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 Article

Social Learning Theory: its

application in the context of
nurse education
Dolores Bahn

Cognitive theories are fundamental to enable problem solving and the ability to understand
and apply principles in a variety of situations. This article looks at Social Learning Theory,
critically analysing its principles, which are based on observational learning and modelling, and
considering its value and application in the context of nurse education. It also considers the
component processes that will determine the outcome of observed behaviour, other than
reinforcement, as identified by Bandura, namely: attention, retention, motor reproduction, and
motivation. © 2001 Harcourt Publishers Ltd

Introduction them. On the other hand, external people attribute

Occupational practice is greatly influenced by
societal, technological, government policy and
economic changes, which lead to variations in
educational requirements. Those involved in the
field of education must consider psychological
theories and learning factors, which may have an
effect on motivation, perception and memory.
The purpose of this work is to critically analyse
the principles of Social Learning Theory,
considering its value and application in the
context of nurse education.
Origin and development of Social
Dolores Bahn EN,
RGN, ODN, BSc Learning Theory
(Hons), Lecturer,
University of Hull, The two central social learning theories are those
School of Nursing of Julian Rotter (1916–) and Albert Bandura
(Continuing
Education Dept),
(1925–). Rotter takes into consideration the
East Riding cognitive aspects of personality, believing that
Campus, Beverley behaviour is the result of the interaction of the
Road, Willerby,
Hull HU10 6NS, UK.
person and the environment. The central aspect
of his theory was the notion of internal versus
Manuscript
accepted: 2
external locus of control. Internal people feel
October 2000 personally responsible for whatever happens to
external forces, such as fate or luck, as being
responsible for the consequences of their actions
(Sternberg 1995). Bandura (1997) states that
beliefs of collective powerlessness can create
psychological barriers more debilitating than
external impediments. This highlights the
importance of nurse teachers promoting the
concept of self-empowerment on pre-registered
students, emphasizing the fact that they can
acquire the skills and knowledge to enable them
to critically analyse long-established practices,
evaluate their effectiveness and, constructively,
be instruments in disseminating the findings. As
post-registered nurses, in a position of authority
they can make a difference to clinical practice by
creating a climate conducive to introducing
appropriate, up-to-date, research-based practices
into the clinical area. The teacher as facilitator
should actively include student participation in
discussions, identifying innovative ways of
implementing change and recognizing the need
for careful analysis of the environment,
considering realistic ways of using limited
resources available. Possible effective measures to
reduce resistance to change should also be

110 Nurse Education Today (2001) 21, 110–117 © 2001 Harcourt Publishers Ltd
doi:10.1054/nedt.2000.0522, available online at http://www.idealibrary.com on

