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 selfdetermination. 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 of human 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 a major 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. 16 th-century German philosopher, Immanuel Kant, proposed that individual rights prevail and openly proclaimed the deontological notion of the Golden Rule. 1

 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 through ethical 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 documents promulgated 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 be informed 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 2

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 this instance, 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 in topic, 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. 3

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 by professional 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. 2. 3. 4. the the the the physical, cognitive, and psychosocial development role of the nurse role of the family teaching strategies

Fundamental Domains of Development physical (biological) maturation cognitive maturation psychosocial (emotional-social) maturation

Contextual Influences 1. Normative age-graded influences 4

- 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 Normative life events - unusual or unique circumstances that are turning points in someones life that cause them to change direction

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o Developmental 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 he demonstrates 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 teachable moments 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.

o Developmental 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 5

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 sensory perceptions

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-andeffect 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.

Psychosocial stage: trust versus mistrust (infant) autonomy versus shame and doubt (toddler)

Toddlers like routines because it gives them a sense of security. Separation anxiety 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, health promotion, and disease prevention. It is good to assign a primary nurse to establish a relationship with the child and parents. Parents should also always be present whenever possible during teaching and learning activities to alleviate stress for the 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 warm tone 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 7

Preschooler: 3-5 years of age

The childrens sense of identity becomes clearer and their world involves others 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 logically without acting it out and it is the transitional period when the child begins to use symbols, such as letters and numbers, to represent 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.

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 normal growth and development, and to offer medical recommendations when illnesses 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 of majority of the nurses teaching efforts. All they will do is assist the child 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 less threatening. 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 structured school systems. They approach learning with enthusiastic anticipation, and their minds are open to new and varied ideas. 9

The child is, by nature, a pragmatist. He is concerned with how things work, rather than 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 as large-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 natural curiosity 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 of themselves, their society, and the world are shaped and expanded. Physical Development The gross and fine-motor abilities of school aged children are increasingly more coordinated. Muscular growth and better coordination enable children to ride a bicycle, run faster and for longer distances, participate in organized sports, write neatly with a pencil, learn to sew, and acquire other skills that require greater strength, endurance, or precision 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 development differing from child to child. Towards the end of this developmental period, girls more so than boys on the average begins to experience prepubescent bodily changes 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 compare their characteristics and capabilities to those of their peers. Although many variations in physique are attributable to individual differences in rate of maturation and 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 the period of concrete operations. It is no accident that throughout most of the world, children begin formal education at age six or seven. The intellectual skills of middle childhood are well suited for 10

school because during this time, logical, rational thought processes and the ability to reason inductively and deductively developed. Children in this age are able to think more objectively are willing to listen to others, and will selectively use questions 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 or consequences of their choices

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

In shift of precausal to causal thinking, the child begins to incorporate the idea that illness 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 and special qualities that distinguish them from others. During this period, children learned initiativehow to act on their own without the help or advice of other people. A school-ages child while doing a project will as, am I doing a good job? 11

when they are encourage in their efforts for practical tasks and are praised for the finished 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 failure and being left out of groupsthey worry in their inabilities and become self critical as they compare their own accomplishment to those of their peers. They also fear illness and disability that could significantly disrupt their academic progress, interfere with social contacts, decrease their independence, and result in loss of control over body functions.

Teaching Strategies

In todays healthcare environment, those in middle to late childhood and their families must be taught in an efficient, cost effective manner how to maintain health and manage illness. Woodring emphasizes the importance of following sound educational principles with the child and family, such as identifying individual learning styles, determining readiness to learn, and accommodating particular learning needs and abilities to achieve positive health outcomes. With their increased ability to comprehend information and their desire for active involvement and control of their lives, it is very important to include school-aged children in patient education efforts. The nurse in the role of educator should explain illness, treatment plans, and procedures in simple, logical terms in accordance with the childs level of understanding and reasoning. Although children at this stage of development are able to think logically, their ability for abstract thought remains limited. Therefore, teaching should be presented in concrete terms with step-by-step instructions. It is imperative that nurse observes childrens reactions and listens to their verbal feedback to confirm that info shared has not been misinterpreted/confused. Teaching parents directly is encouraged to that they may be involved in fostering their childs independence, providing emotional support and physical assistance and giving guidance regarding the correct techniques or regimens in self-care management. In attempting to master self-care skills, children thrive on praise from others who are important in their lives as rewards for their accomplishments and successes. Education for health promotion and health maintenance is most likely to occur in the school system through the school nurse, but the parents as well as the nurse outside the school setting should be told what content is being addressed. Information then can be reinforced and expanded on when in contact with the child in other care setting. 12

