Dunia tanpa sempadan, pengetahuan dan mentality memberikan kesinambungan kepada pengalaman yang menakjubkan dalam dunia pemikiran
World without borders, knowledge and mentality provide continuity to the amazing experience in the world of thought
Stress is your body's way of responding to any kind of demand.
It can be caused by both good and bad experiences.
When people feel stressed by something going on around
them, their bodies react by releasing chemicals into the blood.
These chemicals give people more energy and strength, which
can be a good thing if their stress is caused by physical danger.
But this can also be a bad thing, if their stress is in response to
something emotional and there is no outlet for this extra energy
and strength
What cause of stress
Many different things can cause stress.
From physical (such as fear of something dangerous) to
emotional (such as worry over your family or job) – these often
referred as “stressors.”
Some of the most common sources of stress are:
Survival Stress - You may have heard the phrase "fight or flight"
before. This is a common response to danger in all people and
animals. When you are afraid that someone or something may
physically hurt you, your body naturally responds with a burst of
energy so that you will be better able to survive the dangerous
situation (fight) or escape it all together (flight). This is survival
stress.
Internal Stress - Have you ever caught yourself worrying about
things you can do nothing about or worrying for no reason at
all? This is internal stress and it is one of the most important kinds
of stress to understand and manage. Internal stress is when
people make themselves stressed. This often happens when we
worry about things we can't control or put ourselves in situations
we know will cause us stress. Some people become addicted
to the kind of hurried, tense, lifestyle that results from being
under stress. They even look for stressful situations and feel stress
about things that aren't stressful.
Environmental Stress - This is a response to things around you
that cause stress, such as noise, crowding, and pressure from
work or family. Identifying these environmental stresses and
learning to avoid them or deal with them will help lower your
stress level.
Fatigue and Overwork - This kind of stress builds up over a long
time and can take a hard toll on your body. It can be caused
by working too much or too hard at your job(s), school, or
home. It can also be caused by not knowing how to manage
your time well or how to take time out for rest and relaxation.
Good stress vs Bad stress
So if stress can be so bad for you, how can there be "good" or
"positive" stress?
If you are suffering from extreme stress or long-term stress, your
body will eventually wear itself down. But sometimes, small
amounts of stress can actually be good.
Understanding your stress level is important. If nothing in your life
causes you any stress or excitement, you may become bored
or may not be living up to your potential. If everything in your
life, or large portions of your life, cause you stress, you may
experience health or mental problems that will make your
behavior worse.
Understanding the illness link about the stress:
Neurobiological perspectives:
The body pays a price if must constantly adapt to stress.
This ‘price’ can be expressed in terms of what is referred to as
allostatic load - (allostatic (or allotasis) - is the process of achieving
stability, or homeostasis, through physiological or behavioral
change).
If the body is exposed to high levels of stress hormones such as
cortisol and becomes susceptible to disease because of altered
immune system functioning – a high allostatic load.
Psychodynamic perspectives:
Franz Alexander (1950) – repressed emotional impulses created
a chronic negative emotional state that impacted health, thus
setting the stage for problems like ulcers, asthma, or essential
hypertension.
Cognitive and personality perspectives:
Physical threats obviously create stress – so do negative
emotions such as resentment, regret, and worry.
Negative emotions stimulate sympathetic nervous system
activity and may keep the body’s stress systems aroused and
the body in a continual state of emergency, sometimes for far
longer than it can bear, as suggested by the notion of allostatic
load.
Personality traits have been linked to immune system
functioning – e.g. negative emotions linked to slow antibody
production.
Physical and mental signs of short-term stress
Often occurring in quick 'bursts' in reaction to something in your
environment, short-term stress can affect your body in many ways.
Some examples:
•Making your heartbeat and breath faster
•Making you sweat more
•Leaving you with cold hands, feet, or skin
•Making you feel sick to your stomach
•Tightening your muscles or making you feel tense
•Leaving your mouth dry
•Making you have to go to the bathroom frequently
•Increasing muscle spasms, headaches, fatigue, and shortness of
breath.
While this burst of energy may help you in physical situations where
your body needs to react quickly, it can have bad effects on your
mind and performance if there is no outlet or reason for your stress.
These effects may include:
•Interfering with your judgment and causing you to make bad
decisions
•Making you see difficult situations as threatening
•Reducing your enjoyment and making you feel bad
•Making it difficult for you to concentrate or to deal with
distraction
•Leaving you anxious, frustrated or mad
•Making you feel rejected, unable to laugh, afraid of free time,
unable to work, and not willing to discuss your problems with
others.
