Nurse As Educator 6th Edition

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Susan B. Bastable, EdD, RN

Krankenpflege
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Professor Emerita and Founding Chair
Department of Nursing
Purcell School of Professional Studies
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The Pedagogy NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DI
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Nurse as BartlettPrinciples
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of Teaching This interactive©approach
Jones addresses
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different
NOTLearning
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for Nursing Practice, Sixth Edition learning styles,NOT
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drives comprehension of various strategies ensure mastery
CHA PTEof
R key
1 concepts. The pedagog-
that meet the learning needs of students, while ical aids that appear in most chapters include
also generating enthusiasm about the topic. Overview of Education
the following:
in Health Care
Susan B. Bastable
Kattiria M. Rosario-Gonzalez

CHAPTER HIGHLIGHTS
Chapter Highlights Found at the beginning • Historical Foundations for Patient Education in Health Care
• The Evolution of the Teaching Role of Nurses
• Social, Economic, and Political Trends Affecting Health Care
of each chapter, these highlights provide a • Purposes, Goals, and Benefits of Patient and Nursing Staff/Student Education
• The Education Process Defined
• TheInterprofessional
Contemporary Role of the Nurse as Educator
quick-look overview of the content presented • Patient-Centered Education
• Quality and SafetyCare
and Practice
• The Institute of Medicine

© Jones & Bartlett Learning,
in each chapter. LLC © Jones & Bartlett Lea
Education in Nursing
• Report: The Future of Nursing
• Barriers to Teaching and Obstacles to Learning
• Factors Affecting the Ability to Teach
NOT FOR SALE OR • Factors Affecting

DISTRIBUTION the Ability to Learn
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• Questions to Be Asked About Teaching and Learning
• State of the Evidence
Key Terms A list of terms at the beginning of KEY TERMS
barriers to teaching interprofessional practice patient-centered care (PCC)
each chapter will expand the student’s profes- education process
interprofessional
learning
obstacles to learning
staff education
teaching and instruction
education (IPE) patient education
sional vocabulary.
4 Chapter 1 Overview of Education in Health Care © Ricardo Vasquez/EyeEm/Getty Images.
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OBJECTIVES
After completing this chapter, the reader will be able to:
Objectives These learning objectives provide
1.
2.
Discuss the evolution of patient education in health care and the teaching role of nurses.
Recognize trends affecting the healthcare system in general and nursing practice in particular.
instructors and students with a snapshot of the
3. Identify the purposes, goals, and benefits of patient and nursing staff/student education.
4.
5.
Compare the education process to the nursing process.
Define the terms education process, teaching, and learning.
key information they will encounter in each
6. Identify why patient and staff/student education is an important duty for nurses.
7. Analyze the significance of interprofessional education (IPE) and interprofessional practice to the
delivery of patient care. chapter. They serve as a checklist to help guide
8. Explain why the patient-centered care (PCC) movement is an important trend in health care.

9.
10.
Discuss the barriers to teaching and the obstacles to learning.
Formulate questions that nurses in the role of educator should ask about the teaching–
learning process.
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Education in health care today—both pa- Patient education is an issue in nursing
tient education and nursing staff/student practice and will continue to be a significant
education—is a topic of utmost interest to focus in the healthcare environment (Friberg
nurses in every setting in which they prac- et al., 2012). Because so many changes are
tice. Teaching is an important aspect of the occurring in the healthcare system, nurses are
nurse’s professional role (Andersson et al., increasingly finding themselves in challeng-
2015; McKenna et al., 2018; Steketee & Bate, ing, constantly changing, and highly complex
2013), whether it involves educating patients positions and, in some cases, do not have the
and their family members, colleagues, or nurs- appropriate skills to effectively teach patients
ing students. The current trends in health care (Gillespie & McFetridge, 2006; McKenna

are making it essential that patients be pre- et al., 2018; Pollack, 2017; Vennum, 2017).
pared to assume responsibility for self-care Nurses in the role of educators must under-
management and that nurses in the work- stand the forces, both historical and present
place be accountable for the delivery of safe, day, that have influenced and continue to in-

