NCM 102 – HEALTH EDUCATION Infancy (0–12 Months of Age) and Toddlerhood (1–3

Years of Age)
B. Principles of Teaching and Learning Related to
Health ➢ The most important idea is that older toddlers
should not be excluded from healthcare teaching
1. Development Stages of the Learner Across the and can participate in the education process.
Lifespan ➢ Physical, Cognitive, and Psychosocial
➢ The nurse as educator must consider the Development: Piaget defined the sensorimotor
characteristics of learners with respect to their period as the stage of infancy to toddlerhood
developmental stage in life when planning, when learning is enhanced through sensory
designing, implementing, and evaluating an experiences and motor activities.
educational program. Pedagogy, andragogy, and ➢ The toddler has the capacity for basic reasoning,
geragogy are three different orientations to understands object permanence, has the
learning in childhood, young and middle beginnings of memory, and begins to develop an
adulthood, and older adulthood. elementary concept of causality.
➢ Three major stage-range factors associated with ➢ They are oriented primarily to the "here and
learner readiness—physical, cognitive, and now" and have little tolerance for delayed
psychosocial maturation—must be considered at gratification.
each developmental period throughout the life ➢ They have short attention spans, are easily
cycle. The role of the nurse in assessment of distracted, are egocentric in their thinking, and
stage-specific learner needs, the role of the are not amenable to correction of their own ideas.
family in the teaching–learning process, and the ➢ They can respond to simple, step-by-step
teaching strategies specific to meet the needs of commands and obey such directives as "kiss
learners at various developmental stages of life Daddy goodnight" or "put your hat on".
should be minimized. ➢ Language skills are acquired rapidly during this
➢ The term developmental stage is used to refer to period, and parents should foster this aspect of
the various stages of development, which are not development by talking with and listening to
necessarily related to chronological age. their child.
➢ It is now understood that three important ➢ Erikson (1963) states that the period of infancy
contextual influences act on and interact with the is one of trust versus mistrust, leading to
individual to produce development: age-graded autonomy and self-assertion. Toddlers must
influences, history-graded influences and life learn to balance feelings of love and hate,
events. cooperate and control willful desires, and
➢ This chapter focuses on the patient as the learner express their independence through
throughout the life span, but nurses and nurse demonstrations of negativism.
educators can apply the stage-specific ➢ Toddlers like routines and ritualistic exercises,
characteristics of adulthood and the associated but separation anxiety is common in hospitals
principles of adult learning to any audience. and healthcare interventions.
DEVELOPMENTAL CHARACTERISTICS ➢ Teaching Strategy: Patient education for
infancy through toddlerhood should focus on
➢ The developmental phases as individuals assessing the parent's and child's anxiety levels
progress from infancy to senescence are and helping them cope with their feelings of
important to understand the behavioral changes stress related to uncertainty and guilt. Primary
that occur in the cognitive, affective, and nurses should be assigned to establish a
psychomotor domains. relationship with the child and parents, and
➢ Musinski (1999) identified three phases of parents should be present whenever possible
learning: dependence, independence, and during learning activities.
interdependence. ➢ Nursing interventions should promote children's
➢ Covey (1990) identified the "maturity use of gross motor abilities and stimulate their
continuum," which is characterized by the ability visual, auditory, and tactile senses. The approach
to physically, intellectually, and emotionally care to children should be warm, honest, calm,
for oneself and make his or her own choices. accepting, and matter-of-fact. Fundamental to
➢ However, full physical maturity does not the child's response is how the parents respond
guarantee simultaneous emotional and to healthcare personnel and medical
intellectual maturity. interventions.
THE DEVELOPMENTAL STAGES OF ➢ The following teaching strategies are suggested
CHILDHOOD to convey information to members of this age
group.
➢ Pedagogy is the art and science of helping
children learn, and the four stages of childhood These strategies feed into children’s natural tendency
are divided according to their maturational levels. for play and their need for active participation and
sensory experiences:

• For Short-Term Learning

 • Read simple stories from books with lots of ➢ Precausal thinking allows preschoolers to
pictures. understand that people can make things happen,
• Use dolls and puppets to act out feelings and but they are unaware of causation as the result of
behaviors. invisible physical and mechanical forces.
• Use simple audiotapes with music and ➢ Preschoolers are curious, can think intuitively,
videotapes with cartoon characters. and pose questions about almost anything.
• Role-play to bring the child’s imagination closer ➢ They mix fact and fiction, tend to generalize,
to reality. think magically, develop imaginary playmates,
• Give simple, concrete, nonthreatening and believe they can control events with their
explanations to accompany visual and tactile thoughts.
experiences. ➢ They also have a limited sense of time and
• Perform procedures on a teddy bear or doll first develop sexual identity and curiosity.
to help the child comprehend what an experience ➢ Preschoolers have a lack of understanding of
will be like. Allow the child something to do— their bodies related to structure, function, health,
squeeze your hand, hold a Band-Aid, cry if it and illness.
hurts—to channel their responses to an ➢ They fear body mutilation and pain, and their
unpleasant experience. ideas regarding illness are primitive with respect
• Keep teaching sessions brief (no longer than to cause and effect.
➢ Erikson (1963) has labeled the preschooler's
about five minutes each) because of the child’s
short attention span. psychological maturation level as the period of
initiative versus guilt.
• Cluster teaching sessions close together so that
➢ Excess energy and a desire to dominate can lead
children can remember what they learned from
to frustration and anger.
one instructional encounter to another.
➢ Play in the mind of a child is equivalent to adult
• Avoid analogies and explain things in
work and is a means for self-education.
straightforward and simple terms because
➢ It helps the child act out feelings and
children take their world literally and concretely.
experiences to master fears, develop role skills,
• Individualize the pace of teaching according to
and express joys, sorrows, and hostilities.
the child’s responses and level of attention.
➢ Teaching Strategy: The nurse should take every
• For Long-Term Learning
opportunity to teach parents about health
• Focus on rituals, imitation, and repetition of promotion and disease prevention measures,
information in the form of words and actions to provide guidance on normal growth and
hold the child’s attention. development, and offer instruction about
• Use reinforcement as an opportunity for children medical recommendations when illnesses do
to achieve permanence of learning through arise.
practice. ➢ Parents should be included in all aspects of the
• Employ the teaching methods of gaming and educational plan and the actual teaching
modeling as a means by which children can experience, as they can serve as the primary
learn about the world and test their ideas over resource to answer questions about children's
time. disabilities, their idiosyncrasies, their favorite
• Encourage parents to act as role models because toys, and their fears of pain and bodily harm.
their values and beliefs serve to reinforce ➢ The primary caretakers, usually the mother and
healthy behaviors and significantly influence the father, are the recipients of the majority of the
child’s development of attitudes and behaviors. nurse's teaching efforts and should be included
PRESCHOOLER (3–6 YEARS OF AGE) as participants during teaching sessions.

➢ Preschool children develop independence and The following specific teaching strategies are
independence through interactions with others recommended:
and mimicking behaviors of playmates and For Short-Term Learning
adults.
➢ Physical, Cognitive, and Psychosocial • Provide physical and visual stimuli because
Development: Preschoolers develop fine and language ability is still limited, both for
gross motor skills, but still need supervision due expressing ideas and for comprehending verbal
to lack of judgment. instructions.
➢ The preschooler's stage of cognitive • Keep teaching sessions short (no more than 15
development is labeled the preoperational period minutes) and scheduled sequentially at close
by Piaget (1951, 1952, 1976). Preschoolers can intervals so that information is not forgotten.
recall past experiences and anticipate future • Relate information needs to activities and
events but have only a vague understanding of experiences familiar to the child.
their relationships. • Encourage the child to participate in selecting
➢ Thinking remains literal and concrete, and between a limited number of teaching–learning
reasoning is transductive rather than inductive or options, such as playing with dolls or reading a
deductive. story, which promotes active involvement and
helps to establish nurse–client rapport.
 • Characteristics of the Learner ➢ They can make decisions and act in accordance
• Arrange small group sessions with peers as a with how events are interpreted, but they
way to make teaching less threatening and more understand only to a limited extent the
fun. seriousness or consequences of their choices.
• Give praise and approval, through both verbal ➢ Children in the early period of this
expressions and nonverbal gestures, which are developmental phase also know the functions
real motivators for learning. and names of many common body parts, and can
• Give tangible rewards, such as badges or small differentiate between external and internal
toys, immediately following a successful organs with a beginning understanding of their
learning experience as reinforcers in the mastery complex functions.
of cognitive and psychomotor skills. ➢ Teaching Strategy: School-aged children and
• Allow the child to manipulate equipment and their families must be taught in an efficient,
play with replicas or dolls to learn about body cost-effective manner how to maintain health
parts. Special kidney dolls, ostomy dolls with and manage illness.
stomas, or orthopedic dolls with splints and ➢ Woodring (2000) emphasizes the importance of
tractions provide opportunity for hands-on following sound educational principles with the
experience. Use storybooks to emphasize the child and family, such as identifying individual
humanity of healthcare personnel; to depict learning styles, determining readiness to learn,
relationships between child, parents, and others; and accommodating particular learning needs
and to assist with helping the child identify with and abilities.
particular situations. For Long-Term Learning ➢ Teaching should be presented in concrete terms
• Enlist the help of parents, who can play a vital with step-by-step instructions, and parents
role in modeling a variety of healthy habits, such should be informed of what their child is being
as practicing safety measures and eating a taught.
balanced diet. ➢ Siblings and peers should also be considered as
• Reinforce positive health behaviors and the sources of support.
acquisition of specific skills. ➢ Education for health promotion and maintenance
is most likely to occur in the school system
SCHOOL-AGED CHILDHOOD (6–12 YEARS OF through the school nurse, but the parents as well
AGE) as the nurse outside the school setting should be
told what content is being addressed.
➢ School-aged children are motivated to learn due
➢ Nurses can provide health education to school-
to their curiosity and desire to understand more
aged children in a variety of settings, such as
about themselves, their bodies, and the world.
schools, physicians' offices, community centers,
➢ Physical, Cognitive, and Psychosocial
outpatient clinics, or hospitals.
Development: School-aged children are
➢ The specific conditions that may come to the
increasingly more coordinated and able to
attention of the nurse include behavioral
control their movements with greater dexterity.
disorders, hyper-activity, learning disorders,
➢ Physical growth is highly variable, with girls
diabetes, asthma, and enuresis.
more so than boys experiencing prepubescent
➢ Extensive teaching may help children and
bodily changes.
parents understand a particular condition and
➢ Cognitive development is characterized by
learn how to overcome or deal with it.
logical thought processes and the ability to
➢ To foster normal development, children must be
reason inductively and deductively.
invited to participate in planning for and
➢ Concepts such as conservation, reversal, and
carrying out learning activities, such as
inferred reality are mastered.
administering an injection to a stuffed animal or
➢ This phase of development is characterized by
another person.
the development of memory, decision making,
insight, and problem solving. The following teaching strategies are suggested when
➢ Children are able to engage in systematic caring for children in this developmental stage of life:
thought through inductive reasoning, express
concrete ideas about relationships and people, For Short-Term Learning
and carry out mathematical operations. ➢ Allow school-aged children to take
➢ They have developed the ability to concentrate responsibility for their own health care because
for extended periods, can tolerate delayed they are not only willing but also capable of
gratification, have a good understanding of the manipulating equipment with accuracy.
environment as a whole, and can generalize from ➢ Because of their adeptness in relation to manual
experience. dexterity, mathematical operations, and logical
➢ They understand time, can predict time intervals, thought processes, they can be taught, for
are oriented to the past and present, have some example, to calculate and administer their own
grasp and interest in the future, and have a vague insulin or use an asthma inhaler as prescribed.
appreciation for how immediate actions can have ➢ Teaching sessions can be extended to last as long
implications over the course of time. as 30 minutes each because the increased
cognitive abilities of school-aged children aids
 in the retention of information. However, lessons ➢ Motivation, self-esteem, and positive self-
should be spread apart to allow for perception are personal characteristics that
comprehension of large amounts of content and influence health behavior.
to provide opportunity for the practice of newly
acquired skills between sessions. ➢ Group activities are an effective method of
➢ Use diagrams, models, pictures, videotapes, and teaching health behaviors, attitudes, and values.
printed materials as adjuncts to various teaching
methods because an increased facility with
ADOLESCENCE (12–18 YEARS OF AGE)
language (both spoken and written) as well as
with mathematical concepts allows for these Adolescents are among the nation's most at-risk
children to work with more complex populations, and understanding their thought and
instructional tools. behavior is essential for effective patient education.
➢ Choose audiovisual and printed materials that
show peers undergoing similar procedures or ➢ Physical, Cognitive, and Psychosocial
facing similar situations. Development: Adolescents vary greatly in their
➢ Clarify any scientific terminology and medical biological, psychological, social, and cognitive
jargon used. development.
➢ Use analogies as an effective means of providing ➢ During the period of formal operational thought,
information in meaningful terms, such as “A they are capable of abstract thought and complex
chest x-ray is like having your picture taken” or logical reasoning.
“White blood cells are like police cells that can ➢ This capacity enables them to conceptualize
attack and destroy infection.” invisible processes and make determinations
➢ Use one-to-one teaching sessions as a method to about what others say and how they behave.
individualize learning relevant to the child’s own ➢ Elkind (1984) labeled this belief as the
experiences and as a means to interpret the imaginary audience, which has considerable
results of nursing interventions particular to the influence over an adolescent's behavior.
child’s own condition. ➢ Adolescents are also able to understand the
➢ Provide time for clarification, validation, and concept of health and illness, the multiple causes
reinforcement of what is being learned. of diseases, the influence of variables on health
➢ Select individual instructional techniques that status, and the ideas associated with health
provide opportunity for privacy, an increasingly promotion and disease prevention.
important concern for this group of learners, ➢ Adolescents face pressures from peers and
who often feel quite self-conscious and modest feelings of invincibility, which can lead to a
when learning about bodily functions. belief of invulnerability.
➢ Employ group teaching sessions with others of ➢ Recent research has revealed that adolescents
similar age and with similar problems or needs 15-17 are not as susceptible to the personal fable
to help children avoid feelings of isolation and to as once thought, but they still need support and
assist them in identifying with their own peers. guidance.
➢ Prepare children for a procedure well in advance ➢ Erikson (1968) has labeled the psychosocial
to allow them time to cope with their feelings dilemma adolescents face as one of identity
and fears, to anticipate events, and to understand versus role confusion.
what the purpose of a procedure is, how it relates ➢ Adolescents struggle to establish their own
to their condition, and how much time it will identity, match their skills with career choices,
take. and determine their "self."
➢ Encourage participation in planning for ➢ Adolescents have a strong need for belonging to
procedures and events because active a group, friendship, peer acceptance, and peer
involvement will help the child to assimilate support, and often rebel against adults they
information more readily. consider authoritarian.
➢ Provide much needed nurturance and support, ➢ Conflict, toleration, or alienation characterize
always keeping in mind that young children are the relationship between adolescents and their
not just small adults. parents and other authority figures.
➢ Adolescents demand personal space, control,
For Long-Term Learning privacy, and confidentiality due to illness, injury,
and hospitalization.
➢ Help school-aged children acquire skills that
➢ Teaching Strategy: Adolescents are at high risk
they can use to assume self-care responsibility
for serious health problems, such as asthma,
for carrying out therapeutic treatment regimens
diabetes, a range of disabilities, and
on an ongoing basis with minimal assistance.
psychological problems.
➢ Assist them in learning to maintain their own
➢ Despite this, they use medical services the least
well-being and prevent illnesses from occurring.
frequently of all age groups, and their health
➢ Research suggests that lifelong health attitudes
issues have been largely ignored by the
and behaviors begin in early childhood and
healthcare system.
remain consistent throughout middle childhood.
➢ The educational needs of adolescents are broad
and varied, with topics ranging from sexual
 adjustment, contraception, and venereal disease ➢ Suggest options so that they feel they have a
to accident prevention, nutrition, and substance choice about courses of action.
abuse. ➢ Give a rationale for all that is said and done to
➢ Healthy teens often view health help adolescents feel a sense of control.
recommendations as a threat to their autonomy ➢ Approach them with respect, tact, openness, and
and functioning. flexibility to elicit their attention and encourage
➢ The most important details are that adolescents their responsiveness to teaching–learning
need privacy, understanding, an honest and situations.
straightforward approach, and unqualified ➢ Expect negative responses, which are common
acceptance in order to develop a mutually when their self-image and self-integrity are
respectful, trusting relationship, and that the threatened.
existence of an imaginary audience and personal ➢ Avoid confrontation and acting like an authority
fable can contribute to the exacerbation of figure.
existing problems or cause new ones. ➢ Instead of directly contradicting their opinions
➢ Additionally, adolescents' language skills and and beliefs, acknowledge their thoughts and then
ability to conceptualize and think abstractly give casually suggest an alternative viewpoint, such
the nurse a wide range of teaching methods and as “Yes, I can see your point, but what about
instructional tools to choose from. the possibility of . . . ?”

