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1. ETHICAL, LEGAL AND ECONOMIC FOUNDATIONS OF THE

EDUCATIONAL PROCESS

Healthcare organizations are laden with laws and regulations ensuring

clients rights to a quality standard of care, to informed consent and

subsequently to self-determination. Consequently, it is crucial that the

providers of care be equally proficient in both educating nursing students and

staff who are or will be the practitioner educators of tomorrow.

Although the physician is primarily held legally accountable for the medical

regimen, it is a known fact that patient education generally falls to the nurse.

Indeed, the role of a nurse as an educator is pronounced and essential in

rendering care to the patient.

We are living in a time wherein the public is not only aware, but demands

their rights as recipient of care of the medical profession. They recognize

their constitutional rights to freedom of choice and rights to self-

determination.

In answer to that demand, federal and state governments, accrediting bodies

and professional organizations find it necessary to legislate and provide

standards and guidelines to ensure the protection of human rights when it

comes to matters of health care.

This creation of health care standards and guidelines also answers to the

serious breaches of public confidence and shocking revelations of abuses ofhuman rights in the name of biomedical researches. These issues of human

rights are fundamental to the delivery of quality healthcare services, thus, it

is essential for an educator to empower the client to make informed choices

and to be in control of the consequences of those choices regardless of the

outcome.

A DIFFERENTIATED VIEW OF ETHICS, MORALITY AND THE LAW

Although ethics has been known to be a branch of classical philosophy, due

to the complexities of modern-day living and the heightened awareness of an

educated public, ethical issues related to healthcare have surfaced as amajor concern of both healthcare providers and recipients of these services.

Ethical principles of human rights are rooted in natural laws and inherent in

these natural laws are the principles of respect for others, truth-telling,

honestly and respect for life. 16th-century German philosopher, Immanuel

Kant, proposed that individual rights prevail and openly proclaimed the

deontological notion of the Golden Rule.

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Ethics refers to the guiding principles of behavior, and ethical refers to norms

or standards of behavior. In another source, ethics deals with what is the

proper course of action for man. It simply answers the question, What do I

do? Ethical pertains to dealing with morals or the principles of morality.

Moral refers to an internal value system, or the moral fabric of ones being,

and this value system, defined as morality, is expressed externally throughethical behavior. Lastly, legal rights and duties refer to rules governing

behavior or conduct that are enforceable under threat of punishment or

penalty, such as fine, imprisonment, or both.

REPUBLIC ACT 9173: PHILIPPINE NURSING ACT OF 2002

Section 28. Scope of Nursing:

(c) provide health education to individuals, families and communities

Section 35. Prohibitions in the Practice of Nursing.

A fine of not less than fifty thousand pesos (P 50, 000) nor more than one

hundred thousand pesos (P 100,000) or imprisonment of not less than one (1) year

nor more than six (6) years, or both, upon the discretion of the court, shall be

imposed upon: (d) any person violating any provision of this Act and its rules and

regulations.

APPLICATION OF ETHICAL AND LEGAL PRINCIPLES TO PATIENT EDUCATION

In considering the ethical and legal responsibilities inherent in the process of

patient education, six major ethical principles are intricately woven throughout the

ANAs Code of Ethics, the AHAs Patients Bill Of Rights and similar documentspromulgated by other healthcare organizations as well as the federal government.

These principles, which encompass the very issues that precipitated federal

intervention into healthcare affairs, are the following:

Autonomy

It is derived from the Greek words auto (self) and nomos (law) and refers to

right of self-determination. It is the capacity of a rational individual to make

an informed, uncoerced decision. The law requires, either at the time of

hospital admission or prior to the initiation of care or treatment in a

community health setting, that every individual receiving health care beinformed in writing of the right under state law to make decisions about his or

her health care, including the right to refuse medical and surgical care and

the right to initiate advance directives. Documentation of such instruction

must appear in the patients record, which is the legal document validating

that informed consent took place. While health education, per se, is not an

interpretive part of the principle of autonomy, it certainly lends credence to

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ethical notion of assisting the public to attain greater autonomy when it

comes to matters of health promotion and high-level awareness.

Veracity

Also called truth telling, is closely linked informed decision making and

informed consent. A landmark decision by Justice Benjamin Cardozo during

the early 20th century specified an individuals fundamental right to make

decisions about his or her own body. Set the nurse Tumas case as an

example. Nurse Tuma had advised a cancer patient of alternative treatments

without consultation with the clients physician. Tuma was sued by the

physician for interfering with the medical regimen that he had prescribed for

care of this particular patient. As stated in the New York State Nurse Practice

Act of 1972, A nursing regimen shall be consistent with and shall not vary

from any existing medical regimen.

Confidentiality

It refers to personal information that is entrusted and protected as privileged

information via a social contract, healthcare standard or code, or legal

covenant. A certain distinction must be made between the terms anonymous

and confidential, though. Anonymous is when researchers are unable to link

any subjects identity in their records. Confidential id when identifying

materials appear on subjects but can only be accessed by the researchers.

However, any medical personnel can reveal any information if it proves that it

can cause any harm to the patient or anyone close in proximity to the

patient. An example occurs when a patient tests positive for HIV/AIDS and

has no intention of telling his or her spouse about this diagnosis. In thisinstance, the physician is obligated to warn the spouse directly or indirectly

of the risk of potential harm.

Nonmalfeasance

It means to do no harm and constitutes the ethical fabric of legal

determinations encompassing negligence and/or malpractice. It is the

avoidance of performing an act that legally injustified, harmful, or contrary to

law. For further understanding, contrary to this term, negligence is defined as

conduct which falls below the standard established by law for the protection

of others against unreasonable risk of harm. As compared with the term intopic, malpractice refers to a limited class of negligent activities committed

within the scope of performance by those pursuing a particular profession

involving highly skilled and technical services; negligence, misconduct, or

breach of duty by a professional person that results in injury or damage to a

patient.

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Beneficence

It is defined as doing good for the benefit of others. it is a concept that is

legalized through adherence to critical tasks and duties contained in job

descriptions; in policies, procedures and protocols set forth by the healthcare

facility; and in standards and codes of ethical behaviors established byprofessional nursing organizations. It speaks of acting in best interest of the

patient but not necessarily to the detriment of the well-being of the

healthcare provider.

Justice

This term speaks to the fairness and equal distribution of goods and services.

It is unjust to treat a person better or worse than another person in a similar

condition or circumstance, unless a difference in treatment can be justified

with a good reason. In todays healthcare climate, professionals must be as

objective as possible in allocating scarce medical resources in a just manner.

2. TEACHING AND LEARNING ACROSS THE LIFESPAN

Developmental Stages of the Learner

- when planning, designing, and implementing an educational program, the nurse as

educator must consider the characteristics of learners with respect to their

developmental stage in life --- an individuals developmental stage influences the

ability to learn.

