THE NATURE OF THE LEARNER

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HUMAN DEVELOPMENT – is the dynamic process of change that occurs in the physical, psychological, social, spiritual and emotional constitution and make up of an individual which starts from CONCEPTION to DEATH. Changes may entail: GROWTH – which is quantitative involving increase in the size of the parts of the body DEVELOPMENT – which is qualitative involving gradual changes in character

Two Major Processes that takes places during growth and development:
LEARNING – a complex process which involves changes in mental processing, development of emotional functioning and social development skills which develop and evolve from birth to death. MATURATION – includes bodily changes which are primarily a result of heredity or the traits that a person inherits from his parents which are genetically determined, preprogrammed inherited biological patterns are reflected in maturation.

PERIODS OF LIFE SPAN DEVELOPMENT

Prenatal Development – includes the time from conception to birth, from single cell to an organism complete with brain and behavioral capabilities produced in 9 months ( 270-280 days or 40 weeks). Heredity – is the sum total of characteristics which are biologically transmitted thru parents to offspring. These characteristics are determined by the genes which are made up of DNA which determine the hereditary characteristics which are found in the chromosomes. Chromosomes – are found in the nucleus of each cell which contains the GENES

Infancy

extends from birth up to 18 to 24 months, characterized by time of extreme dependence on adults , babyhood and the beginning of many psychological activities like language, symbolic thought, sensorimotor coordination and social learning. Sensorimotor development – head turns to direction of touch, lifts chin and head, hold head erect, reaches for objects, sits with support, stands with help, crawls, and walks with support.

Early Childhood
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begins from the end of infancy to about 56 years which is sometimes called “ PreSchool Years”.
 Become more self – sufficient and care for themselves  Develop school readiness skills like identifying letters and following instructions.  Spend many hours in play with peers

How the child’s Pre- school experiences affects his growth and development:

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If physiological and psychological needs are met, the child develops a healthy and pleasant personality learns to communicate and develop understanding of himself and his environment the quality of the interaction between the child and parents affects the child’s own attitude.

The relationship that the child has with the “Significant Others” who are in constant touch and contact with the child will determine the child’s self –esteem or self concept like:

if the child thinks he/she is loved through the stimulation and nurturance that is given to him/her, the child develops high self-esteem which makes the child enthusiastic and open to experiences. if the child feels not accepted and not cared for, he /she develops confusion, fear or inferiority complex.

Middle and Late Childhood (School Age)
This is the period where:  The fundamental skills of reading, writing and arithmetic are mastered; and  When the child is formally exposed to the world and its culture, he/she becomes more achievement centered with increased self – control.

Adolescence
 – Marks the transition from childhood to

early adulthood; approximately from 10-12 years and ending at 18-22 years old.  -Where full physical development is achieved.  Puberty – marked by the development of sexual characteristics

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Pursuit of independence and an identity is prominent Thoughts are more logical, abstract and idealistic More time is spent outside the family More marked internal than external development during later adolescence Spends more time with the physical looks and improving appearance

Early Adulthood
 begins in late teens or early twenties

through the thirties. It is a period of:
establishing personal and economic independence career development selecting a mate intimate relationships, and starting a family

Middle Adulthood
 from 35-45 years old up to 65 years old. It is

characterized by:
menopause for women climacteric or andropause for men time of expanding personal and social involvement and responsibility, assisting next generation in becoming competent

Late Adulthood
 Or senescence, begins from 65 to 80 years

old and lasting until death
time of adjustment to decreasing strength and health life review retirement adjustment to new social roles affiliations with members of one’s age group

FOUR THEORIES OF HUMAN DEVELOPMENT
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1.Psychosexual Development Theory Sigmund Freud – the Father of Modern Psychology, believed that human beings pass through a series of stages that are dominated by the development of sensitivity in a particular erogenous zone or pleasure giving area in the body. The person must be able to resolve the conflicts that each stage poses before he can move on to the next higher stage. Failure to resolve the conflict results to frustration and the individual may become so addicted to the pleasure of a given stage that he develops fixation and fails to move on to the next higher stage of development.

