# Situation: A 60-year-old man had an abdominoperineal resection with a permanent descending colostomy for rectal cancer 7 days ago. The stoma is pink and moist, and the colostomy is functioning. His wife will help him at home. The nurse begins discharge teaching. The nurse plans his discharge teaching, pairing each learning objective with a teaching method. Which pairing is MOST appropriate?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629755  
> language: ko  
> subject: Nursing Practice III — Care of Clients with Problems in Surgery, Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory and Immunologic Response, Cellular Aberrations

## 문제

Situation: A 60-year-old man had an abdominoperineal resection with a permanent descending colostomy for rectal cancer 7 days ago. The stoma is pink and moist, and the colostomy is functioning. His wife will help him at home. The nurse begins discharge teaching.

The nurse plans his discharge teaching, pairing each learning objective with a teaching method. Which pairing is MOST appropriate?

## 보기

1. Choose to join a support group, taught by meeting a colostomy user **✔ 정답**
2. Measure his stoma correctly, taught by a video and a written quiz
3. Express acceptance of his stoma, taught by a talk on bowel anatomy
4. State three foods that cause gas, taught by return demonstration

**정답: 1**

## 해설

Teaching methods are chosen first by the domain of the objective. Choosing to join a support group is an affective objective (attitudes and values), and affective learning is best served by testimonies, role models, and discussion, such as meeting a person who lives with a colostomy. Measuring the stoma is a psychomotor skill that needs demonstration and return demonstration, and stating foods is a cognitive objective that does not need a skill demonstration.

## 심화 해설

When planning discharge teaching for a patient with a new permanent colostomy, the nurse must first identify the learning domain of each objective, because the teaching method must match the type of learning being targeted. The three domains are cognitive (knowledge), psychomotor (skills), and affective (attitudes, values, and feelings). Pairing an objective with an incompatible method reduces learning effectiveness even when the content is accurate.

Domain–Method Matching

| Objective | Domain | Appropriate Method | Inappropriate Method |
| --- | --- | --- | --- |
| Choose to join a support group | Affective | Meeting a colostomy user, role modeling, discussion | Lecture on anatomy, written quiz |
| Measure stoma correctly | Psychomotor | Demonstration and return demonstration | Video plus written quiz alone |
| Express acceptance of stoma | Affective | Counseling, support group, testimonies | Talk on bowel anatomy |
| State three gas-forming foods | Cognitive | Discussion, pamphlet, teach-back | Return demonstration |

The objective "choose to join a support group" reflects a shift in values and willingness to engage with peers, which is an affective-domain outcome. Affective learning is best facilitated through exposure to role models, personal testimonies, and interactive discussion rather than didactic content delivery. Meeting a person who lives successfully with a colostomy provides a concrete, emotionally resonant example that can influence attitudes and motivate the patient to consider peer support [1][4].

Measuring the stoma is a psychomotor skill. Key point! Psychomotor objectives require demonstration followed by supervised return demonstration so the learner can practice and receive corrective feedback. A video plus a written quiz assesses recall, not the ability to physically trace and cut the skin barrier to the correct size. Without hands-on practice, the patient may measure incorrectly at home, increasing the risk of peristomal skin damage [1].

Stating three foods that cause gas is a cognitive objective. It involves recalling factual information, which is appropriately taught through verbal instruction, written materials, or teach-back. Watch out! Return demonstration is used to verify a physical skill, not to confirm that a patient can list information. Asking for a return demonstration of "stating foods" is a mismatch between objective domain and method.

Expressing acceptance of the stoma is also an affective objective. A talk on bowel anatomy addresses cognitive knowledge about physiology but does not directly address the emotional work of integrating the stoma into one's self-image. Affective objectives such as acceptance are better supported by counseling, peer interaction, and opportunities to verbalize feelings in a safe environment [4].

The most appropriate pairing is therefore "choose to join a support group" with "meeting a colostomy user," because the method directly targets the affective domain through role modeling and shared lived experience. This alignment is consistent with evidence that educational interventions for new ostomates improve self-care knowledge and psychosocial adaptation when the teaching strategy matches the intended outcome . For a patient preparing for discharge with a permanent colostomy, addressing the affective domain early can reduce feelings of isolation and improve long-term adjustment [4].References (research sources)

- [1]Teach-Back Communication Versus Pictorial-Based Learning on Self-Care Knowledge and Adherence, Self-Efficacy and Peristomal Skin Healing in Patients After Emergency Surgery Colostomy: A 3-Arm, Randomised, Controlled Trial.RCT/clinical trialRajabi Z, Khatiban M, Falahan SN, Soltanian AR (2025) · DOI: 10.1002/nop2.70258

- [4]Colostomy Care: A Guide for Home Care Clinicians.Research articleBerti-Hearn L, Elliott B (2019) · DOI: 10.1097/NHH.0000000000000735

## 임상 시나리오

Matching Teaching Methods to Learning DomainsDischarge teaching for a new colostomy patient
First identify the learning domain of each objective. Affective objectives target attitudes and values; psychomotor objectives target physical skills; cognitive objectives target knowledge.

Choosing to join a support group is an affective objective. It is best taught by meeting a colostomy user who can serve as a role model and share a personal testimony.

Measuring the stoma is a psychomotor skill requiring demonstration and return demonstration. Stating gas-forming foods is a cognitive objective best taught by discussion or written materials.

CautionDo not pair a psychomotor skill with passive methods like video plus written quiz alone. The patient must practice the skill with hands-on guidance to ensure safe self-care at home.

## 핵심 개념

- **Affective domain** — Learning involving attitudes, values, and feelings; best taught through role models, testimonies, and discussion.
- **Psychomotor domain** — Learning involving physical skills; best taught through demonstration and return demonstration.
- **Cognitive domain** — Learning involving knowledge and facts; best taught through discussion, written materials, or teach-back.
- **Return demonstration** — A teaching method where the learner performs a skill back to the instructor to confirm competence.
- **Colostomy** — A surgical opening in the colon brought to the abdominal surface for stool elimination.

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