- examined from:

1. the physical, cognitive, and psychosocial development2. the role of the nurse3. the role of the family4. the teaching strategies

Fundamental Domains of Development

physical (biological) maturation

cognitive maturation

psychosocial (emotional-social) maturation

Contextual Influences

1. Normative age-graded influences4


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- related to chronological age and are similar for individuals in a particular

age group

2. Normative history-graded influences- common to people in a particular generation exposed to similar historical

events

3. Normative life events- unusual or unique circumstances that are turning points in someones life

that cause them to change direction

oDevelopmental Characteristics

Phases of Learning Maturity Continuum

Dependence- infant and young child who are totally dependent on others

Independence- when a child develops the ability to care for himself and make his own

choices, including responsibility for learning

Interdependence- when an individual has advanced in maturity to achieve self-reliance, a

sense of self-esteem, the ability to give and receive, and when hedemonstrates a level of respect for others

Before any learning starts, the nurse as educator must asses how much knowledge

the learner already possesses. He does not always have to wait for teachablemoments to arrive since he can create these opportunities by taking an interest in

and attending to the needs of the learner. The plan for teaching must match the

developmental level of the learner.

oDevelopmental Stages of Childhood

Pedagogy is the art and science of helping children to learn, or simply, teaching

children. In all stages of childhood, learning is subject-centered.

Infancy and Toddlerhood

Infant: first 12 months of life

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Toddler: 1-2 years of age

Parents are the primary learners rather than the very young child due to their

total dependence.

Physical, Cognitive, and Psychosocial Development

Patient Education must focus on teaching the parents of very young children

the importance of stimulation, nutrition, the practice of safety measures to

prevent illness and injury, and health promotion.

Cognitive stage: sensorimotor period

- coordination and integration of motor activities with sensoryperceptions

As children mature, learning is enhanced through sensory experiences and

through movement and manipulation of objects in the environment. Towards

the end of toddlerhood, the child begins to develop object permanence,

which is realizing that objects and events exist even when they cannot be

seen, heard, or touched.

Motor activities and others reactions in response to their own actions

promote their understanding and awareness of the world and of themselves.

The toddler has the capacity for basic reasoning, understands object

permanence, has the beginnings of memory, and begins to develop an

elementary concept of causality, which is the ability to grasp a cause-and-

effect relationship.

Children at this age have short attention spans and are egocentric in their

thinking. Asking questions is the feature of this age group. Children could feel

that illness is a punishment, this is called, egocentric causation.

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Psychosocial stage: trust versus mistrust (infant)

autonomy versus shame and doubt (toddler)

Toddlers like routines because it gives them a sense of security. Separationanxiety is also evident.

Teaching Strategies

Patient education for infancy may not be illness related since more

time is spent teaching aspects of normal development, safety, healthpromotion, and disease prevention.

It is good to assign a primary nurse to establish a relationship with thechild and parents. Parents should also always be present whenever

possible during teaching and learning activities to alleviate stress forthe child.

The environment best for teaching this age group is in a place familiar

to them. It should also be safe for the child.

Movement is an important mechanism by which toddlers

communicate. Play could be utilized.

It is best to develop rapport with children to elicit their active

involvement and cooperation. The best approach should be warm,honest, calm, patient, and accepting. Always wear a smile, use a warmtone of voice, and give praises.

Short-term

Read simple stories with plenty of pictures.

Use dolls and puppets to act out feelings.

Role-play enhances childs imagination to reality.

Perform procedures on a doll or teddy bear to allow the child to

anticipate what it would feel like.

Keep teaching activities brief (no longer than 5 minutes).

Individualize the pace of teaching according to the childs responses

and level of attention.Long-term

Focus with rituals, imitation, and repetition of information in the form

of words and actions.

Use reinforcement as an opportunity for them to achieve permanence

of learning through practice.

Employ teaching methods of gaming and modeling.

Encourage parents to act as role models.

Early Childhood

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Preschooler: 3-5 years of age

The childrens sense of identity becomes clearer and their world involvesothers external to the family unit. They acquire new behaviors that give them

more independence from their parents. They learn best through interactions

with others.

Physical, Cognitive, and Psychosocial Development

The physical maturation is an extension of the childs prior growth. Fine and

gross motor skills become more refined and coordinated allowing them to

carry out activities with greater independence. But even with this,supervision is still needed.

Cognitive stage: preoperational period

- emphasizes childs inability to think things through logicallywithout acting it out and it is the transitional period when thechild begins to use symbols, such as letters and numbers, torepresent something

Preschoolers can begin to classify objects into groups and categories, but

have little understanding of their relationships. The child is still egocentric

and is unaware of others thoughts or point of views.Animistic thinking is the

tendency to give inanimate objects life and consciousness.

This is the stage of the whys. They want to know the purpose of everything

but have no concern for the process. The young child still has a limited sense

of time. Waiting 15 minutes for them feels like an eternity. But their attention

span lengthens.

In this stage, sexual identity and curiosity begins to develop. They can further

name external body parts but just have small ideas of how the internal

organs look like.

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Children at this stage have fears of mutilation and pain. Illness for them is

still understood to be a punishment, while health, a reward.

Psychosocial stage: initiative versus guilt

Their kind of play changes from playing alongside one another, to playing and

interacting with others. Through play, they begin to share ideas and imitate

parents of the same sex.

Teaching Strategies

The nurse should teach the parents more about health promotion and

disease prevention techniques, to provide guidance regarding normalgrowth and development, and to offer medical recommendations whenillnesses do arise.

Allow the children to open up about their fears.

Choose words carefully when describing a procedure. Explanations

have to be kept simple.

Parents must also be included in all aspects of the educational plan

and actual teaching sessions. They can provide support for the child,and reinforce the teaching at a later time. They are the recipients ofmajority of the nurses teaching efforts. All they will do is assist thechild in achieving the desired outcome.

Short-term

Provide physical and visual stimuli for expressing ideas.

Keep teaching sessions short (not longer than 15 minutes).

Relate information to experiences familiar to the child.

Arrange small group sessions with peers to make teaching lessthreatening.

Always give praise and approval through both verbal expressions and

non-verbal gestures. Awards are also appreciated more.

Let child manipulate equipment.

Long-term

Encourage parents to portray healthy habits.

Reinforce positive health behaviors and acquisition of specific skills.

Middle and Late Childhood (6-11 years of age)

In middle and late childhood, children have progressed in their physical, cognitive,and psychological skills to the point where most begin formal training in structuredschool systems. They approach learning with enthusiastic anticipation, and theirminds are open to new and varied ideas.

