Learning Level and Teaching Strategies for Early Childhood In Nursing Education
What Is Early Childhood (3-5 Years of Age)
Children in the preschool years continue with development of skills learned in the earlier years of growth. Their sense of identity becomes clearer, and their world expands to encompass involvement with others external to the family unit. Children in this developmental category acquire new behaviors that give them more independence from their parents and allow them to care for themselves more autonomously. Learning during this developmental period occurs through interactions with others and through mimicking or modeling the behaviors of playmates and adults (Crandell et al., 2012; Santrock, 2017).
Developmental Aspects of Early Childhood
The physical maturation during early childhood is an extension of the child's prior growth. Fine and gross motor skills become increasingly more refined and coordinated so that children can carry out activities of daily living with greater independence (Crandell et al., 2012; Kail & Cavanaugh, 2015; Santrock, 2017). Although their efforts are more coordinated, supervision of activities is still required because they lack judgment in carrying out the skills they have developed.
The early childhood stage of cognitive development is labeled by Piaget (1951, 1952, 1976) as the preoperational period. This stage, which emphasizes the child's inability to think things through logically without acting out the situation, is the transitional period when the child starts to use symbols (letters and numbers) to represent something (Crandell et al., 2012; Santrock , 2017; Snowman & McCown, 2015).
Children in the preschool years begin to develop the capacity to recall past experiences and anticipate future events. They can classify objects into groups and categories but have only a vague understanding of their relationships. The young child continues to be egocentric and is essentially unaware of others' thoughts or the existence of others' points of view.
Thinking re-mains literal and concrete-they believe what is seen and heard. Caudal thinking allows young children to understand that people can make things happen, but they are unaware of causation as the result of invisible physical and mechanical forces. They often believe that they can influence natural phenomena, and their beliefs reflect animistic thinking the tendency to endow inanimate objects with life and consciousness (Pidgeon, 1977; Santrock, 2017).
Preschool children are very curious, can think intuitively, and pose questions about almost anything. They want to know the reasons, causes, and purpose for everything (the why), but are unconcerned at this point with the process (the how). Fantasy and reality are not well differentiated. Children in this cognitive stage mix fact and fiction, tend to generalize, think magically, develop imaginary playmates, and believe they can control events with their thoughts.
At the same time, they do possess self awareness and realize that they are vulnerable to outside influences (Crandell et al., 2012; Santrock, 2017).The young child also continues to have a limited sense of time. For children of this age, being made to wait 15 minutes before they can do something can feel like an eternity. They do, however, understand the timing of familiar events in their daily lives, such as when breakfast or dinner is eaten and when they can play or watch their favorite television program. As they begin to understand and appreciate the world around them, their attention span (ability to focus) begins to lengthen such that they can usually remain quiet long enough to listen to a song or hear a short story read (Santrock, 2017).
In the preschool stage, children begin to develop sexual identity and curiosity, an interest that may cause considerable discomfort for their parents. Cognitive understanding of their bodies related to structure, function, health, and illness becomes more specific and differentiated. They can name external body parts but have only an ill defined concept of the location of internal organs and the specific function of body parts (Raven, 2016).
Explanations of the purpose and reasons for a procedure remain beyond the young child's level of reasoning, so any explanations must be kept very simple and matter of fact (Pidgeon. 1985). Children at this stage have a fear of body mutilation and pain, which not only stems from their lack of understanding of the body but is also compounded by their active imagination.
Their ideas regarding illness are also primitive with respect to cause and effect; Illness and hospitalization are thought to be a punishment for something they did wrong, either through omission or commission (London et al., 2017). Children's attribution of the cause of illness to the consequences of their own transgressions is known as egocentric causation (Polan & Taylor, 2015; Richmond & Kotelchuck , 1984).
Erikson (1963) has labeled the psychosocial maturation level in early childhood as the period of initiative versus guilt. Children take on tasks for the sake of being involved and on the move. Excess energy and a desire to dominate may lead to frustration and anger on their part. They show evidence of expanding imagination and creativity, are impulsive in their actions, and are curious about almost everything they see and do.