explored (Bennis et al. 1985, Tappen 1989).
Awareness of Rotter’s theory is also relevant
to patient care, regarding the effect of
hospitalization on individuals. If they feel that
they have no way of changing things, that they
have no control over what happens to them, it
can lead to their developing ‘learned
helplessness’ (Seligman 1975). This greatly
increases stress levels, reduces their ability to
recover, increases morbidity and lengthens their
time in hospital (Hayward 1975, Boore 1978). To
help patients regain a more internal locus of
control, they should be actively involved in the
planning of their care. Extreme examples of
externality are the Hindu and Buddhist karma and
Chinese yuan concepts, believing that everything
in life is predetermined, therefore the individual
has no control over their destiny (Sternberg 1995).
Awareness of such factors in today’s
multicultural society can help nurses to
understand some of the possible reasons for
individual’s attitudes to some situations, rather
than relying on subjective judgements.
However, it should not result in indiscriminate
‘labelling’.
Bandura’s Social Learning Theory represents a
more sophisticated behaviourism than its
predecessor by adopting a truly cognitive–
behavioural approach and addressing the
interaction between how we think and how we
act (Sternberg 1995). Although he acknowledged
that behavioural theories had contributed greatly
to our understanding of behaviour, he felt that
earlier models of development were hampered
by mechanistic approaches. The behaviourist
approach is seen by exponents of this theory as
undervaluing the potential of individuals to
influence their own behaviour (Quinn 1991).
Bandura (1986) sees behaviourism primarily as a
theory of performance control, rather than of
learning, since it clarifies how learned imitative
behaviour can be prompted by others and a
reward prospect; but it does not explain how new
response structures are acquired by observation.
He argues that psychological functioning is
neither driven by inner forces nor buffeted by
environmental stimuli. Symbolic, vicarious, and
self-regulatory processes assume a prominent
role. In his model of reciprocal determinism,
behavioural, environmental and other personal
factors, are interlocking operational determinants
of each other, with the level of influence of one or
© 2001 Harcourt Publishers Ltd
Social Learning Theory
another of these factors varying, depending on
the situation.
Learning process through
modelling
Bandura emphasizes the importance of
observational learning and modelling others by
stating: ‘Learning would be exceedingly
laborious, not to mention hazardous, if people
had to rely solely on the effects of their own
actions to inform them of what to do.
Fortunately, most human behaviour is learned
observationally through modelling: from
observing others, one forms an idea of how new
behaviours are performed, and on later occasions
this coded information serves as a guide for
action’ (Bandura 1977a, p. 22).
Generally speaking, socially prescribed
conduct is mostly applied in the same way it is
learned. But the view that complex structures and
innovative patterns cannot be derived from
imitative experiences is far from universally
accepted (Rosenthal & Zimmerman 1978).
Observation of other people’s behaviour allows
for a more efficient, and safer, way of acquiring
complex patterns of behaviour, than by trial and
error (Quinn 1991). Social learning theory consists
initially of vicarious acquisition of knowledge by
the individual observing a variety of models
(Bandura 1977a). The cognitive aspect of
Bandura’s (1977a) theory leads to the
combination of the different observed
characteristics. Secondly, although not always,
performance may follow, developing a pattern of
behaviour different to the original models. When
models transmit ideas and preferences, there is
no guarantee that the observer will express or
reproduce that behaviour. Anticipatory censure
will deter individuals, if it violates their moral
principles or, if it is socially unacceptable. In fact,
observed models meeting disapproval for their
actions tend to inhibit similar behaviour in
others. On the other hand, prohibited activities
performed without adverse effects may have an
uninhibited effect on the observer. Bandura
(1977a) concludes that reinforcement influences
increase the likelihood of adoptive behaviour.
This seems to highlight the powerful influence
of social or peer acceptability, which can
result in individuals carrying out reprehensible
acts.
Nurse Education Today (2001) 21, 110–117 111
Social Learning Theory
It has long been recognized in practice-
oriented professions, not only nursing, the