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The child is, by nature, a pragmatist. He is concerned with how things work, ratherthan with why they work or how well they work. It is an age at which doing, making,and building are all-important. Now that young people have good small- as well aslarge-muscle control, they are beset by the urge to sew, cook, and bake; they want

to build things, make things, and put things together.

Children at this developmental level are motivated to learn because of their naturalcuriosity and their desire to understand more about:

Themselves

Their bodies

Their world

Influence that different things in the world have on them.

This period is a great change for them, when attitudes, values, and perceptions ofthemselves, their society, and the world are shaped and expanded.

Physical Development

The gross and fine-motor abilities of school aged children are increasingly morecoordinated.

Muscular growth and better coordination enable children to ride a bicycle, run fasterand for longer distances, participate in organized sports, write neatly with a pencil,learn to sew, and acquire other skills that require greater strength, endurance, orprecision than younger children can manage. Brain growth contributes to these

physical achievements, especially as brain pathways governing sensation, action,and thinking become speedier.

Physical growth during this phase is highly variable, with the rate of developmentdiffering from child to child. Towards the end of this developmental period, girlsmore so than boys on the average begins to experience prepubescent bodilychanges and tend to exceed the boys in physical maturation.

Children vary in physical size, weight, and coordination. During middle childhood,these differences can affect social and personal adjustment as children comparetheir characteristics and capabilities to those of their peers. Although manyvariations in physique are attributable to individual differences in rate of maturationand are not necessarily enduring, some can foreshadow potentially long-term

difficulties for children.

Cognitive Development

Piaget labelled the cognitive development in middle and late childhood as theperiod ofconcrete operations.

It is no accident that throughout most of the world, children begin formal educationat age six or seven. The intellectual skills of middle childhood are well suited for

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school because during this time, logical, rational thought processes and the abilityto reason inductively and deductively developed. Children in this age are able tothink more objectively are willing to listen to others, and will selectively usequestions to find answers to the unknown.

begin to use syllogistical reasoningthat is, they can consider two premises

and draw logical conclusions from them.

are intellectually able to understand cause and effect in a concrete way

concepts such as conservation (ability to recognize that the properties of an

object stay that same even though its appearance and position may change)are beginning to be mastered

skills of memory, decision making, insight, and problem solving are all more

fully developed

Children passing through elementary and middle schools:

have the ability to concentrate for the extended periods

can tolerate delayed gratification

are responsible for independently carrying out activities of daily living

can make decisions and act in accordance with how events are interpreted,

however they understand only to a limited extent the seriousness orconsequences of their choices

Children in the early period of this developmental phase know the functions andnames of common body parts whereas older children have more specific knowledgeof anatomy and can differentiate external and internal organs with a beginningunderstanding of their complex functions.

In shift ofprecausal to causal thinking, the child begins to incorporate the idea thatillness is related to cause and effect and can recognize that germs create disease.

Social Development

Eriksons psychosocial theory: Industry versus Inferiority

During this period, children begin to gain an awareness of their unique talents andspecial qualities that distinguish them from others. During this period, childrenlearned initiativehow to act on their own without the help or advice of otherpeople. A school-ages child while doing a project will as, am I doing a good job?

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when they are encourage in their efforts for practical tasks and are praised for thefinished results their sense of industry grows

Relationships with peers and adult external to home envt become important

influences in their development of self-esteem. School-aged children fear failureand being left out of groupsthey worry in their inabilities and become self criticalas they compare their own accomplishment to those of their peers. They also fearillness and disability that could significantly disrupt their academic progress,interfere with social contacts, decrease their independence, and result in loss ofcontrol over body functions.

Teaching Strategies

In todays healthcare environment, those in middle to late childhood and theirfamilies must be taught in an efficient, cost effective manner how to maintainhealth and manage illness. Woodring emphasizes the importance of following soundeducational principles with the child and family, such as identifying individuallearning styles, determining readiness to learn, and accommodating particularlearning needs and abilities to achieve positive health outcomes.

With their increased ability to comprehend information and their desire for activeinvolvement and control of their lives, it is very important to include school-agedchildren in patient education efforts.

The nurse in the role of educator should explain illness, treatment plans, andprocedures in simple, logical terms in accordance with the childs level ofunderstanding and reasoning. Although children at this stage of development areable to think logically, their ability for abstract thought remains limited. Therefore,teaching should be presented in concrete terms with step-by-step instructions. It isimperative that nurse observes childrens reactions and listens to their verbalfeedback to confirm that info shared has not been misinterpreted/confused.

Teaching parents directly is encouraged to that they may be involved in fosteringtheir childs independence, providing emotional support and physical assistance andgiving guidance regarding the correct techniques or regimens in self-caremanagement. In attempting to master self-care skills, children thrive on praise fromothers who are important in their lives as rewards for their accomplishments andsuccesses.

Education for health promotion and health maintenance is most likely to occur inthe school system through the school nurse, but the parents as well as the nurseoutside the school setting should be told what content is being addressed.Information then can be reinforced and expanded on when in contact with the childin other care setting.

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The school nurse in particular is in an excellent position to coordinate the efforts ofall other providers so as to avoid duplication of teaching content or the giving ofconflicting information as well as to provide reinforcement of learning.

According to healthy people 2010 ( U.S. Dept of health and human services, 2000)health promotion regarding, healthy eating, exercise, and prevention of injuries as

well as avoidance of tobacco, alcohol, and drug use are just few examples of goalsset forth to improve the health of Americas children. The schools nurse plays a vitalrole in providing this education to the school-aged child to meet these goals.

Specific conditions that may come to the attention of the nurse in caring for childrenat the phase of development include problems such as:

behacioral disorders

hyperactivity

learning disorders

obesity

diabetes

asthma

enuresis

extensive teaching may be needed to help children and parent understand aparticular condition and learn how to overcome or deal with it.

The need to sustain or bolster their self-image, self-concept, and self-esteemrequires the children be invited to participate, to the extent possible, in planning forand carrying out learning activities. For children newly diagnosed with diabetes, forexample, it is beneficial to allow them to administer an injection to a stuff animal oranother person. This strategy will allow them to participate and will decrease theirfear.

For Short Term Learning:

Allow school-aged children to take responsibility for their own health care.

Teaching sessions can be extended to last as long as 30 minutes each.

Use diagram, models, pictures, video-tapes, printed materials, and computers

as to adjuncts to various teaching methods.

Choose audio visual and printed materials that show peers undergoing similar

procedures or facing similar situations.

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Use analogiesas an effective means of providing information in meaningful

terms.

Clarify any scientific terminology and medical jargon used.

Provide clarification, validation, and reinforcement of what is being learned.

Select individual instructional techniques that provide opportunity for privacy.

Employ group teaching sessions woith others of similar age and with similar

problems or needs.

