FUNDAMENTAL OF NURSING III

LECTURER:

Ns. Esthika Ariany Maisa,m.kep

MEMBERS OF GROUP 2:

M. Ilham Zul (1511314001)

Dzikra Fitria Amita (1511314025)

Balqis Qisty (1511314016)

Nadia Qonita (1511314012)

Ridha Hayati (1511314015)

NURSING FACULTY

ANDALAS UNIVERSITY

PADANG

2015/2016

CHAPTER I

INTRODUCTIONA.Background

Actual chronological age is only a relative indicator of someone’s physical, cognitive,

and psychosocial stage of development. When dealing with the teaching-learning process,

examination of the developmental phases is important as the learner progresses from infancy to

senescence in order to appreciate the behavioural changes that occur in the educational domains.

The person’s ability and readiness to learn are influenced by complex factors involving growth

and development interacting with experiential background, physical and emotional health status,

motivation, stress, surrounding conditions, and available support systems. Before any learning

could occur, assessment of the learner’s knowledge base of the topic of interest is a must. If the

client is a child, new content should be convenient to the developmental stage and should build

on the child’s knowledge base and experience. Determining the best time to teach a learner is the

major question underlying the planning for an educational experience. The answer is when the

learner is ready-the teachable moment is that point in time when s(h)e is most receptive to a

teaching situation. The nurse educator does not always have to wait for a teachable moment to

occur; s(h)e can create teaching opportunities by taking interest in and attending to the needs of

the learner

As otherwise healthy adults age, their performance on cognitive tests tends to decline.

This change is traditionally taken as evidence that cognitive processing is subject to significant

declines in healthy aging. We examine this claim, showing current theories over-estimate the

evidence in support of it, and demonstrating that when properly evaluated, the empirical record

often indicates that the opposite is true. To explain the disparity between the evidence and

current theories, we show how the models of learning assumed in aging research are incapable of

capturing even the most basic of empirical facts of “associative” learning, and lend themselves to

spurious discoveries of “cognitive decline.” Once a more accurate model of learning is

introduced, we demonstrate that far from declining, the accuracy of older adults lexical

processing appears to improve continuously across the lifespan. We further identify other

measures on which performance does not decline with age, and show how these different

patterns of performance fit within an overall framework of learning. Finally, we consider the

implications of our demonstrations of continuous and consistent learning performance

throughout adulthood for our understanding of the changes in underlying brain morphology that

occur during the course of cognitive development across the lifespan

B.Problem Formulationa. When planning, designing, and implementing an educational programme, the nurse

educator must consider the learners’ developmental stage in life?b. What is The mental lexicon?

CHAPTER II

DISCUSSIONS

A. TEACHING STRATEGIES

1. The Developmental Stages of Childhood Within childhood, there are four stages. These are infancy- toddlerhood (0-3

years), preschooling (approx. 3-6 years), school-aged childhood (approx. 6-12), and adolescence (approx. 12-18).

Pedagogy is the art and science of helping children to learn. Throughout childhood, learning is subject-centred. A review of the teaching strategies to be used in childhood in relation to the

physical, cognitive, and psychosocial maturational levels will follow.

2. Teaching Strategies During Infancy and Toddlerhood Patient education need not be illness-related. Less time should be devoted to

teaching parents about illness care. More attention should be given to teaching parents about normal development, safety, health promotion, and disease prevention.

If the child is ill, assessment of the child’s and parents’ anxiety levels and helping them cope with their stress represent the first priority for teaching intervention. This is because anxiety negatively impacts on readiness to learn.

Health teaching should take place at home or day-care centre. During hospitalisation, teaching should take place in safe and secure environment.

The following teaching strategies are suggested for short-term learning:o Read simple stories from books with lots of pictureso Use dolls to act out feelings and behaviourso Use simple audiotapes with music and videotapes with cartoon characterso Role-play to bring the child’s imagination closer to realityo Perform procedures on a doll to help the child understand what an

experience would be likeo Keep teaching sessions brief (5 minutes) and close together

3. Teaching Strategies During Preschooling Preschoolers continue to develop the skills learned earlier. Children require new behaviours that give them more independence and autonomy. Learning occurs through interaction with others and through imitating or modeling

the behaviours of friends and adults.

During interactions with preschoolers and their parents, nurses should teach parents about health promotion and disease prevention, provide guidance regarding normal growth & development, and offer instruction about medical recommendations as illness arises.

Parents are an important source of information about their children’s disabilities, idiosyncrasies [an individualizing characteristic or quality], and favorite toys, all of which may influence their learning.

