For learning to be effective, practitioners need to understand, current thinking on how learning
occurs and the various ways in which adults learn.
Learning can occur through observation and participation opposed to
teaching through definition and theory, depending on the situation.
How adults learn, is crucial to the whole learning and teaching
process.
This assignment will explore the teaching and learning process through
a micro teaching relevant to practice. This will be evaluated through
personal reflection and linked supported by the relevant policies.
The teaching process can be defined in many ways. A learning
approach/theory has been developed to cover each aspect, all of which
are outlined below.
The behaviorist approach is more commonly known as classical and
operant conditioning and is based on a stimulus-response. Pavlov first
introduced classical conditioning. He observed the behavior of dogs
and their salivation at the sight of food. Pavlov deemed this an
unconditional response. He developed this further and sounded a bell
with a meal and discovered the dog would salivate upon hearing the
bell only. Pavlov called this a conditioned response.
E.g. Food (US) ——————————————Salivation
(UR) - UNCONDITIONED
TRIAL PAIRING OF FOOD WITH BELL
Food (US) Bell ———————————-Salivation (UR)
Bell (CS) ——————————————-Salivation (CR) -
CONDITIONED
However, Skinner (1968) introduced operant conditioning. Skinner
experimented with rats. He designed boxes for the rats, which housed a
mechanism that delivered food pellets each time the lever was pressed.
In the rats’ natural behavior, it makes accidental contact with the
lever three or four times and food is delivered. After this the rat
demonstrates an intentional behavior. This indicates learning has
occurred.
Carl Rogers and Abraham Maslow developed the Humanistic approach in
America in the 1960’s in a reaction against the two other prominent
psychology approaches. The emphasis is placed upon the individual and
the stimuli, which motivates individuals to perform certain
behaviors. Maslow’s hierarchy of needs demonstrates this.
Bruner developed the Cognitive approach, in the late 50’s and early
60’s. Bruner compared the mind to a computer, stating that we too are
information processors. He studied the internal mental processes
between the stimuli we receive and the responses we make. Cognition
means to know and the cognitive processes refer to the ways in which
knowledge is gained, used and retained. Cognitive psychology is the
most dominant approach to psychology today.
Constructivist learning approach is a follow on to the cognitive
approach. However the emphasis is placed upon the individuals self
awareness and view on their own learning.
Bandura introduced the Social learning theory in 1977. The theory
states that we don’t merely learn through positive and negative
reinforcement but through imitation. We copy another individual’s
behavior due to identification - we identify with them and
internalize - you become the person. Bandura demonstrates this by
showing a group of children a doll being physically attacked. The
children were later presented with a replication of the doll and were
found to imitate what they had observed.
A domain of learning approach was developed by Bloom in 1972. He
identified the three stages in which learning occurs as the:
Cognitive - knowledge gain
Psychomotor - skill development
Affective - attitude formation.
Research and evidence has proven that no single theory can cover all
aspects of learning. Classical and operant conditioning
stress the importance of immediate feedback in learning to maintain a
positive attitude to learning. However, Cognitive and the domains of
learning, enable clients to develop problem solving skills and the
underpinning knowledge of theory and skills. Each theory has pros and
cons, determining which theory relates to your personal situation,
will assist in effective learning. To demonstrate this, I will analyze
the learning theories and teaching process, in accordance with
planning and delivering my own teaching.
Planning and delivering teachings, is a complex procedure
incorporating many factors. If these are covered in a logical order,
then an effective teaching with positive outcomes should occur.
To ensure this occurs, a process known, as APIE should be followed. If
you Assess, Plan, Implement and evaluate, then your teachings
effectiveness is measurable.
One of the most important factors is to decide what to base your
teaching on and identify your target audience, learning environment,
barriers to learning and relevant policies.
My teaching was based upon Cardiac rehabilitation with regards to
exercise, targeting adults from a multi cultural society who were due
to be discharged from hospital following Coronary Artery Bypass Graft
surgery. In order to make my teaching suitable for the adult learner,
I understood it had to be flexible, with regards to date and timing of
the meeting. Use learning theories/ styles with the emphasis on
discussion and negotiation and place them in control as this
contributes to the fundamental system of life long learning. Recognizing the individual is also extremely important, as understanding their individual needs is imperative. According to
Hudson 1968, research has been carried out by psychologists to
highlight the different ways in which we approach and process
information. However, due to the nature of the teaching, it was
extremely important for me to maintain a degree of control, in
order to guide patients through an uneventful recovery.
I planned for the teaching to take place within the hospital
administration sections seminar rooms, in a hope to reduce the number
of distractions and attempt to increase the individual’s attention
span and concentrate on planning for discharge.
My teaching was linked to the following policies, National service
framework - cardiac rehabilitation, NHS plan - working in partnership
with patients and care delivery in the 21st century.