The following teaching strategies are suggested when For Long-Term Learning
caring for adolescents:
➢ Accept adolescents’ personal fable and
For Short-Term Learning imaginary audience as valid, rather than
challenging their feelings of uniqueness and
➢ Use one-to-one instruction to ensure
invincibility.
confidentiality of sensitive information.
➢ Acknowledge that their feelings are very real
➢ Choose peer group discussion sessions as an
because denying them their opinions simply will
effective approach to deal with health topics as
not work.
smoking, alcohol and drug use, safety measures,
➢ Allow them the opportunity to test their own
and teenage sexuality.
convictions. Let them know, for example, that
➢ Adolescents benefit from being exposed to
while some other special people may get away
others who have the same concerns or who have
without taking medication, others cannot.
successfully dealt with problems similar to theirs.
➢ Suggest, if medically feasible, setting up a trial
➢ Use group discussion, role-playing, and gaming
period with medications scheduled farther apart
as methods to clarify values and problemsolve,
or in lowered dosages to determine how they can
which feed into the teenager’s need to belong
manage.
and to be actively involved.
➢ Nurses can provide guidance and support to
➢ Getting groups of peers together can be very
families to help them understand adolescent
effective in helping teens confront health
behavior, while parents should be taught to set
challenges and learn how to significantly change
realistic limits and foster independence.
behavior (Fey & Deyes, 1989).
➢ Employ adjunct instructional tools, such as
complex models, diagrams, and specific,
detailed written materials, which can be
used competently by many adolescents.
➢ Audiovisual materials in the form of
audiotapes, videotapes, simulated games,
and interactive discs using the hardware of
TV, audiocassette players, and computers
usually are a comfortable approach to
learning for adolescents, who generally
have facility with technological equipment
after years of academic and personal
experience with telecommunications in the
home and at school.
➢ Clarify any scientific terminology and
medical jargon used.
➢ Share decision making whenever possible
because control is an important issue for
adolescents.
➢ Include them in formulating teaching plans
related to teaching strategies, expected outcomes,
and determining what needs to be learned and
how it can best be achieved to meet their needs
➢ for autonomy.
THE DEVELOPMENTAL STAGES OF they join essentially out of their desire to be
ADULTHOOD with and talk to other people in similar
circumstances—retirement, parenting,
➢ Knowles's andragogy framework is the art and
divorce, or widowhood.
science of helping adults learn.
➢ Their drive is to alleviate social isolation or
➢ It is more learner-centered and less teacher-
loneliness.
centered, with the power relationship between
3. Learning-oriented learners view themselves as
the educator and the adult learner becoming
perpetual students who seek knowledge for
more horizontal.
knowledge’s sake.
➢ Knowles's assumptions have major implications
➢ They are active learners all of their lives and
for planning, implementing, and evaluating
tend to join groups, classes, or organizations
teaching programs for adults as they mature.
with the anticipation that the experience will
➢ Adult learning is different from child learning in
be educational and personally rewarding.
that it focuses on differentiation of life tasks and
➢ Learning is a lifelong process that begins at
social roles beyond the responsibilities of home
birth and does not cease until the end of life,
and career.
and as a person matures, it is a significant
➢ The prime motivator to learn in adulthood is to
and continuous task to maintain and enhance
be able to apply knowledge and skills for
oneself.
immediate problems, unlike children who enjoy
learning for the sake of learning. YOUNG ADULTHOOD (18–40 YEARS OF AGE)
➢ Adult learners must be able to perceive the
➢ Early adulthood is a time for establishing
relevance of acquiring new behaviors or
relationships, choosing a lifestyle, and managing
changing old ones for them to be willing and
a home and family.
eager to learn.
➢ Physical, Cognitive, and Psychosocial
➢ Unlike the child learner, who is dependent on
Development: The physical abilities of young
authority figures for learning, adults are more
adults are at their peak, and the body is at its
self-directed and independent in seeking
optimal functioning capacity.
information.
➢ The cognitive capacity of young adults is fully
➢ They also have a rich resource of stored
developed, and they continue to accumulate new
information on which to build a further
knowledge and skills from an expanding
understanding of relationships between ideas
reservoir of formal and informal experiences.
and concepts, and are quicker than children at
➢ Erikson (1963) describes the young adult's stage
grasping relationships. However, they are more
of psychosocial development as the period of
resistant to change and must overcome obstacles
intimacy versus isolation, where they strive to
to learning.
establish a trusting, satisfying, and permanent
➢ Taylor, Marienau, and Fiddler (2000) label
relationship with others. Young adults face many
adults as paradoxical learners.
challenges as they take steps to control their
➢ A variety of reasons explain why adults pursue
lives, and the new experiences and decisions
learning throughout their lives.
they must make can be stressful.
Basically, three categories describe the general ➢ Teaching Strategies: Young adults are generally
orientation of adults toward continuing education healthy and have limited exposure to health
(Babcock & Miller, 1994): professionals.
➢ Health promotion is the most neglected aspect of
1. Goal-oriented learners engage in educational
healthcare teaching, but health issues related to
endeavors to accomplish clear and identifiable
risk factors and stress management are important
objectives.
to help young adults establish positive health
➢ Continuing education for them is episodic
practices for preventing problems with illness in
and occurs as a recurring pattern throughout
the future.
their lives as they realize the need for or
➢ The nurse as educator must find a way to
identify an interest in expanding their
address these issues.
knowledge and skills.
➢ Nurse educators should foster readiness to learn
➢ Adults who attend night courses or
through experiences and provide cues to focus
professional workshops do so to build their
on specific aspects of education for young adults,
expertise in a particular subject or for
such as family planning, contraception, and
advancement in their professional or
parenthood.
personal lives.
➢ When young adults are faced with acute or
2. Activity-oriented learners select educational
chronic illnesses, they are motivated to learn to
activities primarily to meet social needs.
maintain independence and return to normal life
➢ The learning of content is secondary to their
patterns.
need for human contact.
➢ They should be encouraged to select what to
➢ While they may choose to attend support
learn and how they want material to be presented.
groups, special-interest groups, self-help
➢ Adults bring a variety of experiences to the
groups, or academic classes because of an
teaching-learning situation, so it is important to
interest in a particular topic being offered,
 draw on their experiences to make learning OLDER ADULTHOOD (65 YEARS OF AGE AND
relevant, useful, and motivating. OLDER)
➢ Teaching strategies should be directed at
➢ Older persons constitute approximately 12% of
encouraging young adults to seek information
the U.S. population, and those aged 85 and older
that expands their knowledge base, helps them
make up the fastest-growing segment.
control their lives, and bolsters their self-esteem.
➢ Of the total amount ofhealthcare expenditures,
➢ Writing patient education materials and
36% are incurred by those older than 65 years of
audiovisual tools should be used, and group
age.
discussion is an attractive method for teaching
➢ Low educational levels in the older adult
and learning.
population may contribute to their decreased
➢ Assessment prior to teaching should help
ability to read and comprehend written materials,
determine the level at which to begin teaching.
and their educational needs are greater and more
➢ To make learning easier and more relevant,
complex than those for other developmental
present concepts logically from simple to
stages.
complex and establish conceptual relationships
➢ Health education programs can be a cost-
through specific application of information.
effective measure to improve their health status.
MIDDLE-AGED ADULTHOOD (40–65 YEARS OF Ageism perpetuates the negative stereotype of
AGE) aging as a period of decline. Ageism, which
interferes with interactions between the older
➢ Midlife is a transition period between young
adult and younger age groups, must be countered
adulthood and older adulthood, when individuals
by research that focuses on healthy development
reflect on their contributions and values.
and positive lifestyle adaptations, education to
➢ Physical, Cognitive, and Psychosocial
inform people of the significant variations that
Development: Middle-aged adults experience
occur in the way that individuals age, and
physiological changes such as skin and muscle
education to help the older adult learn to cope
tone, metabolism, body weight, endurance and
with irreversible losses.
energy levels, hormonal changes, and hearing
➢ Gerogogy is different from teaching adults.
and visual acuity.
➢ Gerogogy must adapt to normal physical,
➢ These changes affect their self-image, ability to
cognitive, and psychosocial changes to meet the
learn, and motivation for learning about health
needs of older adults, which can create barriers
promotion, disease prevention, and maintenance.
to learning.
➢ Erikson (1963) labeled this psychosocial stage
➢ Physical, Cognitive, and Psychosocial
of adulthood as generativity versus self-
Development: As a person grows older, normal
absorption and stagnation.
physiological changes in all systems of the body
➢ Middle-aged adults may become aware of their
are universal, progressive, decremental, and
own mortality due to concern for their children,
intrinsic.
physical changes, and taking responsibility for
➢ The senses of sight, hearing, touch, taste, and
their own parents. This can lead to increased
smell are usually the first areas of decreased
motivation to follow health recommendations
functioning noticed by older persons.
and pursue new social interests and leisure
➢ Visual and auditory changes, such as cataracts,
activities.
reduced pupil size, and presbyopia, can lead to
➢ They may also become interested in financial
diminished ability to discriminate high-pitched
planning, alternative lifestyles, and ways to
sounds.
remain healthy.
➢ Other physiological changes affect organ
➢ Teaching Strategies: Middle-aged adults may
functioning, such as decreased cardiac output,
be facing midlife crisis issues such as
lung performance, and metabolic rate.
menopause, physical changes in their bodies,
➢ Cognitive ability changes with age as permanent
responsibility for their own parents' declining
cellular alterations occur in the brain itself,
health status, or concern about how finite their
resulting in an actual loss of neurons.
life really is.
➢ Physiological research has demonstrated that
➢ When teaching them, the nurse educator must be
people have two kinds of intellectual ability—
aware of their potential sources of stress, the
crystallized and fluid intelligence.
health risk factors associated with this stage of
life, and the concerns typical of midlife. The decline in fluid intelligence results in the
➢ They need to be reassured or complimented on following specific changes:
their learning competencies, and reinforcement
1. Slower processing time: Older persons need
for learning is internalized and serves to reward
more time to process and react to information,
them for their efforts.
especially as measured in terms of relationships
➢ Teaching strategies for learning are similar to
between actions and results.
those used for young adult learners, but the
➢ However, if the factor of speed is removed from
content is different to coincide with the concerns
IQ tests, for example, older people can perform
and problems specific to this group of learners.
as well as younger ones.
 ➢ Research suggests that this decline in fluid ➢ Despite declining physical attributes, the older
intelligence relates to the decreased speed at adult often has residual fitness and functioning
which older persons process information (Kray potentials. Health teaching can help to channel
& Lindenberger, 2000). these potentials.
2. Persistence of stimulus (afterimage): Older 3. Adequacy of personal resources: Resources,
people can confuse a previous symbol or word both external and internal, are important
with a new word or symbol just introduced. considerations when assessing the older adult’s
3. Decreased short-term memory: Older people current status.
sometimes have difficulty remembering events ➢ Life patterns, which include habits, physical and
or conversations that occurred just hours or days mental strengths, and economic situation, should
before. be assessed to determine how to incorporate
4. Increased test anxiety: Older people are teaching to complement existing regimens with
especially anxious about making mistakes when new required behaviors.
performing; when they do make an error, they 4. Coping mechanisms: The ability to cope with
become easily frustrated. change during the aging process is indicative of
➢ Because of their anxiety, they may take an the person’s readiness for health teaching.
inordinate amount of time to respond to ➢ Positive coping mechanisms allow for self-
questions, particularly on tests that are written change as older persons draw on life experiences
rather than verbal. and knowledge gained over the years.
5. Altered time perception: For older persons, life ➢ Negative coping mechanisms indicate their
becomes more finite, issues of the here and now focus on losses and show that their thinking is
are more important, and many adhere to the immersed in the past.
philosophy of Scarlett O’Hara, “I’ll worry about ➢ The emphasis in teaching is on exploring
that tomorrow.” alternatives, determining realistic goals, and
➢ This philosophy can be detrimental when supporting large and small accomplishments.
applied to health issues because it serves as a 5. Meaning of life: For well-adapted older persons,
vehicle for denial. having realistic goals allows them the
➢ Older adults have the ability to learn and opportunity to enjoy the smaller pleasures in life,
remember, and Erikson (1963) identified ego whereas less well-adapted individuals may be
integrity versus despair as the major frustrated and dissatisfied with personal
psychosocial developmental task. inadequacies.
➢ Health teaching must be directed at ways older
The most common psychosocial tasks of aging involve
adults can maintain optimal health so that they
changes in lifestyle and social status as a result of
can derive pleasure from their leisure years.
• Retirement (often mandatory at 70 years in this ➢ Teaching Strategies: Learning in older adults
country) can be affected by sociological and
• Illness or death of spouse, relatives, and friends • psychological factors such as retirement,
The moving away of children, grandchildren, economics, and mental status.
and friends • Relocation to an unfamiliar ➢ Understanding older persons' developmental
environment such as a nursing home or senior tasks will allow nurses to alter how they
citizens center approach both well and ill individuals in terms
• Depression, grief, and loneliness are common of counseling, teaching, and establishing a
among older persons, resulting in isolation, therapeutic relationship. Social isolation,
financial insecurity, diminished coping loneliness, and sensory deprivation can lead to
mechanisms, and decreased sense of identity, decreased cognitive functioning and a decline in
personal value, and societal worth. psychomotor performance.
➢ Memories can be a beneficial approach to
The following traits regarding personal goals in life establish a therapeutic relationship, as they can
and the values associated with them are significantly give the nurse an insight into their humanness,
related to motivation and learning (Ellison, 1985; their abilities, and their concerns.
Gessner, 1989; Culbert & Kos, 1971): ➢ To check yourself, think about the last time you
1. Independence: The ability to provide for one’s gave instruction to an older patient and ask
needs is the most important aim of the majority yourself if you talked to the family and ignored
of older persons, regardless of their state of the patient when describing some aspect of care
health. or discharge planning.
➢ Independence gives them a sense of self-respect, ➢ Older people can learn, but their abilities and
pride, and selffunctioning so as not to be a needs differ from those of younger persons.
burden to others. Health teaching is the tool to ➢ Older adults have a lower educational level than
help them maintain or regain independence. the population as a whole, and may feel
2. Social acceptability: The approval from others uncomfortable in the teaching-learning situation.
is a common goal of most older adults. ➢ As the older population becomes more educated
➢ It is derived from health, a sense of vigor, and and in tune with consumer activism, they will
feeling and thinking “young.” have an increased desire to participate more in
 decision making and demand more detailed and ➢ Try to schedule teaching sessions before or well
sophisticated information. after medications are taken and when the person
is rested.
➢ Health education for older persons should be
➢ The most important details are to ask what an
directed at promoting their involvement and
individual already knows about a healthcare
changing their attitudes toward learning.
issue or technique before explaining it, to find
➢ Interventions should be supportive, not
out about older persons' health habits and beliefs
judgmental, and should take place in a casual,
before trying to change their ways or teach
informal atmosphere. Individual and situational
something new, to arrange for brief teaching
variables such as motivation, life experiences,
sessions, to be relevant and focused on the here
educational background, socioeconomic status,
and now, and to conclude each teaching session
health-illness status, and motor, cognitive, and
with a summary of the information and a
language skills may all influence the ability of
question-and-answer period to correct any
the older adult to learn.
misconceptions.
The following are specific tips to abide by when 3. Psychosocial Needs
teaching older persons to create an environment for ➢ Assess family relationships to determine how
learning that takes into account major changes in dependent the older person is on other members
their physical, cognitive, and psychosocial for financial and emotional support.
functioning (Picariello, 1986; Hallburg, 1976; Alford, ➢ Determine availability of resources, encourage
1982): active involvement, establish a rapport based on
trust, identify coping mechanisms, and offer
1. Physical Needs constructive methods of coping.
➢ Teaching should be done in an environment that ➢ The older person's ability to learn may be
is brightly lit but without glare, with large print, affected by the medium chosen for teaching.
well-spaced letters, and primary colors. ➢ One-to-one instruction is a method that provides
➢ Bright colors and a visible name tag should be a nonthreatening environment for older adults to
worn by the educator, and white or off-white, meet their individual needs and goals.
flat mat paper and black print should be used for ➢ Group teaching is a beneficial approach for
posters, diagrams, and other written materials. fostering social skills and maintaining contact
➢ To compensate for hearing losses, eliminate with others.
extraneous noise, avoid covering the mouth ➢ Self-paced instructional tools may be
when speaking, directly face the learner, and appropriate, but it is important to know the
speak slowly. Low-pitched voices are heard best, client's previous learning techniques, mental and
but be careful not to drop your voice. At the end physical abilities, and comfort levels before
of words or phrases, do not shout. assigning any such approaches.
➢ Word speed should not exceed 140 words per ➢ Games, role-playing, demonstration, and return
minute. Ask for feedback from the learner to demonstration can be used to rehearse problem-
determine whether you are speaking too softly, solving and psychomotor skills as long as these
too fast, or not distinctly enough. methods, and the tools used to complement them,
➢ Be alert to nonverbal cues from the audience and are designed appropriately to accommodate the
ask older persons to repeat verbal instructions. various developmental characteristics of
To compensate for musculoskeletal problems, members of this age group.
decreased efficiency of the cardiovascular ➢ Written materials are excellent adjuncts to
system, and reduced kidney function, keep augment, supplement, and reinforce verbal
sessions short, schedule frequent breaks, and instructions.
allow time for stretching. Set aside more time
for the giving and receiving of information and
for the practice of psychomotor skills.
2. Cognitive Needs
➢ Older adults can learn anything if new
information is tied to familiar concepts drawn
from relevant past experiences.
➢ To compensate for a decrease in fluid
intelligence, provide older persons with more
opportunities to process and react to information
and to see relationships between concepts.
➢ When teaching, divide directions into short,
discrete, step-by-step messages and wait for a
response.
➢ For decreased short-term memory, coaching and
repetition are useful strategies. For test anxiety,
explain procedures simply and thoroughly,
reassure them, and give verbal rather than
written tests.
 positive benefits for the learners as well as the
teachers.
➢ The most important details are that the family
must make the deliberate decision as to who is
the most appropriate person to take the primary
responsibility as the caregiver, the nurse
educator must determine how caregivers feel
about the role of providing supportive care and
about learning the necessary information, and
the family and the nurse may perceive the
patient problem differently.
➢ Anticipatory teaching with family caregivers can
reduce anxiety, uncertainty, and lack of
confidence, and the greatest challenge for
caregivers is to develop confidence in their
ability to do what is right for the patient.
➢ Rankin and Stallings's 2001 model for patient
and family education serves as a foundation for
assessing the family profile to determine the
family members' understanding of the actual or
potential health problem(s), resources available
to them, their ways of functioning, and their
educational backgrounds.