Physical and mental signs of short-term stress
Long-term stress or stress that is occurring over long periods of time can
have an even greater effect on your body and mind. Long-term stress can
affect your body by:
Changing your appetite (making you eat either less or more)
Changing your sleep habits (either causing you to sleep too much or
not letting you sleep enough)
Encouraging 'nervous' behavior such as twitching, fiddling, talking too
much, nail biting, teeth grinding, pacing, and other repetitive habits
Causing you to catch colds or the flu more often and causing other
illnesses such as asthma, headaches, stomach problems, skin problems,
and other aches and pains
Affecting your sex life and performance
Making you feel constantly tired and worn out.
Long-term stress can also have serious effects on your mental health and
behavior:
Worrying and feeling anxious (which can sometimes lead to anxiety
disorder and panic attacks)
Feeling out of control, overwhelmed, confused, and/or unable to make
decisions
Experiencing mood changes such as depression, frustration, anger,
helplessness, irritability, defensiveness, irrationality, overreaction, or
impatience and restlessness
Increasing dependence on food, cigarettes, alcohol, or drugs
Neglecting important things in life such as work, school, and even
personal appearance
Developing irrational fears of things such as physical illnesses, natural
disasters like thunderstorms and earthquakes, and even being terrified of
ordinary situations like heights or small spaces.
Stress Management
Relaxation training – the most common form of relaxation training is
progressive muscle relaxation, which involves systematically tensing
and then relaxing each major muscle group in the body.
Cognitive restructuring – includes approaches to alter people’s belief
systems and reduce the negativity of their interpretations of
experience.
Behavioral skills training – practice in skills such as time management
and effective prioritizing.
Abnormal Breathing Technique
Breathing exercises such as this one should be done twice a day or
whenever you find your mind dwelling on upsetting thoughts or when
you are experiencing pain:
Place one hand on your chest and the other on your abdomen.
When you take a deep breath in, the hand on the abdomen
should rise higher than the one on the chest. This insures that the
diaphragm is pulling air into the bases of the lungs.
After exhaling through the mouth, take a slow deep breath in
through your nose imagining that you are sucking in all the air in
the room and hold it for a count of 7 (or as long as you are able,
not exceeding 7).
Slowly exhale through your mouth for a count of 8. As all the air is
released with relaxation, gently contract your abdominal muscles
to completely evacuate the remaining air from the lungs. It is
important to remember that we deepen respiration not by
inhaling more air but through completely exhaling it.
Repeat the cycle four more times for a total of 5 deep breaths
and try to breathe at a rate of one breath every 10 seconds (or 6
breaths per minute). At this rate our heart rate variability increases
which has a positive effect on cardiac health.
Ethical quandaries develop when individuals or
communities are forced to make difficult judgements involving moral principles
or values that are in contradiction with one another. These quandaries
frequently give rise to challenges and disputes. Because they require
individuals to make decisions between opposing interests, ethical dilemmas can
offer substantial problems. However, there is not always a straightforward
answer to these conundrums. Its include decision-making conflicts, stakeholder
conflicts, legal and regulatory conflicts, public perception and reputation and
emotional distress.
It is essential to confront ethical conundrums in a
methodical and reflective manner, taking into account a variety of viewpoints,
ethical frameworks, and the potential outcomes of one's actions. Participating
in open discourse, looking for ethical counsel, and fostering a culture of
ethical awareness are all things that may help reduce the likelihood of
disputes and make it easier to deal with these issues. The decision to put an
end to one's life presents complicated obstacles and tensions since it requires
one to make challenging choices regarding medical treatment, care, and the
preservation of human life in the face of severe circumstances or terminal
sickness. This moral conundrum emerges when individuals, families, and
healthcare professionals are put in a position where they must make decisions
that will have an effect on the persons' quality of life, autonomy, and dignity
as they draw closer to the end of their lives.
Communication that is both open and empathic is necessary
to address the problems and tensions that are inherent in end-of-life choice
dilemmas. This communication must involve patients, their families, healthcare
providers, and other stakeholders. Access to palliative care, advance care
planning, and ethical frameworks, such as shared decision making models can all
be helpful in navigating these issues and promoting compassionate
decision-making in end of life circumstances.
1.Case Study 1
Adam was a 2-year-old child
with congenital acute myeloid leukemia. He was admitted to the pediatric
intensive care unit (PICU) after receiving an allogeneic bone marrow
transplant. One week after the transplant, a severe pulmonary infection
developed, resulting in irreversible lung injury; he was ventilator dependent.
Adam was a patient in the PICU for 2 months and he had good and bad days. On his bad days, the PICU
staff struggled to manage his hypoxemia, hypercapnia, and hemodynamic
instability. He had several close calls to death, including being resuscitated
twice after having cardiac arrests. Neurologically at times, he opened his eyes;
he had limited motor ability. When he became restless, he was given sedative
drugs.
