Learning Activities

Read your genetic crystal ball
. Read Theoretical Basis for Learning and Teaching
. Read Factors of Learning
Review the following web sites

• www.jointcommission.org/speakup.aspx
• www.jointcommission.org/standards_information/npsgs.aspx
• www.healthypeople.gov/2020/default.aspx
• www.aha.org/aha/issues/Communicating-With-Patients/pt-care-partnership.html

Assignments
Forum Posting
. Each post should contain a minimum of information from 2 peer reviewed article or professional organization (American Nurses Association, National League for Nursing); information may be taken from their website. (Wikipedia & WebMD are not acceptable resources). Articles may not be an article included in the modules.Postings should be one page. The Forum Grading Rubric is attached.

Topics for Module C Forum
• If faced with a health care decision discussed in “Your Genetic Crystal Ball” what would you do? What is your thought process for making this decision? How can you educate your patient facing a similar decision without biasing them to your personal preferences?
• Is noncompliance an acceptable diagnosis? Discuss one of the concepts discussed in “Factors of Learning” you feel has an impact on patient learning outcomes and/or compliance of a prescribed medication or lifestyle modifications. What can you do as the nurse to affect change related to the factor of learning you selected?

READING MATERIALS

“YOUR GENETIC CRYSTAL BALL”

View the short video “Your Genetic Crystal Ball” by clicking on the link
http://www.cbsnews.com/video/watch/?id=50136239n

“FACTORS OF LEARNING” AND “THEORETICAL BASIS FOR LEARNING AND TEACHING” ARE ATTACHED ON A SEPARATE DOCUMENT.

Factors involved in learning
Motivation – the desire to learn. How quickly and how much a person learns depends on an important factor: the desire to learn. Adults need to know why they need to learn something – it should be applicable to their lives. Just because a nurse thinks a patient needs to learn something doesn’t mean the desire is present in the patient. Sometimes it’s best to provide supporting information before the patient can see the need, such as teaching the harmful effects of smoking before learning the need to stop smoking.

Readiness – the behavior that reflects motivation at a specific time. Readiness involves the patient’s willingness and ability to learn. A huge part of the nurse’s role is to assess the patient’s readiness to learn. The patient often gives clues that she is ready to learn, such as asking questions or intently watching a procedure that will have been done by the patient after discharge.

Active involvement – makes learning more meaningful. Learners, especially adults, need to be actively involved in planning their learning. Adults learn best when they feel accepted and not judged, and they need to have feelings of success. As their self-confidence increases their learning abilities will increase.

Feedback – must be meaningful to the learner. Feedback is especially important in the practice of psychomotor skills. Feedback should be positive, with use of praise and suggestions of alternative ways of doing steps of the skill. Simple to Complex – logically organizes the material helps the learner to comprehend new information, assimilate it with previous learning, and form new understandings. The individual patient should be assessed to determine the level for “simple”. What is simple for one person may not be simple for another. Repetition – helps learners retain new information. Repetition of psychomotor skills is especially important. Information can be repeated by stating it in different ways. Repetition of new information helps learners retain that information. Learners can retain new information better when repetition is used!

Timing – is very important in teaching. Learners retain new information and skills better if the time between learning and use is short. If a newly diagnosed diabetic is taught to give her insulin immediately after diagnosis, she may not have had time to assimilate her new situation. If she is taught to give her insulin an hour before she is discharged home, she won’t have time to practice and have her questions answered. Educators refer to the “teachable moment” as when patients ask questions about their care, or waiting until pain has subsided to teach the patient. Environment – sets the stage for optimal learning. The environment should be comfortable, will lighted, and not too hot or too cold or too noisy. Choose a time when the patient does not have visitors so that privacy is possible. Some patient teaching, however, can take place in group settings. Just think about how you would learn best in different situations and see if that can be applied to your patient. For example, if you were learning how to care for your new colostomy, you would want lots of privacy. Emotions, physiologic factors and cultural and spiritual barriers can all effect learning. Anxiety, fear, pain, and depression can inhibit learning. Language barriers and values must be considerations for teaching. For example, a mother may believe a fat baby is a healthy baby based on cultural beliefs.

