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Midterms Lessons

🍙 𝐨𝐯𝐞𝐫𝐯𝐢𝐞𝐰 𝐨𝐟 𝐞𝐝𝐮𝐜𝐚𝐭𝐢𝐨𝐧 𝐢𝐧 𝐡𝐞𝐚𝐥𝐭𝐡𝐜𝐚𝐫𝐞.

Health Education

Historical Foundations of the Nurse Educator Role

Health education has long been considered a standard The Joint Commission (TJC)
caregiving role of the nurse.
Accreditation mandates require evidence of patient
Patient teaching is recognized as an independent education to improve outcomes.
nursing function.
Healthy People 2000, 2010, and 2020 established
Nursing practice has expanded to include education in educational programs.
the broad concepts of health and illness.
Pew Health Professions Commission
American Hospital Association (AHA)
Put forth a set of health profession competencies for
Patient’s Bill of Rights ensures that clients receive the 21st century.
complete and current information.
Many of the competencies deal with teaching.
Patient’s education was a significant part of
Patient’s Bill of Rights.

Evolution of the Teaching Role of Nursing

In nursing, patient education has long been a major component. International Council of Nurses (ICN)

Florence Nightingale was the ultimate educator. Endorses health education as

essential component of nursing care
National League of Nursing Education (NLNE), now the National
delivery.
League for Nursing (NLN).
State Nurse Practice Act
Observed in 1918 that health teaching is an important function
within the scope of nursing practice. Universally include teaching within
the scope of nursing practice.
American Nurses Association (ANA)
Nursing career ladders often
Responsible for establishing standards and qualifications for
incorporate teaching effectiveness
practice, including patient teaching.
as a measure of excellence in
practice.

Trends Affecting Healthcare

Social, economic, and political forces that affect a nurse’s role in teaching:

Screenings occasioned by advances in genetics and Demographic trends influencing type and amount of
genomics healthcare needed

Federal initiatives outlined in Health People 2020

Midterms Lessons 1
 Growth of managed care Recognition of lifestyle related diseases which are
largely preventable
Increased attention to health and well-being to everyone
in society. Increased prevalence of chronic conditions

Cost-containment measures to control healthcare Impacts of advanced technology

expenses.
Health literacy increasingly required
Concern for continuing education as vehicle prevent
Research findings that client education improves
malpractice and incompetence
compliance
Expanding scope and depth of nurses’ practice
Advocacy for self-help groups
responsibilities.
Increased use of online technologies
Consumers demanding more knowledge and skills for
self-care

Purpose, Goals, and Benefits of Client and Staff Education

Purpose: To increase the competence and confidence of clients to manage their own self-care and of staff and students to
deliver high-quality care.
Benefits of Education to Clients

Increases customer satisfaction Reduces incidence of illness complication

Improves quality of life Promotes adherence to treatment plans

Ensures continuity of care Maximizes independence

Decreases client anxiety Empowers consumers to become involved in planning

their own care

Benefits of Education to Staff

Enhances job satisfaction Increases autonomy in practice

Improves therapeutic relationships Provides opportunity to create change that matters

The Education Process ASSURE Model

Education Process → a systematic, sequential, planned course of action on A useful paradigm to assist nurses
the part of the teacher and learner to achieve the outcomes of teaching and to organize and carry out the
learning. education process.

Teaching/Instruction → a deliberate intervention that involves sharing Analyze the learner.

information and experiences to meet the intended learner outcomes. State the objectives.
Learning → a change in behavior (knowledge, attitudes, and/or skills) that can Select instructional methods and
be observed or measured, and that can occur at any time or in any place as a materials.
result of exposure to environmental stimuli.
Use instructional methods and
Patient Education -. the process of helping clients learn health-related materials.
behaviors to achieve the goal of optimal health and independence in self-care.
Require learner performance.
Staff Education → the process of helping nurses acquire knowledge, attitudes,
Evaluate/revise the teaching
and skills to improve the delivery of quality care to the consumer. plan.

Contemporary Role of the Nurse as an Educator

Midterms Lessons 2
 Nurses act in the role of educator for a diverse audience of learners - patients and their family members, nursing
students, nursing staff, and other agency personnel.

Despite the varied levels of basic nursing school preparation, legal and accreditation mandates have made the educator
role integral to all nurses.

The partnership philosophy stresses the participatory nature of the teaching and learning process.

The new educational paradigm focuses on the learner learning.

Instead of the teacher teaching, the nurse becomes the guide on the side.

Nursing education transformation → gap between Institute of Medicine (IOM) → The Future of Nursing:
nursing education and practice. Leading Change, Advancing Health

Patient engagement → Nursing Alliance for Quality written in response to the Affordable Care Act.
Care (NAQC) goals:
describes the role of nursing in a transformed
consumer-centered healthcare healthcare system.

performance measurement and public reporting recommendations:

advocacy removing scope of practice barriers

leadership expand opportunities for nurses to lead in

collaborative efforts
Quality and safety education in nursing → Robert
Wood Johnson Foundation (RWJF) Quality and Safety implement nurse residency programs
Education in Nursing (QSEN) competencies:
increase proportion of nurses with
patient-centered care baccalaureate degrees to 80% by 2020

teamwork and collaboration double number nurses with a doctorate by 2020

evidence-based practice prepare and enable nurses to lead change to

advance health
quality improvement
build infrastructure for the collection and
informatics
analysis of data
safety
ensure that nurses engage in lifelong learning

Barriers to Teaching

Barriers to teaching are those factors impeding the nurse’s ability to optimally deliver educational services.

Major barriers include:

lack of time to teach environments not conducive to the teaching-learning

process
inadequate preparation of nurses to assume the role of
educator with confidence and competence absence of third-party reimbursement

personal characteristics doubt that patient education effectively changes

outcomes
low-priority status given to teaching
inadequate documentation system to allow for efficiency
and ease of recording the quality and quantity of
teaching efforts

Obstacles to Learning

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 Obstacles to learning are those factors that negatively impact on the learner’s ability to attend to and process
information.

