FUNDAMENTAL OF NURSING III

LECTURER:
Ns. Esthika Ariany Maisa,m.kep

MEMBERS OF GROUP 2:
M. Ilham Zul (1511314001)
Dzikra Fitria Amita (1511314025)
Balqis Qisty (1511314016)
Nadia Qonita (1511314012)
Ridha Hayati (1511314015)

NURSING FACULTY
ANDALAS UNIVERSITY
PADANG
2015/2016

CHAPTER I

INTRODUCTION
A.Background
Actual chronological age is only a relative indicator of someones physical, cognitive,
and psychosocial stage of development. When dealing with the teaching-learning process,
examination of the developmental phases is important as the learner progresses from infancy to
senescence in order to appreciate the behavioural changes that occur in the educational domains.
The persons ability and readiness to learn are influenced by complex factors involving growth
and development interacting with experiential background, physical and emotional health status,
motivation, stress, surrounding conditions, and available support systems. Before any learning
could occur, assessment of the learners knowledge base of the topic of interest is a must. If the
client is a child, new content should be convenient to the developmental stage and should build
on the childs knowledge base and experience. Determining the best time to teach a learner is the
major question underlying the planning for an educational experience. The answer is when the
learner is ready-the teachable moment is that point in time when s(h)e is most receptive to a
teaching situation. The nurse educator does not always have to wait for a teachable moment to
occur; s(h)e can create teaching opportunities by taking interest in and attending to the needs of
the learner
As otherwise healthy adults age, their performance on cognitive tests tends to decline.
This change is traditionally taken as evidence that cognitive processing is subject to significant
declines in healthy aging. We examine this claim, showing current theories over-estimate the
evidence in support of it, and demonstrating that when properly evaluated, the empirical record
often indicates that the opposite is true. To explain the disparity between the evidence and
current theories, we show how the models of learning assumed in aging research are incapable of
capturing even the most basic of empirical facts of associative learning, and lend themselves to
spurious discoveries of cognitive decline. Once a more accurate model of learning is
introduced, we demonstrate that far from declining, the accuracy of older adults lexical
processing appears to improve continuously across the lifespan. We further identify other
measures on which performance does not decline with age, and show how these different
patterns of performance fit within an overall framework of learning. Finally, we consider the

implications of our demonstrations of continuous and consistent learning performance

throughout adulthood for our understanding of the changes in underlying brain morphology that
occur during the course of cognitive development across the lifespan

B. Problem Formulation
a. When planning, designing, and implementing an educational programme, the nurse
educator must consider the learners developmental stage in life?
b. What is The mental lexicon?

CHAPTER II
DISCUSSIONS

A. TEACHING STRATEGIES

1. The Developmental Stages of Childhood

Within childhood, there are four stages. These are infancy- toddlerhood (0-3
years), preschooling (approx. 3-6 years), school-aged childhood (approx. 6-12),
and adolescence (approx. 12-18).
Pedagogy is the art and science of helping children to learn.
Throughout childhood, learning is subject-centred.
A review of the teaching strategies to be used in childhood in relation to the
physical, cognitive, and psychosocial maturational levels will follow.

2. Teaching Strategies During Infancy and Toddlerhood

Patient education need not be illness-related. Less time should be devoted to

teaching parents about illness care. More attention should be given to teaching
parents about normal development, safety, health promotion, and disease
prevention.
If the child is ill, assessment of the childs and parents anxiety levels and helping
them cope with their stress represent the first priority for teaching intervention.
This is because anxiety negatively impacts on readiness to learn.
Health teaching should take place at home or day-care centre. During
hospitalisation, teaching should take place in safe and secure environment.
The following teaching strategies are suggested for short-term learning:
o Read simple stories from books with lots of pictures
o Use dolls to act out feelings and behaviours
o Use simple audiotapes with music and videotapes with cartoon characters
o Role-play to bring the childs imagination closer to reality
o Perform procedures on a doll to help the child understand what an
experience would be like
o Keep teaching sessions brief (5 minutes) and close together

3. Teaching Strategies During Preschooling

Preschoolers continue to develop the skills learned earlier.

Children require new behaviours that give them more independence and autonomy.
Learning occurs through interaction with others and through imitating or modeling
the behaviours of friends and adults.