The school nurse in particular is in an excellent position to coordinate the efforts of all other providers so as to avoid duplication of teaching content or the giving of conflicting 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 goals set forth to improve the health of Americas children. The schools nurse plays a vital role 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 children at 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 a particular condition and learn how to overcome or deal with it.

The need to sustain or bolster their self-image, self-concept, and self-esteem requires the children be invited to participate, to the extent possible, in planning for and carrying out learning activities. For children newly diagnosed with diabetes, for example, it is beneficial to allow them to administer an injection to a stuff animal or another person. This strategy will allow them to participate and will decrease their fear. 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 analogies as 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 with minimal 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 characteristics that influence health behaviour.

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

Adolescence (12-19 years of age)

Adolescence, stage of maturation between childhood and adulthood. The term denotes the period from the beginning of puberty to maturity; it usually starts at about age 14 in males and age 12 in females. The transition to adulthood varies among cultures, but it is generally defined as the time when individuals begin to function independently of their parents.

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How adolescents think about themselves and the world significantly influences facing them, from anorexia to diabetes. Teenage thought and behaviour give insight into the etiology of some of the major health problems of this group of learners. For patient education to be effective, an understanding of the characteristics of the adolescent phase is crucial.

Physical, Cognitive and Psychological Development

Alterations in physical size, shape, and functions of their bodies, along with the appearance and development of secondary sex characteristics, bring about a significant preoccupation with their appearance and a strong desire to express sexual urges.

Piaget termed this stage of cognitive development as the period of formal operations. They are capable of abstract thought and complex logical reasoning and are able to hypothesize and apply the principle s of logic to situations never encountered before.

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

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

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

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

Erikson has identified the psychosocial dilemma adolescents face as one of identity versus role confusion. These children indulge in comparing their self-image with an ideal image. 15

Teenagers have the strong need for belonging to a group, friendship, peer acceptance and peer support. Their concern over personal appearance and their need to look and act like their peers drive them to conform to the dress and behaviour of this age group.

Adolescents demand space, controls, privacy and confidentiality. To then illness injury and hospitalization means dependency, loss of identity, a change in body image and functioning, bodily embarrassment, separation from peers, and possible death.

Teaching Strategies

Healthy teens have difficulty imagining themselves as sick or injured. Those with an illness or disability often comply poorly with medical regimens and continue to indulge in risk-taking behaviours. Probably the greatest challenge to the nurse responsible for the teaching the adolescent, whether healthy or ill, so be able to a mutually respectful, trusting relationship. Adolescence, because of their well developed cognitive and language abilities, are able to participate fully in all aspects of learning, but they need privacy, understanding, an honest and straightforward approach, and unqualified acceptance in the face of their fears of embarrassment, losing independence, identity, and self control.

Important factors in providing education effectively to the adolescent population as cited by the society of adolescent medicine: Availability Visibility Quality Confidentiality Affordability Flexibility Coordination

Adolescents language skills and ability to conceptualize and think abstractly give the nurse educator a wide range of teaching methods and instructional tools from which to choose. 16

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 and self-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 respect their right to individuality, privacy, and confidentiality, teaching effectiveness may be enhanced by including their families to some extent.

