part 1 & 2 - lecture

• Ethics


  Guiding principle of behavior
• Ethical behavior


  Norms or standard accepted by the society where they belong
• Moral values


  Internal belief system. This value system, defined as morality is expressed externally through a person's behavior
• Ethical dilemma


  Specific type of moral conflict in which two or more ethical principles apply to support mutually inconsistent courses of action
• Legal rights and duties


  Refer to rules governing behavior or conduct that are enforceable by law under threat of punishment or penalty such as fine, imprisonment or both
• Ethics and the law

  Intricate relationship, why ethics terminology such as informed consent, confidentiality, nonmaleficence, justice
• Code of ethics


  Represent an articulation of nine provisions for professional values and moral obligations with respect to nurse-patient relationship and with respect to profession and mission
• Legal terms related to nursing practice

  • Autonomy - right to self determination
  • Decision aids - include printed material
  • Veracity - truth telling is closely linked to informed decision making and informed consent
  • Competence - capacity of the patient to make decision
  • Disclosure of information
  • Comprehension - speaks with the individual's ability to understand and grasp intellectually the information being provided
  • Voluntariness - indicates that the patient can make a decision without coercion or force from others
  • Confidentiality - personal information that is entrusted and protected as privileged information via a social contract, healthcare standard or code of legal covenant
  • Nonmaleficence - is defined as do not harm
  • Negligence - conduct which falls below the standard established by law
• Perception is influenced by how an event is structured and is directed toward organization and closure within each learner
• Information process


  Nine events & their corresponding cognitive processes that activate effective learning
• Nine events & their corresponding cognitive processes that activate effective learning

  • Gain the learner's attention (reception)
  • Inform the learner of the objectives and expectations (expectancy)
  • Stimulate the learner's recall of prior learning (retrieval – cognition load, mnemonic devices)
  • Present information (selective perception)
  • Provide guidance to facilitate the learner's understanding (semantic encoding)
  • Have the learner demonstrate the information or skills (responding)
  • Give feedback to the learner (reinforcement)
  • Assess the learner's performance (retrieval)
  • Work to enhance retention and transfer through application and varied practices (generalization)
• Cognitive development


  Observation of children's perception and reasoning at different ages have contributed much to our recognition of the unique, changing abilities of youngsters to think, conceptualize, communicate, and perform (Jean Piaget 1969)
• Schema or mental framework


  Based on how external events conceptualized, organized, and represented within each person
• Social learning theory


  Role modeling, vicarious reinforcement, attentional phase, retention phase, reproduction phase, motivational phase
• Social constructivism


  Perspective, individuals formulate or construct their own version of reality, which means that learning and human development are richly colored by the social and cultural context in which people find themselves
• Social cognition


  Attribution, cognitive-emotional perspective, empathy & moral emotions play significant role in influencing children's moral development, memory storage and retrieval as well as decision making involve both cognitive & emotional brain processing, emotional intelligence, self-regulation
• Psychodynamic learning by Sigmund Freud

  Emphasizes the importance of conscious & unconscious forces in guiding behavior, personality conflicts and enduring effects of childhood experience on adult behaviour, id (primitive), ego (operates based on the reality), superego (conscience and morality)
• Humanistic learning theory


  Has the assumption that every individual is unique and all individuals have a desire to grow in a positive way, specially compatible to with nursing focus on caring and patient centeredness, hierarchy of needs of Abraham Maslow theory
• Neuropsychology and learning


  Is the scientific study of psychological behavior based on neurological assessment of the brain and central nervous system, it is viewed as involving changes in the brain and central nervous system that affect responses and behavior, plasticity of the brain is not fixed but open to learning
• Motor learning


  Is defined as set of processes associated with practice or experience leading to a relatively permanent changes in the capability for movement, motor performance involves initial acquisition of all skills but not necessarily long term retention of that skills, stages of motor learning: cognitive stage, the associates (fixation stage), the autonomous stage
• Stage appropriate teaching strategies

  • Infancy-toddlerhood (birth-1 years old, cognitive stage: sensorimotor, psychosocial stage: trust vs mistrust, autonomy vs shame & doubt)
  • Early childhood (3-5 years old, cognitive stage: preoperational, psychosocial stage: initiative vs guilt)
  • Middle and late childhood (6-11 years old, cognitive stage: concrete operational, psychosocial stage: industry vs inferiority)
  • Adolescence (12-19 years old)
• Precipitation of information


  • Allow manipulation of objects & equipment
  • Give care with explanation
  • Reassure not blame self
  • Explain procedures simply & briefly
  • Provide safe, secure environment
  • Use positive reinforcement
  • Encourage question to reveal perceptions/feelings
  • Use simple drawings and stories
  • Use play therapy with dolls & puppets
  • Stimulate senses, visual, auditory, tactile, motor
  • Forge alliances
  • Encourage physical closeness
  • Provide detailed information
  • Answer questions & concerns
  • Ask for information on child's strengths & likes/dislikes
• Stage appropriate teaching strategies

  • Middle and late childhood
  • Concrete operational
  • Industry vs inferiority
  • More realistic & objective
  • Understand cause and effect
  • Encourage independence & active participation
  • Be honest, allay fear
  • Use logical explanation
  • Allow time to ask questions
  • Use analogies to make invisible process real
  • Establish role models
  • Relate care to other children's experiences: compare procedure
  • Use subject-centered focus
  • Use play therapy
  • Provide group activities either in person or virtually
  • Use diagrams, models, pictures, digital media, printed materials, & computer, tablet, or smartphone application as an adjuncts to various teaching methods
  • Welcome active involvement
  • Forge alliances
  • Provide detailed information
  • Answer questions
  • Ask for information on child's strengths, limitations & likes/dislikes
• Adolescence