Major obstacles include:

limited time due to rapid discharge from care extent of behavioral changes (in number and
complexity) required
stress of acute and chronic illness, anxiety, sensory
deficits, and low literacy lack of support and positive reinforcement from
providers and/or significant others
low literacy and functional health literacy
denial of learning needs, resentment of authority and
loss of control, lack of privacy, and social isolation of
locus of control issues
hospitalization environment
complexity, inaccessibility, fragmentation, and
situational and personal variations in readiness to learn,
dehumanization of the healthcare system
motivation and compliance, and learning styles

Questions to be asked about Teaching and Learning

The following questions can be posed about the elements of the education process, the role of the nurse as an educator, and
the principles of teaching and learning:

How can the healthcare teams work together more Which elements need to be taken into account when
effectively to coordinate educational efforts? developing and implementing teaching plans?

What are the ethical, legal, and economic issues Which instructional methods and materials are available
involved? to support teaching efforts?

Which theories and principles support the education Under which conditions should certain teaching methods
process? and tools be used?

What assessment methods and tools can be used to How can teaching be tailored to meet the needs of
determine learning needs, readiness, and styles? specific clientele?

Which learner attributes positively and negatively What are the common mistakes made in the teaching of
influence education efforts? others?

What can be done about the inequities in the delivery of How can teaching and learning best be evaluated?
education services?

🍙 𝐩𝐫𝐢𝐧𝐜𝐢𝐩𝐥𝐞𝐬 𝐨𝐟 𝐠𝐨𝐨𝐝 𝐭𝐞𝐚𝐜𝐡𝐢𝐧𝐠 𝐩𝐫𝐚𝐜𝐭𝐢𝐜𝐞 𝐢𝐧 𝐮𝐧𝐝𝐞𝐫𝐠𝐫𝐚𝐝𝐮𝐚𝐭𝐞.

PRINCIPLE 1 | Good Practice Encourages Student-Instructor Contact

Student-Instructor Contact: Applications to Teaching:

improves student motivation provide students a workplace that encourages individual and group
interaction
reduces attrition and improves
retention attend student activities/advise clubs

enhances intellectual commitment be accessible: utilize email, computer conferencing

breaks cycle of anonymity maintain office hours and campus presence

create undergraduate teaching and research experiences.

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 PRINCIPLE 2 | Good Practice Encourages Cooperation among Students

Encourage Cooperation among What do Employees Want? Applications to Teaching

Students
good learning is
collaborative and social
collaborative learning…
increases involvement
in learning
improves
understanding and
thinking
more effective than
individualistic or
competitive learning
group skills: teamwork encourage the use of…
ability to learn cooperative and
collaborative learning
communication skills
group projects
computation skills
problem-based learning
adaptability: creative thinking and
problem solving skills form study groups and learning
teams
personal management skills
utilize email, web-meeting tools
leadership skills
use “engaged” lecture format
use “A-T-A” approach

PRINCIPLE 3 | Good Practice Encourages Active Learning

Encourage Active Learning Applications to Teaching

students must do something to learn incorporate discussion, experiments, problem-solving

students are active constructors, utilize aspects of groups, projects, case studies, problem based
transformers of their own knowledge learning, think-pair-share, jigsaw

action leads to meaningfulness utilize email, clicker technologies, discussion boards, web 2.0 (blogs,
facebook, etc.)

consider computer simulation, virtual reality, games

provide incomplete lecture notes

require, collect, grade, return homework

require note-taking, journalling

PRINCIPLE 4 | Good Practice Gives Prompt Feedback

Give (and Get) Prompt Feedback Applications to Teaching

helps students assess competencies don’t assume students understand

provides frequent opportunities to perform provide feedback early and often

focuses learning activities assess frequently

also helps improve teaching utilize email (blackboard) to send grades,

survey the class (feedback is crucial to success)
Feedback is Most Effective When…
The person delivering the feedback exhibits…
empathy
communicate feedback
have students assess own progress and needs
encourage the use of reflective techniques (i.e.,
learning journals, self-assessment inventories,
critical incident reports)

Midterms Lessons 5
 respect incorporate peer feedback mechanisms

specificity use “classroom assessment techniques” (i.e., one

minute paper, brookfield’s critical incident,
genuineness
questionnaire)
self-disclosure
use rubrics
confrontation
use mid-semester feedback (SGIF)
immediacy

concreteness

PRINCIPLE 5 | Good Practice Emphasizes Time on Task

Emphasize Time on Task Applications to Teaching

time + effort = learning provide time management and

lecture note taking
organize course and plan efficiently
provide outline of activities at the
establish clear and realistic course schedule
beginning of each class (”Advance
help students develop good management skills Organizers”)
Key Research Findings build in preview and review time into
Learning increases when teachers focus their questions on content class (knowledge that is applied
that is most important, not what they think will be most interesting to immediately is better learned)
students. teach students to make use of teams
Advance organizers, including graphic ones, help students learn new to divide up work
concepts and vocabulary. Presenting information graphically as well learning does not occur by surprise
as symbolically in an advance organizer reinforces vocabulary
learning and supports reading skills.

PRINCIPLE 6 | Good Practice Communicates High Expectations

Communicate High Expectations Applications to Teaching

expect more and you will likely get it communicate your expectations early and often

becomes self-fulfilling prophecy assess what students expect of themselves

encourage extra effort tell students what they can expect from you

set high, yet reachable standards successful academic experiences early to

confidence

have successful former students talk to new students

provide success role models and mentors

PRINCIPLE 7 | Good Practice Respects Diverse Talents and Ways of Learning

Applications to Teaching

use varied teaching methods (visual, auditory, sensory, examples, diagrams, small groups, electronic)

assess your learning style - we teach according how we, not our students, learn best

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 expect conflict in group problem solving due to cognitive diversity

encourage formation of support groups

The Millennial Student → exposed to a world of instantaneous communication with no boundaries of distance or time.

