Chapter 6

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Affective domain

the most intangible domain of the learning process. It involves affective behavior, which is conduct that expresses feelings, needs, beliefs, values and opinions, the feeling domain


Cognitive domain

the domain involved in the learning of storage of basic knowledge. It is the thinking portion of the learning process and incorporates an individual's previous experiences and perceptions; the learning/thinking domain


Health literacy

the degree to which individuals have the capacity to obtain and then process and understand basic health information as well as basic health information and services needed to make appropriate health decisions



the acquisition of knowledge or skill


Psychomotor domain

the domain involved in the learning of a new procedure or skill; often called the doing domain



a system of directed and deliberate actions intended to induce learning


Infancy (birth to 1 year):

trust versus mistrust; infant learns to trust himself or herself, others and the environment; learns to love and be loved


Toddlerhood ( 1 - 3 years of age)

autonomy versus shame and doubt: toddler learns independence; learns to master the physical environment and maintain self-esteem


Preschool age: (3-6 years old)

initiative versus guilt: preschooler learns basic problem solving; develops conscience and sexual identity; initiates activities as well as imitates


School age (6-12 years of age):

industry versus inferiority, school age child learns to do things well, develops a sense of self-worth


Adolescence (12-18 years of age)

identity versus role confusion; adolescent integrates many roles into-self-identity through imitation of role models and peer pressure


Young adulthood (18-45 years of age)

intimacy versus isolation; young adult establishes deep and lasting relationships, learns to make commitment as a spouse, parent, and/or partner


Middle adulthood (45-65 years of age):

generativity versus stagnation; adult learns commitment to the community and world; is productive in career, family and civic interests


Older adulthood (65+)

integrity versus despair: older adult appreciates life role and status; deals with loss and prepares for death


Types of cognitive and memory impairment:

slowed cognitive functioning; decreased short-term memory; decreased ability to think abstractly; decreased ability to concentrate; increased reaction time (slower to response)


Slowed cognitive functioning:

slow the pace of the presentation, and attend to verbal and nonverbal patient cues to verity understanding. New learning must related to what the individual already knows; concrete and practical information presented with sensitivity and patience. Whenever possible, the readability and language used should be below the 8th grade level; preferably at the 5th grade level of English


Decreased short-term memory:

limit content to one or two objectives. Provide smaller amounts of information at one time. Repeat information frequently. Provide written instructions for home use. Ask them to do, write, say or show something to confirm their understanding


Decreased ability to think abstractly:

use examples to illustrate information. Use a variety of methods, such as audiovisuals, props, videotapes, large-print materials, materials with vivid color, return demonstrations, and practice sessions


Decreased ability to concentrate:

decrease external stimuli as much as possible, keep communication short and use simple sentences without complex grammar. Keep handouts to one page, if at all possible


Increased reaction time (slower to respond):

always allow sufficient time, and be patient, allow more time for feedback.


Types of disturbed sensory perception

hearing impairment, visual impairment, touch and vibration impairment


diminished hearing:

perform a baseline hearing assessment: use ton-and volume-controlled teaching aids; use bright large-print material to reinforce


decreased ability to distinguish sounds:

speak distinctly and slowly and articulate carefully


Decreased conduction of sound:

sit on side of the patient's best ear


Loss of ability to hear high-frequency sounds:

do not shout; speak in a normal voice but a lower voice pitch


Partial to complete loss of hearing:

face the patient so that lip reading is possible. Use visual aids to reinforce verbal instruction. Reinforce teaching with easy-to-read materials; decrease extraneous noise; use community resources for the hearing impaired


Decreased visual acuity:

ensure that the patient's glasses are clean and in place and that the prescription is current


Decreased ability to read fine detail:

use printed materials with large print that is brightly and clearly colored. Print size needs to be fairly large if the older adult patient is using the materials at home


Decreased ability to discriminate among blue, violet and green; tendency for all colors to fade, with red fading the least:

use high contrast materials, such as black on white. Avoid the use of blue, violet and green in type or graphics; use red instead


Thickening and yellowing of lenses of the eyes, with decreased accommodation:

use nonglare lighting, and avoid contrasts of light


Decreased depth perception:

adjust teaching to allow for the use of touch to gauge depth


Decreased peripheral vision:

keep all teaching materials within the patient's visual field


Decreased sense of touch:

increase the time allowed for the teaching of psychomotor skills, the number of repetitions, and the number of return demonstrations


Decreased sense of vibration:

teach the patient to palpate more prominent pulse sites