The Developmental Stages of Adulthood Andragogy, the term coined by Knowles to describe his theory of adult learning, is the art and science of teaching adults. It is often interpreted as the process of engaging adult learners with the structure of learning experience. Education within this framework is more learner-centered and less teacher-centered. Knowles' theory can be stated with six assumptions related to motivation of adult learning:[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 relevance to their work and/or personal lives (Readiness). 5. Adult learning is problem-centered rather than content-oriented (Orientation). 17

6. Adults respond better to internal versus external motivators (Motivation). In contrast to childhood learning, which is subject centered, adult learning is problem 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 for themselves. In planning educational activities for adults, it is important to determine their motives for wanting to be involves. So that is why it is important for nurse educators to understand the purpose and expectations of the individuals who participate in continuing education. Young Adulthood (20-40 years of age) The transition from adolescence to become a young adult has been recently termed emerging adulthood. Young adulthood is a time for establishing long-term, intimate relationships with other people, choosing a lifestyle, deciding an occupation, and managing a home and family. Physical, Cognitive, and Psychological Development During this time physical abilities for most young adults are at their peak, and the body is at its optical functioning capacity. The cognitive capacity of young adults is fully developed, but with maturation, they continue to accumulate new knowledge and skills from an expanding reservoir of formal and informal experiences. Young adults are motivated to learn about the possible implications of various lifestyle choices. Eriksons psychosocial theory for this level of development is intimacy vs isolation. During this time, individuals work to establish a trusting, satisfying, and permanent relationship with others. They strive to establish commitment to others in their personal, occupational, and social lives. Teaching Strategies Young adulthood is considered to be the life-span period that has received the least attention by nurse education. At this developmental stage, prior to the emergence of the chronic diseases that are generally characterize the middle-aged and older years, young adults are generally healthy and tend to have limited exposure to health professionals.

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The nurse educator must find a way of reaching and communicating with his audience about health and promotion. Knowledge about individuals lifestyle can provide cues to concentrate on when determining specific aspects of education for you 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 seek information 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 adult learning, is the art and science of teaching adults. The concept of andragogy is within this framework is more learners centered and less teacher centered. The period of adulthood constitutes three major developmental stages the young adult stage, the middle-aged adult stage, and the older adult stage. In contrast to childhood 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 grasping relationships, and they do not tolerate learning isolated facts as well as children do. Three categories describes the general orientation of adult toward continuing education: 1. Goal-oriented learners Engage in educational endeavors to accomplish clear and identifiable objectives. 2. Activity-oriented learners Select educational activities primarily to meet social needs 3. Learning-oriented learners View themselves as perpetual students who seek knowledge for knowledges 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. 20

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 normal boundaries. 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, 25

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 for themselves.

Four considerations in assisting learning in becoming permanent. 1) Learning is enhaced by organizing the learning experience, making it meaningful & pleasurable, recognizing the roles of emotions in learning & by pacing presentation in keeping with the learners ability to process information 2) 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 of the 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. 26

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 process whereby 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 selfinitiative 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 complete process 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 27

Behaviorists view learning as the product of Stimulus conditions (s) and the responses (R) that follow sometimes termed as S-R model of learning. Behaviorists closely observe responses and then manipulate the environment to 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 a response occurs 2 Concepts of Behavioral learning Theory 1. Respondent Conditioning also termed as Classical or Pavlovian Conditioning theory Respondent Conditioning is developed by Ivan Petrovich Pavlov a famous Russian physiologist. Pavlov learned that when a bell was rung is subsequence time with food being presented to the dog on consecutive sequence the dog will initially salivate when the food is present. The dog will later come to associate the ringing of bell with the presentation of food and salivate upon ringing of the bell. Basic model of learning: Neutral Stimulus (NC) a stimulus that has no particular value or meaning to the learner is paired with a naturally occurring unconditioned stimulus (UCS) and unconditioned response (UCR).After few such pairings the neutral stimulus alone without the unconditioned stimulus, elicits the same unconditioned response. Thus, learning takes place when newly conditioned stimulus (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. 30

 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 various other 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 31

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, 32

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 years old. During this stage, children's thought processes are developing, although they are still considered to be far from 'logical thought', in the adult sense of the word. The vocabulary of a child is also expanded and developed during this stage, as they change from babies and toddlers into 'little people

Gradually during this stage, a certain amount of 'decentering' occurs. This is

when someone stops believing that they are the centre of the world, and they are more able to imagine that something or someone else could be the centre 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 of consciousness. 3. Concrete operational thought This stage was believed to have affected children aged between seven and eleven 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 continues well into the teenage years. The process is divided by Piaget into two stages, the Concrete Operations, and the Formal Operations stage, which is normally undergone by adolescents. the child has the ability to develop logical thought about an object, if they are able to manipulate it.