Assessing Learning Needs Factors in assessing someone’s learning needs include age, health beliefs and practices, cultural factors, economic factors, learning styles, readiness to learn, motivation and reading level. Age should be considered when assessing learner’s needs. Children may be taught about their healthcare depending on age and complexity of material; but certainly their parents or guardians should be taught using adult teaching principles. Health beliefs and practices may or may not be changed through health teaching. Rely on the cultural information you have learned in preceding courses to guide you in this area. Consider each person an individual who may or may not subscribe to the general health beliefs of his or her cultural group. And remember, you can ask the patient to enlighten you in this area as well. Economic factors may prevent a patient from buying supplies or equipment needed for home care. This is a consideration when teaching, and may require help from a case manager or social worker. Learning styles should always be considered in assessing learning needs. Readiness and motivation have been previously discussed as well. All these factors are important in assessing needs.
Theoretical Basis for Learning and Teaching: Pedagogy and Andragogy are terms used for teaching. Pedagogy refers to techniques for teaching children. Knowles, in 1980, coined the term andragogy which he defined as “the art and science of helping adults learn” (Knowles, 1980, p. 43). Nurses use both techniques for teaching patients/clients. In teaching adults, Knowles (1984) provided the following guidelines: As people mature, they move from dependence to independence. An adult’s previous experiences can be used as a resource for learning. An adult’s readiness to learn is often related to a developmental task or social role. An adult is more oriented to learning when the material is immediately useful, not useful sometime in the future. Learning Theories Psychologists study how and why people learn. Early theories focused on mental discipline. Behaviorism followed mental discipline, followed by social learning theories. Cognitive theory, multiple intelligences, humanism, and adult theory are frameworks, philosophies and theories that have been studied. Currently, interpretive pedagogies, such as critical, feminist, postmodern, and phenomenological theories are the focus of educational research. What does this have to do with nursing? The nurse, with a basic understanding of different learning theories can apply the most appropriate theories in specific learning situations for patients in order to provide the most optimal climate for learning. The following information touches on a few of the theories. Mental discipline involves exercise of the mind. Adherents of mental discipline advocate strengthening memory, will, reason, and perseverance. The use of drills, memorizing information, and learning classical languages with the goal of strengthening the mind is typical of mental discipline. One application in nursing is the use of Socratic reasoning, in which questioning leads the learner to deeper levels of understanding. Socratic reasoning is often used in nursing education, especially in the clinical area. Behaviorism is familiar to many as the image of Pavlov’s salivating dog comes to mind. Behaviorism involves conditioned responses in which appropriate responses are rewarded and inappropriate responses are “extinguished” through lack of reward or even punishment. B.F. Skinner is the father of operant conditioning and the black box in which the rat was conditioned to have certain responses to certain stimuli. Today we are encourage to think “outside the box”, however, reward in the form of praise or improved health can be very useful in patient education. Social learning theory proponents include Albert Bandura, H.S. Bowers, and E.C. Tolman. Social learning theory involves characteristics of the person, the person’s behavior, and the environment. Basically, the concept is that the learner’s behavior creates the environment (which is opposite of behaviorism). Another tenant is that observational learning is important for acquiring behavior in situations in which mistakes can be life-threatening or costly. Bandura researched imitation and modeling which involves copying and learning by observation of others. Bandura’s theory has become more cognitive over the years and is now known as ‘social cognitive theory’, in which learning is defined as knowledge acquisition through cognitively processing information. Piaget is known for his Cognitive Development theory in which development is seen as an orderly, sequential process. Piaget’s cognitive developmental process involves four phases: sensorimotor, preoperational, concrete operations, and formal operations.

Preoperational phase – from about 2 to 7 years of age: egocentric approach to accommodate the demands of the environment; able to think of one idea at a time, can use words to express thoughts, and includes others in the environment.

Application of Learning Theories The following information will provide you with examples of the application of learning theories: Behaviorist Provide sufficient time for practice. Provide both immediate and repeat testing and redemonstration. Provide opportunities for learners to solve problems by trial and error. Select teaching strategies that avoid distracting information and evoke the desired response. Praise the learner for correct behavior and provide positive feedback at intervals throughout the learning experience. Provide role models of desired behavior. Cognitive Assess a person’s developmental and individual readiness to learn and adapt teaching strategies to the learner’s developmental level. Provide a social, emotional, and physical environment conducive to learning. Encourage a positive teacher-learner relationship. Select multisensory teaching strategies because perception is influenced by the senses. Recognize that personal characteristics have an impact on how cues are perceived and develop appropriate teaching approaches to target different learning styles Select behavioral objectives and strategies that encompass the cognitive, affective, and psychomotor domains of learning. Blais, K.K., Hayes, J.S., Kozier, B., & Erb, G. (2006). Professional nursing practice. New Jersey: Prentice Hall. Humanism “Social” Encourage learners to establish goals and promote self-directed learning. Encourage active learning by serving as a facilitator, mentor, or resource for the learner. Expose the learner to new relevant information and ask appropriate questions to encourage the learner to seek answers.
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