high-quality care (Dineen-Griffin et al., 2019;
Lockhart, 2016; Shi & Singh, 2015; U.S.
Department of Health and Human Services
fluence their responsibilities in practice.
One purpose of this chapter is to shed
light on the historical evolution of patient ed-
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[USDHHS], 2015). The focus of modern ucation in health care and the nurse’s role as
health care is on outcomes that demonstrate teacher. Another purpose is to offer a perspec-
the extent to which patients and their signifi- tive on the current trends in health care that
cant others have learned essential knowledge make the teaching of clients a highly visible
and skills for independent care or to which and required function of nursing care delivery.
staff nurses and nursing students have ac- Also, this chapter addresses the continuing
quired the up-to-date knowledge and skills education efforts necessary to ensure ongoing
needed to competently and confidently ren- practice competencies of nursing personnel.
der care to the consumer in a variety of set- In addition, this chapter clarifies the broad
tings (Committee on Quality of Health Care purposes, goals, and benefits of the teaching–
in America & Institute of Medicine [IOM], learning process; focuses on the philosophy of
2001; Doyle et al., 2013; IOM, 2001; Sal- the nurse–client partnership in teaching and
mond & Echevarria, 2017). learning; compares the education process to

ii © Ricardo Vasquez/EyeEm/Getty Images.

and healthcare reform, the benefits of client,
staff, and student education must be made
relationship.
Nurses can demonstrate responsibility

clear to the public, healthcare employers,
healthcare providers, and payers of healthcare
benefits. To be effective and efficient, nurses
and accountability for the delivery of care to
the consumer in part through education based
on solid principles of teaching and learning.
must be willing to embrace IPE and be able The key to effective education of the varied au-
The Pedagogy iii

to practice collaboratively with one another diences of learners is the nurse’s understand-
to provide consistently high-quality educa- ing of and ongoing commitment to the role of
tion to the audiences they serve. They also educator.
68 Chapter 2 Ethical, Legal, and Economic Foundations of the Educational Process
educator is legitimized through the definition ethnicity, literacy level, religious affiliation, or
Review Questions
Review Questions Review key concepts from
of nursing practice as set forth by the prevailing other defining attributes. All patients have a

nurse practice act in the state where the nurse right to receive health education relevant to
is licensed and employed and by codes of eth- their physical and psychosocial needs. Justice 1. Which key factors influenced the growth 7. What is the current focus and orientation
your reading with these exercises at the end of

ics governing professional conduct in various also dictates that education programs be de- of patient education during its formative
years?
of patient education?
8. Which social, economic, and political

employment settings. In this respect, patient signed not only to be consistent with organi-
2. How far back in history has teaching been trends today make it imperative that
education is a nursing duty that is grounded zational goals but most important to meet the
each chapter.
in justice; that is, the nurse has a legal respon-
sibility to provide education to all patients,
needs of patients to be informed, self-directed,
and in control of their own health, and ulti-
a part of the nurse’s role?
3. Which nursing organization was the first
patients be adequately educated?
9. What are the similarities and differences
to recognize health teaching as an import- between the education process and the
regardless of their age, gender, culture, race, mately of their own destiny.
ant function within the scope of nursing nursing process?
practice? 10. What are three major barriers to teaching
4. How did the concept of patient education and three major obstacles to learning?
change in the 1960s and 1970s? 11. Which factor serves as both a barrier to
5. Which legal mandate universally includes teaching and an obstacle to learning?
teaching as a responsibility of nurses? 12. What is the present status of research-
Review Questions 6. How have the ANA, NLN, ICN, AHA, TJC,
and Pew Commission influenced the role
and non-research-based evidence pertain-
ing to education?
1. What are the definitions of the terms ethi- 4. How are the six ethical principles applied and responsibilities of the nurse as educator?
© Jones & Bartlett Learning, LLC