Prepare children for procedure well in advance

Encourage participation in planning for procedures and events

Praise and reward them

Long Term Learning

Help them acquire skill that they can use to assume self-care responsibility

for carrying out therapeutic treatment regimens on an ongoing basis withminimal assistance.

Assist them in learning to maintain their own well-being and prevent illness

from occurring.

Motivation, self-esteem, and positive self-perception are personal characteristicsthat influence health behaviour.

Researchers hs shown that the higher the grade level of the child, the greater theunderstanding of illness and an awareness of body cues. Thus children becomemore actively involved in their own health care as they progress developmentally.Because of importance of peer influence, group activities are in an effective methodof teaching health behaviours, attitudes, and values.

Adolescence (12-19 years of age)

Adolescence, stage of maturation between childhood and adulthood. The termdenotes the period from the beginning of puberty to maturity; it usually starts atabout age 14 in males and age 12 in females. The transition to adulthood variesamong cultures, but it is generally defined as the time when individuals begin tofunction independently of their parents.

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How adolescents think about themselves and the world significantly influencesfacing them, from anorexia to diabetes. Teenage thought and behaviour give insightinto the etiology of some of the major health problems of this group of learners. Forpatient education to be effective, an understanding of the characteristics of theadolescent phase is crucial.

Physical, Cognitive and Psychological Development

Alterations in physical size, shape, and functions of their bodies, along with theappearance and development of secondary sex characteristics, bring about asignificant preoccupation with their appearance and a strong desire to expresssexual urges.

Piaget termed this stage of cognitive development as the period offormaloperations.They are capable of abstract thought and complex logical reasoning andare able to hypothesize and apply the principle s of logic to situations neverencountered before.

Formal operational thought enables adolescent to conceptualize invisible processand make determinations about what others say and how they behave. With thiscapacity, they can become obsessed with what they think as well as what other arethinking, characteristics known as adolescent geocentricism.

Imaginary audience, a type of social thinking that has considerable influence overan adolescents behaviour-they may feel embarrassed, self-consciousness becausethey believe that everyone is looking at them, and on the other hand, has the desireto be looked at.

In relation to illnesses, they recognize that illness is a process resulting from adysfunction or nonfunction of a part/s of the body and can comprehend theoutcomes of prognosis of an illness.

Personal fable, another type of social thinking (Elkind); leads adolescents to believethat they are invulnerable.

Erikson has identified the psychosocial dilemma adolescents face as one ofidentityversus role confusion.These children indulge in comparing their self-image with anideal image.

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For Short-Term Learning

Choose peer group discussion sessions as effective approach to deal with

health topics as smoking, alcohol, and drug use.

Share decision making whenever possible because control is an important

issue for adolescent.

Include them in formulating teaching plans

Suggest options

Give rationale for all that is said and done

Expect negative responses, which are common when their self-image andself-integrity are threatened.

Avoid confrontation and acting like an authority figure.

For Long-Term Learning

Accept adolescents personal fable and imaginary audience as valid

Allow them the opportunity to rest their own convictions

Although much of patient education should be directly with adolescents to respecttheir right to individuality, privacy, and confidentiality, teaching effectiveness maybe enhanced by including their families to some extent.

The Developmental Stages of AdulthoodAndragogy, the term coined by Knowles to describe his theory of adult learning, isthe art and science of teaching adults. It is often interpreted as the process ofengaging adult learners with the structure of learning experience. Education withinthis framework is more learner-centered and less teacher-centered.

Knowles' theory can be stated with six assumptions related to motivation of adultlearning:[1][2]

1. Adults need to know the reason for learning something (Need to Know)2. Experience (including error) provides the basis for learning activities

(Foundation).3. Adults need to be responsible for their decisions on education; involvement in

the planning and evaluation of their instruction (Self-concept).

4. Adults are most interested in learning subjects having immediate relevanceto their work and/or personal lives (Readiness).

5. Adult learning is problem-centered rather than content-oriented (Orientation).

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http://en.wikipedia.org/wiki/Adult_learnerhttp://en.wikipedia.org/wiki/Motivationhttp://en.wikipedia.org/wiki/Andragogy#cite_note-0http://en.wikipedia.org/wiki/Andragogy#cite_note-1http://en.wikipedia.org/wiki/Experiencehttp://en.wikipedia.org/wiki/Errorhttp://en.wikipedia.org/wiki/Planninghttp://en.wikipedia.org/wiki/Evaluationhttp://en.wikipedia.org/wiki/Relevancehttp://en.wikipedia.org/wiki/Problemhttp://en.wikipedia.org/wiki/Adult_learnerhttp://en.wikipedia.org/wiki/Motivationhttp://en.wikipedia.org/wiki/Andragogy#cite_note-0http://en.wikipedia.org/wiki/Andragogy#cite_note-1http://en.wikipedia.org/wiki/Experiencehttp://en.wikipedia.org/wiki/Errorhttp://en.wikipedia.org/wiki/Planninghttp://en.wikipedia.org/wiki/Evaluationhttp://en.wikipedia.org/wiki/Relevancehttp://en.wikipedia.org/wiki/Problem


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6. Adults respond better to internal versus external motivators (Motivation).

In contrast to childhood learning, which is subject centered, adult learning isproblem centered.

Three categories that describe the general orientation of adults toward continuing

education:

1. Goal-oriented learners

2. Activity-oriented learners

3. Learning-oriented learner

In most cases, all three types of learners initiate the learning experience forthemselves. In planning educational activities for adults, it is important todetermine their motives for wanting to be involves. So that is why it is important fornurse educators to understand the purpose and expectations of the individuals whoparticipate in continuing education.

Young Adulthood (20-40 years of age)

The transition from adolescence to become a young adult has been recently termedemerging adulthood.Young adulthood is a time for establishing long-term, intimaterelationships with other people, choosing a lifestyle, deciding an occupation, andmanaging a home and family.

Physical, Cognitive, and Psychological Development

During this time physical abilities for most young adults are at their peak, and thebody is at its optical functioning capacity.

The cognitive capacity of young adults is fully developed, but with maturation, theycontinue to accumulate new knowledge and skills from an expanding reservoir offormal and informal experiences.

Young adults are motivated to learn about the possible implications of variouslifestyle choices.

Eriksons psychosocial theory for this level of development is intimacy vs isolation.During this time, individuals work to establish a trusting, satisfying, and permanentrelationship with others. They strive to establish commitment to others in theirpersonal, occupational, and social lives.

Teaching Strategies

Young adulthood is considered to be the life-span period that has received the leastattention by nurse education. At this developmental stage, prior to the emergenceof the chronic diseases that are generally characterize the middle-aged and olderyears, young adults are generally healthy and tend to have limited exposure tohealth professionals.

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The nurse educator must find a way of reaching and communicating with hisaudience about health and promotion. Knowledge about individuals lifestyle canprovide cues to concentrate on when determining specific aspects of education foryou adult. The motivation for adults to learn come in response to internal drives,such as need for self-esteem.

