H E A L T H E D U C A T I O N - NCM 202

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LESSON 1 & 2: HEALTH EDUCATION AND PRINCIPLES AND THEORIES IN TEACHING LEARNING

DEFINITION OF TERMS INDIVIDUAL DIMENSIONS

HEALTH
● “Heal” = HAEL (means WHOLE) 1. Mental - sense of purpose/belief
● THEORY OF HOLISM owns worth
- Whole person and his/her
integrity, soundness, or 2. Spiritual - supreme being; ability to
wellbeing and that the person put into practice moral principles and
functions as a complete beliefs.
entity.
3. Physical - state of one body
fitness/not being ill
DIMENSIONS OF HEALTH
4. Sexual - acceptance of and ability to
achieve satisfactory expression of
BROADER DIMENSIONS
one’s sexuality

5. Social - support system available

1. Societal health - link between
health and the way a society is 6. Emotional - express one’s feelings
structured appropriately / develop & sustain
relationship.
2. Environmental health - refers to
the physical environment where “Being healthy means being able to function
people live. well physically and mentally and to express
the full range of one’s potentialities within
the environment in which one is living” -
Dubos and Dunn

HEALTH
- A state of complete physical, mental
and social well-being and not merely
the absence of disease and infirmity
(WHO, 1946)

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including improving knowledge and

MODERN CONCEPT OF HEALTH
developing life skills that are
conducive to individual and
“OLOF” community health.
- OPTIMUM LEVEL OF
FUNCTIONING of individuals,
HEALTH EDUCATION
families & communities.

Affected by several factors: ● To promote, maintain and enhance

● Political one’s health, prevent illness,
● Behavioral disability, and premature death
● Hereditary through the adoption of health
● Health care behavior, attitudes and perspectives.
● Delivery system It draws health models and theories
● Environmental from, the biological, environmental,
● Socio-economic psychological, physical and medical,
and even paramedical sciences like
nursing.
HEALTH EDUCATION

PURPOSES OF HEALTH EDUCATION

● “Is the translation of what is known
about health into desirable individual
and community behavior by means 1. Aims to positively influence the
of educational process” - Willson health behavior and health
Grout perspectives of individuals and
communities for them to develop
● “ Is the sum experiences which self-efficiency to adopt healthy
favorably influence the habits, lifestyles resulting to healthy
attitudes, and knowledge relating to communities
individual community and social
health”. - Dr. Thomas Wood 2. A means of propagating health
promotion and disease prevention
● “Any combination of learning
experiences designed to facilitate 3. Maybe used to modify or continue
voluntary adaptations of behavior health behaviors if necessary
conducive to health”. - Green, et al,
1980 4. Provides health information and
● Health education (WHO) comprises services
consciously constructed
opportunities for learning involving 5. Emphasizes on good health habits
some form of communication and practices which is an integral
designed to improve health literacy,

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aspect of culture, media and 3. Lessons are adaptable

technology
4. Entertaining and attracts attention
6. Means to communicate Vital
information to the public 5. Uses clear, simple language with local
expression
7. A form of advocacy
6. Emphasizes short term benefit of action
IMPORTANCE OF HEALTH
EDUCATION 7. Provides opportunities for dialogue,
discussion, and learner participation and
feedback
1. Empowers people to decide for
themselves what options to choose to
8. Uses Demonstration to show the benefits
enhance their quality of life
of adopting practices.
CHAPTER 2
2. Enhances the quality of life by promoting
healthy lifestyles PRINCIPLES AND THEORIES IN
TEACHING LEARNING
3. Equips people with knowledge and
competencies to prevent illness, maintain
health, or apply first aid measures to
prevent complications or premature deaths TEACHING
and improves the health status of
individuals, families, communities, states, “Sharing of information and experiences to
and the nation. meet intended learner outcomes in the
cognitive, affective, and psychomotor
4. Creates awareness regarding the domains according to an education -
importance of preventive and promotive Bastable, 2019
care thereby avoiding or reducing the costs
involved in medical treatment or
hospitalization. LEARNING

CHARACTERISTICS OF EFFECTIVE “Is relatively permanent change in mental

HEALTH EDUCATION processing, emotional functioning and/or
behavior as a result of experience” -
1. Directed at people who are directly Bastable, 2003
involved with health related situations and
issues “Lasting or permanent change in behavior
as a result of experience which is primarily
2. Lessons are repeated and reinforced determined or influenced by the
environment where the person is situated”

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CHANGES IN HUMAN DEVELOPMENT

“It is a complex process which involves
changes in mental processing, development
of emotional functioning and social 1. GROWTH - QUANTITATIVE, increase in
transactional skills which develop and the size of body parts; acquisition of more
evolve from birth to death” knowledge

2. DEVELOPMENT- QUALITATIVE, gradual

CONTRIBUTION OF LEARNING
changes in character; evidenced by
THEORIES
intellectual, emotional, and physiological
capabilities
1. Helped us understand the process of
teaching and learning or how individuals
acquire knowledge and change the way 2 MAJOR PROCESSES IN GROWTH
they think, feel, and behave AND DEVELOPMENT

2. Theories have helped the health 1. LEARNING - any relatively permanent

professionals to: a. employ sound methods change in behavior brought about through
and rationales in their health education experience
efforts involving patients/clients b. staff
training & education and in carrying out 2. MATURATION - bodily changes which
health education promotion programs. are genetically determined by results of
heredity or the traits a person inherits from
3. To understand the nature of the learner, parents
the health professional needs to know: a.
basic principles involved in the development
and maturation of the individual
MAJOR LEARNING THEORIES

HUMAN DEVELOPMENT A. BEHAVIORIST THEORIES OF

LEARNING
• Is the dynamic process of change that
occurs in the physical, psychological, social, B. COGNITIVE THEORIES OF
spiritual & emotional constitution and LEARNING
make-up of an individual which starts from
the time of conception to death (from womb C. SOCIAL LEARNING
to tomb).
A. BEHAVIORIST
• It is the scientific study of the changes that
occur in people as they
● Equated with stimulus-response
• age or grow older in years. theories simple stimuli with Positive
and negative reinforcement to

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produce learning responses. RESPONDENT CONDITIONING