Their growing imagination can lead to many fears-of separation, disapproval, pain, punishment, and aggression from others. Loss of body integrity is the preschool child's greatest threat, which significantly affects his or her willingness to interact with healthcare personnel (Poster, 1983; Vulcan, 1984).
In this phase of development, children begin interacting with playmates rather than just playing alongside one another. Appropriate social behaviors demand that they learn to wait for others, give others a turn, and recognize the needs of others. Play in the mind of a child is equivalent to the work performed by adults. Play can be as equally productive as adult work and is a means for self education about the physical and social world (Ormrod, 2012).
It helps the child act out feelings and experiences to master fears, develop role skills, and express joys, sorrows, and hostilities. Through play, children in the preschool years also begin to share ideas and imitate parents of the same sex. Role playing is typical of this age as the child attempts to learn the responsibilities of family members and others in society (Santrock, 2017).
Teaching Strategies In Early Childhood In Nursing Education
The nurse's interactions with preschool children and their parents are often sporadic, usually occurring during occasional well-child visits to the pediatrician's office or when minor medical problems arise. During these interactions, the nurse should take every opportunity to teach parents about health promotion and disease prevention measures, to provide guidance regarding normal growth and development, and to offer instruction about medical recommendations related to illness or disability.
Parents can be a great asset to the nurse in working with children in this developmental phase, and they should be included in all aspects of the educational plan and the current teaching experience. Parents can serve as the primary resource to answer questions about children's disabilities, their idiosyncrasies, and their favorite toys all of which may affect their ability to learn (Bedells & Bevan , 2016; Hussey & Hirsh, 1983).
Children's fear of pain and bodily harm is uppermost in their minds, whether they are well or ill. Because young children have fantasies and active imaginations, it is most important for the nurse to reassure them and allow them to express their fears openly (Heiney, 1991). Nurses need to choose their words carefully when describing procedures and interventions and keep explanations simple (Miller & Stoeckel, 2016).
Pre school children are familiar with many words, but using terms such as cut and knife is frightening to them. Instead, nurses should use less threatening words such as fix, sew, and cover up the hole. Band-Aids is a much more understandable term than dressings, and bandages are often thoughts by children to have magical healing powers (Miller & Stoeckel, 2016).
Although still dependent on family, the young child has begun to have increasing contact with the outside world and is usually able to interact more comfortably with others. However, significant adults in a child's life should be included as participants during teaching sessions. They can provide support to the child, substitute as the teacher if their child is reluctant to interact with the nurse, and reinforce teaching at a later point in time.
The primary care-takers, usually the mother and father, are the recipients of most of the nurse's teaching efforts. They are the learners who will assist the child in achieving desired health outcomes (Callans et al., 2016; Kaakinen, Gedaly Duff, Coehlo , & Hanson, 2010; Whitener, Cox, & Maglich, 1998). The following specific teaching strategies are recommended.
For Short Term Learning
- Provide physical and visual stimuli because language ability is still limited, both for expressing ideas and for comprehending verbal instructions.
- Keep teaching sessions short (no more than 15 minutes) and scheduled sequentially at close intervals so that information is not forgotten.
- Relate information needs to family activities and experiences to the child. For example, ask the child to pretend to blow out candles on a birthday cake to practice deep breathing.
- Encourage the child to participate in selecting among a limited number of teaching-learning options, such as playing with dolls or reading a story, which promotes active involvement and helps to establish nurse-client rapport.
- Arrange small group sessions with peers to make teaching less threatening and more fun.
- Give praise and approval, through both verbal expressions and nonverbal gestures, which are real motivators for learning.
- Give tangible rewards, such as badges or small toys, immediately following a successful learning experience to encourage the mastery of cognitive and psychomotor skills.
- Allow the child to manipulate equipment and play with replicas or dolls to learn about body parts. Special kidney dolls, ostomy dolls with stomas, or orthopedic dolls with splints and tractions provide opportunities for hands on experience. Use storybooks to emphasize the humanity of healthcare personnel; to depict relationships between the child, parents, and others; and to help the child identify with certain situations.
For Long Term Learning
- Enlist the help of parents, who can play a vital role in modeling a variety of healthy habits, such as practicing safety measures and eating a balanced diet; offer them access to support and follow-up as the need arises.
- Reinforce positive health behaviors and the acquisition of specific skills.
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