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The Behavioral Aspects of the Learning Model in Adults

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Learning is defined as a lasting change in mental processing or behaviour as a result of some experience. It is a dynamic process that lasts a lifetime, in which the one obtains new knowledge or skills and changes his judgments, feelings, or actions. Learning allows adapt to stresses and varying conditions in health care. It is pivotal for students getting a new knowledge and skills essential to become a nurse (Bastable 2017).

Learning theories are considered as the core framework for educational systems. Guide of integrated concepts and principles that define, clarify, or predict how individuals learn (Schumacher, Englander and Carraccio 2013). Mentors by knowing and using principles of learning theories are able to use their knowledge much more effectively in several learning situations (Aliakbari et al. 2015). This coursework is a reflection from the event that occurs during clinical placement during the first year of nursing course. This paper will analyse the relevant learning theory, which in this case will be the behavioural learning theory. In practice, this theory rarely is used by itself, usually with cognitive learning theory, although, on purpose of this reflection will be analysed on its own. In the context of occurred situation teaching and learning strategies, principles of assessment and role of the educator will be investigated. In order to guide the reflection, the new reflect model (barksby, butcher and whysall 2015) for clinical practice will be used. Where following mnemonics stand for: recall the events, examine responses, acknowledge feelings, learn from the experience, explore options, create a plan of action and set timescale (barksby, butcher and whysall 2015).

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Recall the event this is a learning reflection based on the situation which i witnessed during my first-year clinical placement in internal diseases department in one of the hospital in Poland. I was in a group of six student’s group and our mentor was a nurse working in this department. During the first day, one of my colleague, under the supervision of our mentor tried to put in the cannula for the newly admitted patient. The student had unsuccessful three attempts where she pierced a vein each time. After those attempts, the annoyed nurse performed this procedure by herself and told the group to observe. After the event, the nurse told the student that it is impossible that she cannot do this procedure and she must practice through the week. Although, if at the end of the week she will be unable to correctly perform the procedure, she will not pass up her internship. Throughout the week we all practiced putting in the cannula and taking blood for a test. When a week passed by the time for assessment came.

Despite practising all week student was not able to perform the procedure correctly. Mentor nurse criticize the student for her incompetence and did not pass her placement. As a result of that student dropped out the nursing course. Responses I was a person who was watching this situation from aside and also was a member of the group. It gave me the certain view on this situation. At that time, I thought that it was an inappropriate nurse’s reaction. She expected from our group competences equal registered nurses when we were on our first year of nursing course. Procedures like intravenous cannulation or taking blood for the test, which we had to perform in a hospital setting at that time, were completed by us for the first time on real patients. It was our first placement and those procedures we practiced previously in a classroom only on mannequins. During this week of practice, we all tried to support that student as she was the only one who struggled with it. We tried explaining how to perform it, did demonstrations and allowed her practice on us, although she still had a problem with it. When we tried to help her as much as we could, our mentor as she was also a nurse working in this department was too busy to support our learning.

Feelings During this whole week, I felt a mixture of anger and confusion. There was nothing in our experience to prepare us for it as it was our first clinical placement and we have not enough knowledge yet to meet the mentor’s requirements. After the incident on the first day and how the nurse reacted, I felt very disappointed with our mentor. This way most of the group lost interest and motivation to learn. The nurse was working in this department this is way she was busy and did not have sufficient time for students. The nurse criticised ineffective student without giving feedback or instructions on how to improve her performance. One of the main principles of behavioural learning theory for mentors is the reinforcement through which behaviour is changed in the desired way (Hand 2006). In this case the nurse tried to use negative reinforcement by punishing her in the end, however, she did not deliver any feedback to the student. The feedback is crucial, will either reinforce their behaviour or force the learner to re-evaluate their behaviour in the light of new evidence (Taylor and Hamdy 2013). Because of lack of feedback, I felt annoyed as the student did not receive a chance to improve. We tried to help her to learn how to conduct this procedure, although, unsuccessful as we have not teaching experience. After I found out that my colleague decided to drop out the course I started also feel anxious and hopeless about my future. I believe my feelings of hopeless were related also to my lack of clinical experience. I found this situation upsetting to witness as it could be avoidable if our mentor devoted more time to students and gave feedback.