Behavior is learned and learning is
most influenced through a. Classical/Pavlovian
manipulation of the environment ● Process which influences acquisition
of new responses to environmental
John B. Watson stimuli: Neutral Stimuli - elicits an
● The proponent emphasizes the unconditioned response through
importance of observable behavior repeated pairing with an
in the study of human beings. unconditioned stimulus.
Defined behavior as muscle
movement associated with the Example:
Stimulus-Response psychology. He Offensive odors —------ queasy feeling
postulated that behavior results from (unconditional stimulus) (unconditional
a series of conditional reflexes & that response)
all emotions and thoughts are a
product of behavior learned through offensive odors(UCS)-------- >queasy
conditioning (de Young, 2003) feeling(UCR) Hospital (NS)+Offensive
odors(UCS)------> queasy feeling (UR)
● LEARNING (several pairings of hospital+offensive
- A RESULT of the conditions or odors------> queasy feeling Hospital
stimuli in the environment and the (CS)-------> Queasy feeling (CR)
learner’s response that follow “S-R
MODEL of LEARNING” b. Systematic Desensitization
● repeated and gradual exposure to
● ENVIRONMENT fear reducing stimulus under relaxed
- Stimuli in the environment is altered and non-threatening circumstances
or the effects or the consequences = SENSE OF SECURITY NO harm
of a response is to come
changed/manipulated to bring about
the intended change for behavior to c. Stimulus Generalization
be applied or transferred through ● apply to other similar stimuli what
practice or formation of habits. was initially learned. Discrimination
learning develops later when varied
experiences eventually enable the
MUCH OF THE BEHAVIORAL
individual to differentiate among
LEARNING IS BASED ON:
similar stimuli

1. Respondent conditioning d. Spontaneous Recovery

2. Operant conditioning ● Applied in relapse prevention
programs( RPP) Although a
response may appear to be
extinguished, it may recover

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and reappear at any time ● Citing in class or publishing

(even years later) especially
when stimulus conditions are
CLASSIFICATION OF EDUCATIONAL
similar to those in the initial
REINFORCERS:
learning experience It helps
us understand why it is so
difficult to completely 1. Status indicators ( appointment as a
eliminate unhealthy habits peer tutor, having own space)
and addictive behavior such
as smoking, alcoholism or 2. Incentive feedback( increased
drug abuse knowledge of exam scores,
knowledge of individual
contributions)
OPERANT CONDITIONING
3. Personal Activities (opportunity to
(Burhuss Frederick Skinner) Focuses on the engage in special projects, extra
behavior of the organism and the time off)
reinforcement that follows after the
response Note: REINFORCEMENT should be
appropriate or directly linked to the
a. REINFORCEMENTS learning tasks and student’s
❖ “responses closely followed by accomplishment
satisfaction will become firmly
attached to the situation and NEGATIVE REINFORCEMENT
therefore more likely to reoccur
when the situation is repeated”
1. Escape Conditioning
b. THORNDIKE’S LAW OF EFFECT - As the unpleasant stimulus is
❖ “when specific responses are applied, the individual response in
reinforced on a proper schedule, the some way that causes the
behaviors can be increased or uncomfortable behavior to cease.
decreased”
2. Avoidance Conditioning
c. REWARD OR PRAISE - the unpleasant stimulus is
❖ “Encourage or motivated” anticipated rather than being applied
directly.

EMPLOYING POSITIVE
REINFORCEMENT

● Verbal ways
● Non-verbal ways

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COGNITION
NONREINFORCEMENT
- More than knowledge acquisition.
Transfer of learning occurs when the
Skinner maintained that the simplest way to learner mediates or acts on the
extinguish response is not to provide any information he/she gets or applies it
reinforcement. in certain situations Involves
intelligence which is the ability to
Note: a desirable behavior that is ignored solve problems or fashion products
may lessen as well If reinforcement is Involves the individuals:
ineffective, then punishment may be
employed - Cognitive processes
- perception Thinking skills
- Under the punishment conditions, - Memory
the individual cannot escape or
avoid the unpleasant stimulus If Ways of processing and structuring
employed, it should be administered information like:
immediately after the response with - Perceiving the information
no distractions or means of escape - Interpreting it based on what is
Punishment must be consistent at already known
the “highest” reasonable level - Reorganizing the information to
come up with new insight or
- Punishment should not be prolonged understanding
or bringing up old grievances or - Stress the importance of what goes
complaining about misbehavior at on “inside” the learner
every opportunity There should be a - The key to learning and changing is
“time out” CARDINAL RULE individual cognition (Perception,
“PUNISH the behavior, not the thought, memory, and ways of
PERSON” processing and structuring
information)
B. COGNITIVE THEORIES OF - To learn, individuals must change
LEARNING their cognition

It stresses that mental processes of PERSPECTIVE THE COGNITIVE

cognition occur between the stimulus and LEARNING THEORY
the response
GESTALT
COGNITIVE - Emphasizes the importance of
- Dwell on the ability to solve perception in learning which focuses
problems rather than responding to on the configuration or organization
stimuli of a pattern or stimulus. A principal
assumption is that each person

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perceives, interprets, and responds

to any situation in his/ her own way
INFORMATION-PROCESSING MODEL
OF MEMORY
PRINCIPLES
1st stage: PAYING ATTENTION
1. Psychological organization - Attention is the key to learning, if not
- is directly toward simplicity, attentive, explain at another time
equilibrium, and regularity“ simple when one is receptive and attentive
and clear explanation of disease
condition” 2nd stage: INFORMATION
- Is important to consider the client’s
2. Perception is selective preferred mode of sensory
- no one can attend or pay attention to processing (visual, auditory, or motor
all the surrounding stimuli at the manipulation)
same time
3rd stage: INFORMATION IS
3. What individuals pay attention to or what TRANSFORMED AND INCORPORATED
they ignore may be affected by factors like - Encoded briefly into short term
needs, personal motives, past experiences, memory, later disregarded or
and the particular structure forgotten or stored “strategies for
storage are imagery, association,
IMPLICATIONS: Rehearsal, and chunking
•Help health educators on how he/she
approaches any learning situation with an 4th stage: ACTION OR RESPONSE
individual or group. - Based on how information was
processed and stored
• One approach may be effective to a
particular client but may not work with STRATEGIES:
another 1. Have learners indicate how they believe
they learn (metacognition)
2. INFORMATION-PROCESSING
- Emphasizes the thinking processes 2. Ask them to describe what they are
like: thinking as they are learning
a. Thought 3. Evaluate learner’s mistake
b. Reasoning
c. Way information is encountered 4. Give them close attention to their inability
and stored to remember or demonstrate information
d. Memory functioning NOTE: Forgetting or having difficulty in
“useful for assessing retrieving information from long term
problems in acquiring, remembering memory is a major stumbling block in
and recalling information” learning which may occur because :