Several family meetings
occurred over his 2-month PICU stay. The palliative care team was consulted 5
weeks into his stay. At the most recent meeting, the palliative care APRN
reviewed Adam’s illness trajectory, discussed his current condition and told Adam’s
parents that the team would like to consider a change in the focus of Adam’s
care.
The pediatric intensivist
discussed Adam’s poor prognosis and his parents were given time to ask
questions. The palliative care APRN discussed the possibility of focusing
Adam’s care on comfort and suggested that it was time to consider decisions
such as withholding cardiopulmonary resuscitation (CPR) if Adam’s heart were to
stop again. She asked Adam’s parents whether they would support this decision.
Adam’s mother said that she agreed that CPR should not be started if her son’s
heart stopped. Adam’s father became angry and stated that the staff was giving
up on his son. He absolutely wanted all treatment continued, including CPR. He
got up and stormed out of the conference room.
Adam’s PICU nurse was not
sure whether to stay in the meeting or leave. She decided to leave and look for
Adam’s father. She found him sitting at his son’s bedside crying. He told her
that he needed a little time alone, so the nurse left and gave him time with
his son. When she returned, she acknowledged how difficult it must be to
participate in these types of decisions. Adam’s father told her that he did not
want to give up on his son. The nurse reinforced what good parents both he and
his wife were. Adam’s father said that he needed time to think about
everything. He had hoped that his son would recover and he was just starting to
realize that he might not. The PICU nurse emphasized that Adam would continue
to receive the best care possible, regardless of what decision was made, and
that the team was there to help not only Adam but also his family. (Wiegand, 2015, pg. 145)
This case study presents a
conflicting decision between both parents of a terminally ill 2-year-old boy
with acute myeloid leukemia. Despite a poor prognosis as well as multiple
resuscitations from cardiac arrests, the father refused to discontinue resuscitation
attempts with the perception that the medical team is giving up on his son. The
mother, however, was accepting of the decision due to the condition of her son.
The medical team, however, was adhering to the ethical principle of autonomy,
by allowing both of the parents, the autonomous legal guardian of their son, to
give their final decision on this end-of-life matter. Despite wanting to
provide the best treatment that may benefit the patient (beneficence), the
medical team also would like to reduce and minimize any harm that may be
inflicted on the 2-year-old boy (non-maleficence).
One of the dilemmas that
may be seen here is the contradiction between the father’s decision from the
medical team’s advice. Other than the literal physical definition of ‘alive’
towards the patient, the decision-maker, in this case, the parents, must also
consider the weight of their son’s quality of life should the treatment and
resuscitation be continued, apart from the consideration of their cultural and
religious norm. The process of end-of-life decision-making should consider the
well-being of the patient from all aspects; physical, emotional, religious, and
even personal beliefs (Puteri, 2015). Though admittedly, a 2-year-old may have
less consideration for religion and personal beliefs, the consideration of
end-of-life decisions should also include the immediate family and guardian.
The counsel team did a
praiseworthy job in assuring the parents that they will strive in providing the
best care possible for whichever path the parents choose to decide. Should the
parents choose the continue treatment, the medical team will work hard in
providing the best treatment that benefits the patient, and if the parents
choose to discontinue treatment and resuscitation, the medicals team will also
give as much effort in maximizing comfort and care if the provision of the best
palliative care for their son, Adam.
Ethically, this end-of-life
decision may only be made by the parents and should not be interfered with by
any other party. However, the medical team and the psychological support team,
if any, should be ready to be transparent and honest (veracity) in providing a
full, detailed explanation of Adam’s condition to both parents. The parents
should be able to make a fully informed decision and psychological and
emotional support services should be made available to the parents should they
need them. End-of-life care is an all-hands-on-deck situation where every party
serves a huge role in ensuring the best outcome for the patient, the parents as
well as the medical team. Despite everyone’s involvement, both decisions of
continuing or discontinuing treatment are not ethical violations as long as all
information is given and received by all parties involved
2.Case
Study 2
The case of Ms. Rahimah is
a hypothetical case study of a 65-year-old woman with end-stage chronic
obstructive pulmonary disease (COPD), a condition characterized by the
progressive deterioration of the airways in the lungs. Despite undergoing
various treatments for her condition over the years, her COPD has continued to
worsen, and she has now reached a point where her doctors have determined that
there are no more viable treatment options available. They have explained that
her condition will ultimately lead to her death, and they have suggested that
she and her family begin to think about her end-of-life care.
Rahimah has expressed to
her doctors and family that she does not want to prolong her suffering any
further, and she has decided to elect hospice care. Hospice care is a form of
palliative care that provides comfort and pain relief to patients who are dying,
and it often involves the withdrawal of life-preservation interventions such as
intubation or resuscitation. Ms. Rahimah's decision to elect hospice care
reflects her desire to prioritize comfort and quality of life overextending her
life at all costs.