STATE OF THE EVIDENCE

➢ Studies have found that teaching and learning

principles can be applied to the education of
middle-aged and older adult clients in healthcare
settings.
➢ However, current nursing and healthcare
research focusing specifically on patient
education approaches is lacking.
➢ To bolster general understanding of the physical,
cognitive, and psychosocial (emotional) traits of
human development, resources such as
Richmond and Kotelchuck (1984) and the
National Resource Center for Health and Safety
in Child Care and Early Education (2017) are
needed.
➢ The fields of psychology in general and
educational psychology in particular focus on
the application of teaching and learning
principles only to preschool and K-12
THE ROLE OF THE FAMILY IN PATIENT classrooms.
EDUCATION ➢ Life-span developmental scientists do not
specifically consider health education of well
➢ The role of the family is a key factor influencing individuals, and the application and translation
positive patient care outcomes. of developmental characteristics to the teaching
➢ Family caregivers provide critical emotional, and learning aspects of healthcare delivery is the
physical, and social support to the patient, and responsibility of nurses and other healthcare
the number of Americans who need long-term providers.
services and supports (LTSS) in the home will ➢ Malcolm Knowles's 1973 theory about adult
continue to grow. learning and Piaget's theory on cognitive
➢ According to federal statistics, 20% of development have been accepted, but recent
individuals over 65 years of age need assistance critics have challenged the assumptions.
from an informal caregiver with at least one ➢ Vygotsky's sociocultural theory adds another
activity of daily living, and for those over 85 dimension to understanding cognitive
years of age, this percentage increases to 41%. development that was not addressed by Piaget.
➢ The approximate value of services provided to ➢ Erikson's theory of the eight stages of
adults by family caregivers is $470 billion psychosocial development is still widely applied,
annually. but the existence of a ninth stage of development,
➢ Family role enhancement and increased hope and faith versus despair, has received
knowledge on the part of the family have relatively little attention.
 ➢ Recently, increased attention has been paid to
the appropriateness of teaching methods and
instructional materials for college-aged students
and adult learners to meet their expectations for
lifelong learning.
➢ This literature highlights the different
experiences, values, beliefs, and needs of
learners from varied backgrounds.
➢ Research needs to be conducted on the creative
leadership role of nurse educators, how teaching
and learning are affected by situational variables,
personality traits, temperament responses, and
sociocultural influences, as well as the role of
family and other support systems on the success
of educational endeavors to help Americans
maintain and improve their health status.

SUMMARY

➢ Nurses must understand the specific and varied

tasks associated with each developmental stage
to individualize the approach to education in
meeting the needs and desires of clients and their
families.
➢ Assessment of physical, cognitive, and
psychosocial maturation within each
developmental period is crucial in determining
the appropriate strategies to facilitate the
teaching–learning process.
➢ The nurse must create an environment conducive
to learning by presenting information at the
learner's level, inviting participation and
feedback, and identifying whether parental,
family, and/or peer involvement is appropriate or
necessary.
➢ Nursing students and staff are the audience of
learners, and nurse educators must establish
objectives and learner-centered approaches that
challenge the educator's creativity to foster self-
direction, motivation, interest, and active
participation for independence and independence
in learning.
HEALTH EDUCATION PROCESS

Nurses are responsible for the education of patients, families, staff, and students, and their role is
particularly challenging due to short lengths of stay, educational and experiential levels, staffing patterns,
part-time employment, and job functions. Additionally, the U.S. population is becoming more culturally
and linguistically diverse due to the increased number of foreign-born individuals entering the country.
These factors all affect the nurse educator's assessment of information needs of nursing students, patients,
and families. To meet these challenges, the nurse educator must be aware of the various factors that
influence how well an individual learns, such as the needs of the learner, the state of readiness to learn,
and the preferred learning styles for processing information. This chapter addresses these three
determinants of learning as they influence the effective and efficient delivery of patient/family, student,
and staff education.

THE EDUCATOR’S ROLE IN LEARNING

The role of educating others is one of the most essential interventions that a nurse performs.
Educators can greatly enhance learning by helping the learner become aware of what needs to be
known, why knowing is valuable, and how to be actively involved in acquiring information. An
assessment of the three determinants of learning enables the educator to identify information
and present it in a variety of ways. The educator also assists in identifying problems or deficits and
learners' abilities, providing important best evidence information and presenting it in unique and
appropriate ways, identifying progress being made, giving feedback and follow-up, and
determining the effectiveness of education provided.

A. ASSESSING THE LEARNER

Learning needs are gaps in knowledge that exist between a desired level of performance and the
actual level of performance. Nurse educators must identify learning needs to design an
instructional plan to address any deficits in the cognitive, affective, or psychomotor domains. Not
every individual perceives a need for education, so it is up to the educator to assist learners in
identifying, clarifying, and prioritizing their needs and interests. This information can be used to
set objectives and plan appropriate and effective teaching and learning approaches.

1. Determinants of Learning
• Learning Needs
Steps in the Assessment of Learning Needs:
1. Identify the learner. The development of formal and informal education
programs for patients and their families, nursing staff, or students must be
based on accurate identification of the learner.
2. Choose the right setting. Ensuring privacy and confidentiality is essential for
establishing a trusting relationship.
3. Collect data about the learner. Educators can identify learning needs of
specific populations by exploring typical health problems or issues of interest,
using a literature search, and systematic reviews to identify key themes
related to patient education.
4. Collect data from the learner. Learners are the most important source of
needs assessment data, and engaging them in defining their own problems
and needs motivates them to learn. Educators may not always perceive the
same learning needs as learners.
5. Involve members of the healthcare team. Nurses must collaborate with other
healthcare professionals to assess learning needs, and organizations such as
the American Heart Association, the American Diabetes Association, and the
American Cancer Society are excellent sources of health information.
6. Prioritize needs. Maslow's hierarchy of human needs can help nurse
educators prioritize learning needs to ensure that the learner's basic needs
are attended to first and foremost before higher needs are addressed.
Prioritizing the identified needs helps the patient or staff member to set
realistic and achievable learning goals. Educators should prioritize learning
needs based on the criteria in BOX 4-1 to foster maximum learning. Without
good assessment, a common mistake is to provide more information than the
patient wants or needs. Education in and of itself is not always the answer to
a problem.
7. Determine availability of educational resources. Nurse educators may need to
focus on other identified needs if proper educational resources are not
available, unrealistic, or do not match the learner's needs.
8. Assess the demands of the organization. Educator must be familiar with
organization's philosophy, mission, strategic plan, and goals to understand
learning needs of both consumers and employees.
9. Take time-management issues into account. Rankin, Stallings, and London
(2005) suggest that time constraints are a major impediment to the
assessment process, so educators should emphasize the importance of taking
the time to do a good initial assessment. Learners should be given time to
offer their own perceptions of their learning needs if the educator expects
them to take charge and become actively involved in the learning process.
Assessment can be conducted anytime and anywhere the educator has
formal or informal contact with learners. Informing a patient ahead of time
that the educator wishes to spend time discussing problems or needs gives
the person advance notice to sort out their thoughts and feelings. In one large
metropolitan teaching hospital, this strategy proved effective in increasing
patient understanding and satisfaction with transplant discharge information.