SUMMARY | Good Practice in Undergraduate Education

1. Encourages Student-Instructor Contact

2. Encourages Cooperation among Students

3. Encourages Active Learning

4. Gives Prompt feedback

5. Emphasizes Time on Task

6. Communicates High Expectations

7. Respects Diverse Talents and Ways of Learning

💡 QUIZ REVIEW | Answer Guide

1. This is a process of assisting people to learn health- 11. The useful paradigm to assist nurses to organize and
related behaviors that can be incorporated into everyday carry out the education process. ⇒ ASSURE MODEL
life with the goal of optimal health and independence in
self-care. ⇒ PATIENT EDUCATION
12. The Patient’s Bill of Rights was first developed by this
organization in 1972. ⇒
AHA (American Hospital
2. This is defined as a change in behavior that can be Association)
observed or measured and that occur at any time or in
13. This refers to the learner’s information needs or the
any place as a result of exposure to environmental
⇒
stimuli. LEARNING
three major learning domains. ⇒
COGNITIVE,
AFFECTIVE, PSYCHOMOTOR DOMAIN
3. As early as 1937, this organization recognized nurses
14. The following are part of the areas that still needs
as agents for the promotion of health and the prevention
⇒
of illness in all settings in which they practiced. NLNE
improvement according to the report of Institute of
Medicine (IOM) on Quality Healthcare, except…
(National League of Nursing Education)
a. Efficiency
4. All of the following describes the nursing process
except… b. Timeliness

a. Determine behavior change (outcomes) in c. Patient Centeredness

knowledge, attitudes, and skills.⇒EDUCATION
PROCESS
b. Determine physical and psychological outcomes.
c. Appraise physical and psychological needs.
d. Carry out nursing care interventions using standard
procedure.
5. All of the following describes the education process
except…
d. Patient Assessment and Evaluation ⇒ NOT AN
AREA OF IMPROVEMENT
The six aims of improvement from IOM are as
follows: care that is safe, timely, effective, efficient,
equitable and patient-centered (STEEEP).
15. All of the following belongs to the umbrella of
psychological learning theories, except…
a. Cognitive Learning Theory

a. Develop care plan based on mutual goal setting to b. Social Learning Theory
meet individual needs. ⇒ NURSING PROCESS c. Psychodynamic Learning Theory

d. None of the above ⇒ CORRECT ANSWER

Midterms Lessons 7
 b. Performs the act of teaching using specific 16. Patient teaching is recognized as an independent
instructional methods and tools. nursing function. ⇒ TRUE

c. Develop teaching plan based on mutually 17. She is considered as an ultimate educator in nursing. ⇒
predetermined behavioral outcomes to meet FLORENCE NIGHTINGALE
individual needs.
18. The following are benefits of education to clients
d. Ascertain learning needs, readiness to learn, and except…
learning styles.
a. Increases consumer satisfaction.
6. They established nursing standards for patient
b. Improves quality of life.
education. These standards, known as mandates,
describe the type and level of care, treatment, and c. Ensures continuity of care.
services that must be provided by a health care agency d. Enhances self-protection. ⇒ NOT A BENEFIT
or organization. ⇒ JCAHO (The Joint Commission on
19. Which of the following is a benefit of education to staff?
Accreditation of Healthcare Organizations)

7. This focuses on the planning and implementation of

a. Increases autonomy in practice. ⇒ CORRECT
ANSWER
teaching based on an assessment and prioritization of
client’s learning needs, readiness to learn, and learning b. Decreases client’s anxiety
styles.⇒ EDUCATION PROCESS
c. Ensures continuity of care.
8. This is defined as those factors that impede the nurse’s
ability to deliver educational services. ⇒BARRIERS TO
d. Enhances self-protection.

TEACHING 20. The new educational paradigm focuses on the teacher

9. This is defined as those factors that negatively affect the

teaching. ⇒TRUE

ability of the learner to pay attention to and process

information. ⇒ OBSTACLES TO LEARNING

10. The acronym “JCAHO” stands for? JOINT ⇒

COMMISSION ON ACCREDITATIONS OF
HEALTHCARE ORGANIZATIONS

🍙 𝐧𝐮𝐫𝐬𝐢𝐧𝐠 𝐩𝐫𝐨𝐜𝐞𝐬𝐬 𝐚𝐧𝐝 𝐞𝐝𝐮𝐜𝐚𝐭𝐢𝐨𝐧.

Educational Process is a structured system of organization and didactic measures aimed at performing requirements of a
definite educational level according to the state standards of higher education. Educational process is based on the principles
of science, humanism, democracy, lifelong and degree education.

The nursing process functions as a systematic guide to client-centered care with 5 sequential steps. These are assessment,
diagnosis, planning, implementation, and evaluation. Assessment is the first step and involves critical thinking skills and data
collection: subjective and objective.

How is the nursing process used in developing health education?

The nursing process is a systematic problem-solving approach used to identify, prevent and treat actual or potential health
problems and promote wellness. Nursing knowledge is used throughout the process to formulate changes in approach to
the patient's changing condition.

As stated by Bastable in “Nurse as Educator: Principles of Teaching and Learning for Nursing Practice”, the nursing process
and education process are quite similar. She claims they both have the same stems to achieve their goal (2014).

Midterms Lessons 8
 The steps involved in both aspects consist of assessment, planning, implementation, and evaluation.

When using these steps to achieve the nursing process, the nurse must assess the patient, plan what care to provide,
carry out that plan, and determine its effectiveness.

When using this process for education, the nurse must determine what the learning needs are and which type of
teaching would best suit the patient.

Once that has been determined, the nurse should formulate a plan to teach this patient based on their individual needs.

The teaching plan should then be carried out, and its success should be evaluated.

In both cases, if the evaluation is found to be negative, a new plan needs to be implemented and then reevaluated until
the goal is met.

Comparison between Education and Nursing Process (Differences)

Elements Nursing Process Education Process

Ascertain (determine) learning needs,

1. Assessment Appraise physical and psychological needs. readiness (willing) to learn, and learning
styles.
Develop teaching plan based on mutually
Develop care plan based on mutually goal
2. Planning predetermined behavioral outcomes to meet
setting to meet individual needs.
individual needs.
Carry out nursing care interventions using Perform the act of teaching using specific
3. Implementation
standard procedures. instructional methods and tools.
Determine physical and psychological Determine behavioral changes (outcomes) in
4. Evaluation
outcomes. knowledge, attitude, practical skills.

🍙 𝐜𝐨𝐠𝐧𝐢𝐭𝐢𝐯𝐞 𝐥𝐞𝐚𝐫𝐧𝐢𝐧𝐠 𝐭𝐡𝐞𝐨𝐫𝐲.