While Ms. Rahimah's
decision may be a difficult one for some family members to understand, it is
ultimately her right to self-determination, as she is entitled to make
decisions about her healthcare based on her values and preferences. Her
decision is an example of the importance of open and honest discussions about
end-of-life care and the role that patients, families, and healthcare
professionals play in these discussions. By taking an approach to end-of-life
care, we can help patients and families make informed decisions that prioritize
comfort, dignity, and quality of life.
End-of-life decisions are
complex and require careful consideration of the patient's preferences and
values. The case of Ms. Rahimah illustrates the importance of respecting a
patient's autonomy in making these decisions, and providing care that
prioritizes comfort, relief from suffering, and an increase in quality of life.
Autonomy is a fundamental
principle in ethics and is especially important in end-of-life care. It
involves allowing a patient to make their own healthcare decisions, including
decisions about their end-of-life care. By treating a patient as autonomous person,
we respect their dignity and agency, and we help to ensure that their values
and preferences are considered in care planning.
In the case of Ms. Rahimah,
it was important to respect her autonomy in making her decision to elect
hospice care. She had the right to make this decision, and it was not
appropriate for others to impose their own beliefs or values on her. Healthcare
professionals should provide information, support, and guidance to help
patients make informed decisions, but they should not pressure patients to
choose a particular course of care.
Aside from respecting
autonomy, it is also important to provide care that is non-maleficent or that
does not cause harm. Hospice care is designed to provide comfort and relief
from suffering, rather than to prolong life at all costs. Healthcare professionals
should ensure that they are not providing treatments or interventions that
could cause harm or prolong suffering and should instead focus on providing
palliative care that addresses the patient's needs and aims to improve their
quality of life.
In addition to
non-maleficence, it is also important to provide care that is beneficial or
that brings about good. End-of-life care should not only be about avoiding harm
but should also be about providing benefits to the patient, such as relief from
pain and distress, and an increase in their quality of life. Palliative care is
designed to do just that, and healthcare professionals should take a holistic
approach to care that addresses the patient's physical, emotional, and
spiritual needs.
Finally, justice is a
principle that requires individuals to be treated fairly and equitably and not
be subjected to discrimination or bias. In the case of Ms. Jones, it is
important that healthcare professionals do not discriminate against her based
on her age, or gender.
3.Case
Study 3
John Anderson, a
68-year-old man, has been living with end-stage heart failure for the past two years. Current Condition severe shortness of breath, fluid retention, declining
organ function. Despite various medical interventions, his condition has progressively
worsened. John's heart function has significantly declined, leading to severe
shortness of breath and fluid retention. He is frequently hospitalized for
complications related to his heart failure. The medical team believes that John
is approaching the end stages of his illness.
Ethical Dilemma:
John's family and
healthcare providers are facing an ethical dilemma regarding end-of-life
decisions. John's condition is unlikely to improve, and his quality of life is
greatly compromised. The medical team and family members have different
opinions on the best course of action. Some family members advocate for
continuing
aggressive interventions, while others believe that
focusing on comfort care and ensuring a peaceful end is more appropriate.
Options Considered:
Continuation of Aggressive Interventions:
Continue with advanced
medical treatments, such as cardiac interventions, mechanical circulatory
support, or transplantation, with the goal of extending John's life. Engage in
ongoing discussions with the medical team to assess the potential benefits, risks,
and burdens of these interventions. Understanding these factors will help John
and his loved ones make informed decisions regarding the continuation of
aggressive treatments. Ensure that John's goals and preferences are considered
in the decision-making process.
Transition to Palliative Care and Symptom
Management:
Transitioning to palliative
care signifies a shift in the treatment approach, placing emphasis on improving
John's quality of life. Instead of pursuing aggressive interventions, the focus
now shifts to providing holistic care that addresses his physical, emotional,
and spiritual well-being. Palliative care aims to alleviate symptoms, manage
pain, and enhance overall comfort, allowing John to make the most of his
remaining time. Symptom management is a vital aspect of palliative care.
Medications are commonly used to alleviate symptoms such as pain, nausea,
anxiety, and shortness of breath. The palliative care team, in collaboration
with John, will develop an individualized plan tailored to his specific needs.
This approach ensures that medication regimens are optimized, providing
effective relief while minimizing potential side effects. Shortness of breath
is a distressing symptom often experienced by individuals with advanced medical
conditions. In palliative care, oxygen therapy and non-invasive ventilation can
significantly improve John's breathing and enhance his comfort. These
interventions aim to alleviate breathlessness, allowing him to engage in
activities that bring joy and maintain a sense of independence.