Methods to Assess Learning Needs

Educators must use objective and subjective data to assess learner needs.
1. Informal Conversations. Nurse educators must rely on active listening to
identify learning needs and provide input by responding to open-ended
questions.
2. Structured Interviews. The structured interview is a form of needs assessment
used to solicit the learner's point of view. It is important to establish a trusting
environment, use open-ended questions, choose a setting that is free of
distractions, and allow the learner to state what are believed to be the
learning needs. Questions can include what caused the problem, how severe
is the illness, what does the illness/health mean to you, what do you do to
stay healthy, which results do you hope to obtain from treatments, what are
your strengths and limitations as a learner, and how do you learn best. These
questions help to determine the needs of the learner and serve as a
foundation for beginning to plan an educational intervention.
3. Focus Groups. Focus groups involve gathering a small number of potential
learners to determine educational need. Facilitators lead the discussion by
asking open-ended questions intended to encourage detailed discussion. It is
important for facilitators to create a safe environment so that participants feel
free to share sensitive information. The groups of potential learners should
be homogeneous, but if the purpose of the focus group is to solicit attitudes
or discuss ethical issues, it may not be necessary or recommended to have a
homogeneous group. Focus groups can provide qualitative data for a
complete assessment of learning needs and can be a rich source of
information when exploring sensitive nursing issues.
4. Questionnaires. Nurse educators can obtain learners' written responses to
questions about learning needs by using checklists, which are easy to
administer, provide more privacy, and yield easy-to-tabulate data. The
educator's role is to encourage learners to make as honest a self-assessment
as possible.
5. Tests. Giving written pretests before planned teaching can help identify the
knowledge levels of potential learners and identify their specific learning
needs before instruction begins. The Diabetes Knowledge Test is an example
of a tool used to assess learning needs for self-management of diabetes.
Redman (2003) describes many other measurement instruments for patient
education that measure knowledge and learning assessment. Educators must
consider the purpose, conceptual basis, development, and psychometric
properties when evaluating the adequacy of any questionnaire or test.
6. Observations. Observing health behaviors in several different time periods
can help the educator draw conclusions about established patterns of
behavior. Watching a learner perform a skill more than once is an excellent
way to assess a psychomotor need. Landry, Smith, and Swank (2006) provide
evidence to support this method.
7. Documentation. Nurse educators should follow a consistent format for
reviewing charts to identify learning needs, and documentation from other
members of the healthcare team can provide valuable insights.

Assessing the Learning Needs of Nursing Staff

Williams (1998) discusses the importance of identifying learning needs of staff
nurses, providing practical advice, and outlining implementation issues.
1. Written Job Descriptions. A written description of job responsibilities can help
staff understand their learning needs and create content for orientation
programs and continuing education opportunities.
2. Formal and Informal Requests. Educators must consider the needs of other
staff members when conducting educational programs.
3. Quality Assurance Reports. Education can use incident reports to identify
learning needs of staff to address safety issues.
4. Chart Audits. Educators can identify trends in practice through chart auditing.
5. Rules and Regulations. Educators should monitor new rules of practice to
ensure effective delivery of care.
6. Self-Assessment. Self-assessment is an important assessment method for
nursing students and staff, and the SLOT/B (strengths, limitations,
 opportunities, threats/ barriers) approach is recommended to promote
professional self-reflection.
7. Gap Analysis. Gap analysis and the Delphi technique are two methods to
assess learning needs. Gap analysis is an organized method to identify
differences between desired and actual knowledge. Delphi is a structured
process using a series of questionnaires or rounds that provides information
about the specific need(s). Educators can use these assessment methods to
collect data on staff at multiple levels, from registered nurses to nursing
assistants. Any plans for educational activities need to consider participants'
personal preferences, mandates, expectations of accrediting agencies, and/or
trends in the profession. These approaches are useful because they benefit
all involved and justify the resources required for the assessment process.

• Readiness to learn
The educator must assess the learner's readiness to learn by understanding what
needs to be taught, collecting and validating information, and applying the same
methods used to assess learning needs. This is done by making observations,
conducting interviews, gathering information from the learner as well as from other
healthcare team members, and reviewing documentation. If the learner is not ready,
the information will not be absorbed. The learner must determine what needs to be
learned and what learning objectives should be to establish which domain and at
which level these objectives should be classified. Timing is important, as anything that
affects physical or psychological comfort can affect a learner's ability and willingness
to learn.

Readiness to learn is based on the current demands of practice and must correspond
to the constant changes in health care. Before teaching can begin, the educator must
take a PEEK at the four types of readiness to learn: physical readiness, emotional
readiness, experiential readiness, and knowledge readiness.

Physical Readiness - The educator needs to consider five major components of

physical readiness—measures of ability, complexity of task, environmental
effects, health status, and gender—because they affect the degree or extent to
which learning will occur.
✓ Measures of Ability. The ability to perform a task requires fine and/or
gross motor movements, sensory acuity, adequate strength, flexibility,
coordination, and endurance. Creating a stimulating and accepting
environment encourages readiness to learn.
✓ Complexity of Task. Variations in the complexity of a task can affect the
extent to which a learner can master behavioral changes in the cognitive,
affective, and psychomotor domains. Older adults develop elaborate
cognitive schemas and find the effort to change difficult, confusing, and
time consuming.
✓ Environmental Effects. Older adults need more time to react and respond
to stimuli, and environmental demands can overwhelm them. When an
activity is self-paced, older learners respond more favorably.
✓ Health Status. The amount of energy available and the individual's
present comfort level are important factors in determining readiness to
 learn. Nurse educators must consider a person's health status, whether
well, acutely ill, or chronically ill, when assessing readiness. Healthy
learners have energy available for learning, while those who are acutely
ill tend to focus their energies on the physiological and psychological
demands of their illness. Physical and emotional stress affects a person's
ability to learn, and medications that induce side effects such as
drowsiness, mental depression, impaired depth perception, decreased
ability to concentrate, and learner fatigue can reduce task-handling
capacity.
The Corbin and Strauss (1991) chronic illness trajectory framework and
Patterson (2001) shifting perspectives model suggest that living with
chronic illness is an ongoing and continually dynamic process, and that
individuals' perspectives shift in the degree to which illness is in the
foreground or background of their world. It is important for nurse
educators to understand this cycle when assessing readiness to learn, as
it is not static but rather fluctuates over time.
✓ Gender. Women are more receptive to medical care and take fewer risks
with their health than men, due to traditionally taking on the role of
caregivers and having more frequent contacts with health providers.

Emotional Readiness - Learners must be emotionally ready to learn. Like physical

readiness, emotional readiness includes several factors that need to be assessed.
These factors include anxiety level, support system, motivation, risk-taking
behavior, frame of mind, and developmental stage.
✓ Anxiety Level. Anxiety affects a person's ability to perform at cognitive,
affective, and psychomotor levels, affecting their ability to concentrate
and retain information. A moderate level of anxiety is best for success in
learning and is considered the optimal time for teaching. Fear is a major
contributor to anxiety and negatively affects readiness to learn in any of
the learning domains. Education is an important intervention to help
people cope with stressful life events, such as pain, fear, and denial of
illness or disability. It helps identify the source and level of anxiety, and
can be moderated by activities such as support groups and relaxation
techniques.
✓ Support System. The availability and strength of a support system can
influence emotional readiness and are closely tied to how anxious an
individual might feel. Kitchie's (2003) descriptive correlational study
suggests that families and friends are important for medication
adherence among older adults who experience chronic illness. Social
support is important in buffering the effects of stressful events, and
health professionals often act as sources of social and emotional support.
Beddoe (1999) describes the reachable moment as the time when a nurse
connects with the client by directly meeting the individual on mutual
terms. When the client feels emotionally supported, the stage is set for
the teachable moment because it is then that the person is most
receptive to learning.
✓ Motivation. Emotional readiness is strongly associated with motivation,
which is a willingness to take action. Assessment of emotional readiness
 involves ascertaining the level of motivation, not necessarily the reasons
for the motivation. Interest in informal or formal teacher-learner
interactions is a cue to motivation. Prior learning experiences are
reflected in the current level of motivation.
✓ Risk-Taking Behavior. Educators can help individuals learn how to take
risks by helping them develop strategies to minimize the risk, develop
worst-case, best case, and most-probable case scenarios, and decide
whether the worst-case scenario is acceptable.
✓ Frame of Mind. Frame of mind involves concern about the here and now
versus the future. Maslow (1970) suggests that physical needs such as
food, warmth, comfort, and safety must be met before someone can
focus on higher order learning. Ramanadhan and Viswanath (2006) found
that non-seeker patients are more likely to come from the lowest income
and education groups and are less attentive about getting health
information from the media. Older individuals tend to make health
decisions primarily based on information provided by the healthcare
professional. These findings have implications for educators when
deciding on the best method for reaching various segments of the
population.
✓ Development Stage. Erikson's theory of psychosocial learning is most
relevant to emotional readiness.

Experiential Readiness - Experiential readiness is determined by a learner's past

experiences with learning, including level of aspiration, coping mechanisms,
cultural background, and locus of control.
✓ Level of Aspirations. Learners' goals are influenced by past failures and
successes, and early successes are important motivators for learning
subsequent skills.
✓ Past Coping Mechanisms. Educators must explore learners' coping
mechanisms to determine if past strategies have been effective and
whether they work in the present learning situation.
✓ Cultural background. The educator's knowledge about other cultures and
sensitivity to behavioral differences between cultures is important to
avoid teaching in opposition to cultural beliefs. Assessment of what an
illness means to the patient from the patient's cultural perspective is
essential in determining readiness to learn. Language is also a part of
culture and may be a significant obstacle to learning if the educator and
the learner do not speak the same language fluently. Obtaining the
services of a qualified interpreter is necessary if the learner and nurse do
not speak same language. Enlisting the help of someone other than a
trained interpreter may negatively influence learning, depending on the
sensitivity of the topic and the need for privacy. Educators should not start
teaching unless they have determined that the learner understands what
they are saying and that they understand and respect the learner's
culture.
✓ Locus of Control. Educators can determine whether a learner's readiness
to learn is prompted by internal or external stimuli by assessing the
learner's previous life pattern.
 Knowledge Readiness - Knowledge readiness is determined by a learner's present
knowledge base, cognitive ability, and preferred style of learning.
✓ Present Knowledge Base. Nurse educators must consider how much someone
already knows about a subject and how proficient they are at performing it
before designing and implementing instruction. They must also consider how
much information the patient wants to receive, as some prefer a more general
approach and others may be overwhelmed by too much information.
✓ Cognitive Ability. The educator must match the level of behavioral objectives
to the cognitive ability of the learner to ensure that the learner is capable of
understanding, memorizing, recalling, or recognizing subject material.
Individuals with cognitive impairment require simple explanations and step-
by-step instruction with frequent repetition. Enlisting the help of members of
the patient's support system helps to reinforce self-care activities.
✓ Learning and Reading Disabilities. Learning disabilities require special or
innovative approaches to instruction to help individuals with low literacy skills
and learning disabilities succeed.
✓ Learning Styles. Educators can tailor teaching to meet the needs of individuals
with different styles of learning, increasing their readiness to learn.

• Learning Styles
Learning styles are the ways in which learners perceive, process, store, and recall what
they are attempting to learn, and are based on biological and sociologically developed
characteristics. Recognizing the diversity of styles can help educators create an
atmosphere for learning that encourages everyone to reach their full potential.

Determining Learning Styles

Learning style is determined through observation, interviews, and administration
of learning style instruments. Assessment is foremost in the educational process
to validate learning style and choose methods and materials to support it.
Understanding and recognizing various styles can influence decision-making
about planning, implementing, and evaluating educational programs.

Learning Style Models and Instruments

Learning styles are an emerging movement but controversial. This chapter
highlights those commonly cited in recent reviews and in health sciences research
literature that refer to the psychometric properties of each tool. Before using any
learning style instrument, it is important to determine the reliability and validity
of the tool and to use more than one measurement tool for assessment.
1. Right-Brain/Left-Brain and Whole-Brain Thinking

*Instrument to measure: Two instruments are used to measure right and

left-brain dominance: the Brain Preference Indicator (BPI) and the
Herrmann Brain Dominance Instrument (HBDI). The BPI reveals a general
style of thought that results in a consistent pattern of behavior in all areas
of life. The HBDI classifies learners in four modes, with each quadrant
corresponding to a brain structure and different preferences for thinking.

Roger Sperry and his research team established that the brain
operates as two brains, with each hemisphere having separate
and complementary functions. There is no correct or wrong side
of the brain to use in information processing, as each hemisphere
gathers the same sensory information but handles the
information in different ways. Educators can find the most
effective way to present information to learners who have a
dominant brain hemisphere. Brain hemisphericity is linked to
cognitive learning style. Most individuals have a dominant side of
the brain, but only 30% have right-brain dominance.

Educators need to employ teaching methods that enable the

learner to use both sides of the brain to stimulate the
development of left-brain thinking. Storyboarding and humor can
help students use both the right and left brain to reflect on end-
life issues. Gardner (1999a) argues that for the brain to be more
than an organ, consideration must be given to many variables.
 Learning styles are influenced by the set of values both educators
and learners bring to the teaching–learning situation.

2. Field-Independent/
Field-Dependent
Perception

Witkin, Oltman, Raskin, and Karp (1971b) identified two styles of learning in the
cognitive domain: field-independent and field-dependent. Field-independent
individuals have internalized frames of reference, are less sensitive to social cues, are
not affected by criticism, and are eager to test their ideas or opinions in a group. Field-
dependent individuals are more externally focused, more aware of social cues, and are
more dependent on others for reinforcement. Sex-related differences in behavior have
been documented in the literature, but the underlying neuroanatomic processes
remain unclear.