cal, moral, and legal, and how do they dif-
fer from one another?
2. Which national, state, professional, and
to the delivery of patient education?
5. What are four examples of direct costs
and five examples of indirect costs in the
CASE STUDY
private-sector organizations legislate, reg- provision of patient/staff education?
ulate, and provide standards to ensure the 6. What are the definitions of the following As a clinical nurse educator at Utopia Hospital, part of your duties is to instruct nurses in the most
protection of human rights in matters of terms: fixed direct costs, variable direct costs, up-to-date processes to improve patient safety and outcomes. Recently, due to an increase in readmission
health care? indirect costs, cost savings, cost benefit, cost re- rates at your hospital for heart failure patients, you have been tasked with developing patient education
3. Which ethical viewpoint, deontological or covery, revenue generation, cost-benefit anal- goals based on feedback from the professional nursing staff that patients must meet before discharge.
teleological, refers to the decision-making ysis, cost-benefit ratio, and cost-effectiveness You set out to find out how these nurses, of which more than half are bachelor’s degree prepared
or higher, are currently educating patients on heart failure medications, lifestyle changes, and self-
approach that choices should be made for analysis?
monitoring techniques. In the process, you sense a definite interest and motivation from the nursing staff
the common good of people? in wanting to improve their teaching skills and the quality of care they are providing, but also you hit a few
roadblocks. Frequently, you hear nurses say, “I don’t really know what or how much to tell patients when
they ask me about heart failure,” “I don’t have time to educate patients throughout the day,” and “I always
Case Studies Located at the end of each chap-
try my best to teach, but I don’t know if my efforts make much of a difference.” Because the nursing staff
CASE STUDY
Katelyn is a new RN working the night shift on a medical/surgical unit. Mr. Williams, a patient in a
room next to Katelyn’s assigned area, has been setting off the bed alarm all night, and other patients
ter,&
© Jones case studies encourage
Bartlett Learning,active learning and
LLC
are starting to complain about the disturbance. Katelyn goes in to assist the nurse, Arlene, who is in
promote critical thinking skills in learners.
the room trying to control the situation. Mr. Williams is out of bed, clearly confused and disoriented,
claiming that he is being held hostage and needs to get out of there. Katelyn helps Arlene get the
patient back into bed safely, but it is clear he is not going to stay there for long. Arlene is clearly
flustered and says, “I’ve had enough!” before hurrying out of the room and returning with four-point
restraints. She turns to Katelyn and states, “The doctor won’t give me any more medication to put this
Students can read about real-life scenarios
patient down, so I am putting these on him just to have time to get some charting done. I’ll take them
off in the morning before anyone sees.” Katelyn knows that Arlene does not have an order for restraints
and that they can cause harm to the patient, especially when not used appropriately.
and then analyze the situation the case study
1.
2.
What plausible actions should Katelyn take at this point?
Which legal and ethical reasons could Katelyn rely on to justify the actions she takes?
presents by answering three or four questions
3. Which of Katelyn’s actions seem the most justified from a moral and ethical standpoint?
relevant to the scenario.


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Identifiers: LCCN 2021022691 | ISBN 9781284229271 (paperback)
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dear professional
Learning, LLC
colleague, mentor, long-time friend, and fellow student
at Columbia University, who was the one to inspire me to write
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granted me a semester off from my educator responsibilities
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did
© Jones & I realize that Learning,
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two editions. Janice is the original author of Chapter 2 and
served as a contributor to my first four editions of this text.
She opened
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over the years have shared their teaching experiences as
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Brief Contents

Foreword xiii © Jones & Bartlett Learning, LLC
Preface xiv
Acknowledgments xvi
Contributors xvii
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PART ONE Perspectives on Teaching
and Learning 1
CHAPTER
© Jones 1 Overview
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in Health Care
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CHAPTER 2 Ethical, Legal, and Economic
Foundations of the Educational
Process. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
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PART TWO Characteristics of the Learner 125

CHAPTER 4 Determinants
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CHAPTER 5 Developmental Stages

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CHAPTER 7 Literacy in the Adult Client Population. . . . . . 269
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Brief Contents vii
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8 Learning,
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the Learner. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329
CHAPTER 9 Educating Learners With Disabilities
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CHAPTER 14 Evaluation in Healthcare Education. . . . . . . . . 629
Appendix A 665
AppendixLLC
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Glossary 685
Index 709




