HEALTH EDUCATION - The nurse sees his or her

actions in terms of long –

Learning – relatively permanent change in range goals (Specialization)
mental processing, emotional functioning,
and or behaviors as a result of experience 4. Proficient (3 – 5 years) – uses
- Life – long dynamic process maxims to guide to their situation
- Enables individuals to adopt to - Holistic understanding of the
demands and changes client
- Focuses on long – term goals
Learning Theories – frameworks that
describe, explain, or predict how people 5. Expert – intuitive grasp of the situation
learn, and what motivates people to learn - Has deep understanding of
and change the total situation
- Performance is fluid and
Learning Models
flexible and highly proficient
BENNER (2001)
PENDER
- 5 Levels of Learning based on
- Understanding of the multi – faceted
Dreyfus’ general model of skill
nature of persons correlating
acquisition
interpersonal nature and interacting
with interpersonal and physical
1. Novice – no experience (SN)
environment as they trail towards
- Taught with rules but rules
health
are context free and are
independent of specific cases GREEN’S PRECEDE – PROCEED MODEL
- Behaviors are limited and
flexible - Provides a comprehensive structure
- No experience in the for assessing health and quality of
application of rules life needs and evaluating health
promotion and other public health
2. Advanced Beginner – demonstrates programs
acceptable performance
PRECEDE
- Has prior experience in Predisposing Outlines a
actual situation Reinforcing diagnostic
- Principles to guide actions Enabling planning process
begin to be formulated to assist in the
Constructs in
development of
Educational
targeted and
3. Competent (after 2 – 3 years) – has Diagnosis and focused health
organizational and planning abilities Evaluation programs
- Differentiate factors
 PROCEED Behaviorist learning is based on:
Policy Guides the
Regulatory implementation - Respondent Conditioning
Organizational and evaluation of (Classical or Pavlovian
Constructs in the programs Conditioning) - emphasizes the
Educational and designed from importance of stimulus conditions
Environmental PRECEDE
and the associations formed in the
Development learning process
- Influences acquisition of
HEALTH BELIEF MODEL new responses to
environmental stimuli
- Explains and predict health - Uses to extinguish
behaviors based on beliefs and previously learned
perception responses
- Focuses on the attitudes and beliefs
of individuals RESPONDENT CONDITIONING MODEL
- Most widely used model for OF LEARNING
understanding health
(UCS) Unconditional Stimulus 
Factors that influence Health Unconditional Response (UCR)
Behaviors (Health Belief Model)
(NS) Neural Stimuli + UCS = UCR
- Perceived Susceptibility –
Ex.
perceived threat to sickness or
disease Hospital + offensive odor = queasy feeling
- Perceived Severity – belief of
consequence NS + UCS = UCR
- Perceived Benefits
Hospital  queasy feeling
- Cues to Action – factors that
prompt action CS  CR
- Self-efficacy – confidence in ability
to succeed Response Conditioning Technique

