CHARACTERISTICS

OF THELEARNER

Thea Estelle M. Quilao, RN

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COURSE CONTENT

•Gender, Socio-economic and Cultural attributes of the Learner

•Special Populations

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Gender, Socio-economic and

Cultural attributes of the Learner

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Learning Objectives

• Identify gender-related differences in the learner based on social and hereditary influences on brain

functioning, cognitive abilities,and personality characteristics.

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Learning Objectives

• Identify three approaches within clinical practice, academia, and

research to prepare practitioners to function in a culturally sensitive

manner.

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Learning Objectives

• Examine ways in which transcultural nursing can serve as

a framework for meeting the learning needs of various ethnic

populations.

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Learning Objectives

• Identify the meaning of stereotyping, the risks involved, and ways to avoid stereotypical

behavior.

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http://www.tommyswindow.com/english.html#

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Brain Structure

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Temporal Lobe

• Regions of the cerebral cortex help to control hearing, memory, and a person’s sense of self and time.

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Temporal LobeMen Women

In cognitively

normal men, a

small region of the

temporal lobe

has about 10%

fewer neurons

than it does in

women.

More neurons are

located in the

temporal region

where

language,

melodies, and

speech

tones are

understood.

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CORPUS CALLOSUM

• The main bridge between the left and right brain contains a bundle of

neurons that carry messages between the two brain hemispheres

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CORPUS CALLOSUM

Men WomenThis part of the brain

in men takes up less

volume than a

woman’s does, which

suggests less

communication

between the two brain

hemispheres.

The back portion of the

callosum in women is

bigger than in men,

which may explain why

women use both sides

of their brains for

language.

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ANTERIOR COMMISSURE

• This collection of nerve cells, smaller than the corpus callosum, also

connects the brain’s two hemispheres.

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ANTERIOR COMMISSURE

Men Women

The commissure in

men is smaller

than in women,

even though men’s

brains are, on

average, larger in

size than women’s

brains.

The commissure in

women is larger than

in men, which may

be a reason why

their cerebral

hemispheres seem

to work together on

tasks from language

to emotional

responses.

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BRAIN HEMISPHERES

• The left side of the brain controls language, and the right side of

the brain is the seat of emotion.

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BRAIN HEMISPHERES

Men Women

The right

hemisphere of

men’s brains tends

to be dominant.

Women tend to use

their brains more

holistically, calling

on

both hemispheres

simultaneously.

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BRAIN SIZE

• Total brain size is approximately 3 pounds.

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BRAIN SIZE

Men Women

Men’s

brains, on

average,

are

larger than

women’s.

Women have smaller

brains, on average, than

men because the

anatomical structure of

their entire bodies is

smaller. However, they

have more

neurons than men (an

overall 11%) crammed

into the cerebral cortex.19

COGNITIVE ABILITIES

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General intelligence

• On IQ tests, during preschool years, girls score higher; in high school, boys score higher on these tests.

• Overall no dramatic differences between the sexes have been found

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Verbal ability

• Girls learn to talk, use sentences, and use a greater variety of words earlier than boys.

• Girls speak more clearly, read earlier, and do consistently better on tests of spelling and grammar.

• On tests of verbal reasoning, verbal comprehension, and vocabulary, the findings are not consistent, and the conclusion is that no significant gender differences in verbal ability exist.22

Mathematical ability

• During the preschool years, there appears to be no gender related differences in ability to do mathematics.

• By the end of elementary school, however, boys show signs of excelling in mathematical reasoning, and the differences in math abilities of boys over girls become even greater in high school.

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Spatial ability

• The ability to recognize a figure when it is rotated, to detect a shape embedded in another figure, or to accurately replicate a three-dimensional object is consistently better for males than for females.

• The spatial ability of males is consistently higher than that of females and probably has a genetic origin.•Women surpass men in the ability to discern and later recall the location of objects in a complex, random pattern

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Problem solving

• Men tend to try new approaches in problem solving and are more likely to be “field independent”

• Males also show more curiosity and significantly less conservatism in risk-taking situations.