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Foreword . . . . . . . . .Learning,
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Review Questions. . . . . . . . . . . . . . . . . . . 30 LLC
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References. . . . . . . . . . . . . . . . . . . . . . . . 31
Acknowledgments . . . . . . . . . . . . . . . xvi
CHAPTER 2 Ethical, Legal,
Contributors . . . . . . . . . . . . . . . . . . . . . xvii
and Economic Foundations
Über uns
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PART ONE Perspectives
on Teaching A Differentiated View of Ethics,
and Learning 1 Morality, and the Law. . . . . . . . . . . . . . 42
© Jones & Bartlett Learning, LLC of Ethical and Legal © Jones & Bartlett Lea
Evolution
1 Overview
CHAPTERNOT of
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Education in Health Care. . . . . . . . . . . 3
Application of Ethical Principles
Susan B. Bastable, Kattiria M. to Patient Education. . . . . . . . . . . . . . . 46
Rosario-Gonzalez The Ethics of Education in
Historical Foundations for Patient Classroom and Practice
© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning,
Settings. . . . . . . . . . . . . . . . . . . . . . . . . 53 LLC
Education in Health Care. . . . . . . . . . . . 5
Legality of Patient Education
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The Evolution of the Teaching Role
of Nurses. . . . . . . . . . . . . . . . . . . . . . . . 9 and Information . . . . . . . . . . . . . . . . . . 58
Social, Economic, and Political Legal and Financial Implications
Trends Affecting Health Care . . . . . . . 10 of Documentation. . . . . . . . . . . . . . . . . 59
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Patient and Nursing Education: Justice
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Staff/Student Education. . . . . . . . . . . . 13 Duty Revisited. . . . . . . . . . . . . . . . . . . . 62
The Education Process Defined . . . . . . . 14 Financial Terminology. . . . . . . . . . . . . . . 63
The Contemporary Role of the Program Planning
Nurse as© Educator. . . . . . . . . . . . . . . . 16 and Implementation. . . . . . . . . . . . . . . 65
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Obstacles to Learning . . . . . . . . . . . . . 23
Questions to Be Asked About State of the Evidence. . . . . . . . . . . . . . . . 67
Teaching and Learning. . . . . . . . . . . . . 27 Summary . . . . . . . . . . . . . . . . . . . . . . . . . 67
State of the Evidence. . . . . . . . . . . . . . . . 28 Review Questions. . . . . . . . . . . . . . . . . . . 68
Summary . . . . . . . . . . . . . . . . . . . . . . . . . 29 References. . . . . . . . . . . . . . . . . . . . . . . . 69
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Contents ix
CHAPTER 3 Applying CHAPTER 5 Developmental

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Motor Learning . . . . . . . . . . . . . . . . . . . 104 The Role of the Family in Patient
Common Principles Education . . . . . . . . . . . . . . . . . . . . . . 214
of Learning. . . . . . . . . . . . . . . . . . . . . 113 State of the Evidence. . . . . . . . . . . . . . . 216
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References. . . . . . . . . . . . . . . . . . . . . . . 118
CHAPTER 6 Motivation and
Adherence: Impact on
Changing Learner Behavior. . . . . . 223
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CHAPTER 4 Determinants Health Behavior Models and
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xii Contents
Analyzing and Interpreting Appendix B Resources and

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Foreword NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DI
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Health care in Learning, LLC
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by highly competent and compassionate care- to learn, learning styles, motivation and ad-
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needs of their patients and who collaborate technology in education all based on the latest
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© Ricardo Vasquez/EyeEm/Getty Images. xiii


Preface NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DI
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legal, ethical, and moral responsibility of regis- dents is critical to the provision of high-quality
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Preface xv
The content of this text reflects a balance This text is comprehensive in scope, tak-
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giver of information only but must function as Teaching patients, well or ill, to maintain op-
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and three new colleagues who joined the team rent references that were used to update the
to contribute their professional knowledge, content of many of the chapters. She made
practice expertise, and fresh perspectives in herself available at all times and responded
revising the content of the remaining chap- promptly to my many requests for books and
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ters. Every one & Bartlett
of them dedicated theirLearning,
efforts LLC journal articles. The in-depth
full-text © Jones inves-& Bartlett Lea
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Also, I extend my sincerest thanks to the once again has written the foreword in this
entire publishing staff of the nursing divi- text. She has been a national leader in health
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sion of&Jones
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& Bartlett LLC
Learning for making care for decades©andJones & Bartlett
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Maria Leon Maimone, rights specialist. They a very close friend and colleague for many
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lication. Also, I want to recognize Escaline countless hours and endless months that I de-
Charlette Aarthi from S4Carlisle Publishing voted to research, writing, and editing, which
Services for © herJones & Bartlett
meticulous skills as a Learning,
project wasLLC
key to making this Sixth Edition© aJones
reality. & Bartlett Lea
xvi © Ricardo Vasquez/EyeEm/Getty Images.


