Chapter 3
Applying Learning Theories to
Healthcare Practice
TOPIC LEARNING OUTCOMES
Define what is teaching
Define what is learning
Define what is theory
Identify 3 learning theories related to health care
practice
Describe what is Behaviorist Learning Theory
TOPIC LEARNING OUTCOMES
Describe what is Cognitive learning theory
Describe what is Social learning theory
Differentiate learning theories related to health
care practice
TOPIC LEARNING OUTCOMES
Distinguish which theory is applicable for given
situations in the health care situation
Relate each theory in the health care practice
TEACHING
the act, practice, or profession of a teacher
LEARNING
Learning: a relatively permanent change in mental
processing, emotional functioning, and behavior as
a result of experience
LEARNING THEORY
Learning Theory: a coherent framework of
integrated constructs and principles that describe,
explain, or predict how people learn
CONTRIBUTION OF LEARNING THEORIES
Provides information and techniques to guide
teaching and learning
Can be employed individually or in combination
Can be applied in a variety of settings as well as for
personal growth and interpersonal relations
Application Questions to Keep in Mind
How does learning occur?
What kinds of experiences facilitate or hinder the
process?
What held ensure that learning becomes
permanent?
BEHAVIORIST THEORY
Concepts: stimulus conditions, reinforcement,
response, drive
To change behavior, change the stimulus conditions
in the environment and the reinforcement after a
response
PAVLOV
Behaviorist Dynamics
Motivation: drives to be reduced, incentives
Educator: active role; manipulates environmental
stimuli and reinforcements to direct change
Transfer: practice and provide similarity in stimulus
conditions and responses with a new situation
Respondent Conditioning
Learning occurs as the organism responds to
stimulus conditions and forms associations
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
Operant Conditioning
Learning occurs as the organism responds to stimuli
in the environment and is reinforced for making a
particular response.
A reinforcer is applied after a response strengthens
the probability that the response will be performed
again under similar conditions.
Changing Behavior Using Operant Conditioning
To increase behavior
positive reinforcement
negative reinforcement (escape or
avoidance conditioning)
To decrease behavior
nonreinforcement
punishment
Advantages of Behaviorism
Highly structured situations
Skills training in which steps and sequences can be
clearly delineated
Disadvantages of Behaviorism
Instruction is mechanistic
Minimizes student involvement in learning
Inappropriate for complex mental processes,
problem-solving, and critical thinking
COGNITIVE 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 Dynamics
Motivation: goals, expectations, disequilibrium,
cultural and group values
Educator: organize experiences and make them
meaningful; encourage insight and reorganization
within learner
Transfer: focus on internal processes and provide
common patterns with a new situation
Gestalt Perspective
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
Learning occurs through the reorganization of
elements to form new insights and understanding
Information-Processing Perspective
The way individuals perceive, process, store, and
retrieve information from experiences determines
how learning occurs and what is learned.
Organizing information and making it meaningful
aids the attention and storage process; learning
occurs through guidance, feedback, and assessing
and correcting errors.
Focus on describing the way information is tracked,
the sequence of mental operations, and the results
of operations.
Cognitive Development Perspective
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.
Recognize the developmental stage and provide
appropriate experiences to encourage discovery.
Social Constructivist Perspective
A person’s knowledge may not necessarily reflect
reality, but through collaboration and negotiation,
new understanding is acquired.
Learning is development
Assimilation, accommodation, & construction are
part of learning
Social Constructivist Perspective ( cont)
Learning is heavily influenced by the culture and
occurs as a social process in interaction with others.
A learner constructs new knowledge by building on
internal representations of existing knowledge thru
personal interpretation of experience.
Social Cognition Perspective
An individual’s perceptions, beliefs, and social
judgments are affected strongly by social
interaction, communication, groups, and the social
situation.
Individuals formulate causal explanations to
account for behavior that have significant
consequences for their attitudes and actions
(attribution theory).