• In the area of human relations, women perform better at problem solving than do men.

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School achievement

• Girls get better grades on average than boys, particularly at the elementary school level.

• Scholastic performance of girls is more stable and less fluctuating than that of boys.

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AFFECTIVE BEHAVIOR

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Aggression

• Males usually being more dominant, assertive, energetic, active, hostile, and destructive.

• The role of the gender-specific hormone testosterone is being investigated as a possible cause of the more aggressive behavior demonstrated by males.

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Conformity and dependence• Females have been found generally

to be more conforming and more influenced by suggestion

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Values and life goals

• Men have tended to show greater interest in scientific, mathematical, mechanical, and physically active occupations as well as to express stronger theoretical, economic, and political values.

• Women have tended to choose literary, social service, and clerical occupations and to express stronger aesthetic, social sense, and religious values.

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Achievement orientation

• Females are more likely to express achievement motivation in social skills and social relations, whereas men are more likely to try to succeed in intellectual or competitive activities.

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GENDER DIFFERENCES IN

RELATION TO THE PROCESS OF

CLIENT TEACHING

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• Overall, women are likely to seek health care more often than men do.

• Although men are less likely to pursue routine health care for purposes of health and safety promotion and disease and accident

prevention, they typically face a greater number of health hazards.

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SOCIO ECONOMIC

DIFFERENCES

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q&a.html 34

SOCIO ECONOMIC

DIFFERENCES

• Socio-economic status is considered to be the single most important determinant of health in our society

• Social class is measured by one or more of the following types of indices: occupation of parents, income of family, location of residence, and educational level of parents.

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• The nurse plays a key role in educating the consumer about avoiding health risks, reducing illness episodes, establishing healthful environmental conditions, and accessing healthcare services.

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• Nurse educators must be aware of the probable effects of low SES on an individual’s ability to learn as a result of suboptimal cognitive functioning, poor academic achievement, low literacy, high susceptibility to illness, and disintegration of social support systems.

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• Low-income people are at greater risk for these factors that can interfere with learning, but one cannot assume that everyone at the poverty or near-poverty level is equally influenced by these threats to their well-being.

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CULTURAL DIFFERENCES

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• To keep pace with a society that is increasingly more culturally diverse, nurses will need to have sound knowledge of the cultural values and beliefs of specific ethnic groups as well as be aware of individual practices and preferences

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Acculturation: A willingness to modify one’s own culture as a result of contact with another culture

Assimilation: The willingness of a person emigrating to a new culture to gradually adopt and incorporate characteristics of the prevailing culture.

Cultural assessment: A systematic appraisal of beliefs, values, and practices conducted in order to determine the context of client needs and to tailor nursing interventionsCultural competence: A conscious

process of demonstrating knowledge and understanding of a client’s culture so as to recognize, accept, and respect cultural differences and to be able to incorporate these cultural beliefs and practices about wellness and illness into the delivery of care by adapting interventions to be congruent with the client’s culture

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Cultural diversity: A term meaning “representing a variety of different cultures”

Cultural relativism: Implies that “the values every human group assigns to its conventions arise out of its own historical background and can be understood only in the light of that background”

Culture: A complex concept that is an integral part of each person’s life and includes knowledge, beliefs, values, morals, customs, traditions, and habits acquired by each person as a member of a society

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Culturological assessment: Defined by Leininger (1978) as a “systematic appraisal or examination of individuals, groups, and communities as to their cultural beliefs, values, and practices to determine explicit needs and intervention practices within the cultural context of the people being evaluated”

Ethnicity: A dynamic and complex concept referring to “how members of a group perceive themselves and how, in turn, they are perceived by others. . . . When ethnic identity is strong, individuals maintain ethnic group values, beliefs,

behaviors, perspectives, language, culture, and ways of thinking”

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Ethnocentrism: A concept describing “the universal tendency of human beings to think that their ways of thinking, acting, and believing are the only right, proper, and natural ways

Ethnomedical: A concept of illness incorporating the relationship of humans with the universe, bridging culture with a sensitivity toward the traditional practices of specific ethnic groupsHistorically underrepresented groups: A

more politically sensitive and correct term used as a substitute for the word minority.