4. Formal operational thought

The formal operational stage begins around age 11 and is fully achieved by age 15, bringing with it the capacity for abstraction. This permits adolescents to reason beyond a world of concrete reality to a world of possibilities and to operate 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 general theory of all possible factors that might affect the outcome and 33

deduce from it specific hypothesis that might occur. They then systematically treat this hypothesis to see which ones do in fact occur in the real world. Thus, adolescent problem solving begins with possibility and proceeds to reality. The second is propositional in nature.

Adolescents can focus on verbal assertions and evaluate their logical validity to real-world circumstances. In contrast, concrete operational children can evaluate the logic of statements by considering them against concrete evidence only.

Cognitive theory has been criticized for neglecting emotions so several slightly different cognitive orientation to emotion have been proposed and are briefly summarized 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, selfmotivation, reading emotions of others and working effectively in interpersonal relationships, which some argue is more important to leadership and, social judgment and behavior than cognitive intelligence Self-regulation includes monitoring cognitive process, emotions, and ones surroundings to achieve goals which is considered as key factor to successful living and effective social behavior.

Implications: Nursing and other health care professional education programs would do exhibit and encourage empathy and emotional intelligence in working with patients, family, and staff and to attend dynamics of self-regulation as a way to promote positive personal growth and effective leadership. Whats the benefit of Cognitive theory to health care? Encouragement of recognizing and appreciating individual and diversity in how people learn and process experiences. Definition of Multiple Intelligences This theory of human intelligence, developed by psychologist Howard Gardner and known as Gardners' Multiple Intelligences Theory, suggests there are at least seven 34

ways that people have of perceiving and understanding the world. Gardner labels each 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 logicalmathematical 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 the intelligences, including role playing, musical performance, cooperative learning, reflection, visualization, story telling, and soon. Assessment -- This theory calls for assessment methods that take into account the diversity of intelligences, as well as self-assessment tools that help students understand their intelligences. While Gardner suggests his list of intelligences may not 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 abstract patterns 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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The Learner

Pedadogical The learner is dependent upon the instructor for all learning The teacher/instructor assumes full responsibility for what is taught and how it is learned The teacher/instructor evaluates learning. The learner comes to the activity with little experience that could be tapped as a resource for learning The experience of the instructor is most influential.

Andragogical The learner is selfdirected The learner is responsible for his/her own learning Self-evaluation is characteristic of this approach.

Role of the learners experiences.

Readiness to learn

Students are told what they have to learn in order to advance to the next level of master

Orientation to learning

Learning is a process of acquiring prescribed subject matter Content units are sequenced according to the logic of the subject matter

Motivation to learning Primarily motivated by external pressures, competition for grades, and the consequences of failure

The learner brings a greater volume and quality of experience Adults are a rich resource for one another Different experiences assure diversity in groups of adults Experience becomes the source of selfidentification Any change is likely to trigger a readiness to learn The need to know in order to perform more effectively in some aspect of ones life is important Ability to assess gaps between where one is now and where one wants and needs to be Learners want to perform a task, solve a problem, live in a more satisfying way Learning must have relevance to real-life tasks Learning is organized around life/work situations rather than subject matter units Internal motivators: selfesteem, recognition, 38 better quality of life, selfconfidence, selfactualization

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 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 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 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's environment (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 40

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 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 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 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 41

instructors who encourage in-class demonstrations, "hands on" student learning experiences, and field work outside the classroom.

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