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NINE EVENTS THAT ACTIVATE

• the information has faded from lack of use
EFFECTIVE LEARNING WITH
CORRESPONDING COGNITIVE
• other information interferes with retrieval
PROCESSES (Roberty Gagne,1995)
(what comes before or after a learning
session may compound storage and
retrieval) 1. Gain the learner’s attention
(reception)
• individuals are motivated to forget for a
variety of conscious or unconscious reasons 2. Inform the learners of the objectives
and expectations
3. COGNITIVE DEVELOPMENT ( expectancy)
- Focuses on qualitative changes in
perceiving, thinking, and reasoning 3. Stimulate the learner’s recall of prior
as individuals mature and grow. learning (retrieval)

PRINCIPAL ASSUMPTION 4. Present information

Learning is a developmental, sequential, (selective perception)
and active process that transpires as the
child interacts with the environment, makes 5. Provide guidance to facilitate
“discoveries” about how the world operates, learner’s understanding
and interprets these discoveries in keeping (semantic encoding)
with what she /he knows.
6. 6. Have the learner demonstrate the
-cognitions are based on how events are knowledge and skills (responding)
conceptualized, organized, and represented
within each person’s schema- a framework 7. Give feedback to the learner
that is partially dependent on the individual’s (reinforcement)
stage of the cognitive stage of development
and readiness to learn 8. Assess the learner’s performance
(retrieval)

9. Work to enhance retention and

transfer through application and
varied practice (generalization)

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JEAN PIAGET - best known cognitive 4. Formal Operation stage ( 12-18 years
development theorists observation of –Adolescence)
children’s perception and thought processes - Teenagers begin to think abstractly,
at different ages contributed much to the able to deal with the future, and can
recognition of: see alternatives and criticize

● unique ways that youngsters reason According to this view: Children take in
● the changes in their ability to information as they interact with people and
conceptualize the environment and either make their
● limitations in understanding, experiences fit with what they already know
communicating, and performing (assimilation) or change their perception
and interpretation in keeping with new
information (accommodation).
FOUR SEQUENTIAL STAGES OF
COGNITIVE DEVELOPMENT
WHAT DO COGNITIVE SAY ABOUT
ADULT LEARNING?
1. Sensorimotor (infancy)
- Infants explore their environment
and attempt to coordinate sensory 1 . Although the cognitive stages develop
information with motor skills. consequentially, some adults never reach
Learning depends on what is the operations stage. They learn better from
experienced at the beginning which explicitly concrete approaches to health
can be learned through visual education
pursuits.
2. Adult developmental psychologists and
2. Preoperational stage ( early childhood gerontologists
3-6 years old) have proposed advanced stages of
- Able to mentally represent the reasoning in adulthood beyond formal
environment, regarding the world operations.
from their own egocentric
perspective, and come to grips with 3. Older adults may demonstrate an
symbolism advanced level of reasoning derived from
their wisdom and life experience, or they
3. Concrete Operational stage may reflect lower stages of thinking due to
( 6-12 years old - Elementary) lack of education, disease, depression,
- Able to attend to more than one extraordinary stress, or medications
dimension at a time, conceptualize
relationships and operate in the
environment

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3. COGNITIVE - behavior is based on how

we are motivated
SIGNIFICANT BENEFIT OF
HEALTH CARE:
ROLE MODELING
is the central concept of the theory much of
C. SOCIAL LEARNING the learning occurs by observation-
- Explain human behavior and its watching other people and discerning what
changes as a product of interaction happens to them
between cognitive, behavioral, and
environmental determinants VICARIOUS REINFORCEMENT involves
viewing other people’s emotions and
- Emphasize the importance of determining whether role models are
environmental or situational rewarded or punished for their behavior
determinants of behavior and their
continuing interaction.
FOUR OPERATIONS INVOLVED IN
MODELING
- Assumes that all actual behavior
patterns must be learned through
TRADITIONAL LEARNING (by 1. Attentional Phase
reinforcement) and
OBSERVATIONAL LEARNING (by - Observation of role model “what a
modeling) person can do and what he/she can
attend to” A necessary condition for
Behavior is shaped by people’s any learning to occur. Research
expectations; these expectations are formed indicates that role models with high
from experience and by watching other status and competence are more
persons. “environmental conditions shape likely to be observed, although the
behavior through learning and the person’s learner’s own characteristics (needs,
behavior in return shapes the environment” self-esteem, competence) may be
- Albert Bandura the more significant determiner of
attention
ACCORDING TO ALBERT BANDURA
2. Retentional Phase
3 DETERMINANTS OF HOW BEHAVIOR
OCCUR
- Processing and representation in
memory
1. ANTECEDENTS - behavior based on the
past as we have seen it - “How experience is encoded or
retained in memory”
2. CONSEQUENCES - behavior is
influenced by its results - involve storage and retrieval of what
was observed

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3. Reproduction Phase

- Memory Guides performance of

model’s action

- “What behavior can be performed”

- Learner copies the observed

behavior

- Mental rehearsal, immediate

reenactment, and corrective
feedback strengthened the
reproduction of behavior

4. Motivational Phase

- Influenced by vicarious
reinforcement and punishment
covert cognitive activity,
consequences of behavior and
self-reinforcement and punishment

- Focuses on whether the learner is

motivated to perform a certain type
of behavior

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LESSON 3: LEARNING PRINCIPLES EXPERIENCES FACILITATE OR

HINDER LEARNING PROCESS:

LEARNING
a. Teacher’s selection of learning
theories and structuring or type of
Learning is relatively permanent change learning experience.
in mental processing, emotional functioning b. Teacher’s knowledge of the nature
and/or behavior as a result of experience of the learner, materials to be
(Bastable, 2003). learned

● Lasting or permanent change in b. Teacher’s knowledge of the:

behavior as a result of experience
which is primarily determined or Nature of the learner
influenced by the environment where Materials to be learned
the person is situated. Teaching methods
● It is a complex process which
Communication skills
involves changes in mental
Ability to motivate the learner
processing, development of
emotional functioning and social
c. Teacher’s ability to relate new
transactional skills which develop
knowledge to previous experiences,
and evolve from birth to death.
values self perception and learner’s
readiness to learn
ENVIRONMENTAL FACTORS
AFFECT LEARNING