Ideology: Consists of the thoughts, attitudes, and beliefs that reflect the social needs and desires of an individual or ethnocultural group.44

Subcultures: Ethnocultural groups of people “who have experiences different from those of the dominant culture by virtue of status, ethnic background, residence, religion, education, or other factors that functionally unify the group and act collectively on each member with a conscious awareness of these differences

Transcultural nursing: Defined by Leininger (1978) as “a formal area of study and practice focused on a comparative analysis of different cultures and subcultures in the world with respect to cultural care, health and illness beliefs, values and practices with the goal of using this knowledge to provide culture-specific and culture-universal care to people”

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Six Cultural Phenomena SOURCE: Adapted from Giger, J. N. & Davidhizar, R. E. (1995),Transcultural Nursing:

Assessment and Intervention, 2nd ed., p. 9. St. Louis: Mosby–Year Book.

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Four-Step Approach to ProvidingCulturally Sensitive Care

SOURCE: Reprintedwith permission from Price, J. L. & Cordell, B.

(1994). Cultural diversity and patient teaching.Journal of Continuing Education in Nursing, 25(4),164.

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Cultural Systems in the Context ofHealth and Illness Care

SOURCE: Adapted fromAnderson, J. M. (1987). The cultural context of caring.Canadian Critical Care Nursing Journal, December,8

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Culturally Competent Model of Care SOURCE: Reprinted with permission from Campinha-

Bacote, J. (1995). The quest for cultural competence in nursing care. Nursing Forum, 30(4), 20.

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• Different cultural backgrounds not only create different attitudes and reactions to illness, but can also influence how people express themselves, both verbally and nonverbally, which may prove difficult to interpret.

• Culture also guides the way an ill person is defined and treated

• Readiness to learn must also be assessed from the standpoint of a person’s culture because this factor is a key element in crosscultural education.

• The client needs to believe that new behaviors are not only possible but also beneficial if behavioral change is to be maintained over the long term.

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specific guidelines for assessment (anderson, 1987)

1. Observe the interactions between patient and family members and among family members.

2. Listen to the patient.3. Consider communication abilities and

patterns1. Explore customs or taboos.2. Determine the notion of

time.3. Be aware of cues for

interaction51

style of interactionwhen no translator is used:• Speak slowly and distinctly, allowing for

twice as much time as a typical teaching session would take.

• Use simple sentence structures, relying on a direct subject-verb pattern and an active rather than passive voice.

• Avoid technical terms and medical jargon• Organize instructional material in the sequence in which the plan of action should be carried out.

• Make no assumptions that the information given has been understood. 52

STEREOTYPING

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• Nurse educators must concentrate on treating the sexes equally when providing access to health education, delivering health and illness care, and designing health education materials that contain bias-free language.

• Thorough and accurate assessment of the learner is the key to determining the particular abilities, preferences, and needs of each individual

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As a nurse educator, ask yourself the followingquestions:

• Do I use neutral language when teaching clients and families?

• Do I confront bias when evidenced by other healthcare professionals?

• Do I request information equally from clients regardless of gender, socioeconomic status, age, or culture?

• Are my instructional materials free of stereotypical terminology and expressions?

• Am I an effective role model of equality for my colleagues?

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As a nurse educator, ask yourself the followingquestions:

• Do I treat all clients with fairness, respect, and dignity?

• Does someone’s appearance influence (raise or lower) my expectations of that person’s abilities or affect the quality of care I deliver?

• Do I routinely assess the educational backgrounds, experiential backgrounds, personal attributes, and economic resources of clients to ensure appropriate health teaching?

• Am I knowledgeable enough of the cultural traditions of various groups to provide sensitive care in our pluralistic society?

