Developmental Stages of the Learner

Dr. Belal M. Hijji, RN, PhD

March 6, 2012

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Learning Outcomes

By the end of this lecture, students will be able to:

• Identify the physical, cognitive, and psychosocial characteristics of learners that influence learning at various stages of growth and development

• Recognise the role of the nurse as educator in assessing stage-specific learner needs according to maturational level

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Introduction

• When planning, designing, and implementing an educational programme, the nurse educator must consider the learners’ developmental stage in life.

• The more homogenous the target audience, the less complex the development of an educational programme to meet their needs.

• An individual’s developmental stage significantly influences the ability to learn.

• At each developmental period throughout the life, the educator must take into account the three major stage-range factors associated with the learner’s readiness – physical, cognitive, and psychosocial maturation.

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Developmental Characteristics

• Actual chronological [زمني] 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 [شيخوخة] 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.

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• 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.

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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.

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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.

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• The following teaching strategies are suggested for short-term learning:– Read simple stories from books with lots of pictures

– Use dolls to act out feelings and behaviours

– Use simple audiotapes with music and videotapes with cartoon characters

– Role-play to bring the child’s imagination closer to reality

– Perform procedures on a doll to help the child understand what an experience would be like

– Keep teaching sessions brief (5 minutes) and close together

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• 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.

Teaching Strategies During Preschooling

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• 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:– Provide physical and visual stimuli both for expressing ideas and

for understanding verbal instruction.

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– Keep teaching session short (15 minutes), sequential and close to each other.

– Relate information needs to activities and experiences familiar to the child.

– 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.

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

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

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

– Allow the child to play with replicas or dolls to learn about body parts.

– Use storybooks to emphasise the humanity of healthcare personnel.

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• 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.

Teaching Strategies During School-Aged Childhood

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• 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:

– Give children the responsibility for their own health; for example teach them to calculate and administer their own insulin.

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– 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.

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

– 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.

– 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.

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

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

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

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• This stage represents transition from childhood to adulthood. • This stage is prolonged and very changeable; many

adolescents and their families experience turmoil [اضطراب].• 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.

Teaching Strategies During Adolescence

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• 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.

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• 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:– Use one-to- one instruction to ensure privacy and confidentiality.– Conduct peer group discussions as an effective approach to deal

with relevant health topic.– Use audiovisual materials as these are usually comfortable

approach to adolescent learning. – Clarify medical terminology and give an adolescent an

opportunity to participate, when possible, in the decision-making process.

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– Give rationale for what is being said to help them feel the sense of control.

– To attract their attention and encourage their responsiveness to teaching, be respectful, tactful, open, and flexible.

– 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.

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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.

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• 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.– Goal-oriented learners engage in educational endeavors to

accomplish clear and identifiable objectives.

– Activity-oriented learners select educational activities to meet social needs.

– Learning-oriented learners view themselves as perpetual students who seek knowledge for knowledge sake.

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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.