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
COGNITIVE THEORY-Advantages
Use of intellectual development gives teacher ↑
professional & personal satisfaction
↑ satisfaction in relationship with learner
↑ Increased use of a variety of instructional
strategies → teacher creativity
↑ learner satisfaction as move into improved
cognitive ability & look forward to more
challenging/ stimulating life
↑ Critical thinking in learner
COGNITIVE THEORY-Disadvantages
↑ time & energy by teacher to become
knowledgeable about different viewpoints
Students stressed if looking for certainty or absolute
answers
Developmental Stages of the Learner Across the
Lifespan
JAN GLENNDELL G. CALMA RN, RRT
LEARNING OUTCOMES
1. Identify the developmental stages of a person
2. Define each developmental stages of a person
3. Describe each developmental stages of man
4. Identify psychological theories applicable in the
developmental stages of a person
LEARNING OUTCOMES
5. Apply psychological theories in the
developmental stages of the learner
6. Define what is teaching
7. Define what is learning
8. Identify principles of teaching and learning
CHRONOLOGICAL AGE VS STAGES OF
DEVELOPMENT
CHRONOLOGICAL AGE
It is a measure of an individual's age based on the
calendar date on which he or she was born.
Chronological age is calculated on most
psychological tests. It is measured in days, months
and years.
STAGES OF DEVELOPMENT
the act, process, or result of developing
Formation of something
HOW DOES ILLNESS AFFECTS THE DEVELOPMENT
OF A LEARNER?
Children with chronic illness often are delayed Example: separation anxiety; play is his/her work;
developmentally fears loss of body integrity; active imagination;
an adolescent who suffers a traumatic event may interacts with playmates
regress developmentally. PRESCHOOLER
Developmental Stages of Childhood Teaching Strategies
PEDAGOGY build trust
is the art and science of helping children learn. allow for manipulation of objects
Child-centered learning use positive reinforcement
Infancy and Toddlerhood encourage questions
Infancy and Toddlerhood provide simple drawings and stories
PIAGET (0 -2 years old) focus on play therapy
SENSORIMOTOR STAGE stimulate the senses
learning is through sensory experiences and SCHOOL-AGED CHILD
through movement and manipulation of objects Piaget: CONCRETE OPERATIONS STAGE
Infancy and Toddlerhood developing logical thought processes and ability to
Erikson: reason syllogistically; understands cause and effect
trust vs. mistrust (birth to 12 months) SCHOOL-AGED CHILD
autonomy vs. shame and doubt (1-3 years) ERIKSON: INDUSTRY VS. INFERIORITY
building trust and establishing balance between gaining a sense of responsibility and reliability;
feelings of love and hate; learning to control willful increased susceptibility to social forces outside the
desires family unit; gaining awareness of uniqueness of
Infancy and Toddlerhood special talents and qualities
Salient Characteristics SCHOOL-AGED CHILD
COGNITIVE Salient Characteristics
Example: responds to step-by-step commands; COGNITIVE
language skills develop rapidly during this stage Example: able to draw conclusions and
PSYCHOSOCIAL intellectually can understand cause and effect
Example: aggravated by personal and external PSYCHOSOCIAL
limits; routines provide sense of security Example: fears failure and being left out of groups;
Infancy and Toddlerhood fears illness and disability
Teaching Strategies SCHOOL-AGED CHILD
focus on normal development, safety, health Teaching Strategies
promotion, and disease prevention encourage independence
use repetition and imitation use logical explanations and analogies
stimulate the senses relate to child’s experience
provide safety use subject-centered focus
allow for play and manipulation of objects use play therapy
PRESCHOOLER provide group activities
Piaget: PREOPERATIONAL STAGE use drawings, models, dolls, painting, audiotapes
egocentric; thinking is literal and concrete; and videotapes
precausal thinking ADOLESCENCE
PRESCHOOLER PIAGET: FORMAL OPERATIONS STAGE
ERIKSON: INITIATIVE VS. GUILT abstract thought; reasoning is both inductive and
taking on tasks for the sake of being involved and deductive
on the move; learning to express feelings through ADOLESCENCE
play ERIKSON: IDENTITY VS. ROLE CONFUSION
