MENTORSHIP IN HEALTH AND
SOCIAL CARE DIPLOMA COURSE
SESSION ONE
/HOW PEOPLE LEARN
/ TUTOR TALK:Chapters from books or journals are suggested in the text of the module. However, in the event of you not being able to find these texts, these are not essential to completing the question papers.AIM
The aim of this unit is to increase your understanding of how people learn in order to develop your ability to empower yourself and others to foster skills for lifelong learning.
/Section 1 – Empowerment
Let’s begin by exploring our understanding of the term empowerment. The everyday usage of the term in healthcare vocabulary is relatively recent and can be traced to changes to the structure of care delivery. These changes followed from the White Paper ‘Working for Patients’ (DoH 1989a) that resulted in the purchaser-provider split. This brought the concept of consumerism, which promotes individual responsibility and consumer choice, into the provision of healthcare, which in turn brought to the fore the concept of empowering the consumer.
/ ACTIVITY 1.1: QUESTIONWith reference to your role as a health or social care practitioner, make notes on your understanding of the term empowerment and list some activities you engage in with the aim of empowering patients or service users.
/ ACTIVITY 1.1: ANSWERYou might have listed activities such as providing information or physical resources for patients or service users with a health, social or disability problem.
These activities may have been intended to enable patients or service users exercise control in making decisions about managing their problem or disability.
The Concise Oxford Dictionary defines empowerment as ‘to authorize, license (a person to do); give power to, make able (person to do). The act of authorizing, licensing and making able according to Jack (1995) does not entail the giving of power. Jack (1995 p11), in his analysis of this definition, states that it ‘has two distinct meanings: enablement and empowerment’. In the former, the enabler controls the power over the process of enabling, whilst empowerment involves the processby which individuals, groups and/or communities become able to take control of their circumstances and achieve their own goals, thereby being able to work towards maximising the quality of their lives.
(Adams, 1990 cited by Jack 1995, p11)
Hamelink (1994, cited by Hogan 2000, p12) appears to indicate that the empowerment process can be initiated by the disempowered or by others acting on their behalf. Hamelink defines empowerment as:
a process in which people achieve the capacity to control decisions affecting their lives. Empowerment enables people to define themselves and to construct their own identities. Empowerment can be the outcome of an intentional strategy which is either initiated externally by empowering agents or solicited by disempowered people.
From the above definitions it can be gleaned that there are two different strands to the concept of empowerment. Common to both is the idea of enabling people to achieve their own identity. You might want to reflect again on your understanding of the term in the context of the activities you described. Before you read Rodwell’s (1996) ‘An analysis of the concept of empowerment’ it will be useful to reflect again on your understanding of the term in the context of the activities you engage in.
/ ACTIVITY 1.2: QUESTIONSpend a few minutes thinking about why you are studying this module and tick the statements below that are relevant;
I had no other option□
To obtain the award and the credits that go with it□
Most of my colleagues have already done it□
Because it will help me achieve my career goals□
To become more skilled in helping others learn□
It was time to start studying again□
Other reasons not listed (Please specify)□
/ ACTIVITY 1.2: ANSWERIf one of your reasons was ‘It was time to start studying again’, was this decision connected, for example, to your assessment of your own learning needs, because others may expect you to show evidence of ongoing continuing education, or a requirement of your professional organisation? Did you have the power to make the decision to undertake the module or were you empowered by another person?
Whatever the reasons for your decision to register for this module, you are now on a journey of exploration of your ability to empower yourself and others to develop the skills necessary for lifelong learning. Going back to Hamelink’s definition, this journey entails construction of your identity as a facilitator of learning.
/ ACTIVITY 1.3: QUESTION- We now ask you to identify:
- How you think this module will enable you to construct your identity as afacilitator of learning.
- How you think this module will enable you to develop a good learning environment.
- For an exploration of concepts of empowerment read: An Analysis of the Concept of Empowerment by Christine Rodwell. In this paper Rodwell (1996) analyses the concept and its use in nursing practice, education, research, and health promotion. From her literature review she identifies attributes essential for empowerment. She describes a model case for empowerment. In her conclusions she states that in order for empowerment to exist there is a need for management structure and education which supports and encourages the development of attributes necessary for empowerment.
- Re-read the section ‘Development of a Model Case’. Think of a situation where you were involved in a group activity either as a learner or a teacher. Were the attributes that Rodwell identifies as necessary for empowerment embraced within the activity?
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Section 2 – Lifelong Learning
While the way health care is organised and delivered has been subject to on-going change and development since the inception of the National Health Service (NHS), change and development have become a pattern of the wider society, nationally and internationally. For us as individuals, caught up in the process of change, it means that we have to adapt to new ways of thinking and doing and this more often than not requires us to develop our knowledge and skills or engage in new learning.