Learning Theory

A coherent framework of integrated constructs and principles that describe, explain, or predict how people learn.

Psychology provides alternative theories and perspectives on how learning occurs and what motivates people to learn
and change.

There are five primary educational learning theories: behaviorism, cognitive, constructivism, humanism, and
connectivism.

Cognitive Learning Theory

Cognitive learning theorists stress the importance of
what goes on inside the learner.
Composed of subtheories and is widely used in
education and counseling.
“Reward is not necessary for learning to take place.”
More important are learners’ goals and expectations,
which create disequilibrium, imbalance, and tension that
motivate learners to act.

The key to learning and changing is the individual’s
cognition.
Cognitive learning is viewed as a highly active process
largely directed by the individual.
Educators trying to influence the learning process must
recognize the variety of past experiences, perceptions,
ways of incorporating and thinking about information.
They also need to consider the diverse aspirations,
expectations, and social influences that affect any

Midterms Lessons 9
 Involves perceiving the information, interpreting it based
on what is already known, and then reorganizing the
information into new insights or understanding.
METACOGNITION → one’s own understanding of their way of learning.
Perspectives
Cognitive-learning theory includes several well-known perspectives.
1. Gestalt perspective
One of the oldest psychological theories.
Emphasizes the importance of perception in
learning and lays the groundwork for various
other cognitive perspectives to follow it.
Refers to the configuration or patterned
organization of cognitive elements, reflecting the
maxim that “the whole is greater than the sum of
its parts”.
A principal assumption is that each person
perceives, interprets, and responds to any
situation in their own way.
A basic gestalt principle is that psychological
organization is directed toward simplicity,
equilibrium and regularity.
2. Information processing
A cognitive perspective that emphasizes thinking processes:
Thought
Reasoning
The way information is encountered and stored
Memory functioning
Nine events that activate effective learning:
Reception → gaining the learner’s attention.
Expectancy → informing the learner of the objectives and
experiences.
Retrieval → stimulating the learner’s recall of prior learning.
Selective Perception → presenting information.
Semantic Encoding → providing the guidance to facilitate the
learner’s understanding.
Reinforcement → giving feedback to the learner.
Retrieval → assessing the learner’s performance.
Generalization → working to enhance retention and transfer through
application and varied practice.
Midterms Lessons
learning situation.
Another central gestalt principle with several ramifications is that
perception is selective.
First, because no one can attend to all possible surrounding
stimuli at any given time, individuals attend (orient) to
certain features of an experience while screening out or
ignoring (habituating to) other features.
Second, what individuals pay attention to and what they
ignore are influenced by a host of factors: past experiences,
needs, personal motives and attitudes, reference groups,
and the actual structure of the stimulus or situation.
Because individuals vary widely regarding these and
other characteristics, they will perceive, interpret, and
respond to the same event in different ways, perhaps
distorting reality to fit their goals and expectations.
a. FIRST STAGE | Attention
The memory process involves
paying attention to environmental
stimuli; attention, then, is the key to
learning.
b. SECOND STAGE | Processing
The information is processed by the
senses. Here, it becomes important
to consider the client’s preferred
mode of sensory processing (visual,
auditory, or motor manipulation) and
to ascertain whether he or she has
any sensory deficits.
c. THIRD STAGE | Memory Storage
The information is transformed and
incorporated (encoded) into short-
term memory, which is either soon
forgotten or is stored in long-term
memory.
10
 d. FOURTH STAGE | Action

This last stage involves the action or

response that the individual
undertakes based on how
information was processed and
stored.

When using the information processing model, educators must analyze the requirements of the activity, design, and
sequence of the instruction events.

Differences in learning styles is one of the many reasons an educational theory or model may not work for everyone.

In learning, barriers can occur when forgetting or having difficulty in inputting or retrieving information.

Through the use of one-to-one patient education, workshops, community health lectures, etc., focused attention, storage,
and memory are all aided.

3. Human/cognitive development

Focuses in qualitative changes in perceiving, thinking, and reasoning as individuals grow and mature.

Cognitions are based on how external events are conceptualized, organized, and represented within each person’s
mental framework or schema, which is partially dependent on the individual’s stage of development in perception,
reasoning, and readiness to learn.

In other words, age and stage of life can affect learning.

According to Piaget’s theory of cognitive learning, children take in or incorporate information as they interact with people
and the environment. They either make their experiences fit with what they already know (assimilation), or change their
perceptions and interpretations in keeping with the new information (accommodation).

In practice, some children may learn more effectively by discovering and putting pieces together on their own, whereas
other children benefit from a more social and directive approach.

4. Social constructivism/cognition

Social Constructivism Social Cognition

Theorists posit that individuals formulate or construct Social cognition perspective reflects a constructivist
their own versions of reality and that learning and orientation and highlights the influence of social factors
human development are richly colored by the social and on perception, thought, and motivation.
cultural context in which people find themselves.
When applied to learning, it emphasizes the need for
Social constructivism is where ethnicity, social class, instructors to consider the dynamics of the social
gender, family life, life history, self-concept, and the environment and groups on both interpersonal and
learning situation itself all influence an individual’s intrapersonal behavior.
perceptions, thoughts, emotions, interpretations, and
Attribution Theory
responses to information and experiences.
Focuses on the cause-and-effect relationships and
Another principle is that effective learning occurs
explanations that individuals formulate to account for
through social interaction, collaboration, and
their own and others’ behavior and the way in which the
negotiation.
world operates.
Each person operates on his or her own unique
These explanations are unique to the individual and
representations and interpretations of a situation, all of
tend to be strongly colored by cultural values and
which have been heavily influenced by that individual’s
beliefs.
social and cultural experiences.

Midterms Lessons 11
 5. Cognitive-emotional perspective

Criticized for neglecting emotions, and efforts have been made to incorporate considerations related to emotions within a
cognitive framework.

The following are several slightly different cognitive orientations to emotions that have been proposed and briefly
summarized.

Empathy and the moral emotions (ex. guilt, shame, distress, moral outrage) play a significant role in influencing
children’s moral development and in motivating people’s prosocial behavior, activism, and ethical responses.

