applying theories of learning to healthcare practice

8/3/2019 Applying Theories of Learning to Healthcare Practice

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Nature of the LearnerHuman Development is the dynamic process of changethat occurs in the physical, psychological, social, spiritual& emotional constitution.

Types of changes:

1. Growth is quantitative involving increase in the size of

the parts of the body.2. Development is qualitative involving gradual changes

in character.


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Major Processes of Human

Development1. Learning -Any relatively permanent change in behavior

brought about through experience.- It is a complex process which involves

changes in mental processing, development of emotionalfunctioning and social transactional skills develop andevolve from birth to death.

2. Maturation Includes bodily changes which are

primarily a result of heredity or the traits that a personinherits from his parents.


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Periods of Lifespan Development1. Prenatal Development Includes the time from

conception to birth.

Hereditary Is the sum of total characteristicswhich are biologically transmitted thru parents tooffspring.

Two types of cells in the human body: Body or Somatic Cells

Germ or Productive Cells


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Periods of Lifespan Development2. Infancy Extends from birth up to 18 or 24 months. It

characterized by:

0 Time of extreme dependence on adults0 Babyhood

Sensimotor Development Head turns to

direction of touch, lifts chain & head, holds head &erect, reaches for objects, sits with support, standswith help, crawls, walks with support.


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Periods of Lifespan Development3. Early Childhood begins from the end of infancy to

about 5-6 years.

Behavior of a child during early childhood( Pre-school)

First Grade marks end of early childhood

Pre-school experience affects his/her growth &development.

The relationship that the child has with the significantothers


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Periods of Lifespan Development4. Middle and Late Childhood School age from 6

11years. Also called as elementary school years.

The fundamental skills of reading, writing andarithmetic are mastered.

The child becomes more achievement centered with

increased self-control when he/she is exposed to theworld and culture.


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Periods of Lifespan Development5.Adolescence Marks the transition of childhood to

adulthood; approximately from 10-12 years and endingat 18-22 years.

Puberty Development of sexual characteristics.

Characteristics of adolescence

Pursuit of independence and an identity is prominent. Thoughts are more logical, abstract, and idealistic

More time is spent outside the family


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Periods of Lifespan DevelopmentDevelopmental Task of Adolescence

Development independence in preparation for

adulthood Establishing a sense of identity

Physical Aspect of Development

More marked internal than external development

during later adolescence Spends more time with the physical looks and

improving appearance


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Periods of Lifespan Development6. Early Adulthood Begins in late teens or early

twenties through the thirties.

Characteristics of early adolescence

Establishing personal and economic independence.

Career development

Selecting a mate

Intimate relationships

Starting a family


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Periods of Lifespan Development7. Middle Adulthood begins from 35-45 years old up

to 65 years old

Characteristics of middle adulthood

Menopause of women

Climacteric or andropause for men

Time of expanding personal and social involvementand responsibility.


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Periods of Lifespan Development8. Late Adulthood or Senescence begins from 65 to

80 years and lasting until death.

Characteristics of late adulthood

Time adjustment to decreasing strength & health

Life Review

Retirement

Adjustment to new social roles

Affiliations with members ofones age group


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Four Theories ofHuman Development


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Theory of Psychosexual Development

SigmundFreud Fatherof ModernPsychology


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Theory of Psychosexual Development

Believed that human beings passthrough a series of stages that aredominated by the development

of sensitivity in particularerogenous zone or pleasure

giving area in the body.


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Eriksons Psychological Stages of

Development Crisis A turning point, crucial period of increase

vulnerability and heightened potential.

Epigenetic Principle personality continues todevelop throughout the entire life sopa


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Major Stages of Social-Emotional

Development1. Infant: Trust vs. Mistrust

2. Toddler: Autonomyvs. Shame and doubt

3. Preschool: Initiative vs. Guilt4. Schoolage: Industry vs. inferiority

5. Adolescence: Identify vs. Role confusion

6. Young adulthood: Intimacy vs. Isolation

7. Middleadulthood: Generatively vs. Stagnation

8. Old age: Ego Integrity vs. Despair


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Piagets Theory of Cognitive

DevelopmentUniversal Constructivist perspective

All humans construct their understanding of the

world in predictable ways. Humans take an active role in their own

development by acting on the physical environment.