The National service framework is the most prevalent. This details the
need for client education and stresses the importance of prevention
(DOH 2000). The first four standards emphasize the importance of
prevention and educating clients with regards to healthy eating,
increasing physical activity, reducing obesity and the percentage of
smokers in society. Standard 12, discusses the need for education
prior to discharge for patients whom have been admitted and diagnosed
with Coronary Heart disease.
With my target group and teaching environment identified, I proceeded
to identify potential barriers to learning, with communication being
my priority. I had to ensure that English was spoken and understood
clearly amongst the patients, which in this case was; otherwise
provisions for an interpreter would have been arranged. Ensuring
patients with a hearing impairment, would hear me, I would speak
slowly, loudly and clearly and patients with a visual impairment could
see me. Handouts would be made available in large print and on
audiotape. The less abled amongst the group would be accompanied by
nursing staff. The seminar room was accessible for all, including
wheelchair users.
Having covered all aspects of the initial planning stages, I devised a
structured and detailed teaching plan incorporating the teaching
methods to be used and aims and objectives for the session. The aims
and objectives were to be specific, measurable, attainable and
recordable targets. I finalized the time scale for the teaching and
all relevant handouts (copy enclosed for your perusal), well in
advance. I had the teaching proof read by an independent source, to
ensure it was clear and precise.
Access to the seminar room, was arranged in advance, so I could
arrange the furniture accordingly and remove any potential
communication barriers (Maslow 1964 cited in Atkinson etal 1987)).
On the day of the teaching, I arrived early, to ensure everything was
in place, greeting patients as they arrived, in attempt to put them at
ease. Once everyone had arrived, I welcomed them and explained who I
was, exactly what my role entailed and what my plans for the session
were. My objectives were:
1. For the patients to understand what exercises they could do and
over what duration.
2. Know the underpinning knowledge and the positive/negative effects.
3. For everyone to feel comfortable with one another and to ask
questions at any time.
The teaching followed an active format, with group participation and
demonstrations and knowledge at the same time. The teaching session
was based upon the Social learning theory and the cognitive approach.
The social learning theory was most relevant due to its components of
positive and negative reinforcement and imitation. When learning
within the group situation, individuals often can feel intimidated by
others, however if all patients worked together, then they copied each
other, imitated and internalized with one another. This was a positive
outcome from the participation perspective of the session, however the
patient or patients who began to stray from the exercise regime for
example, exercised more than was recommended, then their recovery had
a possibility of being delayed and other patients sometimes imitated
this behavior or felt belittled and depressed as they couldn’t
exercise as much or as often. In order to reduce these factors,
positive and negative reinforcement were used. Patients were praised
on their achievements and progression and a more negative approach was
used to those who were straying from the programme although praise was
given for their commitment and enthusiasm. The cognitive approach was
used as a guide for ensuring the patients had the underpinning
knowledge about the exercises. This approach likens the human mind to
a computer, using a stimulus-response mechanism, also similar to
classical and operant conditioning. One hoped the patients would
internalize the theory given to them, which included exercises and
possible side effects if too much or too little was carried out and
liken it to themselves with the response being any side effects they
incurred.
The two theories were used accordingly as one thought the cognitive
approach reduced the number of negative factors with the social
learning theory. The pros and cons with each theory and found the
social learning theory to be essential for group participation but
didn’t account for individualization, which the cognitive process
accounted for. When used together, they supported my teaching style
appropriately. Not all theories work together, it is determining your
personal teaching style, target audience and teaching subject which is
most important and the theories are a reference.
Having completed the teaching on Cardiac rehabilitation with regards
to exercise following surgery, feedback was received. The feedback was
of a written format from 7 independent clients, evaluating the
effectiveness of the teaching, including interest in the topic, eye
contact, information given and amount of client participation. The
feedback was all of a positive perspective, especially highlighting
the motivation and interest shown towards the topic.
Due to the feedback, received, being from a small proportion of
society participating in these classes, the results demonstrated
cannot highlight a true reflection of the teaching. In order to
achieve this, the teaching would have to be delivered to a number of
clients and other rehabilitation nurses from across the area for
comparison, however due to time constraints, this was not possible.
If the teaching session were to be repeated in the future, one would
hope to be able to capture a wider audience from within and outside of
the healthcare profession, using current feedback to build upon and
construct a more effective teaching. One believes the teaching, which
has been delivered, was of a positive outcome as the focus was
concentrated on demonstrating motivation and a high degree of
interest, which was shown in the feedback.
The ideal teaching would incorporate every aspect required, however
due to time restrictions and limited facilities it is virtually
impossible to deliver a teaching which is suitable to every client.
The one solution to this would be to divide clients into groups, of
similar age, ethnic groups and physical and mental ability, however
due to equal opportunities, disability acts and race relations, this
could never occur. One hopes this would never happen in the future as
every client brings something unique and positive to them to each
session. We all learn from one another and one believes if another
teaching were to be, carried out it would be improved, due to
experience.
Having carried out the research and undertaken the teaching, the
importance of client education is extremely important. Government
policies are beginning to highlight this loophole and health
professionals are beginning to visualize society in the future if
client education doesn’t occur.
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