Teaching strategies must be directed at encountering young adults to seekinformation that expands their knowledge based, help them control their lives.

The Developmental Stage of Adulthood

Andragogy, the term coined by Knowles (1990) to describe his theory of adultlearning, is the art and science of teaching adults. The concept of andragogy iswithin this framework is more learners centered and less teacher centered. Theperiod of adulthood constitutes three major developmental stages the young adultstage, the middle-aged adult stage, and the older adult stage. In contrast tochildhood learning, which is subject centered, adult learning is problem centered.

The prime motivator to learn in adulthood is to able to apply knowledge and skills

for the solution of immediate problems. They are quicker than children at graspingrelationships, and they do not tolerate learning isolated facts as well as children do.

Three categories describes the general orientation of adult toward continuingeducation:

1. Goal-oriented learners

Engage in educational endeavors to accomplish clear and identifiableobjectives.

2. Activity-oriented learners

Select educational activities primarily to meet social needs

3. Learning-oriented learners

View themselves as perpetual students who seek knowledge forknowledges sake.

Stages of Adulthood

1. Young Adulthood (20-40 years of age)

The transition from adolescence to becoming a young adult has recently

been termed emerging adulthood.

Physical

Most young adults are their peak, and the body is at its optimal functioning

capacity.

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Cognitive

Formal operations that generalizes situation, and improve their abilities to

critically analyze, problem solve, make decisions about their personal,

occupational and social roles.

Psychosocial

In the initial stage of being an adult we seek one or more companions and

love. If we're not successful, isolation and distance from others may occur.

Teaching strategies

Use problem-centered focus

Draw on meaningful experiences

Focus on immediacy of application

Encourage active participation

Allow to set own pace, be self-directed

Organize material recognize social role

Apply new knowledge through role-playing and hands-on practice

2. Middle-Aged Adulthood (41-64 years of age)

The transition period between young adulthood and older adulthood.

Physical

Stages of maturation, a number of physiological changes begin to take place.

Such as endurance and energy level lessens, hormonal changes, hearing and

visual acuity start to diminish.

Cognitive

Steady state of Formal operation stage that was achieved during

adolescence.

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Psychosocial

Strength comes through care of others and production of something that

contributes to the betterment of society, which Erikson calls generativity, so

when we're in this stage we often fear inactivity and meaninglessness. If we

don't get through this stage successfully, we can become self-absorbed and

stagnate.

Teaching strategies

Focus on maintaining independence and reestablishing normal life

patterns

Assess positive and negative past experiences with learning

Assess potential sources of stress due to midlife crisis issues

Provide information to coincide with life concerns and problems

3. Older Adulthood (65 years of age and older)

Physical

Many physical changes occur that it becomes difficult to establish normalboundaries. Decreased functioning of sensory perceptive abilities, cardiac

output, lung performance and metabolic rate.

Cognitive

Aging affects the mind as well as the body.

Psychosocial

Older adults can often look back on their lives with happiness and are

content, feeling fulfilled with a deep sense that life has meaning and have

made a contribution to life, a feeling Erikson calls integrity. But some adults

may reach this stage and despair at their experiences and perceived failures.

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Teaching strategies

Use concrete examples

Build on past life experiences

Make information relevance and meaningful

Present one concept at a time

Allow time for processing/ response (slow pace)

Use repetition and reinforcement of information

Avoid written exams

Use verbal exchange and coaching

Two kinds of Intellectual Ability:

Crystallized intelligence

Intelligence absorbed over a lifetime

e.g. vocabulary, general information, understanding social interactions,

arithmetic reasoning, and ability to evaluate experiences

Fluid intelligence

The capacity to perceive relationships, reasons, and to perform

abstract thinking

Slower processing and reaction time

Persistence of stimulus

Decreased short term memory

Increased test anxiety

Altered time perception

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3 APPLYING LEARNING THEORIES TO HEALTH CARE PRACTICE

Principles of Learning

Learning is an active process that takes place as individuals interact with their

environment and incorporate new information or experiences with what they

already know or learned. Factors in the environment include:

society & culture structure/pattern of stimuli

effectiveness of role models & reinforcements

feedback for correct & incorrect responses

opportunities to process & apply learning to new situations.

The individual exerts significant control over learning. Learners have a preferred

mode for taking in information. Some individuals best learn on their own. Learning

is an individual matter. The larning theories reviewed here suggest that to learn, the

individual must want to gain something, thich, in turn, arouses the learners by

crating tension and the propensity to act or change behavior. The relative success

or failure of the learners performarnce may affect subsequent learning

experiences.

Educators must have knowledge of the material to be learned, the learner, the

social context, & educational psychology. Also, he be competent, imaginative,

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flexible & etc. All the learning theories in this chapter acknowledge the need to

recognize and relate the new information to the learners past experiences. The

ultimate control over learning rests with the learner, but effective educators

influence & guide the process. Ignoring these may hinder learning.Individuals are

unlikely to learn if they had detrimental socialization experiences, are deprived of

stimulating environments, and are without goals & realistic expectations forthemselves.

Four considerations in assisting learning in becoming permanent.

1) Learning is enhaced by organizing the learning experience, making itmeaningful & pleasurable, recognizing the roles of emotions in learning & bypacing presentation in keeping with the learners ability to process

information2) Practicing new knowledge or skills under varied conditions strengthens

learning.3) Reinforcement. Maybe helpul because it serves as a signal to the individual

that learning has occured.4) Learning tranfers beyond the initial educational setting. It cannot be assumed

to be relatively lasting or permanent; it must be assesed and evaluated.

Learning Theories

- In psychology and education, learning is commonly defined as a process

that brings together cognitive, emotional, and environmental influences and

experiences for acquiring, enhancing, or making changes in one's knowledge, skills,

values, and world views (Illeris, 2004; Ormrod, 1995).

- Is a coherent framework of integrated constructs and principles that

describe, explain, or predict how people learn. The construction and testing of

learning theories over the past century have contributed much to our understanding

of how individuals acquire knowledge and change their ways of thinking, feeling,

and behaving. Whether used singly or in combination, learning theories have much

to offer the practice of health care. Beyond ones profession, however, knowledge ofthe learning process relates to nearly every aspect of daily life.

Learning Theories can be applied at the individual, group, and community levels not

only to comprehend and teach new material, but also to solve problems, change

unhealthy habits, build constructive relationships, manage emotions, and develop

effective behavior.

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Experiential Learning

Experiential learning is the process of making meaning from direct

experience. Simply put, Experiential Learning is learning from experience.

The experience can be staged or left open. Aristotle once said, "For the things

we have to learn before we can do them, we learn by doing them.

