, and
effective for all types of learners. With current trends in healthcare reform,
educational strategies to teach clients, in particular, need to include
instructional materials for health promotion and illness prevention, as well
as instructional materials for health maintenance and restoration.
Making appropriate choices of instructional materials depends on a broad
understanding of three major variables: (1) characteristics of the
learner, (2) characteristics of the media, and (3) characteristics of
the task to be achieved (Frantz, 1980). A useful mnemonic for
remembering these variables is LMAT—standing for “learner, media, and
1. Characteristics of the learner. Many variables are known to influence
learning. Educators, therefore, must know their audience so that they can
choose those media that will best suit the needs and abilities of various
learners. They must consider sensorimotor abilities, physical attributes,
reading skills, motivational levels (locus of control), developmental stages,
learning styles, gender, socioeconomic characteristics, and cultural
2. Characteristics of the media. A wide variety of media—printed,
demonstration, and audiovisual—are available to enhance methods of
instruction for the achievement of objectives. Print materials are the most
common form through which such information is communicated, but
nonprint media include an expansive range of audio and visual possibilities.
Because no single medium is more effective than all other options, the
educator should be flexible in considering a multimedia approach to
complement methods of instruction.
3. Characteristics of the task. Identifying the learning domain (cognitive,
affective, and/or psychomotor) as well as the complexity of those behaviors
that are required, which are based on the predetermined behavioral
objectives, defines the task(s) to be accomplished.
Depending on the instructional methods chosen to communicate
information, educators must decide which media are potentially best suited
to assist with the process of teaching and learning. The delivery system
(Weston & Cranston, 1986), content, and presentation (Frantz, 1980) are the
three major components of media that educators should keep in mind when
selecting print and nonprint materials for instruction.
Delivery System
The delivery system includes both the software (the physical form of the
materials) and the hardware used in presenting information. For
instance, the educator giving a lecture might choose to embellish the
information being presented by using a delivery system, such as the
combination of PowerPoint slides (software) and a computer (hardware).
The content on DVDs (software), in conjunction with DVD players
(hardware), and CD-ROM programs (software), in conjunction with
computers (hardware), are other examples of delivery systems.
The choice of the delivery system is influenced by the size of the intended
audience, the pacing and flexibility needed for delivery, and the sensory
aspects most suitable to the audience. More recently, the geographical
distribution of the audience has emerged as a significant influence on choice
of delivery systems, given the popularity of distance education modalities.
The content (intended message) is independent of the delivery system and is
the actual information being communicated to the learner, which might
focus on any topic relevant to the teachinglearning experience. When
selecting media, the nurse educator must consider several factors:
 The accuracy of the information being conveyed. Is it up-to-date, reliable,
and authentic?
 The appropriateness of the medium to convey particular information.
Brochures or pamphlets and podcasts, for example, can be very useful tools
for sharing information to change behavior in the cognitive or affective
domain but are not ideal for skill development in the psychomotor domain.
Videos, as well as real equipment with which to perform demonstrations
and return demonstrations, are much more effective tools for conveying
information relative to learning psychomotor behaviors.
 The appropriateness of the readability level of materials for the intended
audience. Is the content written at a literacy level suitable for the learner’s
reading and comprehension abilities? The more complex the task, the more
important it is to write clear, simple, succinct instructions enhanced with
illustrations so that the learner can understand the content.
According to Weston and Cranston (1986), the form of the message—in other
words, how information is presented—is the most important component for
selecting or developing instructional materials. However, a consideration of
this aspect of the media is frequently ignored. Weston and Cranston describe
the form of the message as occurring along a continuum from concrete (real
objects) to abstract (symbols).
Realia refers to the most concrete form of stimuli that can be used to deliver
information. For instance, an actual woman demonstrating breast self-
examination is the most concrete example of realia. Because this form of
presentation might be less acceptable for a wide range of teaching situations,
the next best choice would be a manikin. Such a model, which is analogous
to a human figure, has many characteristics that simulate reality, including
size and three-dimensionality (width, breadth, and depth), but without being
the true figure that may very well cause embarrassment for the learner. The
message is less concrete, yet using an imitation of a person as an
instructional medium allows for an accurate presentation of information
with near-maximal stimulation of the learners’ perceptual abilities. Further
along the continuum of realia is a video presentation of a woman performing
breast self-examination. The learner could still learn accurate breast self-
examination by viewing such a video, but the aspect of three dimensionality
is absent. In turn, the message becomes less concrete and more abstract.