Memory storage and retrieval, as well as moral decision making, involve both cognitive and emotional brain
processing.

Emotional intelligence (EI) entails an individual managing his emotions, motivating himself, reading the emotions of
others, and working effectively in interpersonal relationships.

Self-regulation includes learners monitoring their own cognitive processes, emotions, and surroundings to achieve
goals.

Conclusion

A significant benefit of the cognitive theory to healthcare is the recognition of individuality and diversity in how people
learn and process experiences.

This theory highlights the wide variation in how learners actively structure their perceptions; confront a learning situation;
encode, process, store, and retrieve information; and manage their emotions.

The challenge for educators is to identify each learner’s level of cognitive development and the social factors that affect
learning.

Difficulties may arise in ascertaining exactly what is transpiring inside the mind of each individual and in designing
learning activities that encourage people to restructure their perceptions, reorganize their thinking, regulate their
emotions, change their attributions and behavior, and create workable solutions.

Teaching people to learn how to learn and to monitor and regulate their own learning is now considered part of the
educator’s job.

🍙 𝐛𝐞𝐡𝐚𝐯𝐢𝐨𝐫𝐚𝐥 𝐥𝐞𝐚𝐫𝐧𝐢𝐧𝐠 𝐭𝐡𝐞𝐨𝐫𝐲.

Behavioral Learning Theory

A school of thought that believes humans learn through their experiences by associating a stimulus with either a reward
or a punishment.

The use of positive reinforcement is a typical behaviorism example. If a kid receives an A on their spelling exam, they are
given a small gift. Students will study hard and work hard in the future to get their reward.

Behaviorism is key for educators because it impacts how learners react and behave in the classroom, and suggests that
educators can directly influence how their learners behave. It also helps identify that a learners home environment and
lifestyle can be impacting their behavior, helping them see it objectively and work to assist with improvement.

Types of Behavioral Learning Theory

1. Classical Conditioning

Midterms Lessons 12
 Discovered by Russian physiologist Ivan Pavlov, classical conditioning is a type of unconscious or automatic learning.
This learning process creates a conditioned response through associations between an unconditioned stimulus and a
neutral stimulus.

Although classical conditioning was not discovered by a psychologist, it has had a tremendous influence over the school
of thought in psychology known as behaviorism. Behaviorism assumes that all learning occurs through interactions with
the environment and that environment shapes behavior.

Put in another way, classical conditioning involves placing a neutral stimulus before a naturally occurring reflex. In
Pavlov’s classic experiment with dogs, the neutral signal was the sound of a tone, and the naturally occurring reflex was
salivating in response to food. By associating the neutral stimulus (sound) with the unconditioned stimulus (food), the
sound of the tone alone could produce the salivation response.

Types of Stimulus How does classical conditioning work?

a. Unconditioned Stimulus → stimulus that leads to PHASE ONE | Before Conditioning

an automatic response. If a cold breeze makes you
In the before conditioning phase, an unconditioned
shiver, for instance, the cold breeze is an
stimulus is paired with an unconditioned response. A
unconditioned stimulus; it produces an involuntary neutral stimulus is then introduced.
response (shivering).
PHASE TWO | During Conditioning
b. Conditioned Stimulus → stimulus that was once
The during conditioning phase involves repeatedly
neutral (didn’t trigger a response) but now leads to a
response. If you previously didn’t pay attention to pairing a neutral stimulus with an unconditioned
dogs, but then got bit by one, and now you feel fear stimulus. Eventually, the neutral stimulus becomes
every time you see a dog, the dog has become a the conditioned stimulus.
conditioned stimulus. PHASE THREE | After Conditioning
c. Neutral Stimulus → stimulus that doesn’t initially In the after conditioning phase, the conditioned
trigger a response on its own. If you hear the sound stimulus alone triggers the conditioned response.
of a fan but don’t feel the breeze, for example, it
wouldn’t necessarily trigger a response; which would
make it a neutral stimulus.

2. Operant Conditioning — B.F. Skinner

Method that uses reinforcement and punishment to modify behavior.

Reinforcement → stimulus that is applied after the Punishment → stimulus that hinders the learner from
learner makes a response to stimuli that encourages doing a response again; absence of reinforcer is
them to do it again. considered a punishment.

☁ example of reinforcement.

stimuli: nurse asks the patient to walk.

☁ example of reinforcement.

stimuli: fun conversation with friends.

response: patient walks. response: person makes a bad joke.

reinforcement: family/nurse cheers for reinforcement: nobody laughs.

the patient.
outcome: patient learns that those types
outcome: patient is encouraged and will of jokes are not funny and becomes
try walking more to become independent. motivated to tell better jokes.

Everyone is different and responds to stimuli differently. What worked for one patient may not work for the next.

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 example: a child who was praised for walking after an injury may take it positively, but an elderly person may view it
as a form of pity.

3. Observational Learning

Process of learning by watching the behaviors of others. When individuals observe other behaviors, they constantly
retain those behaviors and repeat similar actions in the future. Observational learning also refers to shaping and
modelling, which typically occurs during childhood.

example: a child can learn how to paint her nails by watching.

example: an adult may learn to lift weights by watching others on videos.

According to Bandura’s research, there are four processes that influence observational learning:

attention → to learn, an observer must pay attention to something in the environment.

retention → simple attention is not enough to learn a new behavior. An observer must also retain, or remember, the
behavior at a later time.

reproduction → process where the observer must be able to physically perform the behavior in the real-world; easier
said than done.

motivation → all learning requires some degree of personal motivation. For observational learning, the observer
must be motivated to produce the desired behavior.

4. Respondent Conditioning — Ivan Pavlov

Ivan Pavlov was the first to identify and demonstrate a Behavioral Learning Theory.

Described it as complicated at first, but the explanation for learning or conditioning is really simple.

☁
Neutral Stimulus → a stimulus that has no meaning or
value to the learner is paired with a naturally occurring example.
unconditioned stimulus (UCS) and unconditioned
UCS: smell of dog food → UCR: the dog
response (UCR). This alone does not evoke response
begins to salivate
since this stimulus has no value to the learner.