Shared Decision-Making and Advance Care Planning:
Shared decision-making is
crucial in the continuation of aggressive interventions. It involves
collaboration between John, his family, and the medical team. By providing
comprehensive information about the available treatment options, their
potential outcomes, and associated risks, the medical team can empower John and
his family to actively participate in the decision-making process. This
collaborative approach ensures that the final decision aligns with John's
values, preferences, and long-term goals.
4.Conclusion
From the case study
presented, there are 3 prong conflicts that can be observed regarding
decision-making for end-of-life care; the patient’s advocate vs healthcare
worker, the patient vs her family member, and the patient’s family member vs
the healthcare worker.
In this dire situation,
everyone involved does have their best intention at heart, aiming for the best
outcome for the patient, but when it concerning the end of life care, the
willingness to participate in the conversation is varied, both for the patient’s
themself and their relatives as it is emotionally challenging (Gjerberg, E. et
al, 2015) and it poses communication challenge even with the healthcare
provider (Naomi, R. et al. 2016). Adding the weight of the situation is when
the patient can’t exercise their autonomy, the responsibility to make the
decision will fall onto their legal next-of-kin, as this has always been part
of hospital policies.
However, many of the
patient’s relatives did not really know what the patient’s needs were, despite
the patient’s belief in them (Georg Bollig et al. 2016).
Since all the case studies
happen in hospital settings and involve palliative care, referring to
Palliative Care Services Operational Policy 2010 by the Ministry of Health
(MOH) is essential as it provides ethical guidelines for handling the
situation. As palliative care is generally a new medical specialty recognized
by MOH in 2005, another guideline that can be helpful to assist in the
decision-making for the professional parties is Handbook in Palliative Medicine
in Malaysia, developed in 2015. The reasons this was emphasized was that this
policy and handbook can assist in making better solutions for the case studies,
as it is coherence with Principal A: Beneficence and Non-Maleficence, of APA
General Principle (2010) when the psychologists' scientific and professional
judgments and actions may affect the lives of others, they need to be alert and
guarded against personal, financial, social, organizational, or political
factors that might lead to misuse of their influence.
According to the policy,
effective communication skills are essential tools in palliative care and
healthcare providers must develop these skills, including effective listening,
providing information, facilitating decision making and coordinating care among
the patient, family, and other healthcare providers, as this has proven to
better prepare the patient for their final outcome and reduce moral distress
for their relatives (Georg Bollig et al. 2016). This provision is aligned with
Principle E: Respect for People's Rights and Dignity, of APA General Principle
(2010), where individual differences are respected and taking these differences
into consideration when working with others.
Managing end-of-life care
decision’s making can also be guided by the Resolution on Palliative Care and
End-of-life Issues, adopted by the APA Council of Representatives, which
“endorses the principles that care for individuals with advanced serious illness
should be comprehensive, high quality, integrated, interdisciplinary,
patient-centered and family oriented, coordinated across all providers and
settings; accessible, and available through governmental and private health
insurers and care delivery programs. Individuals should have the opportunity to
engage in conversations about their health care, the results of which should be
incorporated into ongoing care plans.” (2017, para 74).
eorg Bollig, Eva
Gjengedal and Jan Henrik Rosland (2016) They know! —Do they? A qualitative
study of residents and relatives’ views on advance care planning, end-of-life
care, and decision-making in nursing homes. Palliative Medicine Vol. 30(5)
456–470 DOI: 10.1177/0269216315605753
Gjerberg, E.,
Lillemoen, L., Førde, R. et al. (2015) End-of-life care communications and
shared decision-making in Norwegian nursing homes - experiences and
perspectives of patients and relatives. BMC Geriatric 15 https://doi.org/10.1186/s12877-015-0096-y
Naomi R. George,
Jennifer Kryworuchko, Katherine M. et al. (2016) Shared Decision Making to
Support the Provision of Palliative and End-of-Life Care in the Emergency
Department: A Consensus Statement and Research Agenda. Academic Emergency
Medicine https://doi.org/10.1111/acem.13083
Jahn
Kassim, P. N., & Alias, F. (2015). End-of-life decisions in Malaysia:
Adequacies of Ethical Codes and Developing Legal Standards. Journal of Law and
Medicine.
Wiegand,
D. L., MacMillan, J., dos Santos, M. R., & Bousso, R. S. (2015). Palliative
and end-of-life ethical dilemmas in the Intensive Care Unit. AACN Advanced
Critical Care, 26(2), 145–146. https://doi.org/10.4037/nci.0000000000000085
American
Heart Association. (2017). Shared Decision-Making in Advanced Heart Failure: A
Scientific Statement from the American Heart Association. Circulation: Heart
Failure, 10(9), e000025.