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Key Concepts

1. Mental Structures begins with reflexes in infancyevolving into schemata and more complex structure

Operations

2. Schema metal concept formed through

experiences with objects and events3. Schemata are building blocks of cognitive

structures

4. Operations mental actions allowing children to

interact with the environment using their minds andbodies.

5. Organization humans have natural and innatetendency to organize their relationship with theenvironment.


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Moral development Theory

Lawrence KohlbergThree Levels and Six Stages

I. Pre-conventional Level Stages I Punishment\ obedience orientation Stages II Instrumental- relativist orientation

II. Conventional Level Stages III Good boy\ nice girl orientation Stages IV Law and other OrientationIII. Post-conventional Level Stages V Social contract orientation Stages VI Universal ethical principle orientation.


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THE DETERMINANTS OF LEARNING

Haggard (1989)

states that educators role in learning isprimarily to assess the learner in relation to:

Learning needs

Learning readiness Learning style


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The Determinants of LearningLEARNING NEEDS

Are gaps in knowledge that exist between a desiredand actual level of performance.

1. Informal conversations or interviews

2. Structural interviews

3. Written pretests

4. observation


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LEARNING Is a relatively permanent change in mental

processing, emotional functioning and or behavior as aresult of experience.

it is a lifelong process that is constantly evolving thattakes place from the mother of conception up to death.

is an ongoing process that is dynamic and constantlyevolving from womb to womb


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Steps in the Assessment of

Learning Needs.(Bastable, 2003)1. Identify the learner who is learner, group or

individual and what are learner needs.

2. Choose the right setting establish a trustingenvironment by ensuring privacy and confidentially.

3. Collect data on the learner determining thecharacteristics learning needs of the targetpopulation, patient or any recipient of learning

material4. Include the learner as a source of information

allow the learner to actively participate in identifyinghis needs and problems


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Steps in the assessment of learning

needs5. Include members of the healthcare team

collaborate with the healthcare professionals who mayhave insights or knowlegde of the patient or learner.

6. Determine availability of education resources demonstrate the materials and equipment will be used. Itshould be appropriate, available, affordable, easy andsimple to manipulate.

7. Assess demands of the organization its philosophy,vision, mission and goals to know what its educationalfocus is. Is more on health promotion and preventivedisease.


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Continuation of steps assessment8. Consider time-management issues allow learner

to identify their learning needs.

identify potential opportunities to assess patientanytime, anywhere.

minimize distractions\interruptions during plannedassessment interviews.

9. Priority needs it maybe based on Maslow'shierarchy of needs.


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MASLOWS HEIRARCHY of NEEDS

SELFACTUALIZATION

SELF-ESTEEMNEEDS

LOVE ANDBELONGINGNESS NEEDS

SAFETY AND SECURITY NEEDS

PHYSIOLOGICAL NEEDSOxygen,food,elimination,temperaturecontrol,sex,movement,rest,comfort.

r er a or r or z ng earn ng


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r er a or r or z ng earn ngNeeds

(HC Educ. Ass. 1985)I. Mandatory must immediate care for life

threatening or needed for survival

II. Desirable must met to promote well-being andare not life-dependent

III. Possible nice to know learner needs which arenot directly related to daily activities.

Readiness to Learn. Is the time when the patient is willing to learn

Is receptive to information


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Types of Readiness to Learn (PEEK)

P = Physical Readiness

1. Measures of abilityadequate strength, flexibility andendurance is needed to teach a patient.

2. Complexity of task

Difficulty level of the subject or the task to be mastered.

psychomotor skills require varying degrees of manualdexterity

physical energy output but once acquired or mastered

usually retained better and longer than learning in thecognitive and effective domains


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Types of Readiness to Learn3. Environmental effects refers to an environment

that is conductive to learning

4. Health status patient in a state of good health orill health

5. Gender

Is a changing perspective in attention-seeking

behavior with the blending of roles in the home orworkplace

increased attention to healthy lifestyle (men andwomen)


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Types of Readiness toE = Emotional Readiness

1. Anxiety Level

May or may not be hindrance to learning

Some degree of anxiety may motivate a person tolearn either high or low will interfere anxiety

moderate level of anxiety contributes to ability

fear greatly contributes to anxiety and exertsnegatives effects on readiness to learn.


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Types of readiness to learn

2. Support system

Strong support system composed of the immediatefamily and friends

Weak or absent support system elicits sense ofinsecurity, despair, frustration and a high level ofanxiety.