Conditioned Stimulus → when the neutral stimulus is

NS: whistle ⇒ no response
repeatedly paired with the unconditioned stimulus, an NS: whistle + UCS: smell of dog food ⇒ UCR:
association between the previously neutral stimulus and the dog begins to salivate
the UCS is formed. The resulting response is called the CS: whistle → CR: the dog begins to salivate
conditioned response (CR).

Various Fields where Behavioral Learning Theory is Applied

Behaviorism in Education

Demonstrating the desirable response or behavior to Providing new behavioral goals.

students.
The instructor continuously tries to improve student
The educator explains acceptable and unacceptable behavior by showing new desirable behaviors and
classroom behaviors to the students. rewarding them.

Reinforcing the desired behavior or response. Being consistent.

The educator encourages good behavior through It is important for educators to be consistent when
reinforcement and discourages inappropriate assessing and reacting to both desirable and

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 behavior through punishment. undesirable behaviors.

Behaviorism in Psychology Behaviorism in the Workplace

The cornerstone of behavioral psychology holds that Managers in the human resource department, training and
anybody can be trained to perform whatever job they are development, sales and other key areas can use behavioral
physically capable of performing, regardless of their learning in the workplace to enhance employees’ skills,
personal preferences, personality traits, or genetic make-up. increase their occurrence of desirable behaviors and

This idea can be used by psychologists in cognitive- minimize undesirable actions.

behavioral therapy and behavioral therapy to try and identify According to behavioral learning, the best methods for
the behaviors that a patient’s problems - such as achieving these objectives are giving employees the chance
depression, anxiety, and substance abuse - and try to to observe managers, rewarding them for positive workplace
eliminate them through conditioning. They also use behaviors and disciplining them for negative ones.
behavioral learning to encourage fresh, constructive
behaviors that will probably enhance the lives of their
patients.

Behaviorist Teaching Strategies

The following are some strategies that educators can implement while teaching:

Periodic Reviews Question-and-Answer Sessions

Reviewing is essential for reinforcing the Questions can serve as important stimuli that provoke
behavior. responses.

Educators can conduct reviews with Educators can increase the difficulty of their questions to
students to repeat and revisit material provide students with additional support. It is essential that
that they previously taught. educators provide a reward with additional support. It is
essential that educators provide a reward for correct
This helps improve students’
responses. Students’ motivation to answer correctly and
information retention and serves as
prepare for question-and-answer sessions in advance
reinforcement.
increases.
Students can re-evaluate and
Behavioral Learning Theory assumes that if students are
understand concepts that they
given with right stimulus, then they will give a response that
initially found unclear.
the teacher wants.
Teachers can also conduct reviews to
Drills
assess each student’s performance in
the classroom. Drill is a useful technique to introduce a new lesson and to
familiarize learners with new concepts and an excellent way
Reviewing a child’s behavior and
for students to practice their skills.
performance can help teachers
identify issues and correct their It assists them with retaining concepts by mandating the
behavior. continuous repetition of actions and helps them reinforce
important skills and behavior. As a result, students know
Working individually with students can
precisely how to behave when the drill begins because of
help improve their performance and
multiple repetitions.
demonstrate a teacher’s care,
encouraging them to perform better. Drill exercises can give the teacher immediate feedback
about a learners’ understanding at each phase of the
Guided Practice Sessions
lesson.
With guided practice sessions, educators
Drill execution ideas:
can directly assist students in overcoming
problems and learning new behaviors.

Midterms Lessons 15
 During the sessions, an educator a. Choose the drill tools most suitable to the lesson theme:
instructs students on the ways to flashcards or games such as charades, board games,
respond by outlining the precise steps etc.
they can take.
b. Adequately prepare for your chosen tools.
Instead of relying only on theory, these
c. Prepare the ground rules that will encourage active
in-person demonstrations are an
participation by the learners: timing, members’ active
excellent way to gain practical
participation, number of ideas per person, etc.
knowledge.

🍙 𝐩𝐬𝐲𝐜𝐡𝐨𝐝𝐲𝐧𝐚𝐦𝐢𝐜 𝐭𝐡𝐞𝐨𝐫𝐲 𝐨𝐟 𝐥𝐞𝐚𝐫𝐧𝐢𝐧𝐠.

Psychodynamic Theory

The Psychodynamic theory is a theory of personality by Sigmund Freud that focuses more on emotions rather than
cognition or responses.

This is useful to healthcare workers as the theory helps in recognizing and assessing emotions, particularly negative
emotions, that is important in nurse-patient-physician-family interactions.

Main point → Behavior may be conscious or unconscious; individuals may or may not be aware of their emotions nor the
reasons why they feel, act, or think the way they do.

Id, Ego, and Superego

Ego Id

Important consideration in healthcare fields for both healthcare The consciousness and
workers and patients unconsciousness of a person’s
behavior is due to the Id which is
Healthcare workers require ego to cope with numerous
based on basic instincts, impulses,
predicaments in their workplace as they face conflicting values,
and desires we are born with.
ethics, demand, and burnout
The “primitive” instincts, impulses,
Significant aspect of the learning and healing process involves ego
and source of motivation. These are
strength
the traits we are born with, the
Example: instinctive part of the personality
A patient with ego strength → can cope with medical treatments Includes sex, self-preservation, and
because they recognize the long-term value of enduring aggression
discomfort and pain to achieve positive outcome
As a person develops, external
A patient with weak ego development → may miss their factors make it difficult to satisfy
appointments and treatments or engage in short-term these instinctive drives.
pleasurable activities that work against their healing and
recovery
Superego
When ego is threatened, defense mechanisms are employed to
protect the self. The component of personality
composed of the internalized ideals
short term use: a way of coming to grasp reality
we have acquired from our parents
long term use: allows individuals to avoid reality and may act as and society. It works to suppress the
a barrier to learning and transfer (harmful) urges of the ID (primitive drive), and

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 Defense mechanisms are useful in the field of healthcare especially tries to make the ego behave
for: morally, rather than realistically.

1. nursing students: grappling with the challenges of nursing It is known as our conscience.
education
One with strong superego would
2. staff nurses: dealing with the strains of working in hospitals have a strong sense of right and
and long-term care facilities wrong.