*Instrument to measure: Witkin, Oltman, Raskin, and Karp (1971a) devised the Group
Embedded Figures Test (GEFT) to measure field independence/dependence, which is
how a person's perception of an item is influenced by the context in which it appears.
Bonham (1988) points out that the GEFT measures the ability to do something, not
the manner (style) in which that task is done. Older adults generally do not do well on
tests in which speed is important, and age bias is a concern. The best time to use the
GEFT is when the educator wants to measure the extent to which learners are able to
ignore distractions from other persons who may offer incorrect information or ideas.
Field-independent students tend to be more confident with online technologies, and
field-dependent students may need more assistance with web-based courses.

Noble, Miller, and Heckman (2008) found that nursing students were classified as
more field dependent than students in other health-related disciplines. Flynn and
associates (1999) found a significant association between the number of interruptions
and distractions in an ambulatory care pharmacy and dispensing errors. Consideration
of field independence/dependence can be useful for educators who are involved with
teaching in a clinical setting. The GEFT instrument is available for purchase from
MindGarden (http://www.mindgarden.com).

3. Dunn and Dunn Learning Style

Rita Dunn and Kenneth Dunn developed a user-friendly model to help
educators identify characteristics that allow individuals to learn in different
ways. They identified five basic stimuli that affect a person's ability to learn:
environmental elements, emotional elements, sociological patterns, physical
elements, and psychological elements.

The most important details in this text are the environmental elements that
affect learning. These include sound, light, temperature, and design. Sound
affects learning in different ways, so the educator should permit learners to
study in silent areas or while listening to music on headsets. Light should be
provided in both well-lit and dimly lit areas, and temperature should be
adjusted to accommodate different comfort levels. Design should be varied to
allow learners to sit more formally or informally while learning.

Motivation increases when learning success increases, and motivated learners

need short learning assignments that enhance their strengths. Responsibility
is related to conformity, and the educator should give learners choices and
allow them to select different ways to complete the assignment. Structure
should vary depending on the learner's ability to make responsible decisions
and the requirements.

Learning alone is different from learning with others, with self-instruction,

one-to-one interaction, or lecture-type methods being the best approaches.
Some learners are flexible and can learn alone as well as with authority figures
and peer groups.

Perceptual Strengths are four types of learners: auditory, visual, tactile, and
kinesthetic. Auditory learners should be introduced to new information first by
hearing about it, followed by receiving verbal feedback. Visual learners learn
best by viewing, watching, and observing. Tactile learners learn through
touching, manipulating, and handling objects. Kinesthetic learners learn more
easily by doing and experiencing, and they benefit most from opportunities
for field trips, role play, interviewing, and return demonstration.

A list of rules should be established to satisfy oral needs of those who prefer
intake while learning. The four time-of-day preferences identified by Dunn
(1995) are early-morning, late-morning, afternoon, and evening learners.
Adults fall on the two extremes of the continuum, while school aged children
have high energy levels in the late morning and early afternoon. This time
sensitivity can make it easier or more difficult to learn a new skill or behavior
at certain times. To enhance learning potential, educators should structure
teaching and learning to occur during the times that are most suitable for the
learner. Nurse educators should schedule teaching during the learner's best
time of day and provide opportunity for mobility by assigning them to less
restrictive sections of the room and giving frequent 30- to 60-second breaks
during which they can stand.

Learners with hemispheric preference tend to learn best in environments with

low illumination, background music, casual seating, and tactile instruction
resources, while those with left-brain preference prefer bright lighting, quiet
setting, formal seating, and visual or auditory resources.

*Instrument to measure: The Dunn and Dunn learning style inventory is a self-
report instrument used to identify how individuals prefer to function, learn,
concentrate, and perform educational activities. It is not intended to be an
indicator of underlying psychological factors, value systems, or attitudes.
4. Jung – Myers Briggs Typology
Carl G. Jung (1921/1971) developed a theory that explains personality
similarities and differences by identifying attitudes of people (extraverts and
introverts) and opposite mental functions (opposite mental functions). He
proposed that people are likely to operate in a variety of ways depending on
the circumstances, but they tend to develop comfortable patterns that dictate
behavior in certain predictable ways. Isabel Myers and her mother, Katherine
Briggs, identified 16 personality types, each with its own strengths and
interests, based on four constructs: 1. Extraversion–Introversion (E–I) reflects
an orientation to either the outside world of people and things or to the inner
world of concepts and ideas. Individuals who prefer extraversion operate
comfortably and successfully.

Introversion and Sensing-Intuition (S-N) are two opposite preferences that

differ in how people perceive the world. Those with an introverted preference
are more interested in the internal world of their minds, hearts, and souls,
while those with an extraverted preference are thoughtful, reflective, and
slow to act. Thinking-Feeling (T-F) is the approach used by individuals to arrive
at judgments through objective versus subjective processes, while feeling-F is
used by those with a feeling preference to analyze information, data,
situations, and people and make decisions based on logic. Thinking types trust
objectivity and put faith in logical predictions and rational arguments, while
feeling types explore and weigh all alternatives and make decisions
impersonally, emotionally, and carefully.

*Instrument to measure: The Myers-Briggs Type Indicator (MBTI) is a forced-

choice, self-report inventory that measures differences in personality types. It
can be useful for educators to understand how learners perceive and judge
information and how they prefer to learn.
5. Kolb’s Experiential Learning Model
David Kolb's learning style model suggests that learning is a cumulative result
of past experiences, heredity, and the demands of the present environment. It
includes four modes of learning that reflect two major dimensions: perception
and processing. The orientations of learners are divided into two stages:
reflective observation (RO) and active experimentation (AE). At the RO stage,
learners rely on objectivity, careful judgment, personal thoughts, and feelings
to form opinions. At the AE stage, learners like to experiment to influence or
change situations and see the results of their actions.

Kolb describes each learning style as a combination of the four basic learning
modes (CE, AC, RO, and AE). The diverger combines the learning modes of CE
and RO, and is good at observing, gathering information, and gaining insights
rather than taking action. Kolb's four learning styles are involved, sensitive to
feelings, assimilator, converger, and accommodator. Divergent thinkers learn
best through group discussions and brainstorming sessions, assimilators
through lecture, one-to-one instruction, and self-instruction methods,
convergers through demonstration/return demonstration, and
accommodators through hands-on experience. Kolb believes that
understanding a person's learning style, including its strengths and
weaknesses, is essential for successful career development.

Kolb's four learning styles were expanded to nine distinct styles, which were
added to the original accommodator, diverger, assimilator, and converger.
These styles were created by dividing the AC–CE and AE–RO scores at the 30th
percentile and 60th percentile of the total norm group and plotting them on
the Nine-Region LearningStyle Type Grid (Kolb & Kolb, 2005). The Northerner,
Easterner, Southerner, and Westerner styles emphasize feeling (CE) while
balancing acting (AE) and reflecting (RO). The ninth style, a balancing learning
style, was added to reduce confusion with those who did not fit perfectly into
one of the four learning styles.

*Instrument to measure: The Learning Style Inventory (LSI) is a 20-item self-

report questionnaire that assesses learning flexibility, with four mode scores
(CE, RO, AC, and AE) and two-dimension scores (concrete-abstract and
reflective-active). Kolb's model has internal consistency and external validity.
6. 4MAT System
McCarthy (1981) developed a model based on previous research on learning
styles and brain functioning to create the 4MAT system, which describes four
types of learners: Type 1/Imaginative, Type 2/Analytical, Type 3/Common
sense, and Type 4/Dynamic. McCarthy defines the learning process as a
natural sequence from Type 1 to Type 4, where learners engage the right brain
by sensing and feeling their way through an experience, then move to the left
brain to analyze what they have experienced. Finally, Type 3 learners begin
with the left brain by working with defined concepts and then shift to the right
brain to experiment with what is to be learned. The 4MAT system is a
sequential approach to learning that includes personal meaning, accurate
information, practical application of knowledge, innovative and inspiring
learning, and more complex synthesis and extension. A recent quality
improvement project used the framework of the 4MAT system to provide a
structured approach to patient education designed to improve adherence to
a skin care regimen during radiation treatment. Results showed increased
nurse and patient satisfaction for those involved.

*Instrument to measure: McCarthy's 4MAT model is accepted as a useful

approach for presenting new information, and Tsai (2004) found that it
improved learners' achievement, retention, and satisfaction.
7. Gardner’s Eight Type of Intelligence
Howard Gardner (1983) identified seven kinds of intelligence in children:
linguistic, logical-mathematical, spatial, musical, bodilykinesthetic,
interpersonal, and intrapersonal. Gardner (1999b) identified an eighth kind of
intelligence, called naturalistic, and Gardner (2006) is considering another
kind, called existential. Linguistic intelligence is located in Broca's area of the
left side of the brain, and children with this type of intelligence have highly
developed auditory skills and think in words. The right side of the brain deals
with concepts, while the left side remembers symbols. Children with high
logical-mathematical intelligence can do arithmetic problems quickly, use
computers, and do experiments.

They also enjoy strategy board games, building blocks, jigsaw puzzles, and
daydreaming. Musically intelligent children can sing, play musical
instruments, dance, and keep time rhythmically. They also learn best with
music playing in the background. Bodily-kinesthetic intelligence involves the
basal ganglia and cerebellum of the brain, while interpersonal intelligence
involves the prefrontal lobes of the brain. Naturalistic intelligence involves
sensing abilities in making patterns and connections to elements in nature.

Intrapersonal intelligence involves strong personalities, preferring the inner

world of feelings and ideas, and preferring to be alone. Educators should
approach children from the perspective of these different intelligences.
Gardner's theory of the eight intelligences can be used to assess each child's
style of learning and tailor teaching accordingly. For example, if an educator
wants to assist a child in learning about a kidney disorder, they can use one of
the following eight approaches: Linguistic, Spatial, Bodily-kinesthetic, Logical-
mathematical, Musical, Interpersonal, Intrapersonal, and Naturalist. These
approaches can help the child identify tactile features of the kidney or act out
appropriate behavior. Additionally, they can provide pet therapy, allow the
child to engage in outside activities that are a form of exercise, or offer videos
that feature nature, science, or animals.

*Instrument to measure: Howard Gardner does not believe individuals need

to be tested to find their preferred learning style.
8. VARK Learning Style
The VARK model focuses on a person's preference for taking in and putting out
information, which is divided into four categories: visual, aural, read/write,
and kinesthetic. It is designed to be a starting place for educators and learners
to have a conversation about different strategies for teaching and learning.

*Instrument to measure: The VARK questionnaire (version 7.8) provides users

with a profile of their learning preferences for taking in and giving out
information. It is available for free and can be used as a low-stakes diagnostic
tool by students and teachers. In a pilot study, Koonce, Giuse, and Storrow
(2011) used the VARK assessment to tailor health information materials for
emergency department patients who were hypertensive. Although there were
no significant differences in changes in quiz scores on a hypertensive
knowledge assessment between the experimental and control group, patients
who received the learning style-tailored information reported higher levels of
satisfaction with the intervention materials.
Interpretation of the Use of Learning Style Models and Instruments
Learning style is an important concept, but educators must be mindful of other factors
such as readiness and capabilities to learn, educational background, and rates of learning.
Learning styles vary from person to person and differ from capabilities. Some learning
theorists advocate that learning style be matched with a similar teaching style for learners
to attain an optimal level of achievement. However, research in this area is clouded by
inconsistent findings and there is insufficient evidence to justify this approach. Instead,
educators should be more concerned with matching their instruction to the content they
are teaching.

Learners process information in the same way, and research suggests that learning style
preferences prevail over time. To assess individual learning styles, educators must
evaluate the instrument for validity, reliability, and applicability to the population for
which it is intended. They must also adhere to copyright laws and use multiple learning
style models and instruments. It may not always be practical to administer learning style
instruments due to cost, time, accessibility, or appropriateness for a specific population.
Educators should become familiar with the different models and instruments available
and the various ways in which styles are classified so that they are easier to recognize.
Identify key elements of an individual's learning style by observing and asking questions,
match teaching methods and instructional materials to those unique qualities, encourage
learners to become aware of their learning styles, be cautious about saying that certain
teaching methods are always more effective for certain styles, prompt learners to expand
their style ranges, provide learning choices that enable learners to operate in the style by
which they prefer to learn, and use a team of educators who have varied teaching styles
to present new and complex information in different ways to ensure mastery of
information.

State of the Evidence

The most important details in this text are the four dimensions of evidence that nurse
educators need to consider when assessing the available evidence: level of evidence
(study design), quality of evidence (concern with bias), relevance of evidence (implying
applicability), and strength of evidence (precision, reproducibility, and attributability). The
framework suggested by Lohr (2004) was helpful in deciding what is considered
appropriate evidence, where the evidence comes from, and whether all the evidence
counts. The research included in this chapter supports the importance of conducting an
educational assessment, but the deficit of evidence on the process and criteria for
assessment is striking. The amount of research-based evidence about the three
determinants of learning suggests that educational assessment is not an easy area in
which to conduct research.

Summary
The assessment phase of learning is essential for determining learning needs, readiness
to learn, and individual learning styles. Educators must identify and prioritize learning
needs, assess the learner's readiness to learn based on physical, emotional, experiential,
and knowledge components, and assess learning styles by interviewing, observing, and
using instrument measurement. By accepting the diversity of needs, readiness levels, and
styles among learners, nurse educators can create a versatile atmosphere and facilitate
optimal experiences that encourage all learners to reach their full potential.
Reference: Bastable, S.B. (2019) Nurse as educator: Principles of teaching and learning for
nursing practice. Jones & Bartlett Learning.

Prepared by:

Jennifer C. Valenzuela, RN, EMT-B, MAN©

Clinical Instructor
NCM 102 - HEALTH EDUCATION
OVERVIEW OF THE CONCEPTS OF HEALTH AND HEALTH EDUCATION
There are many different elements in the environment, including living and nonliving
entities, man-made and natural objects like mountains, rivers, trees, animals, and plants,
among others. Our health condition is impacted by the surroundings. Those who live in
unsanitary environments are more likely to contract certain diseases. So, the factors with
which we contact determine the growth, upkeep, and development of our bodies. People's
health status can be improved or we can get good health if the atmosphere is clean and
fresh.
Providing information on health-related topics and raising people's awareness of the need
of maintaining good health are two goals of health education. Environmental education
informs people about the biological, physical, and sociocultural components of the
environment and encourages them to use resources in a way that preserves the
ecological balance. Education in the fields of health, population, and the environment is
a multifaceted field that is essential to the development of a balanced ecosystem and
healthy lifestyles.
1. Health and Health Education Defined

What is Health?