Emotional support paves the way for the teachablemoment

3. Motivation is a strongly associated with emotionalreadiness or willingness to learn


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Types of readiness to Learning

4. Risk-taking behavior activities that are undertakenwithout much thought to what negatives consequencesor effects might be.

5. Frame of mind depends on what the priorities of the

learner are in terms of his needs6. Developmental stage determines the peak time for

readiness to learn teachable moment

E = Experiential Readiness

refers the previous learning experience whether itspositive or negative

1. Level of aspiration depends on short or long term

goal which influence motivation to achieve


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Experiential Readiness2. Past coping mechanisms refers how the learner

was able to cope with or handle previous problems orsituations and how the effective were the strategies

used.

3. Cultural background

Awareness of the culture of the learner is of prime

importance find out also if the patient understands the language

that is being used to communicate with.

4. Locus of control refers motivation to learn


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2 types of locus of control

A. Internal locus of control (intrinsic)B. external locus of control (extrinsic)

5. Orientationrefers to a persons point-of-view

A. Parochial close-minded thinking, conservative intheir approach to new situation, less wiling to learn new

materials.B. Cosmopolitan orientation more worldly perspective

and more receptive to new or innovative ideas


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Knowledge

K = Knowledge Readiness1. Present knowledge base refers as stock knowledge

2. Cognitive ability involves lower level of learningincludes: memorizing, recalling or recognizing concept andideas.

Learning Styles

Indicates how people learn in uniquely different ways:

1. some are global (holistic) thinkers and some are analytic.

2. some learn better from auditory sources than from visualstimuli.

3. Some learn better when with the group than independentlyor alone.


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Basic Concept of cognitive styles

Holistic vs. analytic thinking

Holistic (global) thinkers interested in the gistof things, the essence or general idea

Analytic thinkers - think logically and objectivelylooking at the details first

Verbal vs. visual representation

see or hear as in terms of words or verbalassociations

see or hear as mental pictures or images


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Learning Style Models

Two most commonly used learning models that arefrequently used in nursing

David Kolbs Cycle of Learning (1984)

Anthony Georges Cognitive Styles model (1982)Kolbs model (Cycle of Learning)

learning is a continuous process which is a cumulativeresult of previous or past experiences, heredity

interaction with the environment.


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Kolbs Theory of Experiential

Learning

Concrete experience (CE) abilities: Learning fromactual experience

Reflective observation (RO) abilities: Learning byobserving others

Abstract conceptualization (AC) abilities: Creatingtheories to explain what is seen

Active experimentation (AE) abilities: Usingtheories to solve problems

o s eory an e r


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o s eory an e rcharacteristic predominantly

manifested by the learnerConverger: learns by AC and AE:

o Good at decision-making, problem solving

o

prefers dealing with technical work thaninterpersonal relationships

Learning Methods:

learns best through demonstration

Diverger: stresses CE and RO:o people and feeling oriented and likes to work in

groups


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Learning Methods:o learns best through group discussion and brainstorm

Accommodator: relies heavily on CE and AE:

o acts more on intuition, instinct or gut feelings rather thanon logic; an achieverLearning Methods:

o most challenging to educators bec. They learn bestthrough new and exciting learning experience

Assimilator: emphasizes AC and RO:o more concerned with abstract ideas than peopleo very good in inductive reasoningo interacting ideas; uses logical thinking


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Learning Methods:

o learn best through lectures, one-to-one instruction

o

self instruction methods with ample readingmaterials


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Concrete experience

FEELING

ABSTRACT CONCEPTUALIZATION THINKING

ACCOMODATOR

CONVERGER

DIVERGER

ASSIMILATOR


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Gregorc Cognitive Styles Model

1. Perception Ability

way one receives or grasps incoming information

stimulus in a continuum ranging from abstractnessto concreteness

2. Ordering ability

way one arranges and systematizes incoming stimuli

in continuum or scale ranging from sequence torandomness


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4 Mediation Channels

1. Concrete sequential (CS)o learners like highly structured, quiet learning environments

without interruptionso like concrete learning materials, esp. visuals and gives on

details

o may interpret words literally.2. Concrete random (CR)

o intuitive, trial-and-error method of learning, looks foralternatives

3. Abstract sequential (AS)o learners are holistic thinkers and need consistency in

learning environmento do not like interruptionso have good verbal skills, are rational and logical