important role of staff in the practice setting in
supporting, supervising and teaching students. It
is also recognized that it takes more than just
placing a student in a practice environment to
educate nurses in practical skills (Andrews &
Wallis 1999). The principle of role modelling is to
allow the student to observe a prestigious trained
nurse, enabling the student to foster the
professional role. This not only involves the
learning of clinical skills, but learning about
professional attitudes and interactions with
patients and other members of the
multidisciplinary team (Quinn 1991). The process
of professional socialization can be seen as a
specific part of adult socialization were role
modelling and interaction with the professional
group acts as a mechanism to clarify what that
professional role is (Olsson & Gullberg 1991;
Buckenham 1998). This process has long been
recognized as very significant in maintaining
social conformity and discipline (Miller &
Dollard 1941). Vicarious learning in the context of
nurse education has close links with socialization.
In the traditional nurse training, teachers and
clinicians, the agents of control, had a very
powerful position and newcomers had to fit
conveniently into the system. It is difficult to see
if the reasons for socialization were for the
enhancement of the learner or for the ‘total good’
of the service (Holloway & Penson 1987). Gray
and Smith (1999) explored the socialization
process of HE nursing students in the 1990s in a
3-year, grounded theory, longitudinal study.
Initially, students aim to ‘fit in’ with the ward
routine in an effort to loose their ‘outsider’ status
but the basic skills they are acquiring are
auxiliary nurse’s basic skills and they soon turn
their attention to being a student nurse who will
become a staff nurse. By their final placement,
students reported increased assertiveness and
confidence in their ability to holistically assess,
plan, and implement and evaluate care.
However, they acknowledge that this can only
happen by the combination of a good learning
environment, a good mentor, and a student who
is assertive enough.
Bandura (1977a) considers modelling as a
powerful means of transmitting values, attitudes
and even patterns of thought and behaviour.
At the same time he stresses that modelling
112 Nurse Education Today (2001) 21, 110–117
conceptualized as simple imitation has limited the
scope of research, as observers were tested for
precise reproduction of the modelled behaviour.
In his social cognitive theory, modelling influences
have a wider psychological effect, as observers
acquire cognitive skills and new patterns of
behaviour by observing others (Bandura 1986).
Whether the individual performs observed
behaviour or not will rely heavily on the probable
consequences of the modelled course of action
(Bandura 1986). Bandura (1977a) identifies a
number of component processes that will
determine the outcome of observed behaviour,
involving factors, other than reinforcement (1)
attentional; (2) retention; (3) motor reproduction;
and (4) motivation.
Attentional processes
If we first consider nursing trainees in the not so
distant past, they were an integral part of the
workforce, their observational learning was
closely linked to its practical application. In 1986,
the Royal College of Nurses estimated that about
three-quarters of nursing care in hospitals was
provided by student nurses (Chandler 1991). The
school of nursing, which was part of the hospital,
provided theoretical input, reinforced by clinical
teaching in the ward. Students would attend to
the significant features of the modelled behaviour
from a member of staff, the quality of which was
limited by that individual’s experiential
knowledge. The component processes governing
observational learning in the social learning
analysis, identified by Bandura (1977a) are
present. Missing is the cognitive aspect, as they
were only encouraged to reproduce precisely
what they had learned, without question,
reflection or critical evaluation of their actions.
The aim was not to develop nursing practice, but
to preserve past practice (French 1995). The
process of attention does not involve just
absorbing sensory information, it involves self-
directed exploration (Bandura 1986). Bandura
(1986) suggests that attention can be encouraged
by incentives such as verbal and non-verbal
responses. However, there is competition for
students’ attentional processes in the ward
environment because of the dominant nature of
ward routine which, rather than encouraging the
exploration and learning about patient
individuality and interpersonal skills, can divert
© 2001 Harcourt Publishers Ltd

their attention to the practical demands of the
ward, succumbing to a conservative occupational
socialisation (Hislop et al. 1996). Some feel that
the root of the problem may lie with nurse
educators not being closely involved with the
clinical areas, resulting in one group of nurses
teaching and a different one ‘caring’, with each
group having conflicting expectations of the
students (Ferguson & Jinks 1994; Castledine
1999). Today students observe their models,
cognitive processes come into action, through
central processing (Bandura 1977a), critically
analysing actions and procedures and
questioning practices. This leads to problems due
to differing educational philosophies, as
educationalists aim at producing competent
nurses, capable of independent practice and
professional judgement. Holloway and Penson
(1987) and Shead (1991) argued at the time that
the service sector want competent and compliant
students, who will be an asset to the smooth
running of the institution by getting the work
done. There are still some traditionally trained
nurses who feel that nurses on HE programmes
develop critical thinking at the expense of core
clinical skills (Castledine 1999). Although not
suggesting that the above sentiments be
generalized, Kelly (1999, p. 1065) reports that
graduate nurses work twice as hard to
demonstrate that their education was not ‘an
impediment to being a good practical nurse’.
There are no easy solutions to this conflict, but it
is recognized that isolating professional from
educational perspectives will continue to widen
the much-debated theory practice gap (Caldwell
1997). Beattie (1975) recognized the need for
curriculum models to be viewed from a wide
perspective incorporating content, product,
process and cultural analysis. Caldwell (1997)
suggests the provision of a pre- and post-
registration curriculum meeting the needs of the
student, profession and service, whilst reflecting
prevalent social, political, educational and
professional ideologies. Emphasis on the
developmental process of education, rather than
just the product, will prepare students for life-
long learning (Ferguson & Jinks 1994).
Retention process
Observational learning is greatly influenced by
retention of knowledge (Bandura 1977a). People
© 2001 Harcourt Publishers Ltd
Social Learning Theory
expecting to perform an observed task will retain
the input by imaginal and verbal systems which
can be further reinforced by rehearsal and
repeated exposure (Bandura 1977a). Bandura
(1986) also highlights the effect of the observer’s
perception of functional value or usefulness of
the modelled behaviour. This process in nurses
would be assisted by integrating important
physiological and psychological abstract
knowledge of the reality of practice, gained in
school, into a real situation (Hislop et al. 1996).
Observers who code their modelled activity into
words, concise labels or imagery learn and retain
behaviour better than those who simply watch or
are preoccupied by other matters while observing
(Bandura 1977a). It has been suggested that the
negative attitude from qualified staff to today’s
student’s supernumerary status can make them
feel ‘useless’ and a burden to the staff. Lankshear
(1998) and Joyce (1999) state that there is evidence
to support that there is confusion on the part of
qualified staff, students and teachers regarding
the meaning of the term ‘supernumerary status’.
Lankshear (1998) is in favour of dropping the
term altogether as its misinterpretation could
even compromise learning opportunities by
assuming they are there to ‘observe’ standing in
the middle of the ward doing nothing. After all,
student doctors, teachers and social workers are
referred to as students, not ‘supernumerary
students’. These students’ coding of a modelled
activity and their ability to retain it may be
reduced because they are preoccupied with the
sense of conflict between the student and the
model (Bandura 1977a). Student nurses in the
past socialized into the nursing profession, by
living in the nurse’s residence, attending lectures
in uniform, being an integral part of the work
force, thus developing a sense of belonging with
the culture. Nursing students’ peers are other
university students from a variety of disciplines,
and their identity is that of undergraduate
student (Holloway & Penson 1987). A better
liaison between teaching, clinical staff and the
student could go some way towards alleviating
the problem.
Bandura (1977a) suggests that coding
modelled events in concise symbols and
meaningful verbal codes can be a very effective
way of retaining observed knowledge. However,
faulty coding and storage of knowledge will
result in problems accessing and retrieving
Nurse Education Today (2001) 21, 110–117 113
Social Learning Theory
knowledge (Lauder et al. 1999). Lauder et al.
(1999) recommend the exploration, analysis and
control of one part of the mind by another part of
the mind’s thought process by metacognitive
strategies. Metacognition emphasizes the self-
managed role of the learner, constructing
knowledge about one’s cognitive states and
abilities, including affective and motivational
characteristics of thinking. The individual seeks
self-knowledge of cognitive states and processes;
and control of executive aspects (Paris &
Winograd 1990). Bandura (1977b) acknowledges
that metacognitive processes can aid organizing,
monitoring and regulating of our thinking
processes. Maintaining a reflective diary of
experiences and recording the individual’s
thoughts and feeling could aid the process of
analysing one’s own thought processes and aid
retention. New events repeated often with the
important aspects highlighted can help retention,
but repetition alone, although it increases the
number of memory traces, is not as effective as
rehearsal, because it involves applying memory
strategies (Bandura 1986). Ward-based
discussions could be a good medium for
rehearsal.
Motor reproduction processes
This third component to observational learning
relies on converting symbolic representations into
actions, which in nursing it may not take place
until the student is qualified. Because individuals
are not able to observe their own performance,
they need to rely on informative feedback by the
model, so that self-corrective adjustments can be
performed (Bandura 1977a). The amount of
observational learning may be underestimated,
because unless encouraged, people perform less
than they have learned (Bandura 1986). The
production stage is closely linked to the
individual’s performance skill, so that guided
practice is required if complex behaviours are to
be created (Bandura 1986). The concept of
scaffolded instruction is applicable here, by
hierarchically organizing the components of the
behaviour. As simpler components are mastered,
more complex ones can be introduced (Paris &
Winograd 1990). Awareness of how observational
learning occurs and how to enhance it, is very
important for nurses, as they often teach practical
skills to patients. For example, when teaching
114 Nurse Education Today (2001) 21, 110–117
children who have diabetes to inject their own
insulin, or teaching patients who have
tracheotomies to care for their equipment. The
effectiveness of the learning interaction will make
all the difference to that individual’s quality of
life. Even though symbolic representation of
learning is there, there may be physical
limitations in coordinating the variety of actions
required. Therefore learners need to develop a
rapport with the model, based on mutual
understanding and support, to recognize
individual strengths and limitations on applying
the knowledge derived from practice (Gillan
1993). Experienced nurses can verbalize the
behaviour they are performing, so that those
aspects not easily visible can be identified
(Bandura 1986). Another way to ensure the
learner has observed all the mechanisms of
behaviour is by using videos, which can focus on
specific, important aspects, highlighting
important points. The teacher then can provide
feedback in ways of building the learner’s
perception of self-efficacy (Bandura 1986). Videos
can be stopped allowing time for complex
concepts to be discussed and clarified. This mode
of observational learning is widely used for
patient and relatives’ teaching of newly
diagnosed conditions or procedures they may
have to undergo.
Motivational processes
Incentive to perform is provided by three sources:
external, vicarious and self-produced. External
incentives include reward, when modelled
behaviour is met with valued outcomes, but
negative feedback will inhibit performance
(Bandura 1977a). In the past, student nurses
would be prompted and motivated to reproduce
the learned behaviour because their competent
input was needed for the effective use of the
workforce and the efficient run of the ward, so a
positive attitude from the staff would be
prevalent. The move of students to a university
setting has created two potentially conflicting
areas of learning, with input by two different
cultures, those from the educational institution
and those in the clinical area in which they will
function as practitioners. Students’ feelings of
apprehension combined with a mistrustful and
dismissive attitude of some members of the
© 2001 Harcourt Publishers Ltd