PRESCHOOLER struggling to establish own identity; seeking
Salient Characteristics independence and autonomy
COGNITIVE ADOLESCENCE
Example: animistic thinking; limited sense of time; Salient Characteristics
egocentric; transductive reasoning COGNITIVE
PSYCHOSOCIAL
Example: propositional thinking; complex logical abstract thought; reasoning is both inductive and
reasoning; can build on past experiences; deductive
conceptualizes the invisible MIDDLE-AGED ADULTHOOD
PSYCHOSOCIAL ERIKSON: GENERATIVITY VS. SELF-ABSORPTION
Example: personal fable—feels invulnerable, AND STAGNATION
invincible/immune to natural laws reflecting on accomplishments and determining if
Example: imaginary audience—intense personal life changes are needed
preoccupation MIDDLE-AGED ADULTHOOD
ADOLESCENCE Salient Characteristics
Teaching Strategies COGNITIVE
establish trust Example: ability to learn remains steady
identify control focus throughout this stage
use peers for support and influence PSYCHOSOCIAL
negotiate for change, contract Example: facing issues with grown children,
focus on details changes in own health, and increased responsibility
make information meaningful to life for own parents
ADOLESCENCE MIDDLE-AGED ADULTHOOD
ensure confidentiality and privacy Teaching Strategies
use audiovisuals, role play, contracts, and reading maintain independence and reestablish normal life
materials patterns
allow for experimentation and flexibility within safe assess positive and negative past learning
limits experiences
ADULTHOOD: DEVELOPMENTAL STAGES assess potential sources of stress
Young Adulthood provide information relative to life concerns and
Middle-Aged Adulthood problems
Older Adulthood OLDER ADULTHOOD
ADULTHOOD: TEACHING & LEARNING PIAGET: FORMAL OPERATIONS STAGE
Andragogy: the art and science of helping adults abstract thought; reasoning is both inductive and
learn deductive
Adult Learning Principles: relates learning to ERIKSON: EGO INTEGRITY VS. DESPAIR
immediate needs; self-directed; teacher is coping with reality of aging, mortality, and
facilitator; learner desires active role reconciliation with past failures
YOUNG ADULTHOOD GERAGOGY
Piaget: FORMAL OPERATIONS STAGE (begins in Geragogy: the teaching of older persons,
adolescence and carries through adulthood) accommodating the normal physical, cognitive and
abstract thought; reasoning is both inductive and psychosocial changes
deductive OLDER ADULTHOOD
YOUNG ADULTHOOD Salient Characteristics
ERIKSON: INTIMACY VS. ISOLATION cognitive
focusing on relationships and commitment to fluid intelligence—capacity to perceive
others in their personal, occupational, and social relationships, to reason, and to perform abstract
lives thinking, which declines with aging
YOUNG ADULTHOOD crystallized intelligence—the intelligence absorbed
Salient Characteristics over a lifetime, which increases with experience
COGNITIVE psychosocial
Example: cognitive capacity is fully developed, but Example: adjusting to changes in lifestyle and social
continuing to accumulate new knowledge and skills status
PSYCHOSOCIAL OLDER ADULTHOOD
Example: autonomous; independent; stress related Teaching Strategies
to the many decisions being made regarding career, use concrete examples
marriage, parenthood and higher education build on past experiences
MIDDLE-AGED ADULTHOOD focus on one concept at a time
PIAGET: FORMAL OPERATIONS STAGE use a slow pace
use repetition and reinforcement attack needs to know the signs and symptoms
provide brief explanations and when to get immediate help. The nurse
use analogies who works in a hospital must learn how to do
OLDER ADULTHOOD DESIRABLE NEEDS
speak slowly and clearly Needs that are not life-dependent but are related to
use low-pitched tones well-being
minimize distractions DESIRABLE NEEDS
rely on visual aids and supplement with verbal It is important for patients who have cardiovascular
instructions disease to understand the effects of a high-fat diet
use large letters and well-spaced print on their condition. It is desirable for nurses to
provide a safe environment update their knowledge by attending an in-service
give time to reminisce program when hospital management decides to
focus more attention on the appropriateness of
Chapter 4 patient education materials in relation to the
Determinants of Learning patient populations being served.