PSYCHOLOGICAL LEARNING 1. Systematic Desensitization – used

THEORIES USEFUL TO THE CLINICAL to reduce fear and anxiety
PRACTICE Assumption: Fear of a stimulus is learned
- Behaviorist therefore it can be unlearned
- Cognitive Operant Conditioning (B.F. Skinner) –
- Social Learning Theory focuses on the behavior of organism and
BEHAVIORIST the reinforcement that occurs after the
response
- Focuses on what is directly
observable
 - Reinforcement can either increase or
decrease behaviors
Cardinal Rule
Punish the behavior, not the person
Behaviors maybe decreased through:
- Non – reinforcement – simplest
way to extinguish a response by not
providing any kind of reinforcement
- Punishment – used when non –
reinforcement is ineffective
Goal: Decrease behavior
and instill self – discipline
Increase Response:
1. Positive Reinforcement
- Reward  enhance the likelihood
that a response will be repeated in
similar circumstances
2. Negative Reinforcement – removal
of an unpleasant stimulus through:
a. Escape Conditioning – causes
an uncomfortable situation to
cease
b. Avoidance Conditioning –
stimulus to anticipate rather than
being applied directly
Ex.: Feeling ill to avoid
something
COGNITIVE LEARNING THEORIES
- What goes on inside the learner
- Reward is not necessary for learning
- Cognition is the key to learning and
changing
Concepts of Cognitive Theories
 Learning – acquisition of new
knowledge and skills that changes a
person’s behavior
 Metacognition – thinking about
thinking
 Memory – connect new information
to the old
 Transfer – ability to trade
information learned and apply it to
another
 Information processing – how
information is incorporated and
retrieved
Theorists
Jean Piaget – cognitive developmental
theorist
- Children take information as they
interact with people and
environment
Lev Vygotsky – Russian psychologist
- Emphasizes language, social
interactions, and adult guidance in
the learning process
Research
 Young children learn often by
solitary (Palincsar and Bastable)
 Older children learn through social
interactions
 Adults do self – directed learning
emphasizing autonomy and initiative
SOCIAL LEARNING THEORY (SOCIAL
COGNITIVE THEORY)
Albert Bandura (1977) – people learn as
they interact with their environment
- Learning occurs as a result of
observing other people’s behaviors
and consequences
Role Modeling – central concept of the
theory
Nursing managers – influence the
outcomes of the clinical process
Implication of the Social Learning
Theory
 Recover quicker from
disappointments
 View challenging problems as tasks
to be mastered
4 Determinants of a Person’s Belief in
his or her ability
1. Performance accomplishment –
mastery of a task
2. Vicarious experience – learning
through observation
3. Verbal persuasion – acting as a
coach and providing encouragement
4. Physiological state
4 Sources of Self – Efficacy

 Educator or leader to act as 1. Mastery Experiences – doing task

exemplary role model to choose successfully
socially healthy experience - Failing with a task can
weaken self – efficacy
Key Components 2. Social Modeling – witnessing other
people successfully completing a
Attention process – determine which
task
modeled behaviors will be learned
3. Social persuasion
Retention process – the ability to retain 4. Psychological Responses – own
modeled behaviors in memory responses and emotional reactions
to situations
Bandura’s Self – Efficacy Theory - Minimize stress and elevate
mood
- Belief in one’s capabilities to
organize and execute an action Malcolm Knowles – theorized adult
- Person’s belief in his or her ability to learning concepts
succeed in a situation
- Determinants to how people think, Andragogy – teaching adult
behave, and feel
Pedagogy – teaching children
People with a strong sense of self –
Characteristic Pedagogy Andragogy
efficacy: Need to know Learn what Need to
the teacher know why
 Develop a deep interest in the
wants them they need to
activities that they participate to learn learn
 Form stronger commitment to their something
interests and activities
Self - concept Being Responsible Theory of Reasoned – Action
dependent for their
on the own - Based on a person’s intention to do
teacher for learning something
learning - Intention to change the behavior
Motivation Externally Internally
motivated motivated Subjective norms – reaction to behavior
with some
external Behavior control – how easy or difficult
motivation the new behavior is
Role of Teacher’s Adults learn
Experience experience from other’s Behavior Modification Theory
not the experience
children - Based on rewards and punishment
counts - Does what is want and is given
Orientation to Subject - Life – something pleasant (Reward)
Learning centered centered - Does not do what is want and is
and task – given something unpleasant
centered
(Punishment)
Readiness to Must be
Learn ready when
the teacher
says

Transtheoretical or Stages of Change

Model

- Use to discontinue an unhealthy

behavior

Stages in the Process of Change

1. Precontemplation – before they

think about change
2. Contemplation – pros and cons of
the changing behavior
3. Preparation – decide on how to do
the change
4. Action – start the change
5. Maintenance – keeping the new
and resisting the old behavior
6. Termination – when behavior
becomes a habit