1. Society and culture

2. Structure or pattern of stimuli
3. Effectiveness or credibility of role
models and reinforcements.
4. Feedback (correct and incorrect
responses)
5. Opportunities to process and apply
learning to a new situations
6. Type, nature and level of motivation

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COMMON PRINCIPLES OF LEARNING Ex. Role-playing, case studies, buzz

sessions, Q & A format, small group
discussion, demonstration and RD.
COMMON PRINCIPLES OF LEARNING -
help motivate the learner (de Young,2003) 3. Provide an environment
conducive to learning.
1. Use several senses
Always consider the comfort
and convenience of the
learner

4. Assess the extent to which the

learner is ready to learn.
Readiness to learn is
affected by factors:
Emotional (anxiety, fear
and depression)
Physical (pain, visual, or
auditory impairment,
anesthesia)
Students in medical courses are made to
imitate the procedures that are
5. Determine the relevance of the
demonstrated by the instructors
information
(role-modeling).
Anything that is perceived by
They are graded according to the
the learner to be important or
skills they exhibited an degree of
useful will be easier to learn
comprehension of the rationale
and retain.
behind the steps.
6. Repeat the information
It is expected that by imitating, learners
Continuous repetition of
would be able to retain 70% of the lesson.
information enhances
learning
Application of the skills and
Applying the information to a
knowledge in the actual care of
different situation help in the
patients in the hospital - learners will
learning process.
have 90% RETENTION

7. Generalize the information

2. Actively involve the patients or
clients in the learning process: Application of the information
to a number of situations
Use interactive methods involving
the participation of the learners

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8. Make learning a pleasant learner know learning has

experience occurred
Teacher must:
Give frequent 4. ASSESS or EVALUATE - use
encouragement evaluation feedback to revise,
Recognize modify, revitalize or revamp the
accomplishment; and LE.
Give positive
feedback

9. Begin with what is known: moving

toward the unknown
Present information in an
organize manner
Start your presentation with
an information that the
learner already knows or
familiar with.

10. Present information at an

appropriate rate
Pace in which information is
presented;
Too fast or too slow

LEARNING TO BE
RELATIVELY PERMANENT:

1. ORGANIZE LEARNING
EXPERIENCE - meaningful and
pleasurable

2. PRACTICE or REHEARSE NEW

INFORMATION (mentally or
physically)

3. APPLY REINFORCEMENT
(rewards / recognition) - make

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LESSON 4: HALLMARKS OF GOOD / SIX HALLMARKS OF GOOD OR

EFFECTIVE TEACHING TEACHING IN EFFECTIVE TEACHING IN NURSING
NURSING & BARRIERS TO (JACOBSEN)
EDUCATION AND OBSTACLES TO
LEARNING
1. PROFESSIONAL COMPETENCE - is
evidenced by
Characteristics of an Effective
Teacher: :
A. THOROUGH KNOWLEDGE
(subject matter and proper
● Positive expectations
demonstration of skills)
● Enthusiasm
B. READING RESEARCHING,
● Effective classroom manager/
UNDERTAKING CONTINUING
Organization
PROFESSIONAL EDUCATION, and
● Ability to design lessons and
has CLINICAL PRACTICE AND
activities
EXPERTISE
● Rapport with students

2. POSSESSION OF SKILLFUL
At the end of the presentation the INTERPERSONAL SKILLS WITH
students will be able to: STUDENT-rated as the MOST
IMPORTANT the teacher:
1. Identify the six hallmarks of
good/effective teaching i nursing; A. takes personal interest in the welfare
2. Share personal views and of the student
experiences related to the six B. FAIR and JUST
hallmarks; C. sensitive to their feelings and
3. Distinguish barriers to teaching from problems
obstacles to learning; and D. conveys respect to the students
4. State their insights regarding the E. allows learner to freely express
factors identified themselves and ask questions
F. accessible for conference and
consultations
G. conveys a sense of warmth

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THREE BASIC APPROACHES BY 4. Teaching practices which include :

WHICH INSTRUCTOR CAN INCREASE
SELF ESTEEM AND REDUCED
ANXIETY ARE THROUGH : ● mechanics
● methods
● skills in the classroom and clinical
A. emphathic listening - seeing the world practice
through his/her own eyes ● thorough knowledge of the subject
matter
B. accepting the learners as they are ● presents the materials in clear,
interesting, logical, and organized
C. communicating honestly with your manner
students (ex. expectations , responsibilities )

NOTE: in the performance of the duties and 5. Evaluation practices which include :
responsibilities as a memntor , the teacher
is guided by the principle of ” in loco ● clearly communicating expectations
parentis ● providing timely feedback on student
progress
● correcting the students tactfully
3. Desirable personal characteristics ● being fair in the evaluation
of the teacher which includes processes
● giving test that are pertinent to the
charisma or personal magnetism, subject matter and assignments
enthusiasm, cheerfulness, self control,
patience , flexibility, sense of humor, good 6. Availability to students especially
speaking voice , self confidence, willingness
to admit error or lack of knowledge and a in the laboratory , clinical, and other skills
caring attitude ( Kotzabassaki 1997 and application area which are mostly marked
Fanbrother, 1996) by stressful and/or critical situations

BARRIERS TO EDUCATION AND

OBSTACLES TO LEARNING

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BARRIERS TO OBSTACLES IN of teaching

EDUCATION LEARNING and
learning
(factors hindering (factors that b. Nurse’s
, preventing, the negatively affect don’t feel
nurse’s ability to the ability of the competent
deliver learner to attend or
educational and process confident
services to the information) (d/t
patient / family inadequate
members FACTORS: preparation
for their
FACTORS: roles as
nurse
1. LACK OF 1. STRESS educators)
TIME TO OF ACUTE
TEACH AND 3. PERSONAL 3. LACK OF TIME
(greatest CHRONIC CHARACTERISTI TO LEARN d/t
barrier) ILLNESS, CS OF NURSE rapid patient
due to: ANXIETY, AS A TEACHER discharge can
SENSORY influence outcome discourage or
a. Short DEFICITS, of the teaching frustrate the
period of LOW learning process learner
confineme LITERACY
nt AMONG 4. LOW 4. PERSONAL
b. Very PATIENTS PRIORITY GIVEN CHARACTERISTI
demanding can result TO PT. AND CS OF THE
schedules to STAFF LEARNER
of nurses diminished EDUCATION (readiness to
c. Very learners EDUCATION BY learn, motivation
demanding motivation ADMINISTRATIO and compliance,
responsibili and N AND developmental
ties learning SUPERVISORY stage
PERSONNEL characteristics
2. LACK OF 2. NEGATIVE and learning
PREPARA INFUENCES OF styles)
TION OF THE HOSPITAL
NURSES ENVIRONMENT 5. LACK OF 5. EXTENT OF
TO TEACH ITSELF resulting SPACE AND BEHAVIORAL
to loss of control, PRIVACY IN CHANGES
a. Lack of lack privacy, and VARIOUS NEEDED CAN
knowledge social isolation ENVIRONMENTA OVERWHELM
on L SETTINGS THE LEARNER
principles AND