Experiential learning focuses on the learning process for the individual

(unlike experiential education, which focuses on the transactive process

between teacher and learner). An example of experiential learning is going to

the zoo and learning through observation and interaction with the zoo

environment, as opposed to reading about animals from a book.

American educational theorist David A. Kolb believes that learning is the processwhereby knowledge is created through the transformation of experience.

He states that in order to gain genuine knowledge from an experience, certain

abilities are required:

1. the learner must be willing to be actively involved in the experience;

2. the learner must be able to reflect on the experience;

3. the learner must possess and use analytical skills to conceptualize the

experience; and

4. the learner must possess decision making and problem solving skills in order

to use the new ideas gained from the experience.

Experiential learning can be a highly effective educational method. It

engages the learner at a more personal level by addressing the needs and

wants of the individual. Experiential learning requires qualities such as self-

initiative and self-evaluation. For experiential learning to be truly effective, it

should employ the whole learning wheel, from goal setting, to experimenting

and observing, to reviewing, and finally action planning. This completeprocess allows one to learn new skills, new attitudes or even entirely new

ways of thinking.

Behavioral Theories of Learning

Focuses mainly on what is directly observable

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Behaviorists view learning as the product of Stimulus conditions (s) and theresponses (R) that follow sometimes termed as S-R model of learning.

Behaviorists closely observe responses and then manipulate the environmentto bring about the intended change

To modify the peoples attitudes and responses behaviorist either alter the

stimulus conditions in the environment or change what happens after aresponse occurs

2 Concepts of Behavioral learning Theory

1. Respondent Conditioning also termed as Classical or Pavlovian Conditioningtheory

Respondent Conditioning is developed by Ivan Petrovich Pavlov a famousRussian physiologist. Pavlov learned that when a bell was rung issubsequence time with food being presented to the dog on consecutivesequence the dog will initially salivate when the food is present. The dog willlater come to associate the ringing of bell with the presentation of food andsalivate upon ringing of the bell.

Basic model of learning:

Neutral Stimulus (NC) a stimulus that has no particular value or meaning tothe learner is paired with a naturally occurring unconditioned stimulus (UCS)and unconditioned response (UCR).After few such pairings the neutralstimulus alone without the unconditioned stimulus, elicits the sameunconditioned response. Thus, learning takes place when newly conditionedstimulus (CS) becomes associated with the conditioned response (CR)- a

process that may occur without conscious thought or awareness.

UCS UCR

NS+ UCR UCR

(several pairings)

NS UCR

Principles of respondent conditioning maybe used to extinguish a previously

learned response. Responses decrease if the presentation of the conditioned

stimulus is not accompanied by the unconditioned stimulus overtime.

Systematic desensitization- a technique based on respondent conditioning

that is used by psychologist to reduce fear and anxiety in their clients. Used

to extinguish tension headaches and teach an ADHD or autism to swallow

pills.

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Stimulus generalization- the tendency of initial learning experiences to be

easily applied to other similar stimuli.

Dicrimination Learning- when an individual learned to differentiate among

similar stimuli due to more experiences

Spontaneous Recovery- a useful respondent conditioning concept that needs

to be given careful considerations in relapse prevention programs.

2. Operant Conditioning

Operant conditioning was developed by B.F Skinner. It focuses on the

behavior of the organism and the reinforcement that occurs after response.

Reinforcer- A stimulus or event applied after a response that strengthens the

probability that the response will be performed again. When specific

responses are reinforced on the proper schedule , behavior can either

increased or decreased.

To Increase Probability of Response:

A. Applying positive reinforcement after a response occurs.

This greatly enhances the likelihood that a response will be repeated in

similar circumstances.

B. Applying negative reinforcement after a response was made.

This is a form of reinforcement involves the removal of an unpleasant

stimulus through either Escape conditioning or avoidance conditioning.

Escape Conditioning- as anunpleasant stimulus is being applied , the

individual responds in some way that causes the uncomfortable stimulation

to cease.

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Avoidance Conditioning- the unpleasant stimulus is anticipated rather than

being applied directly.

To Decrease Probability of Response

A. Nonreinforcement- an organisms conditioned response is niot followed by

any kind of reinforcement.

B. Punishment-following a response, an aversive stimulus that the organism

cannot escapeor avoid is applied.

Criticisms and Caution of Behavioral Theory

It is a Teacher-centered model in which in which learners are assumed to be

passive and easily manipulated.

Promotes materialism rather than self-initiative, a love of learning, and

intrinsic satisfaction.

Clients changed behavior may may deteriorate over time, especially when

theyre back to their former environment.

Cognitive Learning Theory

Is assumed to be compromised of a number of sub theories and is widely

used in education and counseling

The Key to learning and changing is the individuals Cognition

Cognition- perception, thought, memory and ways of processing and

structuring information.

Cognitive Learning- is a highly active process largely directed by the

individual, involves perceiving the information, interpreting it, based

on whats already known and then reorganizing the information into

new insights or understanding.

Cognitive Theorists maintain that reward is not necessary for learning. More

important5 are learners goals and expectations which create disequilibrium,

imbalance and tension that motivate them to act.

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A learners metacognition , or understanding of her way of learning, influences

the learning as well.

Cognitive learning theory includes several well-known perspectives. One of

the oldest psychological theories is Gestalt Perspective which emphasizes

the importance of perception in learning and laid the ground work for variousother cognitive perspective that followed.

Gestalt perspectives principal assumption is that each person perceives,

interprets and responds to any situation in his or his own way.

Basic Gestalt Principle:

Simplicity, equilibrium and regularity.

Perception is selective which has several ramifications.

First,because no one can attend to all the surrounding stimuli at

any given time. Second, what individuals pay attention to and

what they ignore are influence by host factors: Past experiences,

needs, personal motives and attitudes, reference groups and the

particular structure stimulus or situation.

Information processing- is a cognitive perspective that emphasize thinking process:

thought, reasoning, the way information is encountered and stored and memory

functioning.

Memory Process:

Stage 1: Attention- paying attention to environmental stimuli

Stage 2: Processing-information is processed by the senses. Its is important to

consider the clients preferred mode of sensory processing(visual, auditory, or

motor manipulation)

Stage 3: Memory storage- the information is transformed and incorporated briefly to

the short term memory after which it is either disregarded or stored in the long

term memory. Long term involves organization of information by using the

preferred strategy such as imagery, rehearsals or breaking the information into

units.

Stage 4: Action- the individuals makes on basis of how information was processed

or stored.

9 Corresponding Cognitive Processes that effective activate learning:

Gain learners attention

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Inform the learner of the objectives and expectations

Stimulate the learners recall of prior learning

Present information

Provide guidance to facilitate learners understandings

Have the learner demonstrate the information or skill

Give feedback to the learner

Assess the learners performance

Work tolerance retention and transfer to application and varied

practice.

