Chapter 5Developmental Stages

of the Learner

Developmental Characteristics

• Chronological age versus stage of development

• Example: Children with chronic illness often are delayed developmentally; an adolescent who suffers a traumatic event may regress developmentally.

Developmental Characteristics (cont’d)

• Rationale: Chronological age per se is not a good predictor of learning ability. At any given age, there can be a wide variation in physical, cognitive, and psychosocial variables. Developmental stage acknowledges that human growth and development are sequential, but not always specifically age-related.

Developmental Stages of Childhood

Pedagogy is the art and science of helping children learn.

• Infancy and Toddlerhood• Preschooler• School-aged Child• Adolescence

Infancy and Toddlerhood

• Piaget: sensorimotor stage– learning is through sensory experiences and

through movement and manipulation of objects

• Erikson: trust vs. mistrust (birth to 12 months) autonomy vs. shame and doubt (1-3 years)– building trust and establishing balance between

feelings of love and hate; learning to control willful desires

Infancy and Toddlerhood (cont’d)

• Salient Characteristics– cognitive

– Example: responds to step-by-step commands; language skills develop rapidly during this stage

– psychosocial– Example: aggravated by personal and external

limits; routines provide sense of security

Infancy and Toddlerhood (cont’d)

• Teaching Strategies– focus on normal development, safety,

health promotion, and disease prevention– use repetition and imitation– stimulate the senses– provide safety– allow for play and manipulation of objects

Preschooler• Piaget: preoperational stage

– egocentric; thinking is literal and concrete; precausal thinking

• Erikson: initiative vs. guilt– taking on tasks for the sake of being

involved and on the move; learning to express feelings through play

Preschooler (cont’d)• Salient Characteristics

– cognitive– Example: animistic thinking; limited sense of

time; egocentric; transductive reasoning– psychosocial

– Example: separation anxiety; play is his/her work; fears loss of body integrity; active imagination; interacts with playmates

Preschooler (cont’d)

• Teaching Strategies– build trust– allow for manipulation of objects– use positive reinforcement– encourage questions– provide simple drawings and stories– focus on play therapy– stimulate the senses

School-Aged Child

• Piaget: concrete operations stage– developing logical thought processes and

ability to reason syllogistically; understands cause and effect

• Erikson: industry vs. inferiority– gaining a sense of responsibility and

reliability; increased susceptibility to social forces outside the family unit; gaining awareness of uniqueness of special talents and qualities

School-Aged Child (cont’d)

• Salient Characteristics– cognitive

– Example: able to draw conclusions and intellectually can understand cause and effect

– psychosocial– Example: fears failure and being left out of

groups; fears illness and disability

School-Aged Child (cont’d)• Teaching Strategies

– encourage independence– use logical explanations and analogies– relate to child’s experience– use subject-centered focus– use play therapy– provide group activities– use drawings, models, dolls, painting,

audiotapes and videotapes

Adolescence

• Piaget: formal operations stage– abstract thought; reasoning is both

inductive and deductive• Erikson: identity vs. role confusion

– struggling to establish own identity; seeking independence and autonomy

Adolescence (cont’d)• Salient Characteristics

– cognitive– Example: propositional thinking; complex logical

reasoning; can build on past experiences; conceptualizes the invisible

– psychosocial– Example: personal fable—feels invulnerable,

invincible/immune to natural laws– Example: imaginary audience—intense

personal preoccupation

Adolescence (cont’d)

• Teaching Strategies– establish trust– identify control focus– use peers for support and influence– negotiate for change, contract– focus on details– make information meaningful to life

Adolescence (cont’d)

• Teaching Strategies (cont’d)– ensure confidentiality and privacy– use audiovisuals, role play, contracts, and

reading materials– allow for experimentation and flexibility

within safe limits

Adulthood:Developmental Stages

• Young Adulthood• Middle-Aged Adulthood• Older Adulthood

Adulthood:Teaching & Learning

• Andragogy: the art and science of helping adults learn

• Adult Learning Principles: relates learning to immediate needs; self-directed; teacher is facilitator; learner desires active role

Young Adulthood• Piaget: formal operations stage (begins

in adolescence and carries through adulthood)– abstract thought; reasoning is both

inductive and deductive• Erikson: intimacy vs. isolation

– focusing on relationships and commitment to others in their personal, occupational, and social lives

Young Adulthood (cont’d)

• Salient Characteristics– cognitive

– Example: cognitive capacity is fully developed, but continuing to accumulate new knowledge and skills

– psychosocial– Example: autonomous; independent; stress

related to the many decisions being made regarding career, marriage, parenthood and higher education

Young Adulthood (cont’d)

• Teaching Strategies– use problem-centered focus– draw on meaningful experiences– focus on immediacy of application– allow for self-direction and setting own

pace– organize material– encourage role play

Middle-Aged Adulthood

• Piaget: formal operations stage– abstract thought; reasoning is both

inductive and deductive• Erikson: generativity vs. self-absorption

and stagnation– reflecting on accomplishments and

determining if life changes are needed

Middle-Aged Adulthood (cont’d)

• Salient Characteristics– cognitive

– Example: ability to learn remains steady throughout this stage

– psychosocial– Example: facing issues with grown children,

changes in own health, and increased responsibility for own parents

Middle-Aged Adulthood (cont’d)

• Teaching Strategies– maintain independence and reestablish

normal life patterns– assess positive and negative past learning

experiences– assess potential sources of stress– provide information relative to life concerns

and problems

Older Adulthood

• Piaget: formal operations stage– abstract thought; reasoning is both

inductive and deductive• Erikson: ego integrity vs. despair

– coping with reality of aging, mortality, and reconciliation with past failures

• Geragogy: the teaching of older persons, accommodating the normal physical, cognitive and psychosocial changes

Older Adulthood (cont’d)

• Salient Characteristics– cognitive

– fluid intelligence—capacity to perceive relationships, to reason, and to perform abstract thinking, which declines with aging

– crystallized intelligence—the intelligence absorbed over a lifetime, which increases with experience

– psychosocial– Example: adjusting to changes in lifestyle and

social status

Older Adulthood (cont’d)

• Teaching Strategies– use concrete examples– build on past experiences– focus on one concept at a time– use a slow pace– use repetition and reinforcement– provide brief explanations– use analogies

Older Adulthood (cont’d)

• Teaching Strategies (cont’d)– speak slowly and clearly– use low-pitched tones– minimize distractions– rely on visual aids and supplement with

verbal instructions– use large letters and well-spaced print– provide a safe environment– give time to reminisce

Role of Family in Patient Education

• Family is the most important variable influencing patient outcomes.

• JCAHO accreditation standards warrant family participation.

• The nurse educator and family should be allies.

• It is important to choose the most appropriate caregiver to receive information.

Summary

• Readiness to learn in children is very subject-centered, and motivation to learn in adults is very problem-centered.

• Rate of learning and capacity for learning, as well as situational and emotional barriers to learning, vary according to stages of development.

Summary (cont’d)• Knowledge of tasks associated with each

developmental stage will help individualize the approach to education in meeting the needs and desires of learners and their families.

• Nurses, as the main source of health education, must determine what needs to be taught, when to teach, how to teach, and who the focus of teaching should be in light of the developmental stage of the learner.