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DISCOURAGE PROVIDERS
HIM/HER
9. INADEQUATE
6. ABSENCE OF 6. LACK OF TIME TO
THIRD PARTY SUPPORT AND RECORD /
REIMBURSEME POSITIVE DOCUMENT
NT TO SUPPORT REINFORCEMEN PATIENT
PATIENT T FROM THE TEACHING
EDUCATION NURSE AND
PROGRAMS SIGNFICANT
RELEGATES OTHERS
TEACHING AND
LEARNING TO
LESS THAN
HIGH PRIORITY
STATUS

7. SOME 7. DENIAL OF
NURSES AND LEARNING
PHYSICIANS NEEDS,
QUESTIONS RESENTMENT
THE OF
EFFECTIVITY OF SUPERVISORY
PT. EDUCATION AUTHORITY,
AS A MEANS TO AND LACK OF
IMPROVE WILLINGNESS
HEALTH TO TAKE
OUTCOMES RESPONSIBILIT
Y ( locos of
control)

8. CONTENT 8.
NEED TO BE INCONVENIENC
STANDARDIZED, E, COMPLEXITY,
TEACHING INACCESSIBLIT
RESPONSIBILITI Y,
ES NEED TO BE FRAGMENTATIO
CLEAR, AND N, AND
LINES OF DEHUMANIZATI
COMMUNICATIO ON OF THE
N MUST BE HEALTHCARE
STRENGTHENE SYSTEM.
D AMONG
HEALTHCARE

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Learning theories BEHAVIORIST THEORY BY JOHN

CONTRIBUTIONS OF LEARNING WATSON
THEORIES

1. Learning theories have helped us ● Learning process is simple

understand the process of teaching and ● Focus mainly of what is directly
learning or how individuals acquire observable behavior
knowledge and feel and behave ● View learning as the product of the
stimulus conditions (S) and the
2.Theories have helped the health response R) that follow
professionals to: ● Termed as S-R model of learning
employ sound methods and rationales in ● the responses are observed then
their health education efforts involving manipulated to bring about the
patients/clients desired change
● To bring about the desired change in
• staff training & education and in carrying the attitudes and responses, the
out health education promotion programs. behaviorist recommend either:

Learning basic principles involved in the > alternating the stimulus conditions in
development and maturation of the the environment
individual is .... A must for health
professional to know to understand the > changing what happens after the
nature of the learner response occurred

● Motivation is explained as the desire

5 MAJOR LEARNING THEORIES
to reduce drive (drive reduction)
;hence ,satisfied complacent.or
a. Behaviorist satiated individuals have little
motivation to learn and change
b. Cognitive ● getting behavior to transfer from the
initial learning situation to other
c. Social Learning setting is largely a matter of
PRACTICE (strengthening HABITS)
and a similarity in the stimuli and
responses between the learning
situation and future situations where
the response is to be elicited

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●Principles of respondent conditioning may

A. RESPONDENT CONDITIONING
be used to extinguish a previously learned
response
■termed as classical or pavlovian ●Response decreased if presentation of
conditioning the conditioned stimulus is not accompanied
■Emphasizes the importance of stimulus by unconditioned stimulus over time
conditions and the associations formed in ●--Ex.if visitor becomes dizzy in one
the learning process hospital and goes to another hospital
■A neutral stimulus (NS)- a stimulus without smelling offensive odor then such
that has no particular value or meaning to discomfort about the hospital may be
the learner- is paired with naturally lessened after several experiences
occurring unconditioned or unlearned
stimulus(UCS) and the unconditioned
response(UCR) SYSTEMATIC DESENSITIZATION
■After a few such pairings, the NS alone
without the unconditioned stimulus elicits ●Is a technique based on respondent
the same response conditioning that is used by psychologist to
■Learning takes place when newly reduce fear and anxiety
conditioned stimulus(CS) becomes ●The assumption ...fear of a particular
associated with conditioned response (CR) stimulus or situation is 1 so therefore be "
■Often occurring without thought or unlearned"
awareness ●Based on the principle that repeated
and gradual exposure to fear inducing
stimulus under relaxed and non-threatening
circumstances will give the patient that
sense of security that no harm will come so
that he will no longer fear the stimulus(
Rehab, preop, phobias)

STIMULUS GENERATION

●The tendency of initial learning

experience to be easily applied to other
similar stimuli
offensive odors(UCS)-------- >queasy
feeling(UCR) Hospital (NS)+Offensive Ex. When listening to a friend describe a
odors(UCS)------> queasy feeling (UR) hospital experience, it becomes apparent
(several pairings of hospital+offensive that a highly positive or negative comment
odors------> queasy feeling Hospital may color the listener's evaluation of
(CS)-------> Queasy feeling (CR) hospital stay and so with subsequent
hospitalization

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time after an operation, praise and

●But with varied experiences, one learns encouragement( reward) for his
to differentiate among similar stimuli hence effort at walking ( response) will
the discrimination learning occurs improve the chances that he will
●Much of clinical practice involves continue struggling for
discrimination learning independence

Thorndike's law of effect

SPONTANEOUS RECOVERY
●when specific responses are reinforced
on a proper schedule, the behaviors can be
increased or decreased"
The principle may operate as follows: ●"REWARD or PRAISE" = encouraged or
●Although a response may appear to motivated
extinguished, it may " recover" and
reappear at any time( even years later),
especially when stimulus conditions are
similar to those in initial learning experience OPERANT CONDITIONING
●It helps us understand why it is so MODEL
difficult to completely eliminate unhealthy
habits and addictive behavior such as
● contingencies to increase or
smoking, alcoholism or drug abuse
decrease the probability of the
organism's response
OPERANT CONDITIONING
To increase To decrease

