STAGES IN LEARNING

AND PHYSICAL
ENVIRONMENT

Nadeemuddin
 Objectives
By the end of class students will be able:

1.Discuss the stages of learning.

2.Compare different stages of development with learner.
3.Discuss the impact of physical environment and emotional
wellbeing on learning.
4.Relate the humanistic, dialectical learning theories with
physical and emotional wellbeing.
5.Apply the learning strategies according to the stage of
learning.
 INFANCY-TODDLERHOOD

Learner:

• Approximate age: Birth-2years

• Cognitive stage: Sensorimotor
• Psychosocial stage: Trust vs. mistrust (Birth-12mon)
Autonomy vs. shame & doubt (1-2 yrs.)
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General Characteristics:

• Dependent on environment
• Needs security
• Explores self and environment
• Natural interest
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Teaching Strategies:

• Orient teaching to caregiver

• Use repetition and imitation of information
• Stimulate all senses
• Provide physical safety and emotional security
• Allow play and manipulation of objects
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Nursing Intervention:
• Welcome active involvement
• Forge alliances
• Encourage physical closeness
• Provide detailed information
• Answer questions and concerns
• Ask for information on child’s strength/limitations
and like/dislike
 EARLY CHILDHOOD

Learner:

• Approximate age: 3-5 years

• Cognitive stage: Preoperational
• Psychosocial stage: Initiative vs. guilt
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General Characteristics:
•Selfish
•Thinking precausal, concrete, verbatim
•Believe illness self-caused and discipline
•Limited sense of time
•Fears physical injury
•Cannot generalize
•Animistic thinking (objects possess life or human
characteristics)
•Separation anxiety
•Motivated by curiosity
•Active imagination, prone to fears
•Play his/her work
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Teaching Strategies:

•Use warm, calm approach

•Build trust
•Use repetition of information
•Allow manipulation of objects and equipment
•Give care with explanation
•Reassure not be blame self
•Explain procedures simply and briefly
•Provide safe, secure environment
•Use positive reinforcement
•Encourage question to tell perceptions/feelings
• use simple drawings and stories
•Use play therapy, with dolls and puppets
•Stimulate senses: visual, auditory, tactile, motor
 MIDDLE AND LATE CHILDHOOD

Learner:

• Approximate age: 6-11 years

• Cognitive stage: Concrete operations
• Psychosocial stage: Industry vs. inferiority
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General Characteristics:

•More realistic and objective

•Understand cause and effect
•Deductive/inductive reasoning
•Wants concrete information
•Able to compare objects and events
•Variable rates of physical growth
•Understands seriousness and consequences of actions
•Subject centered focus
•Immediate orientation
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Teaching Strategies:

•Encourage independent and active participation

•Be honest relieve fears
•Use logical explanation
•Allow time to ask question
•Use analogies to make invisible processes real
•Establish role models
•Relate care to other children’s experiences; compare
procedures
•Use subject centered focus
•Use play therapy
•Provide group activities
•Use drawing, models, dolls, painting, audio-and-video taps
 ADOLESCENCE

Learner:

• Approximate age: 12-19 years

• Cognitive stage: Formal operations
• Psychosocial stage: Identity vs. role confusion
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General Characteristics:

•Abstract, theoretical thinking

•Can build on past learning
•Reasons by logic and understands scientific principles
•Future orientation
•Motivated by desire for social acceptance
•Peer group important
•important (imaginary audience)
•Feels unassailable, invincible /immune to natural laws
(personal story)
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Teaching Strategies:

•Establish trust reality

•Know their agenda
•Address fears/concern about outcomes of illness
•Identify control focus
•Include in plan of care
•Use peers for support and influence
•Transfer changes
•Focus on details
•Make information meaningful to life
•Ensure confidentiality and privacy
•Arrange group sessions
•Use audiovisuals, role play, contracts, reading materials
•Provide for experimentation and flexibility
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Nursing Intervention:

• Explore emotional and financial support

• Determine goals and expectations
• Assess stress levels
• Respect values and norms
• Determine roles responsibilities and relationships
• Encourage in 1:1 teaching without parent present,
but with adolescent’s permission inform family of
content covered
 YOUNG ADULTHOOD