Erikson’s Psychosocial Stages of Development
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Each stage has a major developmental task or dilemma that must be resolved … the individual is presented with a crisis he must resolve. Crisis – a turning point, crucial period of increased vulnerability and heightened potential. The individual develops a “ healthy personality” by mastering life’s outer and inner dangers. Epigenetic principle – personality continues to develop throughout the entire life span. Each part of the personality has a particular time in the life span when it must develop, if it is going to develop at all.

Eight Major Stages of Social –Emotional Development

Infant : Trust vs. Mistrust - needs of infant must be met by caretakers who are responsive and sensitive… infants must be cuddled and fondled.
development of trust results into a sense of safe and dependable place non- resolution may develop into mistrust and fear of the future and a suspicious mind.

Toddler

Autonomy vs. Shame and Doubt - as a child begins to crawl, walk and explores his surroundings, the conflict is whether to assert their wills or not.
resolution : children acquire sense of independence and competence when parents are patients and encouraging. Non – resolution : children develop excessive shame and doubt when parents are overprotective and always curtail their child’s freedom of movement.

Pre- school

Initiative vs. Guilt – development of mental and motor abilities
resolution : children will develop initiative if parents allow them freedom to run, slide, play with other children, go bike riding etc. non- resolution: children develop sense of inadequacy and feel that they are mere intruders or “ istorbo” and “ pasaway”; they become passive recipients of whatever the environment brings.

School Age

: Industry vs. Inferiority - child’s concern is ‘ how things work” and how they are made.
resolution : children gain a sense of industry or accomplishment if their efforts are recognized, rewarded and reinforced. Non-resolution: children acquire a sense of inadequacy and inferiority especially if parents/ teachers, rebuff, ridicule, constantly scold or ignore the child’s efforts to improve.

Adolescence
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: Identity vs. Role Confusion Entering adolescence, children experience “ psychological revolution” search for answers to the questions “ who am I”, what do I value”, “ where am I headed in life?; trying on many new roles; and parent/teen conflict usually occurs.
resolution : establishment of an integrated and coherent image of oneself as a unique person resulting to a sense of centered identity. Non – resolution : role confusion or negative identity like “ hoodlum” or delinquent.

Young Adulthood

Intimacy vs. Isolation
Intimacy : the capacity to reach out and make contact with other people; ability to share with and care for another person without fear of losing oneself in the process; ex. Deep friendships and lasting relationships Rejection : results to withdrawal, isolation and formation of shallow relationships.

Middle Adulthood

: Generativity vs. Stagnation
Generativity – entails selflessness ; reaching out beyond one’s own concerns to embrace the welfare of society and future generations through creative or productive work and caring for children. Stagnation – people are pre-occupied with their material possessions or physical well being ( self – centered, embittered individual)

Old Age

Ego Integrity vs. Despair – towards twilight years, people tend to take stock of their lives or do a self accounting. May result to sense of satisfaction with their accomplishments or despair.

Piaget’s Theory of Cognitive Development

Universal Constructivist Perspective – the child constructs reality by interacting with the environment and that children have predictable qualitative differences in how they think about things at different ages. 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.

Key Concepts :
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Mental Structures – cognitive structures – begins with reflexes in infancy evolving into schemata and more complex structures called operations Schema – a mental concept formed through experiences with objects and events Schemata – are building blocks of cognitive structures Operations – mental actions allowing children to interact with the environment using their minds and bodies; invariant sequence where child must first develop concrete operations before formal operations. Organization – humans have natural and innate tendency to organize their relationship with the environment; people organize activity lawfully, constructing a reality that makes sense at that time.