Experience and options

This experience made me think about how adults learn and how differently this situation could end. I realised that there are different ways of how adults learn. Malcolm Knowles (1978) states that adults do not learn in this same way as children. As the first one, he presented the term ‘‘andragogy” to distinguish pedagogy from adult learning. It is appropriate to state that the learning is a continuum, which lasts through all life, with many difficulties and strategies at different times (Merriam et al. 2007) In healthcare education, it is significant to be aware that some learners have already achieved a university degree, and others came from high school, so the level of their knowledge is differential. Healthcare education is consisting of postgraduate studies and also of continuing professional development. Each of students has individual limitations, knowledge, and preferences. That why the task for an educator is to make available a favourable environment in which each student can get an opportunity to learn. (Taylor and Hamdy 2013) The learning environment involves physical, emotional, and intellectual security for students. It is essential to create a space for a student which allows them to think and grow. (Guney and Al 2012)

In the situation, I witnessed we never got the appropriate environment in which we could effectively adapt to new knowledge. Environment need to facilitate learning through motivating and supporting students (Papp et al, 2003) and as we were left alone to practice, without support, the learning environment was unfavourable and unstructured and overwhelming environment makes students feel vulnerable and anxious (Papp et al, 2003). Behaviourism is the theory which can be related to this reflection. Behavioural learning theory focuses on the noticeable change in one’s behaviour, reject mind or mental activity. Theory leaks to external stimuli till a desirable response will be received (Guney and Al 2012). The vital principles for behaviourist are based on the basic rules of a conditioned reflex, concentrate on frequent behaviour which ultimately will become a habit (Duchscher 2000). It focusses on noticeable behaviours which may be measured as in this case the desirable behaviour was correctly performed intravenous cannulation. Practical application of behaviourism Plan new learning on what a student knows, specific goal, reinforcement through feedback, (Thurlings et al. 2013) MENTOR search has shown problems with the level of support student nurses receive from clinical staff who are acting as their mentors.

According to (Pellatt 2006) fostering a relationship that is conducive to learning requires effort on the part of the mentor, (Adams 2004) ) suggests that mentors need to take the time to get to know their students. (Castledine 2002) found that clinical placements often are unwelcoming and unattractive to new students. O’Driscoll et al (2010) identify that the challenges faced by mentors include inadequate training to become a mentor and difficulties in taking responsibility for students without any reduction in their workload. Mentors felt that students should take more responsibility for their own learning and recognise opportunities, rather than expecting to be “spoon fed” Principles of behaviourism for mentors Reinforcement- strength motivation and encourage to behave in a desirable way through feedback this case give feedback about the procedure what went bad how to improve and perform it correctly. Knowing one achievements, goals and areas for improvement is essential to the learning process(Matua et al 2014). The feedback should also mention specific strategies the individual can use to improve their learning and performance and should provide not only information on their performance but also a guide for their next steps (Matua et al 2014).

The benefits of feedback include increased student confidence, motivation, and self-esteem as well as improved clinical practice. Benefits such as enhanced interpersonal skills and a sense of personal satisfaction also accrue to the supervisor. Barriers to the feedback process are identified as inadequate supervisor training and education, unfavourable ward learning environment and insufficient time spent with students (Clynes and Raftery 2008) 3. Pendleton’s Model of Feedback Areas of improvement are first identified by the learner and then followed by a discussion with the person giving the feedback about strategies to improve their performance (Chowdhury & Kalu 2004). . ‘Situation – Behaviour – Impact’ Feedback Tool This tool allows the learner to reflect more on their actions whilst understanding precisely what you are commenting on and why, as well as think about what they need to change. From this, the learner then has the chance to reflect on the situation and their behaviour and discuss with you strategies for improvement Goal specification- target of learning and know how it will contribute to the practice Practice- lead to mastery Strategies demonstrating successful airway management skills, I was fulfilling some elements of the role modelling and therefore from a behaviourist adult learning perspective, the incident was a learning opportunity for the student Plan of action and Timescale.

Through understanding the ways in which people learn we can plan the most effective ways in which we can help them to learn. The model presented (Cope, Cuthbertson and Stoddart 2000) emphasises the importance of student nurses being taught to link the theory learnt in university to the realities of nursing practice. Teaching is a major aspect of the mentors’ role; however, mentors often report a lack of both time and resources to facilitate learning, which can lead to students feeling unsupported, and may contribute to higher drop-out rates. In order to provide high-quality nursing care to patients, student nurses need to learn theoretical knowledge as well as practical skills. Subsequently, when the student attempted to replicate airway management the next time, it is possible that she would be unsuccessful once again. Some theory is more connected than others. The mentor’s role is to decide which theory use relying on the best available evidence.

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