Piagets Theory of Cognitive Development

Jean Piaget, a Swiss psychologist, introduced concepts of cognitive

development.Piaget defined four stages of cognitive development

( sensorimotor, Preoperational, concrete, Formal operational thought) within

each stage are finer units called schemas.These stages become evident over

the course of infancy, early childhood, middle childhood and adolescence

respectively.

According to Piagets theory, children take information as they interact with

people and environment.

They either make it fit with what they know (assimilation) or change their

perception and and interpretations in keeping with new information

(accommodation).

1. Sensory Motor Stage

Knowledge about objects and the ways that they can be manipulated is

acquired. Through the acquisition of information about self and the world,

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and the people in it, the child begins to understand how one thing can cause

or affect another, and begins to develop simple ideas about time and space.

2. Preoperational Thought

Children usually go through this stage between the age of two to seven yearsold. During this stage, children's thought processes are developing, althoughthey are still considered to be far from 'logical thought', in the adult sense ofthe word. The vocabulary of a child is also expanded and developed duringthis stage, as they change from babies and toddlers into 'little people

Gradually during this stage, a certain amount of 'decentering' occurs. This iswhen someone stops believing that they are the centre of the world, and theyare more able to imagine that something or someone else could be thecentre of attention.

Animism' is also a characteristic of the Pre-operational stage. This is when a

person has the belief that everything that exists has some kind ofconsciousness.

3. Concrete operational thought

This stage was believed to have affected children aged between seven andeleven to twelve years old.

During this stage, the thought process becomes more rational, mature and'adult like', or more 'operational', Although this process most often continueswell into the teenage years. The process is divided by Piaget into two stages,the Concrete Operations, and the Formal Operations stage, which is normallyundergone by adolescents.

the child has the ability to develop logical thought about an object, if they areable to manipulate it.

4. Formal operational thought

The formal operational stage begins around age 11 and is fully achieved byage 15, bringing with it the capacity for abstraction. This permits adolescentsto reason beyond a world of concrete reality to a world of possibilities and tooperate logically on symbols and information that do not necessarily refer to

objects and events in the real world.

There are 2 major characteristics of formal operational thought.

The first is hypothetic-deductive reasoning

When faced with a problem, adolescents come up with a generaltheory of all possible factors that might affect the outcome and

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deduce from it specific hypothesis that might occur. They thensystematically treat this hypothesis to see which ones do in factoccur in the real world. Thus, adolescent problem solving beginswith possibility and proceeds to reality.

The second is propositional in nature.

Adolescents can focus on verbal assertions and evaluate theirlogical validity to real-world circumstances. In contrast, concreteoperational children can evaluate the logic of statements byconsidering them against concrete evidence only.

Cognitive theory has been criticized for neglecting emotions so several slightlydifferent cognitive orientation to emotion have been proposed and are brieflysummarized in the following list.

Empathy and moral emotions

Memory stage and retrieval, as well as moral decision making

involve both cognitive and emotional brain process

Emotional intelligence entails managing ones emotion, self-

motivation, reading emotions of others and working effectivelyin interpersonal relationships, which some argue is moreimportant to leadership and, social judgment and behavior thancognitive intelligence

Self-regulation includes monitoring cognitive process, emotions,

and ones surroundings to achieve goals which is considered askey factor to successful living and effective social behavior.

Implications:

Nursing and other health care professional education programs would do exhibitand encourage empathy and emotional intelligence in working with patients, family,and staff and to attend dynamics of self-regulation as a way to promote positivepersonal growth and effective leadership.

Whats the benefit of Cognitive theory to health care?

Encouragement of recognizing and appreciating individual and diversity inhow people learn and process experiences.

Definition of Multiple Intelligences

This theory of human intelligence, developed by psychologist Howard Gardner andknown as Gardners' Multiple Intelligences Theory, suggests there are at least seven

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ways that people have of perceiving and understanding the world. Gardner labelseach of these ways a distinct 'intelligence' -- in other words, a set of skills allowing

individuals to find and resolve genuine problems they face.

Gardner defines an "intelligence" as a group of abilities that:

Is somewhat autonomous from other human capacities; Has a core set of information-processing operations;

Has a distinct history in the stages of development we each pass through;

Has plausible roots in evolutionary history.

How Multiple Intelligences make an impact on students' learning

Curriculum --Traditional schooling heavily favors the verbal-linguistic and logical-mathematical intelligences. Gardner suggests a more balanced curriculum that

incorporates the arts, self-awareness, communication, and physical education.

Instruction -- Gardner advocates instructional methods that appeal to all theintelligences, including role playing, musical performance, cooperative learning,reflection, visualization, story telling, and soon.

Assessment-- This theory calls for assessment methods that take into account thediversity of intelligences, as well as self-assessment tools that help studentsunderstand their intelligences. While Gardner suggests his list of intelligences maynot be exhaustive, he originally identified the following seven:

Verbal-Linguistic -- The ability to use words and language Logical-Mathematical -- The capacity for inductive and deductive thinking and

reasoning, as well as the use of numbers and the recognition of abstractpatterns

Visual-Spatial -- The ability to visualize objects and spatial dimensions, and

create internal images and pictures

Body-Kinesthetic -- The wisdom of the body and the ability to control physical

motion

Musical-Rhythmic -- The ability to recognize tonal patterns and sounds, as

well as a sensitivity to rhythms and beats

Interpersonal -- The capacity for person-to-person communications and

relationships

Intrapersonal -- The spiritual, inner states of being, self-reflection, and

awareness

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Social learning theory

Social learning theory is largely the work of Albert Bandura(1977;2001), who

mapped out a perspective on learning that includes consideration of the

personal characteristics of the learner, behavior patterns, and the

environment. Thus, 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.

Bandura is known for his 1961-1963 experiments utilizing an inflatable clown

known as a Bobo doll in order to test modeling behaviors in children. Role

modeling is a certain concept of the theory. As an example, a more

experienced nurse who demonstrates desirable professional attitudes and

behaviors sometimes is used as a mentor for a less experienced nurse.

Vicarious reinforcement is another concept from the social learning theory

and involves determining whether role models are perceived as rewarded or

punished for their behavior. Reward is not always necessary, however, and

the behavior of a role model may be imitated even when no reward is

involved for either the role model or the learner.

An important factor of Banduras social learning theory is the emphasis on

reciprocal determinism. This notion states that an individuals behavior is

influenced by the environment and characteristics of the person. In other

words, a persons behavior, environment, and personal qualities all

reciprocally influence each other. Bandura proposed that the modeling

process involves several steps:

First, attentional phase, in order for an individual to learn something, they

must pay attention to the features of the modeled behavior. Second,

retention phase, which involves the storage and retrieval of what was

observed. Third, reproduction phase, where the learner copies and improves

the observed behavior. Fourth, motivational phase, which focuses on whether

the learner is motivated to perform a certain type of behavior.