●Developed largely by B.F. SKINNER

A. positive A.
●FOCUSES on the BEHAVIOR of the
reinforcement: Nonreinforcement:
organism and the REINFORCEMENT that application of an organism's
follows after the response pleasant stimulus conditioned
response is not
Reinforcer Reward followed by
●Stimulus or Event applied after a conditioning: a reinforcement
pleasant stimulus is
response that strengthens the probability
applied following an B. Punishment:
that the response will be performed again organism's following a
●responses closely followed by response response, an
satisfaction will become firmly attached to aversive stimulus is
the situation and therefore more likely to B. Negative applied which the
reoccur when the situation is repeated reinforcement: organism cannot
removal of an escape or avoid
unpleasant stimulus
Example:
Although patient moans and groans Escape
as he attempts to walk for the first

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conditioning: as an EDUCATIONAL REINFORCERS

aversive stimulus is
applied, the
organism makes a ●RECOGNITION (praise, certificate of
response that accomplishment, pat on the back)
causes the ●TANGIBLE REWARDS (grades, food,
unpleasant stimulus
prizes, citation)
to cease
●SCHOOL RESPONSIBILITIES
Avoidance (opportunities for increased self
conditioning: an management, participation in Decision
aversive stimulus is Making)
anticipated but ●STATUS INDICATORS (appointment as
response.is made peer tutor; having own space)
to avoid unpleasant
●INCENTIVE FEEDBACK (increased
event
knowledge of exam scores; knowledge of
individual contributions)
●PERSONAL ACTIVITIES (opportunity to
engage in special projects; extra time off)
APPLICATION/IMPLICATIONS: Note:
REINFORCEMENT should be appropriate
or directly linked to the learning tasks and
●PRAISE may assist in the transfer of
student's accomplishment.
learning
●Learning under the CONTROL OF
REWARD is preferable under control of
punishment Negative Reinforcement
Hilgard, 1956

EMPLOYING POSITIVE 1.Escape conditioning: As the

REINFORCEMENT unpleasant stimulus is applied, the
individual response in some way that
●VERBAL WAYS causes the uncomfortable behavior to cease
●NON-VERBAL WAYS Ex. Suppose a student is being chastised in
●CITING IN CLASS or PUBLISHING front of the groupmates for always being
late and missing quizzes, he/she says
something humorous. The CI stops
criticizing and laughing. Because humor
allows him/her to escape the unpleasant
situation( stimulus), chances are that she
will apply humor again for the same
stressful situation.

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2. Avoidance conditioning and more likely not to be taken seriously or

●The unpleasant stimulus is anticipated to decrease the behavior they intend
rather than being applied directly ●Punishment should not be prolonged or
Example: bringing up old grievances or a complaining
A student fearing a CI or the test(unpleasant about misbehavior at every opportunity
stimulus) may tell the parents he/she has a ●There should be a " time out"
stomach ache. If allowed to stay home, the
student increasingly may complain of NOTE: CARDINAL RULE "PUNISH the
sickness to avoid unpleasant situation behavior, not the PERSON"
Note: It is use to explain some people's
tendency to become ill to avoid doing
COGNITIVE THEORIES OF LEARNING
something they do not want to do

3. Nonreinforcement ●Stress the importance of what goes on"

●Skinner maintained that the simplest inside" the learner
way to extinguish response is not to provide ●The key to learning and changing is
any reinforcement individual's cognition ( perception, thought,
Example: memory, and ways of processing and
Offensive jokes by a classmate maybe structuring information)
handled by showing no reaction; after such ●To learn, individual must change their
several experiences, the joke teller, who cognition
more than likely wants attention may curtail
his abrasive behavior ●A highly active process largely directed
by the individual and learning involves
Note: a desirable behavior that is ignored ■Perceiving the information
may lessen as well ■Interpreting it based on what is
■already known Reorganizing the
●If reinforcement is ineffective, then information to new insights or
punishment maybe employed understanding
●Under the punishment conditions, the
individual cannot escape or avoid the ●Maintain that reward is not
unpleasant stimulus necessary...more important are the learners'
●If employed, it should be administered goal and expectations and the tension,
immediately after the response with no disequilibrium and imbalance that they
distractions or means of escape cause which will act as their motivators
●Punishment must be consistent at the ●Transfer of learning occurs
"highest" reasonable level ■when the learner mediates or
acts on the information in some
Example: A CI who apologizes and smile ways
while student's behavior is being ■Similar pattern in the initial
admonished may send mixed messages situation and subsequent situation

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and the particular structure of the stimulus

PERSPECTIVE OF THE or situation
COGNITIVE LEARNING THEORY
Information-processing
Perspective of the Cognitive Learning
Theory Cognitive perspective that emphasizes the
thinking processes like;
1. Gestalt a. Thought
2. Information processing b. Reasoning
3. Cognitive development c. The way information is encountered and
stored
d. Memory functioning
Gestalt This perspective is particularly useful for
assessing problems in acquiring,
●Emphasizes the importance of remembering and recalling information
perception in learning

●Rather than focusing on discrete stimuli

gestalt refers to the configuration or
patterned organization of cognitive elements
reflecting the maxim that the " whole is
greater than the sum of the parts"

●A principal assumption is that each

person perceives, interprets, and responds
to any situation in his/her own way

●Psychological organization is directed

toward simplicity, equilibrium and regularity Stage I
(basic principle) ●Paying attention to environmental
Ex. Give the patient a clear and simple stimuli;
explanation of his disease condition to allay ●attention is the key to learning
his fears and uncertainties Note: if not attentive explain at another time
when one is receptive and attentive
Perception is Selective (central Gestalt
principle) 2nd stage
●Information is processed by senses
●No one can attend or pay attention to all ●It is important to consider the client's
surrounding stimuli at the same time preferred mode of sensory processing (
●What individual pay attention to or what visual, auditory, or motor manipulation)
they ignore may be affected by factors like ●Ascertain if there are sensory defecits
needs, personal motives, past experiences

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3rd stage ●According to Sternberg(1996) style of

thinking of the learner must be considered
●The information is transformed and in the perspective of information processing
incorporated (encoded) briefly into short ●Style of thinking - a preference for using
term memory, after which its either abilities in certain ways.
disregarded or forgotten or stored in long Note: people may shift from preferring one
term memory thinking style to another
●Long term memory involves the ●Information - processing perspective is
organization of information by using particularly helpful for assessing problems
preferred strategy for storage in acquiring, remembering and recalling
a. Imagery information
b. Association
c. Rehearsal Strategies
d.Breaking the information into units 1. Have learners indicate how they believe
they learn( metacognition)
4th stage 2. ask them to describe what they are
thinking as they are learning
●The action or response that the 3. Evaluate learner's mistake
individual makes on the basis of how the 4. Give them close attention to their inability
information was processed and stored to remember or demonstrate information