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SPECIAL POPULATIONS

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Learning Objectives

• Describe how visual and hearing deficits require adaptive intervention.

• Identify the various teaching strategies that are effective with learning

disabilities.• Describe the different

physical and mental disabilities for appropriate

adaptation of the teaching–learning plan.

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Learning Objectives

• Enhance the teaching–learning process for someone with a communication

disability.

• Discuss the effects of a chronic illness on people and their families as well as

on the teaching–learning process.

• Describe adaptive computing and its application for people with disabilities.

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• The shock of any disability, whether it occurs at the beginning of life or toward the end, has a tremendous impact on individuals and their families.

• At the onset and all through the habilitation or rehabilitation process, the patient and family are met with new information to be learned, as successful habilitation or rehabilitation means acquiring knowledge and applying it to their situation.

• The physical, social, emotional, and vocational implications of living with a disability necessitate the nurse as educator to be well prepared to meet any member of this special population right where they are in their struggle to live independently.

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Habilitation

includes all the activities and interactions that enable an individual with a disability to develop new abilities to achieve his or her maximum potential

REHabilitationrelearning of previous skills, which

often requires an adjustment to altered functional abilities and altered lifestyle

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disability

• the inability to perform some key life functions and is often used interchangeably with functional limitations

• a physical or mental impairment which substantially limits one or more of the major life activities of the individual (American Disabilities Act)

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THE NURSE AS EDUCATOR’SROLE IN ASSESSMENT

• determine the extent of clients’ knowledge with respect to their disability,

• determine the amount and type of new information needed to effect a change in behavior,

• evaluate the clients’ readiness to learn.• obtain feedback from the clients

• use assessment skills of observation, testing, and interviewing of family members and significant others as well as taking into account the findings of the team of healthcare professionals.

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determining the disabledperson’s readiness to learn

(Diehl,1989)1. Do the individual and family members demonstrate

an interest in learning by requesting information or posing questions in an effort at problem solving or determining their needs?

2. Are there barriers to learning such as low literacy or vision or hearing impairments? If so, is the client willing and able to use supportive devices?

3. What learning style best suits the client in processing information and applying it to self-care activities?

4. Is there congruence between the goals of the client and family?

5. Is the environment conducive to learning?6. Does the client value the learning of new

information and skills as a means to achieve functional improvement? Does the client correlate learning with the opportunity to regain an optimal level of functioning?64

TYPES OF DISABILITIES

•sensory deficits• learning disabilities

•developmental disabilities•mental illness

•physical disabilities•communication disorders

•chronic illness65

SENSORY DEFICITS

Be considerate and refrain from– Talking and walking at the same time.– Bobbing your head excessively.– Talking with your mouth full, while chewing gum, and so forth.– Turning your face away from the deaf person while

communicating. Standing directly in front of a bright light, which may cast a shadow across your face, or glare directly into the patient’s eyes.

– Placing an IV in the hand the patient will need for sign language.

Hearing ImpairmentBe natural:– Don’t be rigid and stiff or attempt to over articulate your speech.– Use simple sentences.– Be sure to get the person’s attention by a light touch on the arm

before you start to talk.– Face the patient and stand no more than six feet from the patient

when trying to communicate.

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SENSORY DEFICITS

Because blind persons are unable to see shapes, sizes, and the placement of objects, tactile learning is an important technique to use when teaching.

When using printed or handwritten materials, enlarging the print (font size) or handwriting is typically an important first step for those who have diminished sight.

Visual ImpairmentTips on caring for a blind or visually impaired patient:

Secure the services of a low-vision specialist.Persons who have long-standing blindness have learned to develop a heightened acuity of their other senses of hearing, taste, touch, and smell.When explaining procedures, be as descriptive as possible

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SENSORY DEFICITS

Providing a template (writing guide) for signing their name or writing checks and addressing envelopes is a way to encourage independence.

Audiotapes and cassette recorders are very useful tools

If you are assisting the person who is blind to ambulate, always use the “sighted guide” technique; that is, allow the person to grasp your forearm while you walk about one-half step ahead of them.

