Bloom's Taxonomy of Education and its effect on Nursing Education

"Bloom's Taxonomy has long been the standard framework among clinical nurse educators and staff development coordinators for designing learning experiences or, at the least, has provided general guidance in development of objectives" (Horton, 2007). Bloom’s Taxonomy of educational objectives was developed by Benjamin Bloom in 1956 as a means to classify learning objectives and create learning tools for testing. There are three domains each containing subcategories that make up Bloom’s taxonomy. They are the cognitive domain, the affective domain, and psychomotor domain. Anderson and Krathwokl revised Bloom's taxonomy in 2001. While Bloom's Taxonomy has been a guideline to teach nurses, it can also be utilized as a guide for providing patient education. Each level of taxonomy builds upon the next requiring the learner to achieve a satisfactory level of each before moving forward to the next phase (Horton, 2007). A learner can be in more than one domain at a time as some levels overlap within the respective domain. Each domain and level will be discussed with examples of patient education for diabetes as an example. The cognitive domain includes six categories: remember, understand, apply, analyze, evaluate, and create. When a patient presents with a chronic illness, it has a huge impact on the patient and family. As teaching begins, the patient is given information that they are expected to remember for the long term. Information includes signs/symptoms of the disease process, medications administered for treatment and side effects, prevention, and how to perform home testing such as glucose monitoring to maintain manageable levels. Understanding the information given allows them to construct meaning from teaching provided. Applying the knowledge they have gained they are now able to choose a diet appropriate to assist in maintaining blood sugar levels within the specified range. Once these levels are mastered a patient can gather all supplies needed to check the glucose level, evaluate the results based on guidelines provided in teaching; and adjust insulin dosage and diet. The highest level of the cognitive domain is that of creating a new lifestyle. Diet and exercise recommendations over the long term, planning out days/weeks of meals and activity to achieve the desired outcome are now part of the patient's needs. In the affective domain, we evaluate the patient and how they utilize their emotions to cope with the diagnosis. At this point, we as health care providers are learning our patient. Assessing the patient’s readiness to learn, motivation to accept and change to improve the condition, and the attitude in which the patient is presenting in the wake of a new diagnosis. When a patient is diagnosed with a chronic illness, they go through several phases; denial, anger, bartering, acceptance. At the time when the patient reaches acceptance is when they become more receptive to receive the teaching required to improve their health status. Responding to the information is the next phase. It involves the patient beginning to retain information and request new information or clarification of that already provided. Over time, they begin to see the importance of changes needed within their life and organize how to put the changes into effect in their life. This plan may involve simply writing out a schedule on a calendar or seeking the help of a nutritionist to plan out meals or personal trainer to work with them exercising. These changes do not always take place overnight. As a patient internalizes the teaching, they enlist the help and support of family and friends by informing them of the information that has been shared with them to aid in a successful outcome. The psychomotor domain of bloom's taxonomy evaluates the manual skills needed to improve the outcome, including tasks such as performing an accucheck, administering medication, adjusting amounts of medication needed. There are five phases in this domain; imitation, manipulation, precision, articulation, and naturalization. Imitation occurs when the patient is aware of the right sites to check glucose, range appropriate for sugar, dosage of insulin needed, and site to administer. These become repetitive, so the patient doesn't have to think about them; it's a pattern. Manipulation involves the patient knowing the necessary supplies needed to check their sugar level and administer insulin if needed. All supplies are gathered at the appropriate time as not to delay treatment. When a patient can accurately withdraw the right amount of medication from a vial to administer, they have accomplished the precision. Articulation is the ability for that patient to adjust their insulin and diet based upon the value given at the time of the glucose test. Lastly, naturalization occurs when the patient is completely autonomous in maintaining appropriate sugar levels without the assistance of medical personal right by their side. They have become independent and can control their health choices, medication regimen and lifestyles without input of others except for following ups. In conclusion, Bloom's Taxonomy acts as "a two-dimensional framework for meeting educational needs" (Su & Osisek, 2011) in the transferring of knowledge from medical professionals to patients. The ability of the nurse to provide quality education lies in the ability to transfer the knowledge gained through continuing education and critical thinking (Larkin & Burton, 2008). The domains discussed in this paper are the original taxonomy thought to be better suited for testing. A revision of Bloom's Taxonomy in 2001 "focuses on student learning" (Su & Osisek, 2011). Regardless of the chosen taxonomy, it is important to implement our teaching at the appropriate times and assess accordingly. A teaching framework such as Bloom’s Taxonomy allows educators to assess what the learner knows. “According to Mager (1997), the educator must have a clear picture of the outcomes that are expected in order to facilitate learning” (Horton, 2007). Tailoring each teaching to the patient, allows for the individualization and optimization of the best care possible, resulting in the best outcome for the patient. Choosing appropriate times, reinforcing, and allowing the patient time to absorb each subject ensures that a successful outcome will be met.

References
Horton, B. B. (2007, November/December). Clinical staff development: Planning and teaching for desired outcomes. Journal for Nurses in Staff Development, 23(6), 260-268.
Larkin, B. G., & Burton, K. J. (2008, September). Evaluating a case study using Bloom's Taxonomy of Education. AORN Journal, 88(3), 390-402.
Su, W. M., & Osisek, P. J. (2011). The revised Bloom's Taxonomy: Implications for educating nurses. The Journal of Continuing Education in Nursing, 42(7), 321-327.
University of Phoenix (2011). Weblink Bloom’s Taxonomy retrieved from NUR427 week one on October 17, 2014.