CHAPTER 11: THE LEARNING PROCESS

"Life is hard, don't try to do it alone… Everybody needs people to talk with, to laugh with… to cry
with. People who believe in you. People who'll keep believing in you.”
- Virginia Cassady Clinton Kelley

LEARNING AS A PROCESS
Although there are a number of different learning theories, there is considerable
agreement among educators that learning is essentially a changed behavior brought about by
exposure to various stimuli and that certain elements must be accomplished for learning to take
place. However, each theory places emphasis on different aspects of learning. Teaching precedes
learning which is initiated by a process or activities and is the central focus of a nurse educator
to create change in the learners. Following is the learning process:

1. Learning occurs from the point-of-view of the end-result or outcome of teaching.

Learning is manifested through change in behavior according to what is acceptable,
consistent with the nursing discipline, and which learning is applied for.
Results or outcomes of behavioral change, such as concepts, skills and attitudes, are
described rather than the ongoing process of learning (Davis: 2006).

2. Learning as a process is more concerned with what happens during the course of learning
than in the end-results of learning.
Emphasis of the learning process is on the dynamics of learning, the sequence and the
pattern of change of behavior in the individual and group of learners.
The learning process determines the level of interest and understanding of the different
aspects of the learning situation which causes the learner to react, organize and pattern her
behavior during a learning activity.

3. Learning is also described as a function.

Function emphasizes certain critical aspects of learning, such as motivation, retention,
transfer and other ongoing activities involved in the learning process. The learner gets involved
in a series of mental activities that will work out to grasp comprehensively all the concepts taught.
In this aspect, the learner undergoes unlearning, relearning, and learning.

STAGES OF LEARNING
A teacher must understand the stages of teaching and learning in order to provide enough
time and resources for training students so that the level of knowledge desired can be achieved.
It is important to include in the learning plan the identification of available training resources and
acquiring outside resources when needed. The following stages and characteristics of learning
were adapted from the theory of Dreyfus as cited by Patricia Benner (Tomey and Aligood: 2007):

1. Novice
a. Has awareness of the subject area, but only in terms of abstract concepts and ideas;
b. Possesses little to no ability to put ideas into practice in a reliable way; and
 c. Follows a set of rules without regard for context in learning

2. Advanced Beginner
a. Has attained marginal learning to an acceptable performance level after coping with real
experiences;
b. Begins to understand the scope of the subject area and acknowledge her lack of
knowledge about the discipline; and
c. Able to apply tools, processes, and principles in contexts similar to well defined cases they
have studied.

3. Competent
a. Attained learning after exposure to a working knowledge of a number of areas making up
the subject;
b. New skills and capabilities are internalized with the ability to go beyond rule-bound
procedures in a more complex setting; and
c. Capable of adapting their learning to varying situations by analyzing changed
circumstances and choices of alternatives.

4. Proficient
a. Has gained from experience in different situations;
b. Tools and concepts have been internalized and can be applied to a variety of situations
without much effort; and
c. Has an intuitive, holistic grasp of a situation without having to ignore the problem prior
to determining a solution.

5. Expert
a. Has fully internalized both perception and action into their normal work processes.

Table 6: Benner's Stages of Learning

ADVANCED
NOVICE COMPETENT PROFICIENT EXPERT
BEGINNER
Situational needs perceives considers internalizedinternalized
Analysis elements to similarity various and intuitive
and intuitive
be clearly and with prior alternatives; grasp of
pattern
objectively examples; more situation recognition
defined; no have enough realistic, has based on
background experience to critical view deep
experience of grasp of self experiential
situations situations background
Decision none; rule- dependent able to focuses on actions are
making guided, task upon analyze choice that instinctual,
behavior completion matching a situations in best achieves automatic
oriented situation to a order to intuitive plan manner;
determine
 proper rule the best transparent
set alternative view of self
Exercising difficulty feel highly consciously moves instinctual
judgments discerning responsible consider the quickly based does what
between but rely for value of on previous normally
relevant and help from alternative experience works;
irrelevant more outcomes meeting
aspects of experienced patients’
nursing mentors needs is of
situation utmost
importance
Skills and guided marginally internalized intuitive and intuitive and
tools performance acceptable and applied applies applies
for skill performance in more consciously in instinctual in
acquisition having coped unstructured all settings; all settings;
with real settings; skilled recognize all
situations gaining sense responses to variables in
of mastery situation; problem
increased solving and
confidence in decision
their own making; no
knowledge longer relies
on rules but
connect
decision with
standards
Formal 2 to 5 days 5 to 10 days 20 to 30 days as needed to informal
training time address through
specific interaction
issues that with other
may arise experts
Training with 1 to 2 months 3 to 6 months 12 to 18 1 to 3 years 5 to 10 years
practice months

THE LEARNING PROCESS

The elements of the learning process consist of setting goals, selecting appropriate
stimuli, perceiving, responding to stimuli, determining consequence and integrating learning
experiences (Wiggens: 2006).