Nine events that activate effective learning Note :

with corresponding cognitive processes Forgetting or having difficulty in retrieving
information from long term memory is a
1. Gain the learners attention(reception) major stumbling block in learning which may
2. Inform the learners of the objectives and occur because :
expectations (expectancy)
3. Stimulate the learner's recall of prior > the information has faded from lack of use
learning (retrieval) > Other information interferes with retrieval (
4. Present information ( selective what comes before or after learning session
perception) 5. Provide guidance to facilitate may confound storage and retrieval)
learner's understanding(semantic encoding) > Individuals are motivated to forget for a
6. Have the learner demonstrate the variety of conscious or unconscious reasons
knowledge and skills (responding)
7. Give feedback to the learner( Cognitive development
reinforcement) 8. 8.Assess the learner's
performance(retrieval) ●The 3rd perspective that Focuses on
9. work to enhance retention and transfer qualitative changes in perceiving, thinking
through application and varied practice( and reasoning as individuals mature grow
generalization) (Robert Gagne,1995) and matures
●cognitions are based on how events are
conceptualized, organized and represented

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within each person's schema- a framework Preoperational stage (early

that is partially dependent on the individual's childhood-3-6yrs)
stage of cognitive stage of development and
readiness to learn ●Youngsters are able to mentally
representthe environment, regard the world
Principal Assumption.. from their own egocentric perspective and
come to grips with symbolism
●Learning is a developmental, sequential,
and active process that transpires as the Concrete operations stage (6-12yrs.-
child interacts with the environment, makes elementary)
" discoveries" about how the world
operates, and interprets these discoveries in ●Children are able to attend to more than
keeping with what she /he knows( schema) one dimension at a time, conceptualize
relationships and operate on the
Jean Piajet best known cognitive environment
developmental theory
Formal operational stage (12-18yrs-
●His observation of children's perception adolescence)
and thought processes at different ages
contributed much to the recognition of.. ●Teenagers begin to think abstracly, able
to deal with the future and can see
➤unique ways that youngsters reasons alternatives and criticize
the changes in their ability to conceptualized
According to this view:
➤ Limitations in understanding, children take in information as they interact
communicating and performing with people and the environment and either
make their experiences fit with what they
4 sequential stages of cognitive already know (assimilation) or change their
development (jean Piaget) perception and interpretation in keeping with
new information( accomodation)
1. sensori- motor
2. Preoperational Illustration:
3. Concrete operations young children do not usually understand
4. Formal operations that death is final. They respond to the
experience in their own way..perhaps asking
Sensori- motor (infancy) God to give back the dead or believing that
if they behave,the deceased loved one will
●Infants exolore their environment and be back
attempt to coordinate sensory information
with motor skills Implication:
Some children may learn more effectively
by discovering and putting pieces together

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on their own (Piaget)...while some learn

benefit from more social and directive
approach( Lev Vygotsky)

What do cognitive theorist say about

adult learing?

1. although the cognitive stages develop

consequentially, some adult never never
reach the operations stage
>They learn better from explicitly
concrete approaches to health education
●Role modelling is the central concept of
2. Adult developmental psychologist and the theory
sed advanced gerontologist have ●According to early social learning
propostages of reasoning in adulthood theory, much of the learning occurs by
beyond formal operations. observation- watching other people and
Example: not until early middle age may discerning what happens to them
adults become able to deal with ●Learning is often a social process and
contradictions, synthesize information, and other individual especially significant others
more effectively integrate what they have provide compelling examples or role models
learned( characteristic that differentiate for how to think, feel and act
adults thaought from adolescent thinking) ●Vicarious reinforcemeny-involves
viewing other people's emotion and
3. Older adults may demonstrate an determining whether role models are
advance level reasoning derived from their rewarded or punished for their behavior
wisdom and life experience, or they may
reflect lower stages of thinking due to lack 1. Attentional phase
of education, disease, depression, ●A necessary condition for any learning
extraordinary stress or medications to occur
●Research indicate that role modells with
high status and competence are more likely
to be obsrved, although the learner's own
Significant benefit to health care characterestics( needs, self-esteem,
●Its encouragement of a recognition and competence) may be the more significant
appreciation of the individuality and rich determiner of attention
diversity in how people learn and process
experiences 2. Retention phase
●involve storage and retrieval of what
was observed

3. Reproduction phase

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appropriate means of instruction that will

●learner copies the observed behavior enable the learner to master the subject
●Mental rehearsal, immediate under consideration
reenacment and corrective feedback
strenghtened the reproduction of behavior Steps in the assessment of learning
needs
4. Motivational Phase
●Focuses on wether the learner is 1. Identify the learner
motivated to perform a certain type of 2. Choose the right setting
behavior 3. Collect data on the learner
●Reinforcement or punishment for a role 4. Include the learner as source of
model's behavior, the learning situation and informatiom 5. Involve the members of the
the appropraiteness of the subsequent health care team
situation where the behavior is to displayed 6. Prioritize needsdetermine availability of
affect the learner's performance educational resources
7. Assess demands of the organization
DETERMINANTS OF LEARNING 8. Take time management issues into
account
1. learning needs( what the learner needs to
learn) Methods to assess learning needs
2. Readiness to learn( when the learner is
receptive to learning) 1. Informal conversations
3. Learning style( how the learner best learn 2. Structure interviews
3. Focus group
Learning Needs 4. Self- administered questionnaire
5. Test
Defined 6. Observation
7. Patients
●as gaps in the knowledge that exist 8. Chart audits
between a desired level of performance and 9. Formal and informal request
the actual performance 10. Chart audits
●As gap between what someone knows
and what someone needs to know Readiness to learn
Gap exist because of lack of knowledge,
attitude and skills ●The time when the learner
●90%-95% of the learners according to demonstrates an interest in learning the
many educators of education psychology type or degree of information necessary to
can master a subject with a high degree of maintain optimal health or to become more
success if given sufficient time and skillful in the is job
appropraite types of help. ●Occurs when the learner is receptive to
●The teacher must first discover the learning and willing to be able to participate
needs of the learner and then fin the most in the learning process