Educator’s Role in Learning POSSIBLE
The educator plays a crucial role in the learning Needs for information that are “nice to know” but
process by: not essential or required because they are not
assessing problems or deficits directly related to daily activities or the particular
providing information in unique ways situation of the learner
identifying progress made POSSIBLE
giving feedback The patient who is newly diagnosed as having
reinforcing learning diabetes mellitus most likely does not need to know
evaluating learners’ abilities about traveling across time zones or staying in a
The Educator’s Unique Position foreign country because this information does not
ASSESSMENT OF THE LEARNER relate to the patient’s everyday activities.
* ASSESSMENT OF THE LEARNER INCLUDES Methods to Assess Learning Needs
ATTENDING TO THE THREE DETERMINANTS OF Informal conversations
LEARNING: Structured interviews
* Learning Needs (WHAT the learner Focus groups
needs to learn) Self-administered questionnaires
* Readiness to Learn (WHEN the learner is Tests
receptive to learning) Observations
* Learning Style (HOW the learner best Patient charts
learns) Take TIME to take a PEEK at the four types of
ASSESSING LEARNING NEEDS Readiness to Learn!
Identify the learner P = Physical readiness
Choose the right setting E = Emotional readiness
Collect data about, and from, the learner E = Experiential readiness
Involve members of the healthcare team K = Knowledge readiness
ASSESSMENT OF LEARNING NEEDS measures of ability (body movements)
Prioritize needs complexity of task (Psychomotor skills)
Determine the availability of educational resources Environmental effects
Assess demands of the organization health status (Healthy learners have energy
Take time-management issues into account available for learning)
PRIORITIZING THE NEEDS gender (women are generally more receptive to
CRITERIA FOR PRIORITIZING NEEDS medical care and take fewer risks to their health
MANDATORY than men)
Needs that must be learned for survival when the THE COMPONENTS OF EACH TYPE OF READINESS
learner’s life or safety is threatened 2. EMOTIONAL READINESS
MANDATORY - ANXIETY LEVEL
EXAMPLE: - Fear is a major contributor to
A patient who has experienced a recent heart anxiety and thus negatively
 affects readiness to learn in any Educators need to guard against relying on teaching
of the learning domains. methods and tools which match their own
- SUPPORT SYSTEM preferred learning styles.
- The availability and strength of Educators are most helpful when they assist
a support system also influence learners in identifying and learning through the
emotional readiness and are their own style preferences.
closely tied to how anxious Six Learning Style Principles
someone might feel. (cont.)
- MOTIVATION Learners should have the opportunity to learn
- The motivation and interest on through their preferred style.
the part of the learner to Learners should be encouraged to diversify their
achieve a task also lead to more style preferences.
meaningful teaching–learning Educators can develop specific learning activities
experiences. that reinforce each modality or style.
THE COMPONENTS OF EACH TYPE OF READINESS Learning Style Models and Instruments
2. EMOTIONAL READINESS Brain Preference Indicator (Right-Brain,
- RISK-TAKING BEHAVIOR Left-Brain, and Whole-Brain)
- personalities, will take more Embedded Figures Test (EFT) (Field-
risks than others. The educator Independent/Field-Dependent)
can help patients develop Environmental Preference Survey (EPS) (Dunn and
strategies to help reduce the Dunn Learning Style Inventory)
risk of their choices. Myers-Briggs Type Indicator (MBTI)
- FRAME OF MIND Learning Style Instruments (cont.)
