CHAPTER 6:

The Determinants of Learning

The Criteria For Prioritizing Learning Needs

MANDATORY learning needs that must be immediately met since they are life threatening or are needed for survival DESIRABLE learning needs that must be met to promote well-being and are not lifedependent POSSIBLE nice to know learning needs which are not directly related to daily activities

C. METHODS IN ASSESSING LEARNING NEEDS

A. Informal Conversations Or Interview Asking open-ended questions where the learner may reveal information regarding their perceived learning needs B. Structured Interviews Nurse asks the patient some predetermined questions to gather information regarding patient needs

C. Written Pretests
Comparing pre-test with the post-test scores

D. Observation Of Health Behaviors Over A Period Of Different Times

Determine established patterns of behavior

To be able to transfer ones skills, knowledge, values, and attitudes to the learner is a teachers ultimate gauge of success.

HOW???

Primarily by providing, arranging or manipulating experiences and situations in the environment so that the learner can have a better understanding, acquisition and application of the learning experience for intelligent and productive living.

REMEMBER: Teaching will always be an integral part of the nursing profession.

Factors that will influence or determine if the learning process will be a success or a failure:

 Assessing the needs will allow the nurse to design her teaching plan according to what the client already knows, what he/she still needs to know, and to determine the approach, strategy, methods and device to be used. Plan, introduce or even manipulate some factors in the learning environment or the learners milieu so that the learners potentials are fully maximized and harnessed.

READINESS TO LEARN Is the time when the patient is willing to learn or its receptive to information.

When assessing readiness to learn, the health educator must:

1. Determine what needs to be taught. 2. Find out exactly when the learner is ready to learn. 3. Discover what the patient wants to learn. 4. Identify what is required of the learner: - what needs to be learned. - what the learning objectives should be. - find out in which domain of learning and at what level the lesson will be taught.

FOUR TYPES OF READINESS TO LEARN (PEEK) (LICHTENTHAL, 1990)

P = Physical readiness E = Emotional readiness E = Experiential readiness K = Knowledge readiness

Physical Readiness
a. Measures ability b. Complexity of task c. Environmental effects d. Health status

Emotional Readiness
a. b. c. d. e. f. g. h. Anxiety level Moderate level of anxiety Support system Nurses who provide emotional support to the patient and family members go through what is termed as reachable moments Motivation Risk-taking Frame of mind Developmental stage

Experiential Readiness
a. Levels of aspiration b. Past coping mechanism c. Cultural background d. Locus control e. Orientation

Knowledge Readiness
Present knowledge base- stock knowledge or how much one already knows about the subject matter from previous actual or vicarious learning Cognitive ability- involves lower level of learning which includes memorizing, recalling or recognizing concepts and ideas and the extent to which this information is processed indicates the level at which the learner is capable of learning

NOTE:
The teacher must recognize that cognitive impairment due to mental retardation requires special techniques & strategies of teaching and the cooperation of the family must be enlisted especially in the self-care activities of the client.

 Learning disabilities and lowlevel reading skills will need special approaches to teaching to prevent discouragement and bolster readiness to learn.

III. LEARNING STYLES

LEARNING STYLE is a characteristic of the cognitive, affective, and physiological behaviours that serve as relatively stable indicators of how learners perceive, interact with, and respond to the learning environment.

 LEARNING STYLE also represents both inherited characteristics and environmental influences. As a result of our hereditary equipment, most people develop learning styles that emphasize some learning abilities over others.

Motivation And Behavior Of the Learner

MOTIVATION: comes Latin word movere which means to move or to set into motion. It is also define as a psychological force that moves a person to some kind of action It is the willingness of the learner to embrace learning, with readiness as evidence of motivation Has been conceptualized in terms of moving forward to reach ones goals or meet a need.

 Hierarchy of Needs- Maslow used this principle as it affects or influences the potency or degree or a persons motivation. Motivation is related to learning behavior or learning and behavior. It is the force that drives the learner to learn or to comply or apply the knowledge resulting to a change in behavior. motivation is significantly related to measures to the compliance with a medical regimen.