3. patients and families: used in learning to cope with illnesses The primary action of the superego
and injuries is to entirely suppress any urges or
desires of the id that are considered
Example of defense mechanisms in healthcare:
wrong or socially unacceptable.
DENIAL (Terminally-ill patients) → Patients typically find it too Finally, the superego strives for
overwhelming to process the information that they are very ill or moral perfections, without taking
likely to die. Although most patients gradually accept the reality reality into account.
of their illness, the dangers are that if they remain in a state of
denial, they may not seek treatment and care, and if their illness
is contagious, they may not protect others against infection.

Goals of Psychodynamic Theory

The theory aims for patients to:

1. Acknowledge emotions 3. Improve interpersonal relationships

Using the psychodynamic theory, people may be able to
understand their emotions, where they come from, and why
certain emotions are being felt. So, with practice, patients
should be able to identify the emotions that they feel and
their patterns. This will allow them to properly address them
and make better choices that recognize, acknowledge, and
support their feelings rather than push them away.
2. Identify patterns
Once a client recognizes their own emotions
and patterns, this will help to make better
choices regarding their relationships, their
feelings about their relationships, and the
like.
Help clients understand their relationships
and patterns and how to improve them or
what to do in certain situations

Along with recognizing emotions, the theory helps patients 4. Recognize and address avoidance
recognize patterns relating to their emotions, behaviors, and
Rather than avoid feelings, patients should
relationships, which will allow them to understand why they
be able to recognize, address, and deal with
may think or do certain things. For example, a patient may
negative emotions and situations and make
recognize that they feel happy when talking to a certain
choices that help them move forward. This
person, or that they feel irritated when doing a certain
also includes healthy coping mechanisms.
activity.

One central assumption of the psychodynamic theory is that personality development occurs in stages, with much of adult
behavior derived from earlier childhood experiences and conflicts. In health care, it is important to consider the patient’s stage
of personality development when designing and carrying out treatment regimens, communication, and health education.

One of the most widely used models of personality development is Erikson’s (1968) eight stages of life, with the model
organized around a psychosocial crisis to be resolved at each stage. difficulties arise and learning is limited when individuals
become fixated or stuck at an earlier stage of personality development. For example, some staff members and patients feel
an inordinate need to control the self, other people, and certain social situations. This behavior may be rooted in their
inability to resolve the crisis of trust versus mistrust at the earliest stage of life. In working with these individuals, it is important
to build a trusting relationship and to encourage them to gradually let go of some control.

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 Another factor that may affect health care practice is resistance. Resistance is the process where people resist talking about
or learning something which is an indicator of underlying emotional difficulties. These difficulties must be dealt with for them to
move ahead emotionally and behaviorally.
Factors Affecting Health Care Practice
1. Personality Development
Adult behavior is derived from earlier childhood
experiences and conflicts.
Erikson’s (1968) 8 stages of life, a psychosocial
crisis to be resolved at each stage.
Considerations of the patient’s stage of
personality development is essential in health
care when designing and carrying out treatment
regimens, communication, and health education.
Difficulties arise and learning is limited when
individuals become fixated or stuck at an earlier
stage of personality development.
example: some staff members and patients feel an
inordinate need to control the self, other people,
and certain social situations. This behavior may
be rooted in their inability to resolve the crisis of
trust versus mistrust at the earliest stage of life. In
working with these individuals, it is important to build
a trusting relationship and to encourage them to
gradually let go of some control.
2. Resistance
Past conflicts, especially during childhood, may
interfere with the ability to learn or to transfer
learning. What people resist talking about or
learning is an indicator of underlying emotional
difficulties, which must be dealt with for them to
move ahead emotionally and behaviorally.
example → A young, pregnant teenager refuses
to engage in a serious conversation about
sexuality (e.g., changes the subject, giggles, looks
out into space, expresses anger) indicates that she
has underlying emotional conflicts that need to be
addressed.
Possible sources of resistance among nursing
students include childhood struggles, a history of
overadaptation, self-image, and learning climate
Criticisms
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3. Childhood learning experience
Some physicians and nurses may have had the
childhood experience of standing helplessly by
watching someone they loved and once depended
on to endure disease, suffering, and death.
Although they could do little as children to improve
the situation, they may be compensating for their
childhood feelings of helplessness and dependency
as adults by devoting their careers to fending off
and fighting disease and death. These motivations,
however, may not serve them well as they attempt
to care for, communicate with, and educate
terminally ill patients and their families.
4. Societal pressure
The reluctance of health professionals to be open
and honest with terminally ill patients may be
derived to some extent from American culture,
which encourages medical personnel to “fix” their
patients and extend life. Staff members may or may
not be conscious of these pressures, but either way
they may feel guilty and perceive themselves as
failures when dealing with a patient who is dying.
5. Transference
Occurs when individuals project their feelings,
conflicts, and reactions—especially those
developed during childhood with significant others
such as parents—onto authority figures and
other individuals in their lives.
Example → A patient that is sick may feel
helpless and dependent and then regress to an
earlier stage in life when they relied on their parents
for help and support. Their childhood feelings and
relationship with a parent–for better or worse–may
be transferred to a nurse or physician taking care of
them. (this dependence may operate against the
autonomy and independence the patient needs
to get back on their feet)
18
 1. The theory is believed to be too deterministic or victim-blaming to be used in the modern day: The original ideas believed
that people had no personal agency or a lack of control over their behavior. It ignores the functions of the human mind.
The theory does not consider factors outside of the person’s unconscious psychology like the environment and genetics.

2. The theory is also considered to be sexist. Freud believed that women were inferior, had weaker superegos (making them
more prone to anxiety).

3. The theory also does not account for social issues (racism, sexism, poverty, homophobia, etc). Some believe that the
theory focuses too much on psychotherapy treatment (which is not always applicable) rather than broader, society-level
social concerns that may have been the true cause of problems that affect the person.

4. Freud’s theory has been criticized for its dependency on case studies, lack of empirical evidence, and its lack of a strictly
analytic approach. It is usually seen as unscientific.

🍙 𝐬𝐨𝐜𝐢𝐚𝐥 𝐚𝐧𝐝 𝐡𝐮𝐦𝐚𝐧𝐢𝐬𝐭𝐢𝐜 𝐥𝐞𝐚𝐫𝐧𝐢𝐧𝐠 𝐭𝐡𝐞𝐨𝐫𝐲.