1. Goal
The teacher must set long-term goals with his or her students. This can be achieved
through a long term process of teaching and learning such as to acquire nursing knowledge,
professional values and skills. This is followed by specifying learning objectives that requires short
term activities to motivate students to learn and ultimately achieve the goal.
The teacher can help the student by:
a. Being available for guidance and as a resource person to the student; and
b. Encouraging the student to apply problem solving and "critical thinking" to a given
situation.

2. Stimuli
Stimuli increase the ability of the student to recognize the patient's specific needs in
relation to the overall problem of the patient.
The teacher can help the student reach his or her goals by:
a. Helping the student identify patient needs; and
b. Selecting and arranging a learning situation which will give the student:
 The maximum opportunity to learn,
 To identify, analyze, and meet nursing problems and
 To motivate a patient to develop self-reliant behavior.

3. Perception
Perception is making the student capable to appraise nursing situations using her senses
and forming insights by:
a. Observing the patient's physical and psychological condition;
b. Reading the patient's chart and nurses notes; and
c. Talking with the patient and her doctor, and other personnel involved in patient care and
finally, her instructor.

The teacher can help the student improve perceptual ability through:
a. Assisting the student in discussing the patient's problem.
b. Providing the necessary cues, to analyze patient needs and problems.
c. Identifying and interpreting the patient's nursing needs, and
d. Directing her attention to critical elements regarding nurse-patient relationship.

4. Response
Response refers to the ability of the student to identify patient care needs and formulates
an appropriate nursing care plan. She also takes effort to communicate with her patients to
disseminate information through health teaching regarding nursing care needs and home care.
The teacher can help the student respond well to patient care needs through:
a. Checking student's nursing care plan,
b. Helping her decide priorities of care,
c. Giving support and encouragement,
d. Helping student realize that the nursing problem may require different approaches
before it can be solved; and
e. More time may be needed before very tangible results can be obtained
 The teacher should help the student formulate long-term planning and facilitate students'
understanding while giving her support to attain immediate success in her nursing career.

The student in turn should recognize that assisting the patient is not sufficient; she may
have to apply further nursing theories and techniques to encourage the patient to work and
negotiate with her so the final goal of patient care is attained.

5. Consequence
Consequence refers to the outcome of nursing care rendered by the student to the
patient, the expected effects, the side effects or adverse reactions to nursing interventions.

Nature of Consequences:
a. There is a rewarding or satisfying response to the student, when health of the patient
progresses or made comfortable while in her state of illness. A dissatisfying response
occurs, on the other hand, if the patient does not respond to treatment or does not seem
to improve in health.
b. A rewarding or satisfying response to the student, if much learning was attained while
meeting the nursing needs of the patient. The student may still gain nursing knowledge
and experience from every nursing measure she used but did not meet patients' needs.

In this situation, the student confirms her response to her nursing care plan; who is to
make a breakthrough in terms of patient care. This in turn encourages her to continue caring for
her patient. The positive response of the patient to nursing care which encourage self-reliant
behavior may also provide meaningful experience for the student which motivates her further to
perform well in the clinical area.

Note: The student's response to a given situation through her nursing care plan is a result of her
perception and analysis of the situation.

6. Integration
In Integration the student utilizes personal knowledge and experiences to solve current
problems. She may also make use of other courses offered throughout the curriculum as basis
for designing her nursing care plan.
The teacher can help the student integrate past learning by:
a. Encouraging the student to examine past nursing knowledge and experiences for validity
and reliability of learning;
b. Identifying what nursing care measures were done to the patient; and
c. Making conscious use of the nursing knowledge and the skills she had acquired in nursing
for a particular patient and or other patients.

By assigning the patient to the student, the teacher indicates her confidence in the
student's ability to integrate and transfer her knowledge of principles and skills that she had
acquired in past learning experiences. The teacher is also able to judge the student's level of
learning and readiness to apply her knowledge and skill to various complex situations.
MEMORY AID

1. The theory of the learning process states that:

a. Learning occurs from the point-of-view of the end-result or outcome of teaching.
b. Learning is more concerned with what happens during the course of learning than the
end-results of learning.
c. Learning can also be described as a function.

2. Stages of Learning
a. Novice - the learner has awareness of the subject area but only in terms of abstract
concepts.
b. Advanced Beginner - has attained marginal learning to an acceptable performance level
after coping with real experiences.
c. Competent - has attained a working knowledge after exposure to a number of areas
making up the subject.
d. Proficient - has an intuitive, holistic grasp of the situation without having to ignore the
problem prior to determining a solution.
e. Expert - has fully internalized both perception and action into their actual work situations.

3. Goal – set of long term process of learning.

4. Stimuli – increase the ability of the student to recognize the patient's specific needs in relation
to the overall problem of the patient.

5. Perception – the ability of the student to assess nursing situations.

6. Response – the student selects and identifies patient care needs and formulates an
appropriate nursing care plan.