Determinants of Learning

• The nurse must identify the information learners need as well as consider their readiness to learn and their styles of learning.
• Learning needs (what the learner needs to learn)
• Readiness to learn (when the learner is receptive to learning)
• Learning style (how the learner best learns)
• Assessment is essential to determine learning needs so that an instructional plan can be designed to address deficits in any of the cognitive, affective, or psychomotor domains.
• The purposes of assessing learning needs are to discover what has to be taught and to determine the extent of instruction or if instruction is necessary at all.
• Learning needs are defined as gaps in knowledge that exist between a desired level of performance and the actual level of performance.
• steps in the assessment of learning needs 1. IDENTIFY THE LEARNERS, 2. CHOOSE THE RIGHT SETTING, 4. INCLUDE THE LEARNER AS THE SOURCE OF INFORMATION, 5. INVOLVE THE MEMBERS OF THE HEALTHCARE TEAM, 7. DETERMINE AVAILABILITY OF EDUCATIONAL RESOURCES, 8. ASSESS DEMANDS OF ORGANIZATION, 9. Take time-management issues into account
• METHODS TO ASSESS LEARNING NEEDS • Informal Conversations • Structured Interviews • Focus Groups • Self-Administered Questionnaires • Tests • Observations • Patient Charts
• ASSESSING LEARNING NEEDS OF STAFF • Written Job Descriptions • Formal and Informal Requests • Quality Assurance Reports • Chart Audits • Rules and Regulations • Four-Step Appraisal of Needs
• Readiness to learn can be defined as the time when the learner demonstrates an interest in learning the type or degree of information necessary to maintain optimal health or to become more skillful in a job.
• Readiness to learn occurs when the learner is receptive to learning and is willing and able to participate in the learning process. The educator must never overuse the expression “The patient is not ready to learn.”
• Readiness to learn can be determined by the learner’s characteristics as follows:  Physical readiness;  Emotional readiness;  Experiential readiness, and  Knowledge readiness.
• There are five major components to physical readiness: measures of ability, complexity of task, environmental effects, health status, and gender.
• 1. MEASURE OF ABILITY. If the task requires gross movements using the large muscles of the body, then adequate strength, flexibility, and endurance must be present.
• MEASURE OF ABILITY. In addition, for information to be accurately processed, sense organs and receptors must be functioning adequately.
• COMPLEXITY OF TASK The nurse educator must take into account the difficulty level of the subject or task to be mastered by the learner. Psychomotor skills, in particular, require different degrees of manual dexterity and physical energy output. Once acquired, however, they are usually retained better and longer than learning in the other domains.
• ENVIRONMENTAL EFFECTS An environment conducive to learning will help to keep the learner’s attention and stimulate interest in learning
• HEALTH STATUS Energy reducing demands caused by the body’s response to illness require the learner to expend large amounts of physical and psychic energy, with little reserve left for actual learning.
• GENDER Research has indicated that women are generally more receptive to medical care and take fewer risks to their health than men. This difference may arise because women traditionally have taken the role of caregivers and therefore are more open to health promotion teaching. Men, on the other hand, tend to be less receptive to healthcare interventions and are more likely to be risk takers.
• Fear is a major contributor to anxiety and thus negatively affects readiness to learn in any of the learning domains
• SUPPORT SYSTEM If persons in the patient’s support system are available to assist with self-care activities at home, then they should be present during at least some of the teaching sessions to learn how to help the patient if the need arises. A strong support system decreases anxiety, while the lack of one increases anxiety levels.
• MOTIVATION Emotional readiness is strongly associated with motivation. Knowing the motivational level of the learner assists the educator in determining when someone is ready to learn. The learner who is ready to learn shows an interest in what the nurse educator is doing by demonstrating a willingness to participate or to ask questions
• RISK-TAKING BEHAVIOR Understanding how much individual risk taking nurses have or do not have will help the educator understand why some learners may be hesitant to try new approaches to delivering care. Wolfe (1994) stated that taking risks can be threatening when the outcomes are not guaranteed. The decision has to be made to take the risk. The next step is to develop strategies to minimize the risk. The learner then needs to develop a worst, best, and most probable case scenario. Lastly, the learner must decide whether the worst-case scenario developed is acceptable.
• . FRAME OF MIND Frame of mind involves concern about the here and now. If survival is of primary concern, then readiness to learn will be focused on meeting basic human needs
• DEVELOPMENTAL STAGE Each task associated with human development produces a peak time for readiness to learn, known as a “teachable moment”.
• Experiential readiness refers to the learner’s past experiences with learning. Before starting to teach, the educator should assess whether
• LEVEL OF ASPIRATION The extent to which someone is driven to achieve is related to the type of short- and long-term goals established, not by the educator, but by the learner.
• PAST COPING MECHANISMS The coping mechanisms someone has been using must be explored to understand how the learner has dealt with previous problems.
• CULTURAL BACKGROUND Knowledge on the part of the educator about other cultures and being sensitive to behavioral differences between cultures are important to avoid teaching in opposition to cultural beliefs.
• Language is also a part of culture and may prove to be a significant obstacle to learning if the educator and the learner do not fluently speak the same language.
• . LOCUS OF CONTROL When patients are internally motivated to learn, they have what is known as an internal locus of control. They are ready to learn when they feel a need to know about something. This drive to learn comes from within the learner.
• ORIENTATION Patients with a parochial orientation tend to be more close-minded in their thinking, are more conservative in their approach to situations, are less willing to learn new material, and place the most trust in traditional authority figures such as the physician.
• PRESENT KNOWLEDGE BASE How much someone already knows about a particular subject or how proficient that person is at performing a task is an important factor to determine before designing and implementing instruction.
• COGNITIVE ABILITY The learner who is capable of understanding, memorizing, recalling, or recognizing subject material is functioning at a lower level than the learner who demonstrates problem solving, concept formation, or application of information.
• LEARNING DISABILITIES It is easy for low-literacy and learning-disabled persons to become easily discouraged unless the teacher recognizes their special needs and seeks ways to help them accommodate or overcome their problems with processing information.
• Learning style refers to the ways individuals process information.
• The left hemisphere of the brain was found to be the vocal and analytical side, which is used for verbalization and for reality based and logical thinking.
• The right hemisphere was found to be the emotional, visual-spatial, nonverbal hemisphere. Thinking processes using the right brain are intuitive, subjective, relational, holistic, and time-free.
• Statistics show that most learners have left brain dominance and that only approximately 30% have right-brain dominance.