The Social Learning Theory Social Learning Theory in Healthcare

Largely based on the work of Albert Bandura (1977-
2001), who mapped out a perspective on learning that
includes consideration of the personal characteristics of
the learner, behavior patterns, and the environment.
Bandura emphasized behaviorist features and the
imitation of role models.
As Bandura’s model of social learning has evolved, the
learner is now viewed as central (what Bandura calls a
“human agency”) which suggests the need to identify
what learners are perceiving and how they are
interpreting and responding to social situations. As such,
careful consideration needs to be given to the
healthcare environment as a social situation.
Applied to nursing education, community mental
health settings, addressing psychosocial problems,
and to maximizing the use of support groups.
example: research indicates that those managers
who are aware of their roles and responsibilities in
promoting a positive work environment enhance
learning, competence, and satisfaction.
Dissatisfaction, in contrast, has a detrimental effect
and is a significant cause of staff turnover.
Mental Providers used social learning theory paradigm
to organize training and produce changes within their
system to make employment a higher priority among
community mental health services.

One of Bandura’s early observations was that This theory is complex and not easily operationalized,
individuals do not need to have direct experiences to measured, and assessed.
learn.

Concepts of Social Learning

1. Role-Modeling

A central concept of social learning theory.

example: a more experienced nurse who demonstrates desirable professional attitudes and behaviors sometimes
serves as a mentor for a less experienced colleague.

Armstrong (2008) emphasizes that to facilitate learning, role models need to be enthusiastic, professionally
organized, caring and self-confident, as well as knowledgeable, skilled, and good communicators.

How nurse mentors perceive their roles is an important consideration in the leadership selection process.

2. Vicarious Reinforcement

Involves determining whether role models are perceived as rewarded or punished for their behavior.

Midterms Lessons 19
 Reward is not always necessary, however, a learner may imitate the behavior of a role model even when no
reward is available to either the role model or the learner.

Bandura’s Model Steps

1. Attentional Phase 3. Reproduction Phase

A necessary condition for any learning to
occur.
Research indicates that role models with
high status and competence are more likely
4. Motivational Phase
to be observed, although the learner’s own
characteristics (ex. needs, self-esteem,
competence) may be the more significant
determiner of attention.
2. Retention Phase
Storage and retrieval of what was observed.
The learner copies the observed behavior.
Mental rehearsal, immediate enactment, and corrective
feedback strengthen the reproduction of behavior.
Focuses on whether the learner is motivated to perform a
certain type of behavior.
Reinforcement or punishment for a role model’s behavior,
the learning situation, and the appropriateness of
subsequent situations where the behavior is to be displayed
all combine to affect a learner’s performance.

Bandura’s Views Culture and Self-Efficacy

Bandura (2001) then shifted his focus to sociocultural Culture and self-efficacy play a key role, with Bandura
influences, viewing the learner as the agent through noting that individualistic cultures interpret self-efficacy
which learning experiences are filtered. differently from the way group-oriented interpret it.

He argues that the human mind is not just reactive; it is Self-efficacy is a low sense of self-efficacy in either
generative, creative, and reflective. kind of culture produces stress.

Essentially, the individual engages in a transactional
relationship between the social environment and the
self, where sociocultural factors are mediated by
“psychological mechanisms of the self-system to
produce behavioral effects.”
Responsibility paces on the educator or leader to act
as an exemplary role model and to choose socially
healthy experiences for individuals to observe and
repeat.

Bandura stresses the internal dynamics of personal

selection, intentionality, self-regulation, self-efficacy, and
self-evaluation in the learning process.

Humanistic Learning Theory

The assumption that every individual is unique and that all individuals have a desire to grow in a positive way.

Positive psychological growth may be damaged by some of society’s values and expectations.

Modified the approach to education and changing behavior by giving primary focus to the subjective needs and feelings of
the learner and by redefining the role of the educator.

Humanistic principles are cornerstones of self-help groups, wellness programs, and palliative care.

Well-suited to working with children and young patients undergoing separation anxiety caused by illness, surgery, and
recovery, and to working in the areas of mental health and palliative care.

Cornerstones of a Humanistic Approach to Learning

1. Importance of emotions and feelings.

Midterms Lessons 20
 2. The right of individuals to make their own choices.

Humanistic theory → compatible with nursing’s focus on caring and patient centeredness.

Taking a skeptical approach → Traynor (2009) suggested the promotion of humanism in nursing in the UK, particularly
by nurse scholars, maybe based more on unexamined professional ideology than on critical examination.

Human perspective → a largely motivational theory similar to the psychodynamic theory.

Motivation → derived from each person’s needs, subjective feelings about the self, and desire to grow.

Transfer of learning → facilitated by curiosity, a positive self-concept, and open situations.

Maslow’s Hierarchy of Needs

Plays an important role in human motivation.

It is assumed that basic-level needs must be met before individuals can be concerned with learning and self-actualizing.

Research findings in support for Maslow’s hierarchy of needs have been inconsistent.

physiological needs → safety → belongingness and love → self-esteem → cognitive → aesthetic → actualization →
transcendence

Carl Rogers (1961-1994)

What people want is unconditional positive self- Fostering curiosity, enthusiasm, initiative, and
regard (feeling of being loved without strings responsibility is considered more important and enduring, and
attached). should be the primary goal of any educator.

Experiences that are threatening, coercive, and Helpful techniques include role playing, listening exercises, and
judgmental undermine the ability and filming students in the clinical setting.
enthusiasm of individuals to learn.
Feelings and emotions are the keys to learning,
Therefore, those in positions of authority need to communication and understanding in humanistic psychology.
convey a fundamental respect for the people
Humanists would argue, the overriding factor that will affect
with whom they work.
the behavior of the young person and the patient who is dying is
Mastering information and facts is not the their feelings, not their cognitions.
central purpose of the humanistic model of
learning.

Positive Psychology

More oriented to health and well-being than to learning per se.

Positive psychology may earnestly encourage patients to be positive and think for themselves well. Yet, this pressure can
overburden patients, and some may blame themselves (or be blamed by others) if they do not improve and their
illness/injury worsens.

Midterms Lessons 21