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Pedagogy versus Andragogy

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38

Pedadogical Andragogical

The Learner The learner is dependentuponthe instructor for alllearning The teacher/instructorassumes full responsibilityforwhat is taught and how itis

learned The teacher/instructorevaluates learning.

The learner is self-directed The learner isresponsible forhis/her own learning Self-evaluation ischaracteristic of thisapproach.

Role of the learnersexperiences. The learner comes to the

activity with littleexperiencethat could be tapped as aresource for learning The experience of theinstructor is mostinfluential.

The learner brings agreatervolume and quality ofexperience Adults are a rich resourceforone another Different experiencesassurediversity in groups ofadults Experience becomes thesource of self-identification

Readiness to learn Students are told whattheyhave to learn in order toadvance to the next levelofmaster

Any change is likely totrigger a readiness tolearn The need to know inorder toperform more effectivelyinsome aspect of ones lifeisimportant Ability to assess gapsbetween where one is nowand where one wants andneeds to be

Orientation to learning Learning is a process ofacquiring prescribedsubject

matter Content units aresequencedaccording to the logic ofthesubject matter

Learners want to performatask, solve a problem, live

ina more satisfying way Learning must haverelevance to real-life tasks Learning is organizedaroundlife/work situations ratherthan subject matter units

Motivation to learning Primarily motivated byexternal pressures,competition for grades,

andthe consequences offailure

Internal motivators: self-esteem, recognition,betterquality of life, self-

confidence, self-actualization


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Types of Learning

1.) The Visual/ Verbal Learning Style

You learn best when information is presented visually and in a written language

format. In a classroom setting, you benefit from instructors who use theblackboard (or overhead projector) to list the essential points of a lecture, or who

provide you with an outline to follow along with during lecture. You benefit from

information obtained from textbooks and class notes. You tend to like to study

by yourself in a quiet room. You often see information "in your mind's eye" when

you are trying to remember something.

2.) The Visual/ Nonverbal Learning Style

You learn best when information is presented visually and in a picture or design

format. In a classroom setting, you benefit from instructors who use visual aids

such as film, video, maps and charts. You benefit from information obtained from

the pictures and diagrams in textbooks. You tend to like to work in a quiet room

and may not like to work in study groups. When trying to remember something,

you can often visualize a picture of it in your mind. You may have an artistic side

that enjoys activities having to do with visual art and design.

3.) The Auditory/ Verbal Learning Style

You learn best when information is presented auditory in an oral language

format. In a classroom setting, you benefit from listening to lecture and

participating in group discussions. You also benefit from obtaining informationfrom audio tape. When trying to remember something, you can often "hear" the

way someone told you the information, or the way you previously repeated it out

loud. You learn best when interacting with others in a listening/speaking

exchange .

4.) The Tactile/ Kinesthetic Learning Style

You learn best when physically engaged in a "hands on" activity. In the

classroom, you benefit from a lab setting where you can manipulate materials to

learn new information. You learn best when you can be physically active in the

learning environment. You benefit from instructors who encourage in-class

demonstrations, "hands on" student learning experiences, and field work outside

the classroom.

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Children were divided into three groups one of which was exposed to

an aggressive adult model, one which was exposed to a passive adult

model, and a control group, which was not exposed to an adult model.

Adults in the aggressive group were asked to verbally and physically

attack the doll, while those in the passive group were asked to play

peacefully. Once the children were given the opportunity to play,results showed that those exposed to the aggressive model were more

likely to imitate what they had seen, and to behave aggressively

toward the doll. It was found that boys were four times more likely

than girls to display physical aggression, but levels of verbal

aggression were about the same. The results of Banduras studies

provided support for the influence of modeling on learning. Further, a

later study in 1965 showed that witnessing the model being punished

for the aggressive behavior decreased the likelihood that children

would imitate the behavior

Julian Rotter moved away from theories based

on psychosis and behaviorism, and developed a learning theory.

In Social Learning and Clinical Psychology(1954), Rotter suggests that

the effect of behavior has an impact on the motivation of people to

engage in that specific behavior. People wish to avoid negative

consequences, while desiring positive results or effects. If one expects

a positive outcome from a behavior, or thinks there is a high

probability of a positive outcome, then they will be more likely to

engage in that behavior. The behavior is reinforced, with positive

outcomes, leading a person to repeat the behavior. This social learning

theory suggests that behavior is influenced by these environmental

factors or stimuli, and not psychological factors alone.

Albert Banduraexpanded on Rotter's idea, as well as earlier work by

Miller & Dollard,and is related to social learning theories

ofVygotsky and Lave. This theory incorporates aspects of behavioral

and cognitive learning. Behavioral learning assumes that people'senvironment (surroundings) cause people to behave in certain ways.

Cognitive learning presumes that psychological factors are important

for influencing how one behaves. Social learning suggests that a

combination of environmental (social) and psychological factors

influence behavior. Social learning theory outlines three requirements

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for people to learn and model behavior

including attention: retention (remembering what one observed),

reproduction (ability to reproduce the behavior), and motivation (good

reason) to want to adopt the behavior.

Types of Learning

1.) The Visual/ Verbal Learning Style

You learn best when information is presented visually and in a written language format. In a

classroom setting, you benefit from instructors who use the blackboard (or overheadprojector) to list the essential points of a lecture, or who provide you with an outline to follow

along with during lecture. You benefit from information obtained from textbooks and class

notes. You tend to like to study by yourself in a quiet room. You often see information "in

your mind's eye" when you are trying to remember something.

2.) The Visual/ Nonverbal Learning Style

You learn best when information is presented visually and in a picture or design format. In a

classroom setting, you benefit from instructors who use visual aids such as film, video, maps

and charts. You benefit from information obtained from the pictures and diagrams in

textbooks. You tend to like to work in a quiet room and may not like to work in study groups.When trying to remember something, you can often visualize a picture of it in your mind.

You may have an artistic side that enjoys activities having to do with visual art and design.

3.) The Auditory/ Verbal Learning Style

You learn best when information is presented auditory in an oral language format. In a

classroom setting, you benefit from listening to lecture and participating in group

discussions. You also benefit from obtaining information from audio tape. When trying to

remember something, you can often "hear" the way someone told you the information, or the

way you previously repeated it out loud. You learn best when interacting with others in alistening/speaking exchange .

4.) The Tactile/ Kinesthetic Learning StyleYou learn best when physically engaged in a "hands on" activity. In the classroom, you

benefit from a lab setting where you can manipulate materials to learn new information. You

learn best when you can be physically active in the learning environment. You benefit from

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instructors who encourage in-class demonstrations, "hands on" student learning

experiences, and field work outside the classroom.

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