Contributors
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Susan Learning,
B. Bastable, LLC
EdD, RN Pamela© R. Jones
Gramet,& Bartlett
PhD, PT Learning, LLC
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Consultant AssociateNOT FOR
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Emeritus
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Department of Nursing State University of New York
Purcell School of Professional Studies Upstate Medical University
Le Moyne College Syracuse, New York
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Syracuse, New © Jones & Bartlett Learning, LLC
Diane Hainsworth, MS, RN-C, ANP
Margaret M. Braungart, PhD
Clinical Case Manager—Oncology (retired)
Professor Emerita of Psychology University Hospital
Center for Bioethics and Humanities State University of New York
State University of New York Upstate Medical University
Upstate
© Medical
JonesUniversity
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Syracuse, New York
Sharon Kitchie, PhD, RNNOT FOR SALE OR DI
Richard G. Braungart, PhD Director of Patient Education and Interpreter
Professor Emeritus of Sociology and Services (retired)
International Relations Licensed COVID-19 Resource Line Call Taker
Maxwell School of Citizenship and Public University Hospital
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SUNY Upstate & University
Medical Bartlett Learning, LLC
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Lois Linden, EdD, RN
Natalie M. Capacci, MS, FNP-C, RN Associate Professor
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Gina M. Myers, PhD, RN
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Leadership
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Kathleen Fitzgerald, MS, RN, CDE
Associate/Research Consultant
Patient Educator (retired)
St. Joseph’s Health
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& Joseph’s Hospital Health Center
Learning, LLC Syracuse,©New
Jones
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© Ricardo Vasquez/EyeEm/Getty Images. xvii

xviii Contributors
M. Janice Nelson, EdD, RN

©Dean
Professor and Jones Previous
Emerita LLC Contributors © Jones & Bartlett Lea
College of Nursing to Recent Editions NOT FOR SALE OR DI
State University of New York
Upstate Medical University Leigh Bastable Poitevent, FNP-BC, RN
Syracuse, New York Nurse Practitioner Colleague Wellness
Atrium Staffing on Assignment to Pfizer, Inc.
Mary Jean (MJ) Petersen,
© Jones & Bartlett Learning, LLC EdD, RN Andover, Massachusetts
Associate Professor (retired) (Chapter 7)
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Priscilla Sandford Worral,
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About the Author