Learner:

• Approximate age: 20-40 years

• Cognitive stage: Formal operations
• Psychosocial stage: Confidence vs. isolation
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General Characteristics:
• Autonomous
• Self-directed
• Use personal experience to enhance or interfere
with learning
• Intrinsic motivation
• Able to analyze critically
• Make decision about personal, occupational, and
social roles
• Competency based learner
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Teaching Strategies:

• Use problem-centered focus

• Draw on meaningful experiences
• Focus on closeness of application
• Encourage active participation
• Allow to set own pace, be self-directed
• Organized material
• Recognized social roles
• Apply new knowledge through role-playing and
hands-on practice
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Nursing Intervention:

• Explore emotional, financial and physical support

system
• Asses motivational level for involvement
• Identify potential obstacles and stressors
 MIDDLE-AGED ADULTHOOD

Learner:

• Approximate age: 41-64 years

• Cognitive stage: Formal operations
• Psychosocial stage: Generativity vs. self-absorption
and inactivity
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General Characteristics:

• Sense of self well-developed

• Concerned with physical changes
• At peak in career
• Explores alternative life-styles
• Reflects on contributions to family and society
• Repeats goals and values
• Questions achievements and success
• Has confidence in abilities
• Desire to modify unsatisfactory aspect of life
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Teaching Strategies:

• Focus on maintaining independence and

reestablishing normal life pattern
• Asses positive and negative past experiences with
learning
• Asses potential sources of stress due to midlife
crisis issues
• Provide information to overlap with life concerns
and problems
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Nursing Intervention:

• Explore emotional, financial and physical support

system
• Asses motivational level for involvement
• Identify potential problems and stressors
 OLDER ADULTHOOD

Learner:

• Approximate age: 65 years and over

• Cognitive stage: Formal operations
• Psychosocial stage: Ego integrity vs. self-absorption
and inactivity
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Cognitive Changes

•Decreased ability to think theoretically, process information

•Decreased short term memory
•Increased reaction time
•Increased test anxiety
•Stimulus resolve (afterimage)
•Focuses on past life experiences
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Sensory/motor deficits
•Auditory changes
•Hearing loss, especially high-pitched tones, consonants (S, Z,
T, F, AND G) and rapid speech
•Visual changes
•Visionary (needs glasses to read)
•Lenses become opaque (dirty look problem)
•Smaller pupil size (decreased visual adaptation to darkness)
•Decreased peripheral perception
•Yellowing of lenses (distorts low-tone colors: blue, green,
violet)
•Distorted depth perception
•Fatigue/decreased energy levels
•Pathophysiology (chronic illness)
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Psychosocial changes
• Decreased risk taking
• Selective learning
• Intimidated by formal learning
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Teaching Strategies:
•Use concrete example
•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 and reinforcement of information
•Avoid written exams
•Use verbal exchange and coaching
•Established retrieval plan (use one and several clues)
•Encourage active involvement
•Keep explanation brief
•Use similarities to demonstrate abstract information
•Speak slowly, clearly
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•Use low-pitched tones

•Face client when speaking
•Minimize distractions
•Avoid shouting
•Use visual aid to supplement verbal instruction
•Provide sufficient light
•Use white background and black print
•Use large letters and well-spaced print
•Avoid color coding with light blues, green, purples, and
yellows
•Increase safety precautions/provide safe environment
•Ensure accessibility (i.e., glasses, hearing aid)
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• Keep sessions short

• Provide for frequent rest periods
• Allow for extra time to perform
• Established realistic short-term goals
• Give time to reminisce
• Identify and present pertinent material
• Use informal teaching sessions
• Demonstrate relevance of information to daily life
• Asses resources
• Make learning positive
• Identify past positive experiences
• Integrate new behaviors with formerly established ones
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Nursing Intervention:

• Involve principal caregivers

• Encourage participation
• Provide resources for support (respite care)
• Asses coping mechanisms
• Provide written instructions for reinforcement
• Provide anticipatory problem solving (what happens if .
. .)
 References

• Bastable, S.B. (2008). Nurse as Educator (3rd ed). Boton;

Jones & Bartlett Publishers. Epp,S. (2008).