The term illusionary representations applies to a less concrete, more
abstract form of stimuli through which to deliver a message, such as moving
or still photographs, audiotapes projecting true sounds, and real-life
drawings. Although many realistic cues, including dimensionality, are
missing from this category of instructional materials, illusionary media have
the advantage of offering learners a variety of real-life visual and auditory
experiences to which they might otherwise not have access or exposure
because of such factors as location or expense. For example, pictures that
show how to stage decubitus ulcers and audiotapes that help learners
discriminate between normal and abnormal lung sounds, although more
abstract in form, do to some degree resemble or simulate realia.
The term symbolic representations applies to the most abstract types of
messages, though they are the most common form of stimuli used for
instruction. These types of representations include numbers and letters of
the alphabet, symbols that are written and spoken as words that are
employed to convey ideas or represent objects. Audiotapes of someone
speaking, live oral presentations, graphs, written texts, handouts, posters,
flipcharts, and whiteboards on which to display words and images are
vehicles to deliver messages in symbolic form. The chief disadvantage of
symbolic representations stems from their lack of concreteness. The more
abstract and sophisticated the message, the more difficult it is to decipher
and comprehend. Consequently, symbolic representations may be
inappropriate as instructional materials for very young children, learners
from different cultures, learners with significant literacy problems, and
individuals with cognitive and sensory impairments.
When making decisions about which tools to select to best accomplish
teaching and learning objectives, the nurse educator should carefully
consider these three media components. When choosing from a wide range
of print and audiovisual options, key issues to be taken into account include
the various delivery systems available, the content or message to be
conveyed, and the form in which information will be presented. Educators
must remember that no single medium is suitable for all audiences in
promoting acquisition and retention of information. Most important, the
function of instructional materials must be understood—that is, to
supplement, complement, and support the educator’s teaching efforts for the
successful achievement of learner outcomes.
Written Materials
Handouts, leaflets, books, pamphlets, brochures, and instruction sheets (all
symbolic representations) are the most widely employed and most accessible
type of media used for teaching. Printed materials have been described as
“frozen language” (Redman, 2007, p. 34) and are the most common form of
teaching tool because of the distinct advantages they provide to enhance
teaching and learning.
The greatest virtues of written materials are as follows:
 They are available to the learner as a reference for reinforcement of
information when the nurse is not immediately present to answer
questions or clarify information.
 They are widely used at all levels of society, so this medium is acceptable
and familiar to the public.
 They are easily obtainable through commercial sources, usually at
relatively low cost and on a wide variety of subjects, for distribution by
 They are provided in convenient forms, such as pamphlets, which are
portable, reusable, and do not require software or hardware resources for
 They are becoming more widely available in languages other than English
as a result of the recognition of significant cultural and ethnic shifts in the
general population.
 They are suitable to a large number of learners who prefer reading as
opposed to receiving messages in other formats.
 They are flexible in that the information is absorbed at a speed controlled
by the reader.
The disadvantages of printed materials include the following facts:
 Written words are the most abstract form in which to convey information.
 Immediate feedback on the information presented may be limited.
 A large percentage of materials are written at too high a level for reading
and comprehension by the majority of clients (Doak, Doak, Friedell, &
Meade, 1998).
 Written materials are inappropriate for persons with visual or cognitive
A wealth of brochures, posters, pamphlets, and client-focused texts is
currently available from commercial vendors. Whether such materials
enhance the quality of learning is an important question for nurse educators
to consider when trying to evaluate these products for content, readability,
and presentation. Commercial products may or may not be produced in
collaboration with health professionals, which raises the question of how
factual the information may be. For example, materials prepared by
pharmaceutical companies or medical supply companies might not be free of
bias. Educators must ask several questions when reviewing printed materials
that have been prepared commercially, including the following:
 Who produced the item? Evidence should make it clear whether input was
provided by a nurse or other healthcare professional with expertise in the
subject matter.
 Can the item be previewed? The educator should have an opportunity to
examine the accuracy and appropriateness of content to ensure that the
information needed by the target audience is provided.
 Is the price of the teaching tool consistent with its educational value?
Getting across an important message effectively may justify a significant
cost outlay, especially if the tool can be used with large numbers of learners.
However, simple printed instruction sheets may do the job just as well at
less expense and can provide the educator with the ability to update the
information on a more frequent basis.