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●no matter how important the information Learning Styles

is or how much the educator feels the
recipient of teaching needs the information, ●Refers to the ways individuals process
if the learner is not ready, the information information
will not be absorb ●Accepting diversity of styles can help
●timing, is a point at which teaching educators create an atmospherebfor
should take place- is very important learning that offers experiences that
because anything that affects the physical encourage each individual to reach his or
or psychological comfort can affect the her full potential
learner's ability and willingness to learn ●No learning style is better or worse than
another
4 Types of readiness to learn (PEEK)
By: lichtenthal Six Learning Style Principles

1. Both the style by which the teacher

P= Physical E=Emotional
Readiness Readiness prefers to teach and the style by which the
student prefers to learn can be identified
● Measures of ●*Axiety level
ability ●*Support system 2. Teachers need to guard against
● Complexity ●*Motivation overteaching by their own preferred learning
of task ●Risk-taking styles
● Environmen behavior
tal effects ●*Frame of mind
● Health ●Developmental 3. Teachers are most helful when they
status stage assist the students in identifying and
● gender learning through their own style preferences

4. Students should have the opportunity to

E= experiential K= knowledge
Readiness Readiness learn through their own preferred style

●Level of ●Present 5. Students should be discourage to

aspiration knowledge base diversify their style preference
●Past coping ●Cognitive ability
mechanisms ●Learning 6. Teacher can develop specific learning
Cultural disabilities
activities that reinforce each modality or
background ●Learning styles
●Locus of control style
●orientation
Learning style models

●Kolb' (a management expert from Case

Wester Reserve University) Learning Styles

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●Believes taht knowledge is Gregorc Cognitive styles model

transformational process that continuously
created and recreated ● Identified 4 sets of dualities(
●Believes taht learning is a continuous situation thet consist of two parts
process grounded in the reality that the taht are complimentary or opposed
learner is not a blank state- every learner to each other
approaches a topic to be learned with ● The mind has the mediation abilities
preconceived ideas of:

Kolb's theory on learning style 1. perception- the wat one

receives or grasp incoming
learning is a cumulative result of : information or stimulus in a
● the past experiences, heredity, and continuum ranging from
the demands of the present abstractiveness to
environment concreteness

● These factors combine to produce 2. Ordering of knowledge the

different individual orientations to way one arranges and
learning systematizes incoming
● By knowing each learner's preferred stimuli in a continuum or
style the educator is better equipped scale ranging from sequence
to assist learners in refining or to randomness which affects
modifying these preconceived ideas the way a person learns
so that real learning can occur
Everyone processes or deals with
Cycle of learning(Kolb's model) perception and ordering of knowledge in all
● It includes four(4) des of learning 4 dimensions but may have preferences or
which refect two major dimensions choices of doing it and may fall into 4
of perception and processing mediation channels:

1. Concrete Sequential(CS)- learners

like highly structured, quiet learning
environments without interruptions;
like concrete learning materials
especially visuals and gives focus on
details; may interpret words literally

2. concrete random (CR)- intuitive,

trial- and - error methods of learning,
looks for alternatives

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3. Abstract sequential(AS)- learners

teaching;
are holistic thinkers and need telling or
consistency in the learning enjoying
environment; do not like verbal
interruptions; have good verbal jokes;
skills. Are rational and logical creative
writing and
appreciation
4. Abstract random(AR)- think of poetry
holistically, learn a lot from visual
stimuli; prefer busy, unstructured
learning environments; focus on 2. Logical / Mathematical
personal relationships. Calculations Refers to Pattern
, inductive recognition,
● Developed the Gregorc Style problem-sol and making
Delineator, a self-report inventory ving, logical deductive predictions,
reasoning & reasoning; estimating,
where the subject chooses the word
analysis, abstraction using
that best describes him/her. The statistic - and inductive &
learning styles are scored and the involves discernment deductive
highest number of total scores both side of of numerical reasoning,
indicates the preferred learning style the brain. patterns discerning
relationships
Gardner's Seven Types of Intelligence ( a and
connections,
theory specific to children's learning styles) performing
complex
1. Verbal / Linguistic calculations,
scientific
Domains of Facets of Facets of
reasoning,
intelligence Intelligence Intelligence
performs
and areas of ( features, ( features,
experiments
the brain aspects, or aspects, or
, seeking
characteristi characteristi
explanations
cs of cs of
,
intelligence) intelligence)
categorizing
Reading, Deals with Understandi information,
writing, written and ng the order computer
speaking-fo spoken and programmin
und in the words or meaning of g.
broca's area language; words;
in left side use and convincing
of the brain meaning of someone, 3. Spatial / Visual
language(s). verbal
debate; Arts, crafts, Involves the Recognizing
explaining in maps, ability to relationship
words, geometry, visualize an of objects in

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design - object to space, the use of for constant

side of the create sense of body movement
brain right internal direction, language and
images; finding way and physical exercise
ability to around, movement
transform or drawing,
create painting,
images; sculpting; 6. Interpersonal Intelligence
forming and color Community Emphasis on Verbal /
rotating discriminatio service, role communicati non-verbal
mental n, visual playing, on and communication
images perspective conflict interpersonal s, discerning
taking, resolution, relationships underlying
active leadership, intentions,
imagination teamwork - behavior and
4. Musical / Rhythmic prefontal perspectives,
lobes empathy,
Appreciation Sensitivity Understandi working
, vocal, to rhythm ng structure cooperatively,
instrumental and beat, of music, sensitive to
, recognition creating other's moods,
composition of tonal melodies / motives and
and rhythm patterns rhythm, feelings,
- found in and pitch sensing leading others,
the right and melodies of making and
side of the appreciation tone, keeping friends
brain of musical playing an
expression instrument, 7. Intrapersonal Intelligence
repeating a Journaling, Related to Accurate
tune, personal inner thought self-percepti
recognizing assessment processes on,
composers s, such as self-reflectiv
reflection and
reflections, e,
metacognitio
5. Bodily / Kinesthetic goal setting, n; includes self-directed
progress spiritual , sense of
Athletics, Taking in Hand-eye reports - awareness / values,
dance, and coordination prefrontal development intuitive,
acting, processing , mimetic area and independent
manual of (imitating or self-knowledg , awareness
dexterity, knowledge impersonati e and
exercise - through the ng) abilities, expression
basal use of speed,
ganglia and bodily agility and
cerebellum sensation; strength;
and other learning is endurance,
structure accomplishe working with
d through tools, need

33