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4. Abstract random (AR)

o learn a lot from visual stimuli

o prefer busy, unstructured learning environments

o focused on personal relationships


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Steps in helping to motivate the

learner1. Use Several Senses2. Actively Involve Clients in the Learning Process

3. Provide an Environment Conducive to Learning

4. Assess Learning Readiness5. Determine the Relevance of Information

6. Repeat the Information

7. Generalize Information

8. Make Learning a Pleasant Experience9. Be Systematic

10. Be Steady

earn ng eor es


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earn ng eor es(Bigge & Shermis, 1992; higard and

bower, 1996; Hill, 1990) is a coherent framework and set of integrated

constructs

principles that describe, explain or predict how people

learn, how learning occurs and what motivates peopleto learn and change

Major learning theories

(patient education and health care practice)

1. Behaviorist2. Cognitive

3. Social Learning


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Behavioral Theories of Learning

John B. Watson

is the proponent of behaviorist theory whichemphasizes the importance of observable behavior in

the study of human being

he defined behavior as muscle movement and it cameto be associated with the Stimulus-Response

psychology

he postulated that behavior results from a series ofconditioned reflexes, that all emotions and thoughts

are product of behavior learned through conditioning


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Respondent Conditioning

1. Classical or Pavlovian conditioning

a process which influences the acquisition of newresponses to environment stimuli:

NS ( neutral stimulus ) is a stimulus that has noparticular value significance or meaning to thelearner

UCR ( unconditional response ) through repeatedpairings with an UCS

there comes a time when the NS, even without theUCS, elicits the same UCR


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Respondent Conditioning2. Systematic desensitization

another technique is widely used in psychology even inmedicine to reduce fear and anxiety in the patient(Wolpe, 1982 )

is also a stress-reducing strategy that is adapted to helppreoperatively patients, rehabilitating drug addicts,

tension headaches and phobias, among other Bastable3. Stimulus generalization is the tendency to apply to other similar stimuli what

was initially learned4. Spontaneous recovery is usually applied in relapse prevention programs (rpp ) explain why it is quite difficult to completely eliminate

unhealthy habits and addictive behaviors


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Ways of Employing Positive

ReinforcementVerbal ways

Non-verbal waysClassification of Educational Reinforcers

( Tosti and Addison 1972 )1. Recognition2. Tangible rewards

3. Learning activities4. School responsibilities

5. Status indications6. Incentive feedback7. Personal activities


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Cognitive Theories of Learning

Cognition

is more than knowledge acquisition

it involves intelligence which is the ability to solve

problems or fashion products that are valued in morethan one setting

deals with perception, memory, thinking skills, and waysof processing and structuring information


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Paigets four major periods of

Cognitive or ID1. Sensorimotor stage: (birth-2yrs) determined basically on actual perception of the senses

and the external or physical factors

2. Abstract thinking: represent reality using symbols that can be

manipulated mentally

3. Logical thinking:

more systematic

uses scientific method

4. Assimilation and Accommodation:

Characterized by hypothesis testing


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Metacognition self-reflection wherein ideas andimagination are tried out to be aware of existing realities(internal dialogue)

Social Learning Theories emphasizes the importanceof environmental or situational determinants of behaviorand their continuing interaction

Reciprocal Determination (Albert Bandura)

environmental conditions shape behavior throughlearning.


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Four Operations

1. Attentional processes: determined what a person can do

what he or she can attend to

2. Retentional processes::

determined how experience is en

coded or retained in memory

3. Motor reproduction processes:

determined what behavior can be performed4. Motivational and reinforcement:

determined the circumstances under whichlearning is translated into performance


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SOCIAL LEARNING THOERY DEALT WITH

COGNITIVE VARIABLES

Walker Mischel (1993) Competence refer to a various skills Encoding strategies

personal experiences that are retained and categorizedby the individual Subjective values what a person consider as a worth having or

accomplishing

Self-regulating system or plans different standards Rules for regulating their behavior Plans for reaching his or her goals.


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Pedagogy versus Andragogy Pedagogy

art and science of helping children learn.

Andragogy

art and science of helping adults learn


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Theory of Adult Learning

(Knowles 1990)Adult Learning

more learner-centered than teacher-centered

becomes an independent self-directed human being

previous experience of the adult serves as a rich sourceof learning

readiness to learn is more oriented to the

developmental tasks of social roles there is a shift of learning orientation from being

subjective-centered to problem-oriented

applying theories of learning to healthcare practice

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