In the Dearing Report on Higher Education (1997), the term ‘lifelong learning’ is linked to the idea that if all individuals in society take responsibility for their own development, this will result in the creation of a ‘learning society’. This drive to create a learning society is a consequence of technological, social, and cultural change, and recognition that the scale and pace of change demands a response from individuals, institutions, and nations. External pressures have, to a large extent, driven changes within the NHS. These are reflected in publications over time such as:
Education and Training Working Paper 10 (DoH 1989b)
Making a Difference, Strengthening the Nursing, Midwifery and Health Visiting Contribution to Health and Healthcare (DoH 1999)
‘Working Together – Learning Together’, A Framework for Lifelong Learning for the NHS (DoH 2001)
Lifelong learning is both a philosophy and, in most health-related disciplines, a professional requirement. DoH (2001) states that;
‘Lifelong learning is primarily about growth and opportunity, about making sure staff are supported to acquire new skills and realise their potential to help change things for the better’
In all events, lifelong learning is about:
- Remaining flexible and open to change
- Learning to reflect on one’s actions and attitudes
- Building upon our existing knowledge and skills base
- Utilising that which we have acquired through experience.
Lifelong learning has been summed up in the following statement by Rogers (1983, p120):
“Teaching and the imparting of knowledge makes sense in an unchanging environment ……… But if there is one truth about modern man it is that he lives in an environment that is continually changing …….. We are, in my view, faced with an entirely new situation in education where the goal of education, if we are to survive, is the facilitation of change and learning.”
Note the distinction Rogers makes between helping others learn in an environment that is unchanging and an environment that is undergoing continuous change. According to Rogers (1983) to be educated is to know how to learn, know how to adapt and change, and know that no knowledge is secure. In the next section we will review some different theoretical perspectives about how people learn.
/Section 3 – Perspectives of Learning
The activity below requires you to recall a recent learning experience you have had where you learned something new or gained new insights. The experience may have occurred in the workplace, in a formal education setting, or a more informal setting such as home, sports or social club.
/ ACTIVITY 1.4: QUESTIONDescribe the learning experience; who was involved, venue, resources used.
Make notes of your new learning.
/ ACTIVITY 1.4: ANSWERThe learning experience you describe in this activity will be used throughout this section as the focus for developing your understanding of how people learn.
In response to item 3 you might have listed the way the learning activity was organised, resources for learning, inter-personal skills of the teacher, or perhaps it was a self-directed activity.
Bear your responses in mind as you read through the range of views about how people learn. Also reflect on the application of the various views to your practice of facilitating learning in the workplace. This will enable you to gain insights into the approach to learning that you believe will enhance your ability to empower yourself and others to learn.
Decisions about what people should learn, and how best they can be enabled to learn or be taught, depends upon what we believe learning is and how it occurs. Theories and concepts of learning are explanations and models proposed by those who have made a study of this complex aspect of human behaviour.
Bloom’s (1964) Taxonomy of Learning provides a useful framework for developing our understanding of what should be learned. Bloom describes three domains or categories of learning, namely:
- The cognitive – Knowledge
- The Affective – Attitudes and feelings
- The Psychomotor – Skills
In more explicit terms, the cognitive domain equates to knowing and understanding; the affective domain equates to emotions and feelings (attitudes); and the psychomotor domain equates to physical actions or doing (Nicklin & Kenworthy 2000). The learning experience you described in Activity 1.4 may have included one or more of Bloom’s three categories. More often these three domains overlap – as Nicklin & Kenworthy (2000) indicate, the separation of knowledge, attitudes and skills into distinct categories may be convenient when designing learning outcomes, but it does not reflect the reality of how people learn.For example, when learning how to move and handle patients, the learner needs to develop inter-personal skills, psychomotor skills and understanding of the underpinning principles of moving and handling.
By now you will be aware that in this module you are asked to engage in activities and many of these require you to think about and make notes about an aspect of your practice. This reflects a belief that learning should be active and that thinking about past and present experiences provides material for learning. However, it is evident that thinking about experiences is not necessarily sufficient for learning to take place and, more importantly, to be able to apply that learning in our practice. We hope that you will actively participate in the learning process as illustrated by David Kolb in his experiential learning cycle, which is described later in this section.
While learning theories can be classified into groups or families, in some cases there are often strong links between the ideas associated with the different groups. As you search through the literature you will find diversity in the way theories of learning are classified. As Jerome Bruner (1996 p50) cites:
‘different approaches to learning and different forms of instruction – from imitation, to instruction, to discovery, to collaboration – reflect differing beliefs and assumptions about the learner – from actor, to knower, to private experience, to collaborative thinker’.