Nurses are in position to instruct preschoolers on expressing themselves openly about their fears.

Nurses should be selective in the language they use with children of this stage, so that they feel less threatened.

The focus of educational sessions will continue to be on significant others, who would learn to help the child achieve desired health outcomes .

The following short-term teaching strategies are recommended:a. Provide physical and visual stimuli both for expressing ideas and for

understanding verbal instruction. b. Keep teaching session short (15 minutes), sequential and close to each other.c. Relate information needs to activities and experiences familiar to the child.d. Give the child an opportunity to select between a limited number of teaching-

learning options [such as playing with doll or reading a story] which promotes active participation and enhance nurse-client rapport.

e. Arrange small group sessions with peers as a means to make teaching less threatening and enjoyable.

f. Provide real motivation for the child’s learning by giving praise and approval both verbally and nonverbally.

g. Following a successful teaching experience, provide tangible rewards as reinforcers in the mastery of cognitive and psychomotor skills.

h. Allow the child to play with replicas or dolls to learn about body parts.i. Use storybooks to emphasise the humanity of healthcare personnel.

4. Teaching Strategies During School-Aged Childhood At this stage, children have progressed to a point where they can begin formal

training in structured school systems. Children are enthusiastic, open-minded, and motivated to learn about themselves and

the world they live in. Teaching in healthcare environment should focus on how to maintain health and

manage illness. Within this stage, it is imperative to identify learning styles, determine readiness to learn, and accommodate particular learning needs and abilities.

Children should be involved in education efforts and should receive instruction about illness, treatment, and procedure in simple logical terms.

School nurses can educate children of this stage for health promotion and health maintenance, and share the content with parents and the nurse outside the school setting to avoid duplication and conflicting information.

Extensive teaching may be needed to help children and their parents understand various conditions and learn how to overcome or deal with them.

What would help children learn in hospitals is the fact that they are used and receptive to structured, direct, and formal learning in school. The following short-term strategies are recommended for children at this stage:a. Give children the responsibility for their own health; for example teach them to

calculate and administer their own insulin.b. Teaching sessions can last as long as 30 minutes and should be spread apart to for

comprehension of large amounts of content and to provide opportunities for exercising newly acquired skills.

c. Use diagrams, models, pictures, videotapes, and printed material besides other teaching methods.

d. Clarify scientific terminology and medical jargon, and use analogies [chest x-ray is like your picture taken, white blood cells are like police cells that can destroy infection] to provide information in meaningful ways.

e. Use one-to-one teaching sessions to individualise learning according to the child’s own experience, and provide time for clarification, validation, and reinforcement of what has been learned.

f. Employ group teaching sessions involving other children of same age and with similar problems or needs.

g. Ensure that children are prepared for a procedure well in advance to allow them time to cope with their feelings and fears.

h. Encourage participation in planning for procedures and events and be supportive educator who provides nurturance.

5. Teaching Strategies During Adolescence This stage represents transition from childhood to adulthood. This stage is prolonged and very changeable; many adolescents and their families

experience turmoil. How adolescents think of themselves and the world influences many healthcare issues

they face from anorexia to DM. Although the majority of adolescents remain healthy, about 20% of them in the US

have at least one serious health problem such as DM, asthma, injury-related disabilities, and psychosocial problems.

Adolescents are at high risk of teenage pregnancy, STD, poverty, suicide, substance abuse, and RTA.

Therefore, the focus of educational efforts is varied and numerous covering topics such as sexual adjustment, contraception, venereal diseases, substance abuse, accident prevention, and nutrition.

Sick or disabled adolescent are often noncompliant with medical regimen and continue their risk-taking behaviour. Because of their preoccupation with body image and functioning, they view health recommendations as a threat to their autonomy and sense of control.

As such, the major challenge facing nurse educator in teaching this group is, probably, to develop a mutually, trusting relationship.

Adolescents can participate fully in all aspects of learning because of their well developed cognitive and language abilities. However, they need privacy, understanding, honest and straightforward approach, and unqualified acceptance of their fear of losing control.

The following strategies for short-term learning are suggested:a. Use one-to- one instruction to ensure privacy and confidentiality.b. Conduct peer group discussions as an effective approach to deal with relevant

health topic.c. Use audiovisual materials as these are usually comfortable approach to adolescent

learning. d. Clarify medical terminology and give an adolescent an opportunity to participate,

when possible, in the decision-making process. e. Give rationale for what is being said to help them feel the sense of control.f. To attract their attention and encourage their responsiveness to teaching, be

respectful, tactful, open, and flexible.g. Expect negative responses as they feel threatened in self-image and self integrity

and avoid confrontation and acting as an authority person. Alternatively, challenge their views and beliefs, and acknowledge their thought.