National
Consensus Project for Quality Palliative Care. (2021). Clinical Practice
Guidelines for Quality Palliative Care, 4th edition. Retrieved from https://www.nationalcoalitionhpc.org/ncp/.
Meier,
D. E. (2011). Increased access to palliative care and hospice services:
Opportunities to improve value in health care. The Milbank Quarterly, 89(3),
343-380.
Upadhyay,
A., & Mello, M. M. (2014). The ethics of chronic pain management. In J. C.
Ballantyne & D. J. Sullivan (Eds.), The Oxford Textbook of Palliative
Medicine (5th ed., pp. 126-134). Oxford University Press.
Akdeniz,
M., Yardımcı, B., & Kavukcu, E. (2021). Ethical considerations in
end-of-life care. SAGE Open Medicine, 9, 20503121211000918.
Cavallaro,
V. (2014). Advance Directive Accessibility: Unlocking the toolbox containing
our end-of-life decisions. Touro L. Rev., 31, 555.
Parks,
S. M., Winter, L., Santana, A. J., Parker, B., Diamond, J. J., Rose, M., &
Myers, R. E. (2011). Family factors in end-of-life decision-making: Family
conflict and proxy relationship. Journal of palliative medicine, 14(2),
179-184.
2. HOW MIGHT THE INCREASE OF ADAPTIVE
BEHAVIOUR BE A DISADVANTAGE FOR STUDENTS INTRINSICALLY MOTIVATED TO
LEARN? 5 - 8
3. WHAT ARE THE EDUCATIONAL
IMPLICATIONS OF THE POTENTIAL FOR
CONCRETE REWARDS TO DIMINISH
INTRINSIC MOTIVATION FOR A GIVEN TASK? 9-11
4. CONCLUSION
12
5. REFERENCES
13
INTRODUCTION
In order to be successful, rewards must stimulate the recipient. It is critical to
determine what the youngster really desires, either through direct questioning or via
careful observation. Often, incentives might be in the form of a chance to do something
desired, such as stand at the front of the line or make a statement over a loudspeaker.
Other than that it may also be something tangible, such as a toy or a cookie. It
may be beneficial to adopt a token system for older children, in which youngsters get
a sticker for each period of excellent conduct. When a specified amount of rewardearned stickers are used, the game is considered complete.
Furthermore, providing students with a reward helps to encourage good and
proper conduct among kids in your class. By rewarding students for excellent
behaviors such as following class rules, being courteous to one another, and
maintaining safety as a priority, you may encourage positive behaviors to be
expressed in your classroom. Teachers are able to devote more time to lesson material
and interactive activities that engage students in learning rather than to classroom
discipline as a result of good student conduct.
Next is if student success leads to student happiness, and in order to have a
classroom full of happy kids, instructors could consider using a reward system. Offering
incentives to kids who are productive in their study both at home and at school may
motivate them to continue their learning. Students are more likely to be motivated to
be more productive when they get rewards because they experience a sense of pride
and accomplishment.
Finally, When students feel a feeling of belonging and respect in the classroom,
they are more likely to experience intrinsic drive to study, according to research. When
evaluative components of the classroom are de-emphasized and students feel that
they have some influence over the learning environment, internalization may be
facilitated more effectively. Furthermore, giving students with activities that are tough
yet attainable, as well as a justification for participating in different learning activities,
might help them to become more intrinsically motivated to complete such tasks.
HOW MIGHT THE INCREASE OF ADAPTIVE BEHAVIOUR BE A
DISADVANTAGE FOR STUDENTS INTRINSICALLY MOTIVATED TO LEARN?
Intrinsic motivation student has the ability to learn without wanting to getting
external reward and they usually motivate themselves to learn because they are willing.
While extrinsic motivation student mostly depends on rewards to learn something. If
teachers regularly give reward to drive positive behavior, later on, the student will be
bored with the same reward and they will demand more expensive reward. Don’t forget
that the institution of learning is established for every child to go through learning
process to make them more prepared for their own future. But, if the student learns not
by himself wanting to learn, how long do you thing the knowledge he gets will last? If
a student applies adaptive behavior to get reward, do you think he will still learn if
there’s no reward? That’s why school should put limitation on the use of concrete
rewards since it can be a disadvantage mostly for students who are intrinsically
motivated to learn.
Kids that always get reward after competing in certain task given by the teacher
in class can influence his classmates either positive or negative way. He or she can
drive motivation away or give motivation to his fellow classmates. As an example of
negative influence, an extrinsically motivated student said to his fellow classmate
behind teachers back “There’s no need for you to study properly from its root. You just
need to memorize properly and know how to answer it so you can get the reward from
teacher”. In this situation, we can conclude that this kid learns only to get the reward.