In this unit we will review the following perspectives of learning:
- The Behaviourist
- The Cognitive
- The Humanist
THE BEHAVIOURIST PERSPECTIVE
Behaviourist theories were first formulated in the 19th century and are more concerned with overt behaviour than what is going on in the mind. They emphasise changing the visible behaviour of the learner rather than the underlying psychological structure and the unobservable behaviour. So, behaviourists are concerned with what people do, not what they think or feel. It is about changing behaviour so that learning is understood as an outcome rather than a process. Behaviourist theories have been derived from experiments on animals and not humans and therefore are considered limiting. Behaviourist theories are based on the idea of a stimulus and a response, whereby the former triggers the latter. Learning occurs through repeatedly building connections between a stimulus and the effect it has on the learner.
/ ACTIVITY 1.5: QUESTIONThe article you are now asked to read introduces you to the ideas of some of the most notable behavioural theorists, namely: Thorndike (trial and error learning), Pavlov (classical conditioning), Skinner (operant conditioning) and Bandura (social learning theory). Bandura’s work, although rooted in behaviourism, incorporates the cognitive processes.
Read the first of three articles by Gilean McKenna (1995), Learning Theories Made Easy: Behaviourism.
Note the examples to show the application of the various theories. Give examples from your own experience.
Note the emphasis behaviourists place on the idea of reinforcement in relation to positive and negative aspects of behaviour.
Refer to your notes on Activity 1.4. Can the features that helped you to learn be explained from the behaviourist perspective; for example, the opportunity to engage in trial and error learning and the feedback that you received.
THE COGNITIVE PERSPECTIVE
‘The term cognition refers to the internal mental processes of human beings, and encompasses the domains of memory, perception and thinking’ (Quinn 2000 p66).
The idea that the internal mental processes play a part in learning challenged the behaviourist perspective that dominated psychology in the first half of the twentieth century. Cognitive theorists claim that computer programmes can provide an analogy of how the human mind works. This is referred to as the computational or information processing model of the mind.
Information processing refers to the way people handle stimuli from the environment, organise data, sense problems, generate concepts and solutions to problems and employ verbal and non-verbal symbols (Joyce and Weil, 1987).
In the cognitive perspective theorists tend to view the learner as a passive recipient of knowledge. Claxton (1990 p29-31) presents an image of the teacher as a petrol-pump attendant who fills learners with refined knowledge delivered ‘by textbook tankers’.
/ ACTIVITY 1.6: QUESTIONRead the second of Gilean McKenna’s articles, Learning Theories Made Easy: Cognitivism.
As you read consider the examples the author gives to illustrate the application of the Gestalt laws of perception, the use of analogy, discovery learning, reception learning and information processing. Think about whether you can relate the examples given to your own experience as a learner or as a facilitator of learning, and make notes.
Identify any features of the cognitive perspective that are reflected in the experience you described in Activity 1.4.
Note that although Bruner is a leading proponent in the development of cognitive theory, he also holds that learners construct their own knowledge. He does not view the learner as passive but as actively participating in the learning process in collaboration with others, including the teacher. For Bruner (1996 p3) it is;
‘the cultural situatedness of meanings that assures their negotiability and, ultimately, their communicability’.
This reflects a situated view of learning that knowledge should be learned in a meaningful context through active learning; the learner acts within the environment rather than on it.
THE HUMANIST PERSPECTIVE
Humanistic psychology is the psychological perspective that emphasises the study of the whole person. Carl Rogers has been one of the most influential theorists in the development of this approach, although his conclusions owe a great deal to earlier work carried out by Abraham Maslow. Rogers (1983) cited by Thompson (1999 p23-33) holds that education should:
‘facilitate the process of change in an individual so that he or she may function fully’.
Rogers’ main area of interest was counselling and psychotherapy; in particular, non-directive counselling and client-centred therapy. However, Rogers’ contention that the counsellor’s function is to foster a climate of trust and openness in which clients can become more aware, and have a better understanding of themselves, runs parallel to modern concepts of education, and his ideas have since been adapted to learning and teaching. Rogers contrasts the kind of learning that is concerned with cognitive functioning with that involving the whole person. He regards learning from and through experience as one end of the spectrum while the other end is memory or rote learning.
Similarly, Malcolm Knowles’ work on adult learning has been most influential. He is the foremost contributor to the view that there are differences between the way children and adults learn. Knowles (1983) uses the term andragogy to describe the ‘art and science of helping adults learn’ in contrast to the term pedagogy which he describes as ‘the art and science of helping children learn’. The term, which according to Knowles et al (1998) was first used in the early 19th century, entered the literature of America in the late 1960s. Andragogy is based on assumptions about the characteristics of adult learners on which traditional pedagogy is based (Knowles 1983). These assumptions, which have grown from four to six over the decades, are: