MODULE 2 – APPLYING LEARNING THEORIES TO HEALTH CARE

DEFINITION OF KEY TERMS:

 Learning: a relatively permanent change in mental processing, emotional functioning, and

behavior as a result of experience.

 Learning Theory: a coherent framework of integrated constructs and principles that describe,
explain, or predict how people learn (Bastable, 2008) – Nursing educators should use learning
theories to demonstrate that their methods are sound and that they have a clear rationale for
their lessons.

CONTRIBUTIONS OF LEARNING THEORIES

 Provide information and techniques to guide teaching and learning

APPLICATION QUESTIONS TO KEEP IN MIND

 How does learning occur?
 What kinds of experiences facilitate or hinder the process?
 What helps ensure that learning becomes permanent?

LEARNING THEORIES

I. BEHAVIORIST THEORY
 Concepts: stimulus conditions, reinforcement, response, drive
 The main objective of this learning theory is to change behavior, change the stimulus conditions
in the environment and the reinforcement after a response.
 views knowledge as something to be acquired, which is found outside and independent of the
learner
 Behaviorists view instruction as the process of providing knowledge (Boghossian, 2006). This
was the prevailing educational theory 20 years ago. The traditional lecture is an example of
a behaviorist teaching strategy.
 In behaviorism, the ideas of positive and negative reinforcement are effective tools of learning
and behavior modification, as well as a punishment and reward system.
 Three basic assumptions of behaviourism are:
o Learning is manifested by a change in behavior.
o The environment shapes behavior.
o The principles of contiguity (in direct contact with something) and reinforcement.
 Behaviorist Dynamics
 Motivation
 Educator
 Transfer

Two Ways to Change Behavior and Learning (OPERANT & RESPONDENT CONDITIONING)
 RESPONDENT CONDITIONING
o Also called association learning or classical/Pavlovian conditioning
o Learning occurs as the organism responds to stimulus conditions and forms associations.
 o A neutral stimulus is paired with an unconditioned stimulus–unconditioned response
connection until the neutral stimulus becomes a conditioned stimulus that elicits the
conditioned response.

OTHER RESPONDENT-CONDITIONING CONCEPTS USED IN PSYCHOLOGY AND HEALTHCARE

 Systematic desensitization
 Stimulus generalization
 Discrimination learning
 Spontaneous recovery

 OPERANT CONDITIONING
o Learning occurs as the organism responds to stimuli in the environment and is reinforced
for making a particular response.
o A reinforcer is applied after a response, strengthening the probability that the response will
be performed again under similar conditions.

 Changing Behavior Using Operant Conditioning

 To increase behavior
o Positive reinforcement
o Negative reinforcement (escape or avoidance conditioning)
 To decrease behavior
o Non-reinforcement
o Punishment

II. COGNITIVE LEARNING THEORY

 Concepts: cognition, gestalt, perception, developmental stage, information- processing,
memory, social constructivism, social cognition, attributions
 To change behavior, work with the developmental stage and change cognitions, goals,
expectations, equilibrium, and ways of processing information.

Cognitive theories make two basic assumptions:

1. Memory system is an active organized processor of information and
2. Prior knowledge plays an important role in learning.
 Cognitive Dynamics
 Motivation
 Educator
 Transfer

 GESTALT PERSPECTIVE
o Perception and the patterning of stimuli (gestalt) are the keys to learning, with each learner
perceiving, interpreting, and reorganizing experiences in her/his own way.
o Perception is selective.

 INFORMATION PROCESSING PERSPECTIVE

o The way individuals perceive, process, store, and retrieve information from experiences
determines how learning occurs and what is learned.
  COGNITIVE DEVELOPMENT PERSPECTIVE
o Learning depends on the stage of cognitive functioning with qualitative, sequential changes
in perception, language, and thought occurring as children and adults interact with the
environment.

 SOCIAL CONSTRUCTIVIST PERSPECTIVE

o Learning is heavily influenced by the culture and occurs as a social process in interaction
with others.

 SOCIAL COGNITION PERSPECTIVE

o An individual’s perceptions, beliefs, and social judgments are affected strongly by social
interaction, communication, groups, and the social situation.

 COGNITIVE – EMOTIONAL PERSPECTIVE

o Efforts to incorporate emotional considerations within a cognitive framework
• Empathy and moral emotions in moral development and prosocial behavior
• Memory storage and retrieval and decision making involves cognitive and emotional
brain processing.
• Emotional intelligence
• Self-regulation

III. SOCIAL LEARNING THEORY

 Concepts: role modeling, vicarious reinforcement, self-system, self- regulation
 To change behavior, utilize effective role models who are perceived to be rewarded, and work
with the social situation and the learner’s internal self- regulating mechanisms.