While student who are intrinsically motivated will spend more time to study each
knowledge properly because of their passion and love to learn. Some of intrinsically
motivated student take time longer time to understand certain knowledge better.
Extrinsically motivated student can promote bad example to intrinsically motivated
student. Furthermore, if intrinsically motivated student happens to always need to
compete with extrinsically motivated student, he or she will feel pressure or feel that
the learning process is no fun anymore and later, it will result to their passion for
learning decrease or extinct.
The use of concrete rewards to increase adaptive behaviors can create
competitive nature among student. It’s great to create healthy and positive
environment but there’ also a bad side to it. As a matter of fact, competition can make
student develop self-discipline but if teachers not properly handling competition in
education, it can discourage learning.
Some student can drive themselves to learn while others need encouragement
or motivation and that’ s where we need the present of external stimulus which is
reward. Once the reward is present, the student aim will change toward the reward.
But what happen if the reward is easily given? The student will lose its independent
self and tend to cling on the reward. In certain cases, if the reward is no longer serve,
the student will no longer follow the adaptive behaviors. The dependency to the reward
may lead to the changes of attitude of some student. Imagine, a kid always gets the
latest toy whenever he does homework, but one day, when his aunty take care or him,
she didn’t give toys to the kid after he finish his homework. He asks many times and
still didn’t get the toy. So, he starts to throw tantrum because of the privileged he
usually got no longer exist. Later on, the kid starts to ignore his homework as a protest.
It’s the same as the student case, when there’s no longer reward, so they no longer
want to develop adaptive behaviors. So, in the end, the intrinsically motivated student
who are willing to learn becomes unwilling to learn. That’s the reason why teacher
should plan properly on when to us the concrete reward.
Other than that, Intrinsic motivation also defined as the doing of an activity for
its inherent satisfaction rather than for some separable consequence. When
intrinsically motivated, a person is moved to act for the fun or challenge entailed rather
than because of external products, pressures, or rewards. Intrinsic motivation occurs
when students are engaged because of internal rewards, like a love of learning or
interest in a subject. When a student has an intrinsic desire, he or she does not require
any form of incentive or punishment to do things because the activity itself has been
able to meet the satisfaction and the internal needs of the student. This statement
makes it clear that not all behaviors can formed through a reinforcement scheme. This
is because there are certain behaviors it is done because the individual in question
gets some form of satisfaction internal or an intrinsic motivation resulting from it
(Mahmood Nazar Mohamed, 1990: 294).
Behavior modification is a way of managing classroom discipline and is
appropriately used to address problematic behaviors, whether negative or positive.
The purpose of using behavior modification is to change the negative behavior or
misbehavior of students detected in the classroom to positive behavior and then
resolve the behavior. These steps are done to create a disciplined and conducive
classroom climate so that teaching and learning activities run smoothly.
Interpersonal methods are things related to the way people are treated another.
There are many types of good interpersonal skills such as communication, conflict
management, and empathy for others. Communication skills are one of those
interpersonal skills good that people can use in their daily lives. Communication is very
important in understanding the world around and others. Students are also able to build
relationships with new people when communicating which is effectively intertwined. In
addition, students are able to communicate well with everyone when we come up with
ideas that build discussion. Conflict resolution can also be made when effective
communication occurs. In conclusion, communication is important for interpersonal as
it plays a large role in adaptive skills.
A person forms perceived abilities from the assessment of his abilities by others.
Perceived abilities from the assessment regarding his actual abilities. The higher a
student’s achievement, the more likely the student is to assess himself or herself as
capable. These perceived abilities affect how the student feels about himself. Students
with high perceived abilities are more likely to have self-confidence. These students
love challenges, have a curious nature and act independently to achieve skills.
Individual behaviors and tasks are influenced by their abilities and ways of controlling
situations. A positive self -concept gives confidence to the individual that he or she is
capable of performing a task. In addition, individuals can determine their own tasks.
He will be involved in the task as well as the goals that bring success to him. An
individual will only have a self -concept that he is capable of and can control his efforts
if he has the intrinsic motivation to strive high. There are various ways that can be done
to help students in improving their intrinsic motivation.
In conclusion, the relationship between teachers and students is forged through
teaching and learning in schools. Teachers should observe teaching and learning in
the context of using materials that aid in teaching. In addition, teachers also need to
be aware of the processes experienced during teaching, namely the implicit elements
that stimulate the smooth process of teaching and learning in the classroom. Motivation
in learning cannot deny the presence of extrinsic and intrinsic motivation in
approaching human motivation.
WHAT ARE THE EDUCATIONAL IMPLICATIONS OF THE POTENTIAL FOR
CONCRETE REWARDS TO DIMINISH INTRINSIC MOTIVATION FOR A GIVEN
TASK?