• is a word that was derived from the old English word for heal which is HAEL
• It means whole because health concerns the whole person and his/her
integrity, soundness or well-being and that the person functions as a complete
entity or unit and that the body, mind and spirit are one.
• Holistic nursing intervention focuses on the total care of the individual as
a complete being rather than on fragmented care which focuses only on the
part or parts which are not healthy or functional.
• Knowledge of the theory of holism allows the nurse to understand the patient with
compassion and caring and to treat him/her as a family member and
not simply a "case" or "room number"
• is holistic (total health) and it includes the different dimensions of health taking
into account the separate influences and interaction of these dimensions
(Aggleton & Homans. 1987).
Concept of Health
Health is frequently seen as the opposite of disease. But, to define health in this limited
manner is to omit many important aspects of its investigation. Being healthy means not
having any illnesses of any type. the absence of disease or infirmity, but also a state of
full bodily, social, and mental well-being, according to the World Health Organization
(WHO). It has concentrated on every facet of health. It includes social adaptability, mental
acuity, and physical fitness.
Physical well-being is the absence of any sickness in the body's organs. This component
of health is concerned with having a perfect physique and having all of the body's organs
functioning properly.
Mental well-being: This is the state of not having any stress, tension, or depression. This
element of health places a strong emphasis on the capacity for making wise decisions
and assessments.

The ability of people to live in society is referred to as social health. A person is an

essential component of society. Another aspect of excellent health is one's ability to adapt
to society. It involves interpersonal relationships, teamwork, leadership goals, and more.
What is Health Education?
In order to enhance health and avoid disease, disability, and early death through
education-driven voluntary behavior change activities, health education is a social
science that draws from the biological, environmental, psychological, physical, and
medical disciplines.
The improvement of health knowledge, attitudes, skills, and behavior is accomplished
through the development of individual, group, institutional, community, and systemic
solutions.
The goal of health education is to improve the living and working situations that affect
people's health as well as their individual and community health behaviors.
2. Process of Health Education

The educational process consists of two main interdependent steps that are
methodical, sequential, rational, and founded on science: teaching and learning
operations. The teacher and the student are two interdependent players in this
process, which creates a continual cycle. Together, they carry out teaching and
learning tasks, the results of which produce behavior changes that both parties
want to see. These adjustments encourage the learner's improvement and, it
should be noted, the teacher's growth as well. Hence, the educational process
serves as a foundation for a shared, participatory method of teaching and learning.

The educational system is consistent throughout the practice of a variety of health-

related professions. In reality, the nursing procedure can be used as a comparison
since each process's steps are parallel to the other's actions' steps. Their
education procedure, similar to the nursing process, is made up of the core
components of evaluation, planning, and implementation, assessment. The
difference between the two is that the nursing process emphasizes preparation
and execution. Medical treatment determined on the diagnosis and evaluation of
the needs of the bodily and psychological needs of the person. In contrast, the
 educational process concentrates on the development and execution of teaching
based on prioritizing and assessment of the client's educational requirements,
preparedness to learn and learning preferences

Paradigm originally developed to assist nurses to organize and carry out the education
process (Rega, 1993)

Analyze the learner

State the objectives
Select the instructional methods and materials
Use the instructional methods and materials
Require learner performance
Evaluate the teaching plan and revise as necessary

HEALTH EDUCATION METHODS

Methods refers to ways through which messages are conveyed to achieve a desired
behavioral change in a target audience.
In health education it is not enough to decide what will be done; by whom and when, we
also need to decide how it will be done (methods).
COMMON HEALTH EDUCATION METHODS
INFORMAL
1. HEALTH TALK
✓ When talks are on health agenda, we call it health talks.
✓ It is the most natural way of communicating with people to share health knowledge
and facts.
✓ Can be conducted with one person or with a family or
 ✓ Group of people or through mass communication
2. LECTURE
✓ It is oral, simple, quick and traditional way of
✓ Presentation of the subject matter.
✓ Presents factual material in direct, logical manner
✓ Economical
✓ In most cases audience is passive.
FORMS OF LECTURE
✓ Traditional - Teacher is the only speaker
✓ Participatory - Begins with learner brainstorming and use pause in between
✓ Feedback - Mini lectures followed by small group
✓ Discussion, it gives opportunity to manipulate lecture content
✓ Mediated - Use of media such as films, slides along with traditional methods
3. BRAINSTORMING
✓ Instead of discussing the problem at great length the participants encouraged to
make a list in a short period of time all the ideas that come to their mind regarding
the problems without discussing among themselves.
✓ Is a means of eliciting from the participants their ideas and solution on health
issues.
Strengths of Brainstorming
• Allows creative thinking for new ideas
• Encourages full participation because all ideas
• Equally recorded
• Draws on group's knowledge and experience
Limitations of Brainstorming
• If not facilitated well, criticism and evaluation may occur.
4. GROUP DISCUSSION
✓ The participants have equal chance to express freely and exchange ideas
✓ The subject of discussion is taken up and shared equally by all the members of the
group.
✓ It is collective thinking process to solve problems.
✓ Extremely useful in health education
Strengths of Group Discussion
• Pools ideas and experiences from group
• Effective after a presentation, film or experience that needs to be analyzed
 • Allows everyone to participate in an active process
Limitations of Group Discussion
• Not practical with more than 20 people
• Few people can dominate
• Others may not participate
• Time consuming
5. BUZZ GROUP DISCUSSION
✓ A large group is divided into small group, of not more than 10 or 12 people in each
small group and they have given a time to discuss the problem.
✓ Then, the whole group is reconvened and the reporters of the small groups will
report their findings and recommendation.
6. DEMONSTRATION
✓ Although basically focuses on practice/skill it involves theoretical teaching as well.
✓ Note that learners remember 20% of what they hear, 50% of what they hear and
see, and 90% of what they hear, see and do, and with repetition close to 100% is
remembered.
✓ Demonstration can be used with individuals and small groups.
✓ If the group is too large, members will not get a chance to practice the skills and
ask questions.
7. ROLE PLAY
✓ A type of drama in a simplified manner. It portrays expected behavior of people.
✓ A role-play is a spontaneous and/or unrehearsed acting out of real-life situations.
A script is not necessary.
✓ It is a very direct way of learning; you are given a role or character and have to
think and speak immediately without detailed planning.
✓ Few minutes for instruction and 5-10 minutes for them to plan & think
✓ A role play should last about 20 minutes.
✓ Allow another 20-30 minutes for discussion
✓ People can better understand their problem and the behavior associated with the
problem
8. DRAMA
✓ Drama is a presentation, in which the subject matter or topic is studied well either
written or in words, and then presented in educative and recreating manner.
✓ Needs detail planning and script development and practicing.
✓ Drama is very effective in behavior change communication because audiences
identify with characters and settings.
✓ Many dramas portray positive, negative, and transitional role models:
 • Positive characters: model healthy values and behavior, and they are
rewarded.
• Negative characters: model unhealthy behavior and antisocial values, and
they suffer as a result.
• Transitional characters: representing the audience, are uncertain at first
about which behavior to adopt.
9. CASE STUDIES
✓ An in-depth analysis of real or simulated problems that help audiences to identify
problems and suggest solutions according to their own contexts.
10. TRADITIONAL MEDIA
It includes but is not limited to:
✓ Poems
✓ Songs
✓ Proverbs
✓ Dances with songs
✓ Fable
✓ Games
✓ Stories
✓ Town criers etc.
✓ Traditional Medias are useful for the following reasons:
• They are realistic and based on the daily lives of local people
• They can communicate attitudes, beliefs, values and feelings in powerful ways.
• They can motivate people to change behavior.
• They can show ways to solve problems.
• Usually, they are very interesting.

FORMAL / SCIENTIFIC METHODS

1. CONFERENCE
✓ Refers to meeting for lectures of discussion where representative of various
stakeholders participates.
✓ Conference has a far broader spectrum of meaning than the other three (seminar,
workshop, and symposium).
✓ Not limited to academic activities only; beyond academic where many diverse
participants participate
2. WORKSHOP
✓ It is a period of discussion and practical work on a particular subject in which a
group of people share their knowledge and experiences.
 ✓ A series of educational and work sessions (where manual work is done).
✓ Small groups of people meet together over a short period of time to concentrate
on a defined area of concern.
✓ It also means a group working together, on a creative project, discussing a topic,
or studying a subject.
✓ Workshops tend to be more intense than seminars.
3. SEMINAR
✓ It is a lecture or presentation delivered to an audience on a particular topic or set
of topics that are educational in nature.
✓ Seminars are educational events
✓ It is usually held for groups of 10-50 individuals for about an hour though usually
not in practice.
4. PANEL DISCUSSION
✓ It is a meeting where experts (two or more) are invited to make short presentation
or speak on different aspect of the same subject area or theme.
5. SYMPOSIUM
✓ It is typically a more formal or academic gathering, featuring multiple experts
delivering short presentations on a particular topic.
✓ It is an academic in nature where experts (academicians) present their views on a
particular theme.
SELECTING THE HEALTH EDUCATION METHOD
Consider the following things before choosing health education methods:
1. Readiness and ability of the learners to change.
2. Your ‘learning’ objectives.
3. Number of people involved.
4. Appropriate method to the local culture.
5. Availability of resources.
6. What mixture of methods is needed?
7. Subject matter
8. Time limitation
9. Characteristics of the target group
EVALUATION IN HEALTH EDUCATION
✓ Evaluation is the systematic collection, analysis and reporting of information about
health education activities.
✓ It is a critical assessment of the good and bad points of health education
interventions, and how they could be improved.
✓ The process of assessing whether the specified objectives have been achieved.
PURPOSE OF EVALUATION
1. Help you to determine how effective you are in achieving your objectives
(Effectiveness)
2. Help you determine whether you have used your resources efficiently while achieving
your objectives. (Efficiency)
TYPES OF EVALUATION
1. PROCESS EVALUATION
✓ Concerned with assessing the process of the health education implementation and
how the work takes place.
✓ It can be carried out throughout the activities and can guide in making changes to
maximize effectiveness and efficiency.
✓ It evaluates the progress of work performance — whether the planned activities
are carried out efficiently, cost effectively and as scheduled.
✓ It is conducted while health education activities are going on.
2. IMPACT EVALUATION
✓ An impact is an immediate effect or change produced by an intervention. In health
education, these immediate changes may include changes in awareness,
knowledge, attitudes, beliefs, skills or health-related behaviors.
✓ It refers to assessing the immediate effects of the health education activities on the
people who have received health education messages.
✓ This type of evaluation is usually carried out at the end of your health education
activities.
3. OUTCOME EVALUATION
✓ ‘Outcome’ usually refers to the long-term changes that may have occurred as a
result of health education interventions. These long-term changes may include
decreases in mortality, morbidity, the prevalence of disease, or the incidence of the
health conditions being studied.
✓ It involves an assessment of some of these measurable long-term outcomes or
effects of your health education activities.
✓ Surveys may be conducted after three or five years, and they may be difficult to
conduct.
 ✓ This type of evaluation may be conducted by external agencies.

3. Purposes of Health Education

Patient education programs are an integral part of today's healthcare delivery to the
public. They aim to support patients through the transition from being invalids to being
independent in care, from being dependent recipients to being involved participants in the
care process, and from being passive listeners to active learners. The benefits of effective
patient education include increased consumer satisfaction, quality of life, continuity of
care, decrease patient anxiety, reduce the incidence of complications of illness, promote
adherence to healthcare treatment plans, maximize independence in the performance of
activities of daily living, and empower consumers to become actively involved in the
planning of their care. Illness is a natural life process, but so is mankind's ability to learn.
Research has shown that informed patients are more likely to comply with medical
treatment plans and find innovative ways to cope with illness.
Additionally, patients are more satisfied with care when they receive adequate information
about how to manage for themselves. As educators, our primary aims should be to
nourish clients as well as mentor staff. We must value education and make it a priority for
both our patients and our fellow colleagues.
PRINCIPLES AND THEORIES IN TEACHING AND LEARNING
Learning is defined in this chapter as a relatively permanent change in mental
processing, emotional functioning, skill, and/ or behavior as a result of exposure to
different experiences.
Learning theory is a coherent framework of integrated constructs and principles that
describe, explain, or predict how people learn.

Psychological Learning Theory

• Behaviorist – Focusing mainly on what is directly observable, behaviorists view

learning as the product of the stimulus conditions (S)and the responses (R)that
follow.

This theory also directly addresses how to break or unlearn bad habits and correct
faulty learning.

Motivation is defined in learning as an internal condition to arouse, direct and

maintain people's learning behaviors (Woolfolk, 2019).
Ivan Petrovich Pavlov (Father of Classical Conditioning)
Respondent conditioning (also termed as sociation learning, classical
conditioning ,or Pavlovian conditioning) emphasizes the importance of stimulus
conditions and the associations formed in the learning process.

Neutral Stimulus (NS)—a stimulus that has no special value or meaning to the
learner
Naturally Occurring Unconditioned or Unlearned Stimulus (UCS)
Unconditioned Response (UCR)
Conditioned Stimulus (CS)
Conditioned Response (CR)

Burrhus Frederic Skinner (Father of Operant Conditioning)

Operant conditioning focuses on the behavior of the organism and the
reinforcement that occurs after the response. When specific responses are
reinforced on the proper schedule, behaviors can be either increased or
decreased.
Skinner identified three types of responses, or operant, that can follow behavior:
1.Neutral operants: Responses from the environment that neither increase nor
decrease the probability of a behavior being repeated.
2.Reinforcers: Responses from the environment that increase the probability of a
behavior being repeated. Reinforcers can be either positive or negative.
3.Punishers: Responses from the environment that decrease the likelihood of a
behavior being repeated. Punishment weakens behavior.