  • Formal operation
  • Identity vs role confusion
  • Abstract, hypothetical thinking, can build on fast learning, reason by logic & understands the scientific principles, future orientation, motivated by desire for social acceptance
  • Peer group important
  • Intense personal preoccupation, appearance extremely important, believes that everyone is focusing on them and their activities (imaginary audience)
  • Feels invulnerable, invincible/immune to natural laws (personal fable)
  • Establish trust, authenticity, know their agenda
  • Address fears/concerns about outcomes of illness
  • Identify control focus
  • Include in plan of care
  • Use peers for support & influence
  • Negotiate changes
  • Focus on details
  • Make information meaningful to life
  • Ensure confidentiality & privacy
  • Arrange peer group session in person/virtually
  • Use audiovisuals, role play, contracts, reading materials
  • Provide for experimentation and flexibility
  • Explore emotional & financial support
  • Determine goals & expectations
  • Assess stress level
  • Determine role responsibilities & relationship
  • Engage in 1:1 teaching without parents present, but with adolescent's permission, inform family of content covered
• Young adult


  • Formal operation
  • Intimacy vs isolation
  • Autonomous
  • Self directed
  • Uses personal experiences to enhance or interfere with learning
  • Intrinsic motivation
  • Able to analyze critically
  • Makes decisions about personal occupation & social roles
  • Competency-based learner
  • Use problem-centered focus
  • Draw on meaningful experience
  • Encourage active participation
  • Allow to set own pace, be self-directed
  • Organize social role
  • Apply new knowledge through role playing & hands on practice (in person or virtually)
  • Explore emotional, financial & physical support
  • Assess motivational level of involvement
• Middle-aged adulthood


  • Formal operations
  • Generativity vs self absorption & stagnation
  • Sense of self well developed
  • Concerned with physical changes
  • At peak in career
  • Explores alternative lifestyle
  • Reflects on contribution to family and society
  • Reexamines goals & values
  • Questions achievements and success
  • Has confidence in abilities
  • Desire to modify unsatisfactory aspects of life
  • Focus on maintaining independence and reestablishing normal life pattern
  • Assess positive & negative past experiences with learning
  • Assess potential sources of stress caused by middle crisis issues
  • Provide information to coincide with life concern & problems
  • Introduce to online resources as appropriate
  • Explore emotional, financial & physical support systems
  • Assess motivational level for involvement
  • Identify potential obstacle & stressors
• Older adulthood


  • Formal operation
  • Ego integrity vs despair
  • Decreased ability to think abstractly, process information
  • Decreased short-term memory
  • Increased reaction to time
  • Increased test anxiety
  • Use concrete examples
  • Build on past life experience
  • Make information relevant and meaningful
  • Present one concept at a time
  • Allow time for processing/response (slow pace)
  • Use repetition & reinforcement of information
  • Avoid written exams
  • Use verbal exchange & coaching
  • Establish retrieval plan (use of several clues)
  • Encourage active involvement
  • Keep explanation brief
  • Use analogies to illustrate abstract information
  • Provide virtual learning opportunities only if comfortable
  • Involve principal caregivers
  • Encourage participation
  • Provide resources for support (respite care)
  • Assess coping mechanisms
  • Provide written instruction for reinforcement
• Sensory/motor deficits in older adulthood

  • Auditory changes: hearing loss, especially high pitch tones, consonants (S,Z,T,F) & rapid speech
  • Farsighted (needs glasses to read)
  • Lens become opaque (glare problem)
  • Smaller pupil size (decreased visual adaptation to darkness)
  • Decreased peripheral perception
  • Yellowing of lenses (distort low-tone colors: blue, green, violet)
  • Distorted depth perception
  • Fatigue/decreased energy level
  • Speak slowly, distinctly
  • Use low-pitched tone
  • Avoid shouting
  • Use visual aids to supplement verbal instruction
  • Avoid glares, use soft white light
  • Provide sufficient light
  • Use white background & black print
  • Use large letters & well-spaced print
  • Avoid color coding with pastel blues, greens, purple & yellow
  • Increase safety precautions/provide safe environment
  • Ensure accessibility & fit of prosthesis (glasses, hearing aid etc.)
• Teaching strategies for older adults

  • Keep sessions short
  • Provide for frequent rest periods
  • Allow for extra time to perform
  • Establish realistic short-term goals
  • Give time to reminisce
  • Identify & present pertinent material
  • Use informal teaching sessions
  • Demonstrate relevance of information to daily life
  • Assess resources
  • Make learning positive
  • Identify positive experiences
  • Integrate new behaviors with formerly established ones
• Geragogy


  Must accommodate the normal physical, cognitive, & psychosocial changes that occur during the growth & development of older adults
• Learning can be affected by such sociological, psychological & cognitive factors as retirement, economics, mental status & information processing abilities
• Prevalent myths that affect teaching to adult learners

  • Senility - maintain their cognitive function into their 80's & 90's
  • Rigid personality
  • Loneliness
  • Abandonment
  • Ageism - describe as prejudice against the older adult
• Crystallized intelligence


  Intelligence absorbed over a lifetime
• Fluid intelligence


  Capacity to perceive relationships, to reason, & perform abstract thinking and can be affected by: slower process and reaction time, persistence of stimulus (after image), decrease short term memory, increased test anxiety, altered time perception
• Role of family in patient education is considered one of the key variables influencing positive patient care outcomes
• Motivation


  A process, state, or a force that arouses, directs and sustains human behavior