The main advantage of using commercial materials is that they are readily
available and can be obtained in bulk for free or at a relatively low cost (Fraze,
Griffith, Green, & McElroy, 2010). A nurse educator might need to spend
hours researching, writing, and copying materials to create informational
materials of equal quality and value, so commercially available materials can
save valuable time. Also, some commercial materials are available online that
can be customized to individual clients.
The disadvantages of using commercial materials include issues of cost,
accuracy and adequacy of content, and readability of the materials. Some
educational booklets are expensive to purchase and impractical to give away
in large quantities to learners unless the educator uses materials that can be
individualized. Fraze and associates (2010) have developed a checklist to
help healthcare providers determine the appropriateness of printed
education materials for use by their clients for improvement of health
outcomes in various clinical settings.
Nurse educators may choose to write their own instructional materials so as
to realize cost savings or to tailor content to specific audiences. Composing
materials offers many advantages (Brownson, 1998; Doak et al., 1998). For
example, by writing their own materials, educators can tailor the information
to accomplish the following points:
 Fit the institution’s policies, procedures, and equipment
 Build in answers to those questions asked most frequently by clients
 Highlight points considered especially important by the team of physicians,
nurses, and other health professionals
 Reinforce specific oral instructions that clarify difficult concepts
Doak and colleagues (1998) outline specific suggestions for tailoring
information to help clients want to read and remember the message and to
act on it. These authors define “tailoring” as personalizing the message so
that the content, structure, and image fit an individual client’s learning
needs. To accomplish this goal, they suggest techniques such as writing the
client’s name on the cover of a pamphlet, and opening a pamphlet with a
client and highlighting the most important information as it is verbally
reviewed. In another example, Feldman (2004) describes successful use of
childcare checklists that had simple line drawings (no more than two to a
page) coupled with brief written descriptions that led parents in stepby-step
fashion through specific care tasks, such as bathing a baby. Audiotapes also
accompanied these pictures and simple instructions. Additional studies
support the efficacy of tailored instruction over nontailored messages in
achieving reading, recall, and follow-through in health teaching (Campbell
et al., 1994; Skinner, Strecher, & Hospers, 1994).
Of course, composing materials also has disadvantages. Educators need to
exercise extra care to ensure that materials are well written and laid out
effectively, which can be a time-consuming endeavor. Although nurse
educators are expected to enhance their methods of teaching with
instructional materials, few have ever had formal training in the
development and application of written materials. Many tools written by
nurses are too long, too detailed, and composed at too high a level for the
target audience. Doak, Doak, and Root (1996) and Brownson (1998) suggest
the following guidelines to ensure the clarity of self-composed printed
education materials:
 Make sure the content is accurate and up-to-date.
 Organize the content in a logical, stepby-step, simple fashion so that
learners are being informed adequately but are not overwhelmed with large
amounts of information. Avoid giving detailed rationales because they may
unnecessarily lengthen the written information. Prioritize the content to
address only what learners need to know. Content that is nice to know can
be addressed orally on an individual basis.
 Make sure the information succinctly discusses the what,
how, and when. Follow the KISS rule: Keep it simple and smart. This can
best be accomplished by putting the information into a question-and-
answer format or by dividing the information into subheadings according
to the nature of the content.
 Regardless of the format employed, avoid medical jargon whenever
possible, and define any technical terms in laypeople’s language.
Sometimes it is important to expose clients to technical terms because of
complicated procedures and ongoing interaction with the medical team, so
careful definitions can minimize misunderstandings. Be consistent with
the words used.
 Find out the average grade in school completed by the targeted client
population, and write the client education materials two to four grade levels
below that level. For individuals who are nonliterate, pictographs can
increase recall of spoken medical instruction (Houts et al., 1998; Kessels,
Always state things in positive—not negative—terms. Never illustrate
incorrect messages. For example, depicting a hand holding a metereddose
inhaler in the mouth not only incorrectly illustrates a drug delivery technique
(Weixler, 1994) but also reinforces that message through the image’s visual
impact alone. Figure 12-1 illustrates the correct way to use an inhaler and
reinforces a positive message.
In addition to the guidelines for clarity and completeness in constructing
written materials, format and appearance are equally important in
motivating learners to read the printed word. If the format and appearance
are too detailed, learners will feel overwhelmed; in such a case, instead of
attracting the learners, you will discourage and repel them (Figure 12-2).
When evaluating printed materials, educators should keep in mind the
following considerations. Nature of the Audience What is the average
age of the audience? For instance, older adults tend to prefer printed
materials that they can read at their leisure. Lengthy materials may be less
problematic for older learners, who frequently have enough time and
patience for reading educational materials. Children or clients who have low
literacy skills, however, like short printed materials with many illustrations.