Visual ImpairmentTips on caring for a blind or visually impaired patient:

Be sure to assess on which medium your client sees better―black ink on white paper or white ink on black paper.Proper lighting is of utmost importance in assisting the legally blind person to read the printed word.Providing contrast is a very helpful technique.

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LEARNING DISABILITIES

National Joint Committee on Learning Disabilities: defined learning disabilities as “a generic term that refers to a heterogeneous group of disorders manifested by significant difficulties in acquisition and use of listening, speaking, reading, writing, reasoning or mathematical abilities”

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LEARNING DISABILITIES

Input disabilities

: the process of receiving and recording information in the brain, include visual perceptual, auditory perceptual, integrative processing, and memory disorders.

• Visual Perceptual Disorders

• Auditory Perceptual Disorders

• Integrative Processing Disorders

• Short-Term or Long Term Memory Disorders

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LEARNING DISABILITIES

Output disabilities

: the process of orally responding and performing physical tasks, include language and motor disorders.

• Language Disorders

• Motor Disorders

• Attention Deficit Disorders

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DEVELOPMENTAL DISABILITIES

: The Developmental Disabilities Act of 1978 defined a developmental disability as a severe chronic state that is present before 22 years of age and is likely to continue indefinitely.

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• When planning a teaching intervention, keep in mind the client’s developmental stage, not his or her chronological age.

• Always remember that facial expression and voice tone are more important than words spoken.

• Keep the information simple, concrete, and repetitive.

• Be consistent, but firm, setting appropriate limits.

• Assign simple tasks with simple directions. Show what is to be done, rather than relying on verbal commands.

MENTAL DISABILITIES

Three essential strategies that have proved successful when teaching people with mental illness (Haber et al., 1997):

1. Teach by using small and brief words, repeating information over and over—use mnemonics, write down important information by placing it on index cards, and use simple drawings or symbols. Be creative.

2. Keep sessions short and frequent.

3. Involve all possible resources, including the client and his or her family. Actively involve them to help determine the client’s learning styles as well as the best way to reinforce content.

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PHYSICAL DISABILITIES

DO Use simple rather than complex statements.

Use gestures to complement what you are saying. Give step-by-step directions.

Allow time for responses. Recognize and praise all efforts to communicate.

Ensure the use of listening devices.Keep written instructions simple, with a

small amount of information on each page.

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PHYSICAL DISABILITIES

DON’T

Х Stop talking or trying to communicate.

Х Speak too fast.

Х Talk down to the person.

Х Talk in the person’s presence as though he or she is not there.

Х Give up

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COMMUNICATION DISORDERS

Expressive Aphasia have the person recall word images have the person repeat words spoken by the

nurse.

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Receptive AphasiaDon’t use baby talk.Speak in normal tones.Speak in short, slow, simple

sentences.Allow the person time to

answer.

COMMUNICATION DISORDERS

DysarthriaTo improve communication with the dysarthric person,

Dreher (1981) makes the ff suggestions:

Be sure the environment is quiet, because you are listening to a person whose speech muscles are weak and uncoordinated.

Ask the speaker to repeat unclear parts of the message.

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Do not simplify your message. Dysarthria does not affect comprehension.

Ask questions that need only short answers, to prevent exhausting the dysarthric patient with the great effort to shape sounds.

Encourage the person to use more oral movement to produce each syllable, to slow the overall rate of speaking, and to speak more loudly.

Ask the patient who is extremely unintelligible to gesture, write, or point to messages on a communication board.

CHRONIC ILLNESS

Noncompliance might enter the assessment. The truth is, the person with a chronic illness requires more than just teaching—that is, the acquiring of information. Acquisition of knowledge does not necessarily help people gain the new skills needed to deal with the problems of everyday life. Integration of the new knowledge into solutions that will provide clients with normalization will make the learning meaningful and, most important, useful. Nurses need to remember to encourage people to work with their particular regimen and individualize it as necessary.

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