6. The Developmental Stages of Adulthood Andragogy is the art and science of helping adults learn. Within this framework,

learning is more learner-centred and less-teacher centred. The period of adulthood encompasses three major developmental stages of young

adult [18-40], middle-aged adult [40-65], and older adult [>65 years]. The emphasis for adult learning revolves around differentiation of life tasks and

social roles with respect to employment, family, and other activities beyond the responsibilities of home and career. Adult learning is problem centred.

Adults pursue learning throughout their life for a number of reasons embedded in three categories that [describe] the general orientation of adults toward continuing education.a. Goal-oriented learners engage in educational endeavors to accomplish clear and

identifiable objectives.b. Activity-oriented learners select educational activities to meet social needs.c. Learning-oriented learners view themselves as perpetual students who seek

knowledge for knowledge sake.

7. Teaching Strategies During Young Adulthood

At this stage,[prior to the emergence of chronic diseases], young adults are generally very healthy and have limited contact with health professionals.

At this stage it is crucial for young adults to establish behaviours conducive to healthy lives both physically and emotionally.

However, health promotion remains a neglected area of healthcare teaching even though there are various educational targets such as behaviour-related risk factors and stress management that are important to address as these impact future health.

The nurse as an educator must find a way of reaching and communicating with this audience about health promotion and disease prevention.

B. THE MENTAL LEXICONA central part of the argument put forward in Ramscar et al. (2014) is that lexical

learning continues throughout the lifespan. This raises a question, where is the evidence of

this continued learning? As Rabbitt (2014) puts it:

Ramscar et al. insist that vocabulary tests cannot be appropriate measures because they are

biased towards [sic] low frequency words and so do not accurately assess older people who

know more rare words that are not tested. It is questionable whether most older people

actually do know more rare words than most young adults, but scores on vocabulary tests

are not the only, or the best comparison. … Perhaps Ramscar et al. elide this point because

of their need to counter a quite different objection that old people generally have only equal

or even lower scores on vocabulary tests than the young.

Ramscar et al. (2004) show how some straightforward facts about sampling and the

statistical nature of lexical distributions (Baayen, 2001) guarantee that vocabulary tests will

become increasingly less accurate as people get older. If we disregard vocabulary tests as a

useful tool for assessing cognitive decline, we are left with Rabbitt’s suggestion that older

people may not actually know more rare words than young people. Does this actually make

sense? Consider life as a continuous process of sampling the world. In infancy, the part of the

world sampled is highly restricted to the cot, the high-chair, and the family (Pereira, Smith, &

Yu, 2014). During the school years, pupils are trained to absorb selected samples of the world

at a rate far beyond that which individual experience would allow. In their twenties and

thirties, speakers marry, and may have children of their own. They move to other places,

travel more widely, and experience an ever-increasing array of technological innovations. In

their sixties, speakers may become grandparents, start a new hobby and become expert bridge

players, or captains of industry. It seems likely that as their experiences of the world

accumulate, speakers will need a more diverse and more specialized vocabulary to

communicate their experiences to other speakers. In other words, given how experience is

sampled over the lifetime, it is extremely unlikely that the limited vocabulary acquired by the

end of puberty would remain unchanged and sufficient for the remainder of life.

In a meta-analysis of 134 studies, Ramscar et al. found that while older participants

outperformed younger adults at FAS recall in smaller studies, in very large surveys of the

elderly population, older participants’ performance declined as the total number of people

tested in a study increased. Moreover, this effect was not due to regression to the mean (the

analysis presented in Ramscar et al., 2014, controlled for this). Instead, it appears that in the

data reported in the literature, there is a clear relationship between the FAS test scores of older

adults and the number of older adults tested.

CHAPTER III

CLOSING

A. Conclusion

We have sought to show how many of the tacit, over-simplified assumptions about the

nature of learning in the literature are leading researchers to seriously overestimate of the degree

to which cognitive function declines with age. We would not wish to argue that this means that

functionality does not change. For instance it may be that a side-effect of some kinds of prior-

learning is that subsequent learning is inhibited in ways that, essentially, amount to functional

losses, Rather, we would suggest that a better understanding of learning can do much to assist

our understanding of cognitive functions themselves in much the same way that children learning

of a native sound system functionally impedes the later learning of non-native phonetic contrasts

REFERENCE

Ramscar Michael, Peter Hendrix, Bradley Loveii, Harald Baayeni, “Learning is not decline

The mental lexicon as a window into cognition across the lifespan” London