Also, what is the preferred learning style of the particular audience? Printed
materials with few illustrations are poorly suited to clients who not only have
difficulty reading but also do not like to read. Representations of information
in the form of simple pictures, graphs, and charts can be included with the
content of printed materials for those individuals who are visual and
conceptual learners.
In addition, does the audience have any sensory deficits? Vision deficits are
common among older adult clients, and deficits in short-term memory may
pose a problem for comprehension. Having materials that can be reread at
the learner’s own convenience and pace can reinforce earlier learning and
minimize confusion over treatment instructions. To accommodate those
individuals with vision impairments, use a large typeface and lots of white
space, separate one section from another with ample spacing, highlight
important points, and use black print on white paper.
Literacy Level Required The effectiveness of client education materials
for helping the learner accomplish behavioral objectives can be totally
undermined if the materials are written at a level beyond the comprehension
of the learner. The Joint Commission (formerly known as the Joint
Commission on Accreditation of Healthcare Organizations) mandates that
health information be presented in a manner that can be understood by
clients and family members. This requirement underscores the importance
of screening potential educational tools to be used as adjuncts to various
teaching methods. A number of formulas (e.g., Fog, SMOG, Fry) are available
for determining readability.
FIGURE 12-1 Diagram illustrating proper technique for inhale
Linguistic Variety Available Linguistic variety refers to choices of
printed materials in different languages. These options may be limited
because duplicate materials in more than one language are costly to publish
and not likely to be undertaken unless the publisher anticipates a large
demand. The growth of minority populations in the United States has
promoted increasing attention to the need for non-English language
teaching materials. Regional differences exist, such that there may be greater
availability of Asian-language materials on the West Coast and more
Spanish-language materials in the Southwest and Northeast than in other
parts of the United States.
FIGURE 12-2 Inadequate versus adequate appearance and form
Brevity and Clarity In education, as in art, simpler is better. Remind
yourself of the KISS rule: Keep it simple and smart. Address the critical facts
only. What does the client need to know? Choose words that
explain how; the why can be filled in by a lecture, one-to-one instruction, or
group discussion. Include simple pictures that illustrate step by step the
written instructions being given. Figure 12-3 provides a good example of a
clear, easy-to-follow instructional tool that is used to teach a patient with
asthma how to determine when a metered-dose inhaler is empty. Using
simple graphics and minimal words, it guides the learner through the
procedure with very little room for misinterpretation and is suitable for a
wide range of audiences.
Layout and Appearance The appearance of written materials is crucial
in attracting learners’ attention and getting them to read the information. If
a tool has too much wording, with inadequate spacing between sentences
and paragraphs, small margins, and numerous pages, the learner may find it
much too difficult and too time consuming to read (see Figure 12-2).
Doak and colleagues (1996) point out that allowing plenty of white space is
the most important step that educators can take to improve the appearance
of written materials. This means double spacing, leaving generous margins,
indenting important points, using bold characters, and separating key
statements with extra space. Inserting a graphic in the middle of the text can
break up the print and may be visually appealing, as well as provide a
mechanism for reinforcing the narrative information. Redman (2007) states
that pictorial learning is better than verbal learning for recognition and
recall. For topics that lend themselves to concrete explanations, this is
especially true. An example used earlier in this chapter is teaching the
psychomotor task of using a metered-dose inhaler (see Figure 12-1). Figure
12-4 includes simple step-by-step instructions written in the active voice on
the correct inhaler technique to use.

FIGURE 12-3 Examples of a clear, easy-to-follow instructional tool for an

Opportunity for Repetition Written materials can be read later, and

again and again, by the learner to reinforce the teaching when the educator
is not there to answer questions. Thus it is an advantage if materials are laid
out in a simple question-andanswer format. Questions demand answers, and
this format allows clients to find information easily for repeated
reinforcement of important messages. If educators write their own materials,
they also must be mindful of the need to keep information current and to
update it for changing client populations.
Concreteness and Familiarity Using the active voice is more
immediate, directive, and concrete. For example, “Shake the inhaler very
well three times” is more effective than “The inhaler should be shaken
thoroughly” (see Figure 12-4). Also, the importance of using plain language
instead of medical jargon cannot be overemphasized. Inadequate client
understanding of common medical terms used by healthcare providers is a
significant factor in noncompliance with medical regimens. A number of
studies indicate that clients understand medical terms at a much lower rate
than nurses expect (Estey, Musseau, & Keehn, 1994; Lerner, Jehle, Janicke,
& Moscati, 2000).