Operant Conditioning Model:

I. To increase the probability of a response:
A. Positive reinforcement: application of a pleasant stimulus.
1.Reward conditioning: a pleasant stimulus is applied following an organism’s
response.
B. Negative reinforcement: removal of an aversive or unpleasant stimulus.
1.Escape conditioning: as an aversive stimulus is applied, the organism makes a
response that causes the unpleasant stimulus to cease.
2.Avoidance conditioning: an aversive stimulus is anticipated by the organism,
which makes a response to avoid the unpleasant event.
Contingencies to Increase and Decrease the Probability of an Organism’s
Response
II. To decrease or extinguish the probability of a response:
A. Nonreinforcement: an organism’s conditioned response is not followed by any
kind of reinforcement (positive, negative, or punishment).
B. Punishment: following a response, an aversive stimulus is applied that the
organism cannot escape or avoid.
• Cognitive – The key to learning and changing is the individual’s cognition
(perception, thought, memory, and ways of processing and structuring
information).

Cognitive learning theory focuses on the internal processes surrounding

information and memory.
Cognition is defined as “all conscious and unconscious processes by which
knowledge is accumulated, such as perceiving, recognizing, conceiving and
reasoning.”
Ex. from as simple as a young student identifying animals from a picture book to
something more complex such as weighing the pros and cons of eating meat.

Jean Piaget (Theory of Cognitive Development)

According to Piaget, a schema is the basic unit of knowledge, and schemata build
up over a lifetime.
Piaget defines a schema: “a cohesive, repeatable action sequence possessing
component actions that are tightly interconnected and governed by a core
meaning.”

The “cohesive, repeatable action” is the child’s recognition of the cow. It is

repeatable in that the child will continue to recognize it (and animals identical to it)
as a cow.
This action of recognition can be broken down into its components: The child
doesn’t just see a cow. They see a thing that is alive, has four legs, is eating grass
and makes a mooing sound. These acts of recognition, of course, can be broken
down further. The child must have some concept of what a live thing is, how to
count to four and so on.

Piaget outlines a four-step process in the formation of schemata:

 • Social Learning – Learning occurs through observation, imitation, and modeling
and is influenced by factors such as attention, motivation, attitudes, and emotions.
This theory accounts for the interaction of environmental and cognitive elements
that affect how people learn.

Albert Bandura (Social Learning Theory)

According to Bandura, people observe behavior either directly through social interactions
with others or indirectly by observing behaviors through media. Actions that are rewarded
are more likely to be imitated, while those that are punished are avoided.
 • Psychodynamic – The theory emphasizes the importance of conscious and
unconscious forces in guiding behavior, personality conflicts, and the enduring
effects of childhood experiences on adult behavior.

Sigmund Freud (Psychoanalytic Theory)

A central principle of the theory is the idea that behavior may be conscious or
unconscious—that is, individuals may or may not be aware of their motivations and why
they feel, think, and act as they do.

Theory of Personality/Self

ID - “Biologically-driven self and includes our instincts and drives. “

EGO - “The rational part of our personality. “
SUPEREGO - “Our conscience; it is our moral compass that tells us how we should
behave. “

Theory of Psychosexual Development

In each psychosexual stage of development, the child’s pleasure-seeking urges, coming

from the id, are focused on a different area of the body, called an erogenous zone.
Freud believed that personality develops during early childhood and that childhood
experiences shape our personalities as well as our behavior as adults. He asserted that
we develop via a series of stages during childhood. Each of us must pass through these
childhood stages, and if we do not have the proper nurturing and parenting during a stage,
we will be stuck, or fixated, in that stage even as adults.

Defense Mechanisms
This are various protective measures to deal with feeling of anxiety as ego restores
balance from its inability to mediate the conflict between the Id and Superego.

Denial - Ignoring or refusing to acknowledge the reality of a threat

Displacement - Taking out hostility and aggression on other individuals rather than
directing anger at the source of the threat
Rationalization - Excusing or explaining away a threat
Repression - Keeping unacceptable thoughts, feelings, or actions from conscious
awareness
Regression - Returning to an earlier (less mature, more primitive) stage of behavior as a
way of coping with a threat.
Intellectualization - Minimizing anxiety by responding to a threat in a detached, abstract
manner without feeling or emotion.
Projection - Seeing one’s own unacceptable characteristics or desires in other people.
Sublimation - Converting repressed feelings into socially acceptable action.
Reaction Formation - Expressing or behaving the opposite of what is really felt.
Compensation - Making up for weaknesses by excelling in other areas.
 • Humanistic Learning Theories

Underlying the humanistic perspective on learning is the assumption that every

individual is unique and that all individuals have a desire to grow in a positive way.

Unfortunately, positive psychological growth may be damaged by some of society’s

values and expectations and by adults’ mistreatment of their children and one another.

Society’s values and expectations:

✓ males are less emotional than females,
✓ some ethnic groups are inferior to others,
✓ making money is more important than caring for people.

Adults’ mistreatment of their children and one another:

✓ inconsistent or harsh discipline,
✓ humiliation and belittling,
✓ abuse and neglect.

Like the psychodynamic theory, the humanistic perspective is largely a motivational

theory. From a humanistic perspective, motivation is derived from each person’s needs,
subjective feelings about the self, and the desire to grow.

Abraham Maslow (Hierarchy of Needs)

He used a pyramid to arrange and illustrate the basic drives or needs that motivate
people.

Within this model, it is assumed that basic level needs must be met before individuals can
be concerned with learning and self-actualizing.

Example:
Patients who are hungry, tired, and in pain are motivated to get these biological needs
met before they will be open to learning about their illness, rules for self-care, and health
education.

The role of any educator or leader is to serve as a facilitator. Listening—rather than

talking—is the skill needed.
Humanism
The humanistic perspective would suggest establishing rapport and becoming
emotionally attuned to patients and their family members.
Emotions are considered to interact with cognitive factors in any learning situation,
suggesting that they cannot be ignored when teaching, learning, reasoning, or making
decisions.
Summary:
Cognitive Learning - learn through perception and thoughts
Behaviorist - learn by acting and responding
Social Learning - learn from demonstration and example
Humanistic & Psychodynamic - learn through feelings & emotions

Prepared by:
Jennifer C. Valenzuela, RN, EMT-B, MAN©
Clinical Instructor
APPLYING LEARNING THEORIES TO HEALTH CARE
APPLYING LEARNING THEORIES TO HEALTH
EDUCATION

1. BEHAVIORIST LEARNING THEORIES

2. COGNITIVE THEORY
3. SOCIAL THEORY
4. PSYCHODYNAMIC THEORY
5. HUMANISTIC THEORY
 1. BEHAVIORIST LEARNING THEORY

• LEARNING IS THE RESULT OF CONNECTIONS MADE BETWEEN THE STIMULUS CONDITIONS IN

THE ENVIRONMENT (S) AND THE INDIVIDUAL’S RESPONSES (R)—SOMETIMES TERMED S-R
MODEL OF LEARNING.
• APPROACHES THE STUDY OF LEARNING BY FOCUSING ON BEHAVIORS THAT CAN BE
OBSERVED , MEASURED, AND CHANGED.

• TO ENCOURAGE PEOPLE TO LEARN NEW INFORMATION OR TO CHANGE THEIR ATTITUDES

AND RESPONSES, BEHAVIORISTS RECOMMEND ALTERING CONDITIONS IN THE
ENVIRONMENT AND REINFORCING POSITIVE BEHAVIORS AFTER THEY OCCUR.
… BEHAVIORIST LEARNING THEORY

• TWO WAYS TO CHANGE BEHAVIOR AND ENCOURAGE LEARNING USING BEHAVIORIST

PRINCIPLES

1- RESPONDENT CONDITIONING
2- OPERANT CONDITIONING
… BEHAVIORIST LEARNING THEORY

1- RESPONDENT CONDITIONING
• EMPHASIZES THE IMPORTANCE OF STIMULUS CONDITIONS IN THE ENVIRONMENT
AND THE ASSOCIATIONS FORMED IN THE LEARNING PROCESS.

2- OPERANT CONDITIONING
• FOCUSES ON THE BEHAVIOR OF THE INDIVIDUAL AND THE REINFORCEMENT THAT
OCCURS AFTER THE RESPONSE.
 LEARNING OR CONDITIONING IS QUITE SIMPLE:

• A NEUTRAL STIMULUS (NS) HAS NO PARTICULAR MEANING OR VALUE TO THE LEARNER IS

PAIRED WITH NATURALLY OCCURRING UNCONDITIONED OR UNLEARNED STIMULUS (UCS)
AND UNCONDITIONED RESPONSE (UCR)
NS+ UCS UCR
• AFTER A FEW SUCH PAIRINGS THE NEUTRAL STIMULUS ALONE WITHOUT THE
UNCONDITIONED STIMULUS WILL PRODUCE THE SAME RESPONSE
NS UCR
• WITHOUT THOUGHT OR AWARENESS LEARNING OCCURS WHEN THE NEWLY CONDITIONED
STIMULUS (CS) BECOMES ASSOCIATED WITH CONDITIONED RESPONSE(CR)
CS CR
 1- RESPONDENT CONDITIONING

EXAMPLE:
SOMEONE WITHOUT EXPERIENCE IN HOSPITAL---(NS)
VISIT SICK PT. …..SMELL ODORS---(UCS)
THAT MAKE HIM FEEL QUEASY (NAUSEOUS) AND LIGHT HEADED---(UCR)
AFTER HIS FIRST VISIT, HIS SUBSEQUENT VISIT TO HOSPITAL—(CS) BECOME ASSOCIATED
WITH FEELING ANXIOUS AND NAUSEATED—(CR)
ESPECIALLY IF THE VISITOR SMELLS ODORS SIMILAR TO THOSE ENCOUNTERED DURING
THE FIRST EXPERIENCE.
 Ivan Pavlov

8
… BEHAVIORAL LEARNING THEORIES

9
1- PRINCIPLE OF RESPONDENT CONDITIONING

• MAY PROVIDE THE BASIS FOR LONG-LASTING ATTITUDES TOWARD MEDICINE,

HEALTHCARE FACILITIES, AND HEALTH PROFESSIONALS.
• USED TO GET RID OF OR EXTINGUISH (SWITCH OFF) A PREVIOUSLY LEARNED
RESPONSE, WHICH HAS BEEN FOUND TO BE ESPECIALLY USEFUL IN TEACHING
PEOPLE TO REDUCE THEIR ANXIETY OR BREAK BAD HABITS.
• TEACHER ENCOURAGE THE LEARNER TO BUILD NEW ASSOCIATIONS FOR LEARNING.
• IN HEALTH CARE, RESPONDENT CONDITIONING HAS BEEN USED TO TREAT
ADDICTION, PHOBIAS, AND TENSION
2- OPERANT CONDITIONING
• TO INCREASE LEARNING, IS TO APPLY POSITIVE REINFORCEMENT OR REWARDS AFTER
THE BEHAVIOR OCCURS.

• TO DECREASE A BAD HABITS, IS ACCOMPLISHED BY USING EITHER

NONREINFORCEMENT OR PUNISHMENT.

• IF NONREINFORCEMENT DOES NOT WORK, THEN PUNISHMENT MAY BE EMPLOYED AS

WAY TO DECREASE RESPONSES.
• THERE ARE A RISKS TO USE PUNISHMENT—LEARNER MAY BECOME SO EMOTIONALLY
UPSET (ASHAMED, SAD, OR ANGRY).
• TO BE EFFECTIVE, IT IS NECESSARY TO ASSESS WHAT KINDS OF REINFORCEMENT ARE
LIKELY TO INCREASE OR DECREASE THE BEHAVIORS TO EACH INDIVIDUAL.
2- OPERANT CONDITIONING- CONT.

• OPERANT CONDITIONING HAS BEEN FOUND TO WORK WELL WITH NURSING HOME
AND LONG-TERM CARE RESIDENTS

• AND WITH PATIENTS WHO ARE NOT VERY VERBAL OR DO NOT ENGAGE IN MUCH
THOUGHT OR REFLECTION

• THE SUCCESS OF OPERANT CONDITIONING PARTIALLY DEPENDS ON WHEN THE

ENFORCEMENT IS APPLIED. IN EARLY STAGES LEARNING NEEDS TO BE REINFORCED
EVERY TIME IT OCCURS
OPERANT CONDITIONING- CONT.

• LEARNING OCCURS AS THE ORGANISM RESPONDS TO S- STIMULI IN THE

ENVIRONMENT AND IS REINFORCED FOR MAKING A PARTICULAR RESPONSE.

• A REINFORCER IS APPLIED AFTER A RESPONSE STRENGTHENS THE PROBABILITY

THAT THE RESPONSE WILL BE PERFORMED AGAIN UNDER SIMILAR CONDITIONS.

13
EXAMPLE OF POSITIVE REINFORCEMENT (PR)

-WE MAY CONTINUE TO GO TO WORK EACH DAY BECAUSE WE RECEIVE A

PAYCHECK ON A WEEKLY OR MONTHLY BASIS.

- IF WE RECEIVE AWARDS FOR WRITING SHORT STORIES, WE MAY BE MORE

LIKELY TO INCREASE THE FREQUENCY OF WRITING SHORT STORIES.
BEHAVIORIST LEARNING THEORY

• THE BASIC PRINCIPLES OF BEHAVIORIST LEARNING ARE SUMMARIZED AS

FOLLOWS:

• 1- FOCUS ON THE LEARNER’S DRIVES, THE EXTERNAL FACTORS IN THE

ENVIRONMENT THAT INFLUENCE A LEARNER’S ASSOCIATIONS, AND ON
REINFORCEMENTS THAT INCREASE OR DECREASE RESPONSES.
 BEHAVIORIST THEORY (CONT…)

• 2- THE TEACHER’S TASK IS FIRST TO ASSESS CONDITIONS IN THE ENVIRONMENT

THAT LEAD TO SPECIFIC RESPONSES, THE LEARNER’S PAST HABITS AND HISTORY OF
S-R CONNECTIONS, AND WHAT IS REINFORCING FOR A LEARNER.