Lawrence Kohlberg – Moral Development Theory

Three Levels and Six Stages of Moral Development
Pre – conventional Level Stage 1 – Punishment / obedience orientation

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ego centered … self centered : “ survival of the fittest” obedience to figure of authority brought about by fear of physical punishment
Stage II – instrumental – relativist orientation

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concerned with satisfying oneself at the expense of others or doing something for others based on what gain or benefit he/she can derive for a favor done

Conventional Level
Stage III – Good boy / nice girl orientation  the child becomes other – directed and the concern is for social approval and acceptance  thus behavior conforms to accepted social and traditional norms and practices Stage IV. Law and order orientation  decisions are based on the rule of the law, honor and commitment duty

Post – conventional Level
Stage V – social contract orientation  depends on social contracts, written documents, abstract thing and highly legalistic concerns  believes in the saying, “ the law must be for the greatest number of people” Stage VI – Universal ethical principle orientation  behaves according to concept of universal social justice  respect for human rights and upholding of the principles of dignity, equality and justice.

THE DETERMINANTS OF LEARNING
Learning Needs – what the learner needs to learn Learning Readiness – when the learner is receptive to learning Learning Style – how the learner best learns

LEARNING NEEDS
Methods in Assessing Learning Needs:  1. Informal conversations or interviews – asking open ended questions  2. Structured interviews – where the nurse may asks the patient some predetermined questions to gather information regarding learning needs; the answers may reveal uncertainties, anxieties, fear, unexpected problems and present knowledge base.  3. Written pretest – can be given to identify the knowledge level of the potential learner and to help in evaluating whether learning has taken place by comparing the pretest and post-test scores.  4. Observations of health behaviors over a period of different times may help determine established patterns of behaviors .

Steps in the Assessment of Learning Needs:

1. Identify the learner

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2. Choose the right setting – establish a trusting environment by ensuring privacy and confidentiality especially if confidential information will be shared. 3. Collect data on the learner – by determining the characteristics learning needs of the target population, patient or any recipient of the learning material 4. Include the learner as a source of information – allow the learner to actively participate in identifying his needs and problems 5. Include members of the healthcare team – collaborate with the other healthcare professionals who may have insights or knowledge of the patient or learner. 6. Determine the availability of educational resources – use appropriate, available, affordable, easy and simple to manipulate materials and equipments

7. Assess demands of the organization – examine the organizational climate, its philosophy, vision, mission and goals to know its educational focus. 8. Consider time management issues – allow learners to identify their learning needs ; identify potential opportunities to assess the patient anytime, anywhere and minimize distractions / interruptions during planned assessment interviews. 9. Prioritize needs – this may be based on Maslow’s hierarchy of needs where the basic lower level physiologic needs must first be met before one can move up to the higher, more abstract level of needs.

Criteria for Prioritizing Learning Needs:
a. Mandatory – learning needs that must be immediately met since they are life threatening or needed for survival.  Ex. Patient with history of recent heart attack should be taught the signs and symptoms of an impending attack and what emergency measures are or what medicines to take.

b. Desirable – learning needs that must be met to promote well being and are not life – dependent.  Ex. Patient with pulmonary tuberculosis needs to understand and appreciate the importance of taking her medicines regularly until the regimen ends to be totally cured. c. Possible – “ nice to know” learning needs which are not directly related to daily activities  Ex. An obese patient who just lost weight because of her diabetes may not necessarily need information on “ tummy tucking” as a surgical and aesthetic procedure to remove the sagging abdominal muscles. Her current mandatory learning needs are related to her illness.

READINESS TO LEARN
In assessing readiness to learn, the health educator must;  1. determine what needs to be taught  2. find out exactly when the learner is ready to learn  3. discover what the patient wants to learn  4. identify what is required of the learner;
what needs to be learned what the learning objectives should be find out in which domain of learning and at what level the lesson will be taught

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6. determine if the timing is right or proper 7. find out if rapport or interpersonal relationship with the learner has been established 8. determine if the learner is showing signs of motivation 9. assess if the plan for the teaching matches the developmental level of the learner

Four Types of Readiness to Learn 1. P= Physical Readiness
measures of ability – adequate strength, flexibility and endurance is needed to be ready to learn complexity of task – the difficulty level of the subject or the task to be mastered. Environmental effects – refers to an environment that is conducive to learning, free from noise and other distractions which may affect the physical readiness to learn. Health status – is the patient in a state of good health or ill health? Does he still have the energy or motivation to learn? Gender – studies show that men are less inclined to seek health consultation or intervention than women. Women on the other hand, are more health conscious and receptive to medical care and health promotion teaching.