In summary, instructor-designed or commercially produced printed
instructional materials are widely used for a broad range of audiences. They
vary in literacy demand levels and may be found written in several
languages. Table 12-1 summarizes their basic advantages and
FIGURE 12-4 Example of instructions written in the active v

TABLE 12-1 Basic Advantages and Disadvantages of Printed Ma

Advantages Disadvantages

Always available Impersonal

Rate of reading is controllable by the Limited feedback; absence of ins
reader opportunity to clear up misint
Complex concepts can be explained both Passive tool
fully and adequately Highly complex materials may be ov
Procedural steps can be outlined learner
Verbal instruction can be reinforced Literacy skill of learner may limi
Learner is always able to refer back to
instructions given in print

Demonstration Materials
Demonstration materials include many types of visual, hands-on nonprint
media, such as models and real equipment, as well as a hybrid of printed
words and visual illustrations (diagrams, graphs, charts, photographs, and
drawings) depicted on what are known as displays, such as posters, bulletin
boards, flannel boards, flip charts, chalkboards, and whiteboards. These
types of media represent unique ways of communicating messages to the
learner. Demonstration materials primarily stimulate the visual senses but
can combine the sense of sight with touch and sometimes even smell and
taste. From these various forms of demonstration materials, the educator can
choose one or more to complement teaching efforts in reaching
predetermined objectives. Just as with written tools, these aids must be
accurate and appropriate for the intended audience. Ideally, these media
forms will bring the learner closer to reality and actively engage him or her
in a visual and participatory manner. As such, demonstration tools are useful
for cognitive, affective, and psychomotor skill development. The major forms
of demonstration materials—models and displays—are discussed in detail
Models are three-dimensional instructional tools that allow the learner to
immediately apply knowledge and psychomotor skills by observing,
examining, manipulating, handling, assembling, and disassembling objects
while the teacher provides feedback (Rankin & Stallings, 2005). In addition,
these demonstration aids encourage learners to think abstractly and give
them the opportunity to use many of their senses (Boyd, Gleit, Graham, &
Whitman, 1998). Whenever possible, the use of real objects and actual
equipment is preferred—but a model is the next best thing when the real
object is not available, accessible, or feasible, or is too complex to use.
Because approximately 30% to 42% of people are visual learners and 20% to
25% are kinesthetic (hands-on) learners, using models not only capitalizes
on their learning styles (preference for learning) but also enhances their
retention and understanding of new information (Aldridge, 2009).
Three specific types of models are used for teaching and learning, as
differentiated by Babcock and Miller (1994):
 Replicas, associated with the word resemble
 Analogues, associated with the words act like
 Symbols, associated with the words stands for
A replica is a facsimile constructed to scale that resembles the features or
substance of the original object. The dimensions of the reproduction may be
decreased or enlarged in size to make demonstration easier and more
understandable. A replica of the DNA helix is an excellent example of a model
used to teach the complex concept of genetics. Replicas can be examined and
manipulated by the learner to get an idea of how something looks and works.
They are excellent choices for teaching psychomotor skills because they give
the learner an opportunity for active participation through hands-on
experience. Not only can the learner assemble and disassemble parts to see
how they fit and operate, but the learner can also control the pace of learning.
Replicas are used frequently by the nurse educator when teaching anatomy
and physiology. Models of the brain, limbs, heart, kidney, ear, eye, joints, and
pelvic organs, for example, allow the learner to get a perspective on parts of
the body not readily viewed without these teaching aids. Resuscitation dolls
are a popular type of replica used to teach the skills of cardiopulmonary
resuscitation (CPR). Learners who regularly refresh their skills using
demonstration models as instructional tools are more likely to maintain
regular and effective knowledge of use of the technique than are learners who
do not (Pinto, 1993).
Using inanimate objects first is a technique educators can use to desensitize
learners before doing invasive procedures on themselves or other human
beings. Instructional models have been found to be effective in reducing fear
and enhancing acceptance of certain procedures (Cobussen-Boekhorst, Van
Der Weide, Feitz, & DeGier, 2000). For example, teaching a client with
diabetes how to draw up and inject insulin can best be accomplished by using
a combination of real equipment and replicas. Clients first draw up sterile
saline in real syringes, practice injecting oranges, and then progress to a
model of a person before actually injecting themselves. Sometimes,
preliminary use of a video before starting to handle equipment directly may
be helpful if learners are very anxious about performing various procedures.