Susan Bacorn program;©anJones & Bartlett
innovative Learning, LLC
4-year undergraduate
NOT FOR SALE OR DISTRIBUTION Bastable earned NOT
dual-degree FOR SALE
partnership OR DISTRIBUTION
in nursing (DDPN)
her MEd in com- supported by two Robert Wood Johnson
munity health Foundation grants in conjunction with the
nursing and her associate’s degree program at St. Joseph’s Col-
EdD in curricu- lege of Nursing in Syracuse; a BS-MS bridge
& Bartlett Learning, LLC © Jones
lum and instruc- & Bartlett
program; Learning, RN-MS
a postbaccalaureate LLC certifi-
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tion in nursing SALE OR
cate program; DISTRIBUTION
a master of science program and
at Teachers Col- three post-MS certificate programs with tracks
lege, Columbia in nursing education, nursing administration,
University, in and informatics; and most recently a family
1976 and 1979, nurse practitioner (FNP) program as well as a
respectively. She LLC
post-MS FNP option. © Jones & Bartlett Lea
received her di- Dr. Bastable has taught NOT undergradu-
FOR SALE OR DI
ploma in nursing from Hahnemann Hospital ate courses in nursing research, community
School of Nursing (now known as Drexel Uni- health, and the role of the nurse as educator,
versity of the Health Sciences) in Philadelphia and courses at the master’s and postmaster’s
in 1969 and her bachelor’s degree in nursing level in the academic faculty role, curriculum
© Jones & Bartlett
from SyracuseLearning, LLC
University in 1972. © Jones
and program & Bartlett
development, Learning, LLC
and educational
Dr. Bastable was professor and found- NOT
assessment andFOR SALE
evaluation. ForOR DISTRIBUTION
31 years, she
ing chair of the Department of Nursing at Le served as consultant and external faculty mem-
Moyne College in Syracuse, New York for 11 ber for Excelsior College (formerly known as
years. She retired in May 2015 and was hon- Regents College of the University of the State
ored with the title of professor emerita. She of New York). Her clinical practice includes
& Bartlett Learning, LLC career in 1979 as assistant
began her academic © Jones & Bartlett
experiences Learning,
in community LLConcology,
health,
professor
R SALE OR DISTRIBUTION at Hunter College, Bellevue School rehabilitation and
NOT FOR SALE OR DISTRIBUTION neurology, occupational
of Nursing in New York City, where she re- health, and medical/surgical nursing.
mained on the faculty for 2 years. From 1987 Dr. Bastable received the President’s
to 1989, she was assistant professor in the Award for Excellence in Teaching at Upstate
College of Nursing at the University of Rhode Medical University and the SUNY Chan-
©InJones
Island. & Bartlett
1990, she joined the Learning,
faculty of the LLC
cellor’s Award for Excellence © Jones & Bartlett Lea
in Teaching.
College of Nursing at the State
NOT FOR SALE OR DISTRIBUTION University of Also, she was recognized for the Women
NOT FOR SALE in OR D
New York (SUNY) at Upstate Medical Uni- Leadership Award from the Greater Syracuse
versity in Syracuse, where she was associate Chamber of Commerce and was honored
professor and chair of the undergraduate pro- with the Distinguished Achievement Award
gram for 14 years. In 2004, she assumed her in Nursing Education from Teacher’s College,
© Jones & Bartlett
leadership Learning,
position LLCCollege and
at Le Moyne Columbia © University.
Jones &InBartlettaddition Learning,
to author- LLC
NOT FORsuccessfully
established an RN-BS completion NOT FOR
ing six editions SALE
of Nurse OR DISTRIBUTION
as Educator, she is
© Ricardo Vasquez/EyeEm/Getty Images. xix

xx About the Author
the author of two editions of Essentials of Pa- mentioned herein, the first of its kind in the
© Jones
tient Education and is the&main
Bartlett
editor Learning,
of two LLC For years she has been ©anJones
country. involved& Bartlett Lea
NOT
editions of the FORHealth
textbook SALE OR DISTRIBUTION
Professional as member of numerous nursing education NOT FOR ad- SALE OR DI
Educator. visory boards. Currently, she also has been an
In retirement, she has been serving in active volunteer for 10 years with Honor Flight
the role of a nursing education consultant Syracuse, an organization that flies veterans to
for national and regional program accredita- Washington, DC to visit the war memorials
© Jones & Bartlett
tions and Learning,
assisting colleges LLCacross
of nursing erected in their © Jones
honor. She is&the
proud parent
NOTNewFOR SALE
York OR states
and other DISTRIBUTION
in replicating the NOT
of two Navy officer FORand
veterans SALE OR DISTRIBUTION
the grandpar-
unique 1+2+1 dual-degree partnership model ent to three beautiful grandchildren.





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Susan B. Bastable, EdD, RN

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© Jones & Educator:

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• The Institute of Medicine

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The Pedagogy iii

68 Chapter 2 Ethical, Legal, and Economic Foundations of the Educational Process

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your reading with these exercises at the end of

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© Jones & Bartlett Learning, LLC

© Jones & Bartlett Learning, LLC © Jones & Bartlett Lea

& Bartlett Learning, LLC In honor of Dr. M. Janice Nelson,

Also, to nursing students and professional colleagues who

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PART TWO  Characteristics of the Learner 125

CHAPTER 5 Developmental Stages

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CHAPTER 7 Literacy in the Adult Client Population. . . . . . 269

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© JonesCHAPTER Cultural Attributes

CHAPTER 12 Instructional Materials. . . . . . . . . . . . . . . . . . . . . . . 535

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CHAPTER 3 Applying CHAPTER 5 Developmental

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Assessment: Clues to Look For. . . . . . 285 CHAPTER 9 Educating Learners

CHAPTER 8 Cultural CHAPTER 10 Behavioral

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Development of Teaching Plans. . . . . . 462 CHAPTER 13 Technology

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Analyzing and Interpreting Appendix B Resources and

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PART TWO Characteristics of the Learner 125