clinical staff, do not provide a motivating climate
for mutual expansion.
Vicarious reinforcement is the result of
learning by observing others successes and
failures (Bandura 1977a). Bandura (1977a, p. 125)
highlights the importance of vicarious
reinforcement: ‘Observed reinforcement not only
informs, it also motivates’. The result of early
adopters demonstrating the advantages of new
practices to the potential adopter, is the
accelerated diffusion of those practices (Bandura
1977a). Students observing other members of staff
trying to change established practices witnessing
a hostile encounter would send an inhibiting
message to the observer. The appropriate and
effective handling of the situation can result in a
valuable learning experience. If, on the other
hand, the individual responds aggressively,
emotionally or inappropriately, the observer may
always move away or avoid dealing with such
situations. Students discussing their experiences
and how the staff reacted to their actions, or lack
of them, can have a significant effect, as students
may arrive with pre-acquired performance
inhibitors which will greatly reduce their learning
development potential. Closer ties between the
tutor, student and clinical supervisor would
allow for discussion of identified or potential
problem areas, which could result in mutually
acceptable solutions to be arrived at.
People respond to their own actions by self-
reward or self-punishment, based on their own
standards of behaviour. That standard of
behaviour will be used as a point for comparison
with other performances (Bandura 1977a). If
success is attributed to one’s own ability and
effort, it results in a great sense of pride, but if
success is attributed to external causes, self-
satisfaction is reduced (Bandura 1977a). Student-
centred learning should therefore be encouraged,
not only to meet individualized educational
needs, but because it increases the learner’s sense
of achievement. This should, however, be
considered with caution. If the individual sets
unrealistically high standards, then failure and
ensuing consequences will result. One way of
preventing this could be drawing a learning
contract between the learner and facilitator, based
on careful assessment of the individual’s
capabilities and time scale, so that realistic,
measurable, achievable goals can be set. The
individual’s perception of self-efficacy to perform
© 2001 Harcourt Publishers Ltd
Social Learning Theory
a task, or follow a course of action, will be
reinforced by its successful accomplishment
(Bandura 1977b). Learners who have the
opportunities to perform nursing skills which
they may later use as qualified nurses, perceive
increased self-efficacy levels (Golberg et al. 1997).
Conclusion
It would appear that the advantage of social
learning theory in nurse education is its focus on
the social aspect of learning appropriate to
education, which takes place in a social
environment, acknowledging the complexity of
the environment and the person. On the other
hand, that same complexity makes interaction
difficult and intervention complicated (Callery
1990).
A collaborative approach to learning through
the use of peers and expert practitioners as role
models and source of feedback is needed.
Instructors working with students must be aware
of their impact, as role models, on student
learning and self-efficacy expectations. The
quality of those who provide a role model will
dictate the quality of the nurses produced
(Theobald 1995).
A great deal of the student’s professional
socialization occurs in the practical arena.
Students complain of feeling alienated from the
ward nursing team and the negative attitude of
some staff towards them. Some of the problem
has been identified as the misunderstanding or
misinterpretation of the term ‘supernumerary
status’. It is necessary for students, clinical staff
and nurse teachers to have a clear understanding
of the term and what is their role prior to clinical
placements (Joyce 1999). Joyce (1999) suggests a
framework for implementing supernumerary
learning in a diploma programme with the
clinical supervisor playing a vital role. During the
student’s initial stages of observation, the clinical
supervisor takes an active, leading role. As the
student progresses towards a more participatory
stage, the supervisor takes the role of a catalyst
guiding the student through the experience. The
supervisor’s role changes with the student’s
progress, becoming less ‘directive’ and more of a
moderator, encouraging reflection and self-
directed learning.
Finally, there appear to be grounds for concern
regarding the ‘reality shock’ experienced by some
Nurse Education Today (2001) 21, 110–117 115
Social Learning Theory
new graduates as they move from the school into
the hospital work environment. Kramer (1974)
first drew attention to this issue. However, 25
years on, Kelly (1999) identifies the stress
experienced by new graduate nurses as they try
to adapt to the ‘work culture’ facing the pressure
to ‘fit in’ in the hospital environment. Kelly (1999,
p. 1068) states: ‘new graduate nurses are caught
in a war between two socialising forces, namely
the academic and the real world of hospital
nursing’. Kramer (1974) stated that successful role
transformation was dependent on the degree of
accommodating devices possessed or learned by
the individual. Kelly (1999) feels that nurse
educators are responsible for providing
instructional strategies to prepare graduates for
the transition and that the educational system
should focus on emancipating individuals to
know themselves and develop a realistic sense of
self-competence.
Modelling is a bi-directional process (Bandura
1977b), so it would be reasonable to expect that,
as more academically qualified nurses enter the
clinical area, some of the role conflicts should be
reduced. It takes time to integrate changes, and it
is not surprising that in nursing, after a century of
stagnation, it is taking some time to assimilate
and adjust to such dramatic changes.
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