For lessons aimed at psychomotor learning, educators can use skills
checklists as a mechanism for evaluating the accuracy of return
demonstrations. Simulation laboratories, for example, often use this
evaluation method.
The second type of model is known as an analogue because it has the same
properties and performs like the real object. Unlike replicas, analogue
models are effective in explaining and representing dynamic systems. A
computer model depicting how the human brain functions is one popular
analogue. Although costly, a sophisticated human patient simulator is
another analogue. The patient simulator is a manikin that physiologically
responds to treatment in a manner similar to what would occur in live clients.
Webbased patient simulation programs for teaching clinical reasoning to
health professionals, such as physical therapists, is growing in popularity,
and the feasibility of these computer analogues is being investigated (Huhn,
Anderson, & Deutsch, 2008).
The third type of model is a symbol, which is used frequently in teaching
situations. Written words, mathematical signs and formulas, diagrams,
cartoons, printed handouts, and traffic signs are all examples of symbolic
models that convey a message to the receiver through imaging, convention,
or association. International signs, for example, convey a familiar and
understandable message to individuals of multilingual or multicultural
backgrounds. However, abbreviations and acronyms common to healthcare
personnel, such as NPO, PRN, and PO, should be avoided when interacting
with consumers because they are likely to be unfamiliar with these
The advantage of models is that they can adequately replace the real object,
which may be too small, too large, too expensive, too complex, unavailable,
or inappropriate for use in a teaching-learning situation. A vast array of
models can be purchased from commercial vendors at varying prices (some
for free) or improvised by the teacher. Models do not need to be expensive or
elaborate to get concepts and ideas across (Aldridge, 2009; Rankin &
Stallings, 2005). In particular, models enhance learning in the following
 Allow learners to practice acquiring new skills without being afraid of
compromising themselves or others
 Stimulate active learner involvement
 Provide the opportunity for immediate testing of psychomotor and
cognitive behaviors
 Allow learners to receive instant feedback from the instructor
 Appeal to the kinesthetic learner who prefers the hands-on approach to
In terms of their disadvantages, some models may not be suitable for the
learner with poor abstraction abilities or for audiences with visual
impairments, unless each individual is given the chance to tangibly appraise
the object using other senses. Also, some models can be fragile, very
expensive, bulky to store, and difficult to transport. Unless models are very
large, they cannot be observed and manipulated by more than a few learners
at any one time. However, this drawback can be overcome by using team
teaching and by creating different stations at which to arrange replicas for
demonstration purposes (Babcock & Miller, 1994).
Whiteboards, posters, story boards, flip charts, and bulletin boards are
examples of displays found in most educational settings. In addition, the
SMART Board is a large whiteboard that uses touch technology for detecting
user input; it is similar in that respect to devices that use personal computing
input, such as a mouse or keyboard (SMART, 2009). SMART Boards are
growing in popularity but are still costly to purchase.
Displays are two-dimensional objects that serve as useful tools for a variety
of teaching purposes. They can be used to convey simple or quick messages
and to clarify, reinforce, or summarize information on important topics and
themes. Although they have been referred to as static instructional tools
owing to the fact that they are often stationary (Haggard, 1989), some
displays may be portable and most are alterable. As demonstration
materials, these tools can effectively achieve behavioral objectives by vividly
representing the essence of relationships between subjects or objects.
Whiteboards, flip charts, and SMART Boards are particularly versatile
means of delivering information. Storyboards—visual tools that use pictures
and written text to explain a sequence of events—are effective in providing
consistent messages to clients in a simple, easy-to-understand format
(Lowenstein, Foord, & Romano, 2009).
These board devices are most useful in formal classes, in group discussions,
or during brainstorming sessions to spontaneously make drawings or
diagrams (with contrasting colored chalk or markers) or to jot down ideas
generated from participants while the educator is in the process of teaching.
Information can be added, corrected, or deleted quickly and easily while the
learners are actively following what the teacher is doing or saying. Such tools
are excellent means of promoting participation, keeping the learners’
attention on the topic at hand, and noting and reinforcing the contributions
of others. Flexible and handy, they provide opportunities for the teacher, in
an immediate and direct fashion, to organize data, integrate ideas, perform
on-the-spot problem solving, and compare and contrast various points of
view. Also, unlike some other types of visuals, these display tools can allow
learners to see parts of a whole picture while assisting the teacher in filling
in the gaps.