During interactions with preschoolers and their parents, nurses should teach parents
about health promotion and disease prevention, provide guidance regarding normal
growth & development, and offer instruction about medical recommendations as
illness arises.
Parents are an important source of information about their childrens disabilities,
idiosyncrasies [an individualizing characteristic or quality], and favorite toys, all of
which may influence their learning.
Nurses are in position to instruct preschoolers on expressing themselves openly about
their fears.
Nurses should be selective in the language they use with children of this stage, so that
they feel less threatened.
The focus of educational sessions will continue to be on significant others, who
would learn to help the child achieve desired health outcomes .
The following short-term teaching strategies are recommended:
a. Provide physical and visual stimuli both for expressing ideas and for
understanding verbal instruction.
b. Keep teaching session short (15 minutes), sequential and close to each other.
c. Relate information needs to activities and experiences familiar to the child.
d. Give the child an opportunity to select between a limited number of teachinglearning options [such as playing with doll or reading a story] which promotes
active participation and enhance nurse-client rapport.
e. Arrange small group sessions with peers as a means to make teaching less
threatening and enjoyable.
f. Provide real motivation for the childs learning by giving praise and approval both
verbally and nonverbally.
g. Following a successful teaching experience, provide tangible rewards as
reinforcers in the mastery of cognitive and psychomotor skills.
h. Allow the child to play with replicas or dolls to learn about body parts.
i. Use storybooks to emphasise the humanity of healthcare personnel.

4. Teaching Strategies During School-Aged Childhood

At this stage, children have progressed to a point where they can begin formal
training in structured school systems.
Children are enthusiastic, open-minded, and motivated to learn about themselves and
the world they live in.
Teaching in healthcare environment should focus on how to maintain health and
manage illness. Within this stage, it is imperative to identify learning styles,
determine readiness to learn, and accommodate particular learning needs and abilities.
Children should be involved in education efforts and should receive instruction about
illness, treatment, and procedure in simple logical terms.
School nurses can educate children of this stage for health promotion and health
maintenance, and share the content with parents and the nurse outside the school
setting to avoid duplication and conflicting information.

Extensive teaching may be needed to help children and their parents understand
various conditions and learn how to overcome or deal with them.
What would help children learn in hospitals is the fact that they are used and
receptive to structured, direct, and formal learning in school. The following shortterm strategies are recommended for children at this stage:
a. Give children the responsibility for their own health; for example teach them to
calculate and administer their own insulin.
b. Teaching sessions can last as long as 30 minutes and should be spread apart to for
comprehension of large amounts of content and to provide opportunities for
exercising newly acquired skills.
c. Use diagrams, models, pictures, videotapes, and printed material besides other
teaching methods.
d. Clarify scientific terminology and medical jargon, and use analogies [chest x-ray
is like your picture taken, white blood cells are like police cells that can destroy
infection] to provide information in meaningful ways.
e. Use one-to-one teaching sessions to individualise learning according to the childs
own experience, and provide time for clarification, validation, and reinforcement
of what has been learned.
f. Employ group teaching sessions involving other children of same age and with
similar problems or needs.
g. Ensure that children are prepared for a procedure well in advance to allow them
time to cope with their feelings and fears.
h. Encourage participation in planning for procedures and events and be supportive
educator who provides nurturance.

5. Teaching Strategies During Adolescence

This stage represents transition from childhood to adulthood.

This stage is prolonged and very changeable; many adolescents and their families
experience turmoil.
How adolescents think of themselves and the world influences many healthcare issues
they face from anorexia to DM.
Although the majority of adolescents remain healthy, about 20% of them in the US
have at least one serious health problem such as DM, asthma, injury-related
disabilities, and psychosocial problems.
Adolescents are at high risk of teenage pregnancy, STD, poverty, suicide, substance
abuse, and RTA.
Therefore, the focus of educational efforts is varied and numerous covering topics
such as sexual adjustment, contraception, venereal diseases, substance abuse, accident
prevention, and nutrition.
Sick or disabled adolescent are often noncompliant with medical regimen and
continue their risk-taking behaviour. Because of their preoccupation with body image

and functioning, they view health recommendations as a threat to their autonomy and
sense of control.
As such, the major challenge facing nurse educator in teaching this group is,
probably, to develop a mutually, trusting relationship.
Adolescents can participate fully in all aspects of learning because of their well
developed cognitive and language abilities. However, they need privacy,
understanding, honest and straightforward approach, and unqualified acceptance of
their fear of losing control.
The following strategies for short-term learning are suggested:
a. Use one-to- one instruction to ensure privacy and confidentiality.
b. Conduct peer group discussions as an effective approach to deal with relevant
health topic.
c. Use audiovisual materials as these are usually comfortable approach to adolescent
learning.
d. Clarify medical terminology and give an adolescent an opportunity to participate,
when possible, in the decision-making process.
e. Give rationale for what is being said to help them feel the sense of control.
f. To attract their attention and encourage their responsiveness to teaching, be
respectful, tactful, open, and flexible.
g. Expect negative responses as they feel threatened in self-image and self integrity
and avoid confrontation and acting as an authority person. Alternatively, challenge
their views and beliefs, and acknowledge their thought.