• THEN TEACHERS MUST EFFECTIVELY MANIPULATE CONDITIONS TO BUILD NEW

ASSOCIATIONS, PROVIDE APPROPRIATE REINFORCEMENT, AND ALLOW FOR
PRACTICE TO STRENGTHEN CONNECTIONS BETWEEN STIMULI IN THE ENVIRONMENT
AND A PERSON’S RESPONSES OR BEHAVIOR.
2. THE COGNITIVE THEORY

Jean Piaget
Swiss Psychologist (1896-1980)

Cognition is: The mental activities involved in

thinking, knowing, & remembering
… COGNITIVE LEARNING THEORY
• IN CONTRAST TO BEHAVIORIST THEORY, COGNITIVE THEORY FOCUSES ON WHAT
GOES ON “INSIDE” THE LEARNER.
ESPECIALLY LEARNERS’:
• PERCEPTION
• THOUGHT
• MEMORY AND
• WAYS OF PROCESSING AND
• STRUCTURING INFORMATION

ACCORDING TO THIS PERSPECTIVE FOR INDIVIDUAL TO LEARN, THEY MUST CHANGE

THEIR PERCEPTION AND THOUGHTS AND FORM A NEW UNDERSTANDING AND
INSIGHTS.
COGNITIVE LEARNING THEORY:

• COGNITIVE THEORISTS , UNLIKE BEHAVIORISTS, MAINTAIN THAT REWARD IS

NOT NECESSARY FOR LEARNING.
• MORE IMPORTANT ARE LEARNERS’ GOALS AND EXPECTATIONS, WHICH
CREATE DISEQUILIBRIUM, IMBALANCE, AND TENSION THAT MOTIVATE THEM
TO ACT.

19
COGNITIVE THEORY CONT…..

• LEARNING INVOLVES PERCEIVING THE INFORMATION, INTERPRETATION, AND

REORGANIZING INFORMATION INTO NEW INSIGHTS.

• THE INDIVIDUALS’ GOALS AND EXPECTATIONS ARE THE SOURCES OF

MOTIVATION THAT CREATE DISEQUILIBRIUM, IMBALANCE, TENSION AND THE
DESIRE TO LEARN.

• IN ORDER FOR THE TRANSFER OF LEARNING TO HAPPEN, THE LEANER MUST

MEDIATE, OR ACT ON THE LEARNING
 THE COGNITIVE THEORY

• PIAGET WAS INTERESTED IN HOW THE MIND WORKS AND ORGANIZES

INFORMATION.

• HE BELIEVED THAT MENTAL DEVELOPMENT IS AN ORDERLY, SEQUENTIAL

PROCESS THAT BEGINS THE DAY THE INFANT IS BORN.
THIS PROCESS IS SAME FOR ALL PEOPLE BUT THE RATE OF PROGRESSION IS
DIFFERENT.
• COGNITIVE DEVELOPMENT IS AN INTERACTIVE PROCESS IN WHICH A
VARIETY OF NEW EXPERIENCES MUST EXIST BEFORE INTELLECTUAL
ABILITIES CAN DEVELOP.
COGNITIVE LEARNING THEORY- APPROACHES TO LEARNING

WITHIN THE COGNITIVE THEORY SEVERAL APPROACHES TO LEARNING SUCH AS:

• GESTALT PERSPECTIVE: PERSONS PERCEIVES INTERPRETS AND RESPONSE TO ANY
SITUATION IN HIS OR HER OWN WAY
• COGNITIVE DEVELOPMENT *****
• INFORMATION PROCESSING *****
• SOCIAL COGNITION: FOCUSED ON THE EFFECT OF SOCIAL CULTURAL FACTORS ON
PERCEPTION THOUGHTS AND MOTIVATION
THE COGNITIVE DEVELOPMENT

• ACCORDING TO PIAGET THERE ARE FOUR SEQUENTIAL STAGES OF COGNITIVE

DEVELOPMENT :
A. THE SENSORIMOTOR STAGE
B. THE PREOPERATIONAL STAGE
C. THE CONCRETE OPERATIONS STAGE
D. THE FORMAL OPERATIONS STAGE
A. THE SENSORIMOTOR STAGE:

• DURING INFANCY WHERE INFANTS EXPLORE THEIR ENVIRONMENT AND

ATTEMPTS TO COORDINATE SENSORY INFORMATION WITH MOTOR SKILLS
B. THE PREOPERATIONAL STAGE

DURING EARLY CHILDHOOD WHERE YOUNGSTERS ARE ABLE TO:

• MENTALLY REPRESENT THE ENVIRONMENT
• REGARD THE WORLD FROM THEIR OWN EGOCENTRIC (SELF CENTERED)
PERSPECTIVE AND
• COME TO GRIPS WITH SYMBOLIZATION
C. THE CONCRETE OPERATIONS STAGE

• THE CONCRETE OPERATION STAGE DURING ELEMENTARY SCHOOL YEARS

WHERE CHILDREN ARE ABLE TO ATTEND TO MORE THAN ONE DIMENSION AT A
TIME CONCEPTUALIZE RELATIONSHIPS AND OPERATE ON THE ENVIRONMENT.
D. THE FORMAL OPERATIONS STAGE

• DURING ADOLESCENCE WHERE TEENAGERS BEGIN TO THINK ABSTRACTLY

(THEORETICALLY), ARE ABLE TO DEAL WITH THE FUTURE AND CAN SEE
ALTERNATIVES AND CRITICIZE
INFORMATION-PROCESSING PERSPECTIVE:

• THE WAY INDIVIDUALS PERCEIVE, PROCESS, STORE, AND RETRIEVE INFORMATION

FROM EXPERIENCES DETERMINES HOW LEARNING OCCURS AND WHAT IS
LEARNED.
• ORGANIZING INFORMATION AND MAKING IT MEANINGFUL AIDS THE ATTENTION
AND STORAGE PROCESS; LEARNING OCCURS THROUGH GUIDANCE, FEEDBACK,
AND ASSESSING AND CORRECTING ERRORS.
• EG. NEXT PG…………………………..

28
INFORMATION PROCESSING
STAGES OF INFORMATION PROCESSING:
• ATTENTION
• SENSORY PROCESSING: USING ONE OR MORE OF THE SENSES
• SHORT TERM MEMORY STORAGE
• LONG TERM MEMORY STORAGE
• ACTION RESPONSE
COGNITIVE LEARNING THEORY

PRINCIPLES OF COGNITIVE LEARNING THEORY:

• FOCUS ON INTERNAL FACTORS WITHIN LEARNERS, SUCH AS THEIR
DEVELOPMENTAL STAGE OF REASONING, PERCEPTIONS, THOUGHTS, WAYS OF
PROCESSING AND STORING INFORMATION IN MEMORY, AND THE INFLUENCE OF
SOCIAL FACTORS ON ATTITUDES, THOUGHTS, AND ACTIONS

• THE ROLE OF THE TEACHER IS TO ASSESS LEARNER’S DEVELOPMENTAL STAGE, GOAL

& EXPECTATIONS, PREFERRED STYLE, THEN ORGANIZE LEARNING EXPERIENCE TO BE
MEANINGFUL AND KEEP LEARNING SIMPLE AND AT APPROPRIATE LEVEL
3. SOCIAL LEARNING THEORY

• LEARNING IS OFTEN A SOCIAL PROCESS, AND OTHER INDIVIDUALS,

ESPECIALLY “SIGNIFICANT OTHERS,” PROVIDE COMPELLING EXAMPLES OR
ROLE MODELS FOR HOW TO THINK, FEEL, AND ACT.

31
… SOCIAL LEARNING THEORY

32
… SOCIAL LEARNING THEORY
• ROLE MODELING IS THE CENTRAL CONCEPT OF THE THEORY

• SOCIAL LEARNING THEORY CAN BE CONSIDERED A BRIDGE OR A TRANSITION

BETWEEN BEHAVIORIST LEARNING THEORIES AND COGNITIVE LEARNING
THEORIES.

• BEHAVIORISTS SAY THAT LEARNING HAS TO BE REPRESENTED BY A

PERMANENT CHANGE IN BEHAVIOR,
… SOCIAL LEARNING THEORY
• PRINCIPLES OF SOCIAL LEARNING THEORY:

• 1- FOCUS ON ROLE MODEL, THE REINFORCEMENT THAT A MODEL HAS RECEIVED, THE SOCIAL
ENVIRONMENT AND THE FOUR SELF REGULATING PROCESSES WITHIN THE LEARNER

• 2- THE ROLE OF THE TEACHER IS TO ACT AS A TYPICAL ROLE MODEL, TO USE EFFECTIVE ROLE
MODELS IN TEACHING THAT ARE REWARDED FOR THEIR BEHAVIOR, TO ASSESS THE
INTERNAL SELF-REGULATION OF THE LEARNER, TO PROVIDE FEEDBACK FOR LEARNER’S
PERFORMANCE
 … SOCIAL LEARNING THEORY

• MUCH OF THE LEARNING OCCURS BY OBSERVATION, WATCHING OTHERS AND

LEARNING WHAT HAPPENS WITH THEM.

• SOCIAL LEARNING THEORY FOCUSES ON THE LEARNING THAT OCCURS WITHIN A

SOCIAL CONTEXT. IT CONSIDERS THAT PEOPLE LEARN FROM ONE ANOTHER,
INCLUDING SUCH CONCEPTS AS OBSERVATIONAL LEARNING, IMITATION, AND
MODELING.
… SOCIAL LEARNING THEORY

• ALBERT BANDURA IS CONSIDERED THE LEADING PROPONENT OF THIS THEORY. HE

OUTLINED A FOUR-STEP, LARGELY INTERNAL PROCESS THAT DIRECTS SOCIAL
LEARNING. THE BEHAVIORIST AND COGNITIVE DIMENSIONS OF THE THEORY
… BANDURA’S PRINCIPLES (1977)

THERE ARE FOUR STEPS, WHICH ARE INTERNAL PROCESSES THAT DIRECT SOCIAL
LEARNING

• 1. ATTENTION PHASE: ATTENTION TO ROLE MODELS THAT ARE HIGH STATUS.

• 2. RETENTION PHASE: THE STORAGE AND RETRIEVAL OF WHAT WAS OBSERVED.
• 3. REPRODUCTION PHASE: LEARNER COPIES THE OBSERVED BEHAVIOR.
• 4. MOTIVATION PHASE: WHETHER THE LEARNER IS MOTIVATED TO PERFORM THE
LEARNED BEHAVIOR.
4. PSYCHODYNAMIC THEORY

PRINCIPLES OF THE PSYCHODYNAMIC THEORY

• 1- FOCUS ON LEARNER’S PERSONALITY DEVELOPMENT, SIGNIFICANT CHILDHOOD

EXPERIENCES, CONSCIOUS AND UNCONSCIOUS MOTIVATIONS, ID(SOCIAL VALUES AND
STANDARDS TAUGHT)-EGO(SELF) –SUPEREGO(INTEGRITY, MORALITY) CONFLICTS AND
DEFENSIVE BEHAVIORS

• 2- THE TEACHER’S ROLE IS TO LISTEN, ASK PROBING QUESTIONS ABOUT MOTIVATIONS AND
WISHES, ASSESS EMOTIONAL BARRIERS TO LEARNING, AND MAKE LEARNING PLEASURABLE
WHILE WORKING TO PROMOTE EGO STRENGTH IN LEARNERS
5. HUMANISTIC THEORY

• THE ASSUMPTIONS THAT EACH INDIVIDUAL IS UNIQUE AND THAT ALL

INDIVIDUALS HAVE A DESIRE TO GROW IN POSITIVE WAY

• ACCORDING TO HUMANISTIC, FEELING AND EMOTIONS ARE THE KEYS TO

LEARNING, COMMUNICATION, AND UNDERSTANDING.
… HUMANISTIC LEARNING THEORIES

• LEARNING OCCURS ON THE BASIS OF A PERSON’S MOTIVATION, DERIVED

FROM NEEDS, THE DESIRE TO GROW IN POSITIVE WAYS, SELF-CONCEPT, AND
SUBJECTIVE FEELINGS.
• LEARNING IS FACILITATED BY CARING FACILITATORS AND A NURTURING
ENVIRONMENT THAT ENCOURAGE SPONTANEITY, CREATIVITY, EMOTIONAL
EXPRESSION, AND POSITIVE CHOICES

41
… HUMANISTIC THEORY

• ONE OF THE BEST-KNOWN HUMANISTIC THEORIST IS ABRAHAM MASLOW

… HUMANISTIC THEORY

PRINCIPLES OF LEARNING:
• 1- FOCUS ON THE LEARNER’S DESIRE FOR POSITIVE GROWTH, SUBJECTIVE
FEELINGS, NEEDS, SELF- CONCEPT, CHOICES IN LIFE, AND INTERPERSONAL
RELATION SHIPS

• 2- THE TEACHER’S ROLE IS TO ASSESS AND ENCOURAGE CHANGES IN

LEARNER’S CONCEPT, AND FEELINGS BY PROVIDING SUPPORT, FREEDOM
TO CHOOSE, AND OPPORTUNITIES FOR CREATIVITY
EXPERIENCES THAT AFFECT LEARNING

• EDUCATOR MUST BE KNOWLEDGEABLE

• LEARNER’S PAST EXPERIENCE
• LACK OF CLARITY AND MEANINGFULNESS ON WHAT IS TO BE LEARNED,
NEGLECT, POOR ROLE MODELS, CONFUSING REINFORCEMENT, INAPPROPRIATE
MATERIALS FOR LEARNER’S ABILITY.
TO ENSURE LEARNING IS PERMANENT
• ORGANIZE THE LEARNING EXPERIENCE
• MAKE IT MEANINGFUL
• PACE THE PRESENTATIONS
• PRACTICING NEW INFORMATION
• REINFORCEMENT
• ASSESS AND EVALUATE LEARNING
LEARNING THEORIES FIGURE
APPLICATION OF LEARNING THEORIES

• EACH THEORY EMPHASIS CERTAIN ASPECTS OF LEARNING

• WE CAN USE ONE OR A COMBINATION OF MORE THAN ONE
• BEHAVIORISTS FOCUS ON STIMULUS CONDITIONS AND PAY ATTENTION TO
REINFORCEMENT, MANIPULATING ENVIRONMENT,
• SOCIAL LEARNING THEORY STRESSES ROLE MODELS THAT WOULD DEMONSTRATE
THE BEHAVIOR
• USE THE THEORY ACCORDING THE TYPE OF THE LEARNER, A PASSIVE LEARNER
MIGHT BENEFIT MORE FROM A BEHAVIORIST APPROACH.