Behavior Change Theories

Health behavior frameworks or principles can be used to facilitate motivation or promote compliance to a health regimen or program. They can help the nurse educator to maintain desired behavior or promote behavior change.

Learning Assessment Of Clients

A. Literacy and Readability Literacy - is defined as the ability of adults to read, understand and interpret information written at the eighth grade level or above - the relative ability of persons to use printed and written material commonly encountered in daily life

 Health Literacy - which refers to how well an individual can read, interpret and comprehend health information for maintaining a high level of wellness. -One who is literate is an educated person or one who is able to read and write

B. Three factors to consider in assessing level of literacy

1. Reading or word recognition -the process of transforming letters into words and being able to pronounce them correctly. 2. Readability - the ease with which written or printed information can be read. 3. Comprehension - the degree to which individuals understand what they have read.

C. Clues Manifested By Patients With Low Literacy

1. Not even attempting to read printed materials. 2. Asking to take PEMs (Printed educational Materials) to discuss with significant others. 3. Claiming that eyeglasses were left at home. 4. Stating that they cant read something because they are too tired or dont feel well. 5. Avoiding discussion of written material or not asking any questions about it. 6. Mouthing words as they try to read.

D. Two test which is most often used to measure patient literacy

a. REALM (Rapid Estimate of Adult Literacy in Medicine) - requires patients to pronounce common medical and anatomical words. - It contains 66 words arranged three columns in ascending order of number of syllabus and increasing difficulty.

REALM (Rapid Estimate of Adult Literacy in Medicine)

b. WRAT (Wide Range Achievement Test)

- the patient is asked to read aloud from a list of 42 words of increasing difficulty. - the examiner asks the patient to pronounce each word and checks off each word that is pronounced incorrectly. - When 10 consecutive words are mispronounced, the test is stopped.

Teaching strategies for low literate patient

(Bastable, 2003)

1. Establish a trusting relationship before beginning the teaching learning process

It is very important for the nurse to communicate her belief and trust in the patient ability to undertake self care activities that could be effectively done by: Focusing on the strength. Specifying what needs to be learned.

2. Use the smallest amount of information possible by teaching only what the patient needs to learn

Priorities behavioral objectives : one or two concepts per section. Limit the teaching session no more than 20 to 30 minutes.

3. Make points of information as vivid and as explicit as possible, Explain information in simple terms.

4. Teach one step at the time

By teaching in increments(starting from the simplest and gradually increasing in The level of difficulty) By organizing Information in to chunks to allow patient Understand Each item first before proceeding to the next To allow the nurse to evaluate progress and give positive reinforcement

5. Use multiple Teaching methods and tools requiring fewer literacy skills aside from the repetition of concepts and information, simple list, video tapes witch the patient can take home and refer from time to time, 6. allow the patient to restate information in their own words and to demonstrate any procedure that is being thought,

7. Keep motivation high encouragement to keep on try, 8. Build in coordination with procedure by using the principle of Tailoring- coordinating patient regiment to their daily schedule Cuing - using props and remainders to get a person to perform a routine task 9. Repetition to reinforce information repetition, in the form of saying the same thing in different ways is one of the most powerful tools to help patient understand their problem and learn self care.

Developing Printed Educational Materials

A. Organizational FACTORS
First sentence is the topic sentence Address no more than 3 or 4 main points Consider using Q and A format Try to use brief headings & subheadings Only one idea per paragraph Reinforce main points with summary Short but descriptive title

B. Linguistic Factors
1. 2. 3. 4. 5. 6. 7. Keep the reading level at grade 5-6 level Use 1-2 syllable words and short sentences Use personal & conversational style. Define technical terms if they must be used. Used words consistently throughout the text Avoid the use of idioms. Use graphics & language that are culturally accepted 8. Use active rather than passive voice. 9. Incorporate examples & simple analogies to illustrate concepts.

C. Appearance Factors
1. Avoid a cluttered appearance by including enough white space 2. Include simple diagrams or graphics 3. Use upper & lower case letters 4. Use 10-14 point type in a plain font. 5. Underlined or bold important words 6. Use lists when appropriate 7. Limit line length for not more than 50-60 characters.

The End