6. The Developmental Stages of Adulthood

Andragogy is the art and science of helping adults learn. Within this framework,
learning is more learner-centred and less-teacher centred.
The period of adulthood encompasses three major developmental stages of young
adult [18-40], middle-aged adult [40-65], and older adult [>65 years].
The emphasis for adult learning revolves around differentiation of life tasks and
social roles with respect to employment, family, and other activities beyond the
responsibilities of home and career. Adult learning is problem centred.
Adults pursue learning throughout their life for a number of reasons embedded in
three categories that [describe] the general orientation of adults toward continuing
education.
a. Goal-oriented learners engage in educational endeavors to accomplish clear and
identifiable objectives.
b. Activity-oriented learners select educational activities to meet social needs.
c. Learning-oriented learners view themselves as perpetual students who seek
knowledge for knowledge sake.

7. Teaching Strategies During Young Adulthood

At this stage,[prior to the emergence of chronic diseases], young adults are generally
very healthy and have limited contact with health professionals.

At this stage it is crucial for young adults to establish behaviours conducive to

healthy lives both physically and emotionally.
However, health promotion remains a neglected area of healthcare teaching even
though there are various educational targets such as behaviour-related risk factors
and stress management that are important to address as these impact future health.
The nurse as an educator must find a way of reaching and communicating with this
audience about health promotion and disease prevention.

B. THE MENTAL LEXICON

A central part of the argument put forward in Ramscar et al. (2014) is that lexical
learning continues throughout the lifespan. This raises a question, where is the evidence of
this continued learning? As Rabbitt (2014) puts it:
Ramscar et al. insist that vocabulary tests cannot be appropriate measures because they are
biased towards [sic] low frequency words and so do not accurately assess older people who
know more rare words that are not tested. It is questionable whether most older people
actually do know more rare words than most young adults, but scores on vocabulary tests
are not the only, or the best comparison. Perhaps Ramscar et al. elide this point because
of their need to counter a quite different objection that old people generally have only equal
or even lower scores on vocabulary tests than the young.

Ramscar et al. (2004) show how some straightforward facts about sampling and the
statistical nature of lexical distributions (Baayen, 2001) guarantee that vocabulary tests will
become increasingly less accurate as people get older. If we disregard vocabulary tests as a
useful tool for assessing cognitive decline, we are left with Rabbitts suggestion that older
people may not actually know more rare words than young people. Does this actually make
sense? Consider life as a continuous process of sampling the world. In infancy, the part of the
world sampled is highly restricted to the cot, the high-chair, and the family (Pereira, Smith, &
Yu, 2014). During the school years, pupils are trained to absorb selected samples of the world
at a rate far beyond that which individual experience would allow. In their twenties and
thirties, speakers marry, and may have children of their own. They move to other places,
travel more widely, and experience an ever-increasing array of technological innovations. In
their sixties, speakers may become grandparents, start a new hobby and become expert bridge
players, or captains of industry. It seems likely that as their experiences of the world
accumulate, speakers will need a more diverse and more specialized vocabulary to
communicate their experiences to other speakers. In other words, given how experience is

sampled over the lifetime, it is extremely unlikely that the limited vocabulary acquired by the
end of puberty would remain unchanged and sufficient for the remainder of life.
In a meta-analysis of 134 studies, Ramscar et al. found that while older participants
outperformed younger adults at FAS recall in smaller studies, in very large surveys of the
elderly population, older participants performance declined as the total number of people
tested in a study increased. Moreover, this effect was not due to regression to the mean (the
analysis presented in Ramscar et al., 2014, controlled for this). Instead, it appears that in the
data reported in the literature, there is a clear relationship between the FAS test scores of older
adults and the number of older adults tested.

CHAPTER III
CLOSING

A. Conclusion
We have sought to show how many of the tacit, over-simplified assumptions about the
nature of learning in the literature are leading researchers to seriously overestimate of the degree
to which cognitive function declines with age. We would not wish to argue that this means that
functionality does not change. For instance it may be that a side-effect of some kinds of priorlearning is that subsequent learning is inhibited in ways that, essentially, amount to functional
losses, Rather, we would suggest that a better understanding of learning can do much to assist
our understanding of cognitive functions themselves in much the same way that children learning
of a native sound system functionally impedes the later learning of non-native phonetic contrasts

REFERENCE

Ramscar Michael, Peter Hendrix, Bradley Loveii, Harald Baayeni, Learning is not decline
The mental lexicon as a window into cognition across the lifespan London