 Social Learning Dynamics

 Motivation: compelling role models perceived to be rewarded, self-system regulating
behavior, self-efficacy
 Educator: model behavior and demonstrate benefits; encourage active learner to regulate
and reproduce behavior
 Transfer: similarity of setting, feedback, self-efficacy, social influences
 A well-known social learning theory has been developed by Albert Bandura, who works within
both cognitive and behavioural frameworks that embrace attention, memory and motivation.
 Bandura put forward “reciprocal determinism”
 ROLE MODELLING is the central concept

IV. PSYCHODYNAMIC LEARNING THEORY _ By Sigmund Freud

 Concepts: stage of personality development, conscious and unconscious motivations, ego-
strength, emotional conflicts, defense mechanisms
 To change behavior, work to make unconscious motivations conscious, build ego-strength, and
resolve emotional conflicts.

 Psychodynamic Dynamics
 Motivation: libido, life force, death wish, pleasure principle, reality principle, conscious and
unconscious conflicts, developmental stage, defenses
 Educator: reflective interpreter; listen and pose questions to stimulate insights
  Transfer: remove barriers such as resistance, transference, reactions, and emotional conflicts

 CENTRAL PRINCIPLE: Behavior may be conscious or unconscious – people may or may not be
aware of their motivations and why they feel, think and act as they do.
 A theory of motivation emphasis is on emotions rather on responses to the environment or on
perceptions and thoughts.
 The id includes two components:
 Eros
 Thanatos

V. HUMANISTIC LEARNING THEORY

 Learning occurs on the basis of a person’s motivation, derived from needs, the desire to grow
in positive ways, self- concept, and subjective feelings.
 Humanistic learning theory is based on the assumption that all people are unique and want to
grow in a positive way.
 Maslow’s theory of the hierarchy of needs is a major influence in the humanistic learning
theory (Bastable, 2008).
 Focuses on the individual as the subject and asserts that learning is a natural process that helps
a person reach self-actualization. Scenarios and role modeling are important factors in
humanistic learning, as are experiences, exploring and observing others.
 Humanist Dynamics
 Motivation: needs, desire to grow, self- concept
 Educator: act as facilitator who respects learner’s uniqueness and provides freedom to
feel, express, and grow creatively
 Transfer: positive or negative feelings and choices as well as freedom to learn, promote, or
inhibit transfer

NEUROPSYCHOLOGY AND LEARNING

 Physiological and neurological bases of thinking, learning, and behavior
 Neurological conditions, mental health issues, and learning disabilities
 Relationship between stress and learning
 Integration of learning theories

GENERALIZATIONS ABOUT LEARNING

 Learning is a function of physiological and neurological developmental changes.
 Brain processing is different for each learner.
 Learning is active, multifaceted, and complex.
 Meaningful practice strengthens learning connections.
 Stress can interfere with or stimulate learning.

MOTOR LEARNING
 Motor learning is useful in addition to theories of psychological learning.

 Examples of skills taught

o Walking with crutches
o Putting on a colostomy bag
o Operating sophisticated medical equipment
  Stages of Motor Learning
o Cognitive stage
 Learner works to develop cognitive map.
o Associative stage
 More consistent performance, slower gains, fewer errors
o Autonomous stage
 Automatic stage, achieving advanced level

 Motor Learning Variables

o Prepractice
 Motivation, attention, goal setting, understanding of task goals, modeling/
demonstration
o Practice
 Massed vs. distributed, variability, whole vs. part, random vs. blocked, guidance vs.
discovery learning, mental
o Feedback
 Intrinsic (inherent) feedback
• Sensory and perceptual that arises when a movement is produced
 Extrinsic (augmented or enhanced) feedback
• Provided to learner from outside source (nurse, biofeedback)

COMMON PRINCIPLES OF LEARNING

 Knowledgeable educator
 Relate new information to learner’s past experiences

LEARNING HINDRANCES
 Ignoring common considerations may hinder learning.
 Other learning hindrances
 Lack of clarity and meaningfulness to what is being learned
 Fear, neglect, or harsh punishment
 Negative or ineffective role models

OTHER LEARNING HINDRANCES

 Inappropriate materials for learner’s ability, readiness to learn, or stage of development
 Detrimental socialization experiences
 Non-stimulating environment
 Lack of goals or realistic expectations

MAKING LEARNING PERMANENT

 Enhance the likelihood of learning
 Organize the learning experience.
 Make learning experiences meaningful and pleasurable.
 Recognize the role of emotions in learning.
 Pace the teaching session appropriately with the learner’s ability to process information.
 Practice new knowledge or skills (mentally and physically) under varied conditions.
 Learner may need incentives and rewards but not always.
  Assess and evaluate learner on skills soon after session as well as at later times to evaluate
knowledge transfer.

STATE OF THE RESEARCH EVIDENCE

 Tests and modifies theories, methods, and assumptions
 Challenges conventional wisdom and myths
 Interdisciplinary focus is beneficial
 Lack of resources is hindrance