2. E = Emotional Readiness
a. Anxiety level – a moderate level of anxiety contributes to successful learning and is the best time for learning, however too much anxiety interferes with the learning ability.  Fear greatly contributes to anxiety and exerts negative effects on readiness to learn whether it be in the cognitive, psychomotor or affective domains of learning or even lead a patient to deny his or her illness.

b. Support system
a strong support system composed of the immediate family and friends, significant others, the community and church will give the patient increased sense of security and well being, while a weak or absent support system elicits sense of insecurity, despair, frustration and a high level of anxiety.

- nurses who provide emotional support to the patient and family members go through what is termed as “ reachable moments” which allow opportunity for both nurse and client to mutually share and discuss concerns and possible solutions or alternatives to care.

c. Motivation
is strongly associated with emotional readiness or willingness to learn.  A telling cue is when the learner starts asking questions and showing interests in what the teacher is doing or saying.

d. Risk taking behavior
are activities that are undertaken without much thought to what their negative consequences or effects might be.
 the role of the health educator is to develop awareness in the patient as to how this can shorten his life span; how to develop strategies to minimize the risk; to recognize the signs and symptoms of probable disease state and what to do should this worst case scenario develop.

e. Frame of Mind

depends on what the priorities of the learner are in terms of his needs which will determine his readiness to learn. An important consideration is Maslow’s hierarchy of needs as a guide in identifying needs prioritization.

f. Developmental stage

determines the peak time for readiness to learn or “ teachable moment “

3. E = Experiential Readiness
 refers to the previous learning experiences

which may positively affect willingness to learn.

a. Level of Aspiration – depends on the short term or long term goals that the learner has set. b. Past Coping Mechanism – refers to how the learner was able to cope with or handle previous problems or situations and how effective were the strategies used.

c. Cultural Background
d. Locus of Control – refers to motivation to learn which may internal or external locus of control. e. Orientation – this refers to a person’s point –of- view which may be Parochial – close minded thinking, conservative in their approach to new situations, less willing to learn new materials and have great trust in the physician. Cosmopolitan – more worldly perspectives and more receptive to new or innovative ideas like current trends.

4. K = Knowledge Readiness

It refers to :
Present Knowledge Base – also referred to as stock knowledge, or how much one already knows about the subject matter from previous and vicarious learning Cognitive Ability – involves lower level of learning which includes memorizing, recalling, or recognizing concepts and ideas and the extent to which information is processed indicates the level at which the learner is capable of learning.

PRINCIPLES OF LEARNING ( MOTIVATION)
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1. Use several senses When dealing with the question of how much people are able to retain what has been learned, it has been shown that people retain : 10% of what they read 20% of what they hear 30% of what they see or watch 50% of what they see and hear 70% of what they say 90% of what they say and do

2. Active Learner Involvement
 To actively involve the patients or clients in

the learning process. Use more interactive methods involving the participation of the learners like role playing, buzz sessions, Q & A format, case studies, small group discussion, demonstration and return demonstration.

3. Conducive Learning Environment  Always consider the comfort and convenience of the learner 4. Learning Readiness 5. Relevance of Information  Anything that is perceived by the learner to be important or useful will be easier to learn and retain.

6. Repeat Information  Continuous repetition of information over a period of time enhances learning; applying the information to a different situation and asking the learner to apply the information to another situation or rewording it and giving practical applications will help in the learning process. 7. Generalize Information  Cite applications of the information to a number of applications. Give examples which will illustrate or concretize the concept. 8. Make Learning a Pleasant Experience  Give frequent encouragement, recognize accomplishments and give positive feedback.

9. Be Systematic  Begin with what is known; move towards the unknown. A pleasant and encouraging learning experience if information is presented in an organized manner and with information that the learner already knows or is familiar. 10. Be Steady  Present information at an appropriate rate. This refers to the pace in which information is presented to the learner….are you talking too fast or too slow about the topic you are discussing?

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