Extrinsic motivation (concrete rewards) involves doing something to obtain
something else. Concrete rewards are things given to the students by others, like
grades, free time, and other things. Extrinsic motivation is often influenced by external
incentives such as rewards and punishments. It is a tangible recognition of one's
endeavor. While Intrinsic motivation involves the internal motivation to do something
for its own sake. An intrinsic reward is an intangible award of recognition, a sense of
achievement, or a conscious satisfaction. Below are the educational implications of the
potential for concrete rewards to diminish intrinsic motivation for a given task.
• Undermine a student’s desire or passion to learn.
According to Tegano, Moran, and Sawers (1991), as cited in Eisenberger,
Pierce, & Cameron (1996), "students who initially display a high level of interest in a
task, an expected reward makes them much less likely to take risks or approach a task
with a playful or experimental attitude. For example, the student could possibly behave
well or study harder only when he or she is offered a concrete reward. Indirectly, It
diminished intrinsic motivation.
• Decrease creativity and intrinsic motivation
The presentation of a reward orients the student to goal-relevant stimuli and
diverts attention from the task and environment that may be used to achieve a creative
solution. Students who are motivated by extrinsic factors complete activities in order
to receive a concrete reward. As a result, it will diminish intrinsic motivation because
they will not work out events on their own but only work to receive a reward like grades,
candy, free time, and other things.
• Negative effects on students' future learning and motivation
The concrete reward diverts motivation away from the achievement of learning
itself and toward an external reward in which the outcome is merely a representation
of the produced behaviour and not what the student internalised or learned due to the
activity. As a result, the use of extrinsic motivators has negative effects on the future
learning and motivation of students. Indirectly, it will diminish intrinsic motivation.
• Lead to helplessness in the face of difficulty as well as selfconsciousness
Henderlong and Lepper (2002) found that when praise is given for exceptionally
easy tasks, it can lead students to believe that they are of low ability level and that their
competence and relatedness will negatively affect their intrinsic motivational
orientation. Because praise is evaluative in nature, it can instil a sense of self-worth
that can lead to helplessness in the face of difficulty as well as self-consciousness
(Kamina & Dweeck, 1999, as cited in Henderlong & Lepper). Giving verbal
reinforcement to students may decrease their intrinsic motivation and have other
negative effects on them.
• The student could possibly behave well or study harder only when he or
she is offered a concrete reward.
This could have significant implications because students could display a lower
level of achievement or effort if the rewards are eliminated at some point. Apart from
not being the best learning strategy, it could affect them long-term as, in the real world,
people are not always rewarded constantly.
• Students would anticipate a shift from learning for the sake of learning to
learning in order to earn a reward.
This would undermine the foundation on which traditional institutions of higher
learning are built. Dependence on extrinsic rewards may cause problems later in life
(post-school) when there are not typically extrinsic rewards for learning.
• Students will refuse to change their behavior.
If used incorrectly or too often, concrete rewards can cause students to become
set in their ways. Change is a constant in school because every day is a different task.
Students need to adapt to stay competitive. However, if students are accustomed to
concrete rewards for specific behaviours, they may be resistant to change because
they think they might not be rewarded for a different kind of behavior. Students need
to know that concrete rewards are related to outcomes, not just their behavior.
CONCLUSION
The enthusiasm that should be shown to the students is the competition
between them. This is because although rewards are great for giving a paradigm shift
to students to be more diligent. But these days it is very easy for humans to hope for
something without having to properly.
The more perfect thing is where parents and teachers also work together to
give them moral support. In addition, every activity they participate in has the support
of all parties. That can also be the reward of mental psychology to continue to succeed.
Therefore, teachers and parents need to work together to create a healthy
atmosphere such as getting attention and support for what they are doing. When it
comes to the learning process, motivation is the most critical factor to consider. No
matter how well a teacher teaches, if a student is not motivated, it is unlikely that the
intended outcomes would be achieved. Positive reinforcement is one method of
assisting pupils in remaining motivated while studying. Positive reinforcement includes
a variety of methods, the most common of which are prizes, which are most often
utilised by instructors in schools. Indeed, incentives are the most powerful motivators
in anyone's life, and this is especially true for students.
Conclusion is, students that get incentives will almost always be motivated to
retain their current levels of performance or to aim for greater levels of accomplishment.
Furthermore, the influence might be seen by their other students as well. Their buddies
will likewise strive to do their best in order to gain the benefits that have been made
available.
REFERENCES
Santrock, J. W. (n.d.) Educational Psycology. Dallas: University of Texas
Wagner, K (February 2007). Intrinsicially Motivated Classrooms a Perspective For
Teachs. All Regis University Theses.