Frame of mind involves concern about the here and Kolb Learning Style Inventory (LSI)
now. 4MAT System
- DEVELOPMENTAL STAGE Gardner’s Eight Types of Intelligence
THE COMPONENTS OF EACH TYPE OF READINESS VARK Learning Styles
3. EXPERIENTIAL READINESS Right-Brain/Left-Brain and
LEVEL OF ASPIRATION Whole-Brain Thinking
The extent to which someone is driven to achieve is Brain Preference Indicator
related to the type of short- and long-term goals Right hemisphere—emotional, visual–spatial,
established, not by the educator, but by the learner nonverbal hemisphere
PAST COPING MECHANISMS Thinking processes using the right brain are
CULTURAL BACKGROUND intuitive, subjective, relational, holistic, and time
LOCUS OF CONTROL free
Learners are ready to learn when they feel a need Left hemisphere—vocal and analytical side
to know about something. This drive to learn comes Thinking process using reality-based and logical
from within the learner. thinking with verbalization
ORIENTATION Right-Brain/Left-Brain and
Whole-Brain Thinking
THE COMPONENTS OF EACH TYPE OF READINESS No correct or wrong side of the brain
4. KNOWLEDGE READINESS Each hemisphere gathers in the same sensory
PRESENT KNOWLEDGE BASE information but handles the information in different
COGNITIVE ABILITY ways
LEARNING DISABILITIES Knowledge of one’s own brain hemispherical
Learning Styles performance can help educators identify the
Learning style refers to the ways individuals process strengths and weaknesses of various teaching
information methods
Six Learning Style Principles Examples of Right-Brain/Left-Brain and Whole-
Both the teacher’ style prefers to teach and the Brain Thinking
learner’s style prefers to learn can be identified. Prefers talking and writing
Recognizes/remembers names
Solves problems by breaking them into parts
Conscious of time and schedules
Prefers drawing and manipulating objects
Recognizes/remembers faces
Solves problems by looking at the whole, looks for
patterns, uses hunches
Not conscious of time and schedules
Field-Independent/Field-Dependent Embedded
Figures Test
Embedded Figures Test
Learners have preference styles for certain
environmental cues.
Helps the educator structure the learning task and
environment
Helps assess the extent to which learners are able
to ignore distractions from other persons
Assesses whether learners see the whole first or the
individual parts of a task when learning
Environment Preference Survey (LSI)
Myers-Briggs Type Indicator
Kolb Learning Style Inventory
4MAT System
There is a combination of Kolb’s model combined
with right/left brain research.
There are four types of learners.
Educators can address all four learning styles by
teaching sequentially from type-one learner to
type-two learner, etc.
Learning sequence is circular and cyclic.
Gardner’s Eight Types of Intelligence
(#8 identified in 1999--naturalistic)
Interpretation of Style Instruments
Caution must be exercised in assessing styles so
that other equally important factors in learning are
not ignored.
Styles only describe how individuals process stimuli,
not how much or how well information is learned.
Style instruments should be selected based on
reliability, validity, and the population for which
they are to be used.
More than one learning style instrument should be
used for appropriate assessment of learner.
Generational Styles- Silents
born 1925-1942 >61 years old
 This group is not clueless about
technology; the fastest growing group
of Internet users
 Older adults may need technology
training.
 Let your students dictate the pace;
don’t rush things.
 Be polite, say “please” and “thank you”.
 Use proper grammar at all times
 Avoid all off-color language or humor.
 Even if you’re using computers for
training, provide plenty of opportunity
for personal
***interaction: Older learners like to interact with
people, not machines.
Generational Styles-Baby Boomers
born 1943-1960 43-60 years old
 Show them that you care, Be nice
 Fairness is important.
 Tell them they are important.
 Know their names.
 Give them a chance to talk-they want to show
you what they know.
 Dialogue and participation is key.
 Don’t be authoritarian; don’t boss them
around.
 Be democratic--Treat them as “equals”
 Acknowledge what they know; ask them lots of
questions so they can demonstrate what they
know
 Treat them as though they’re young, even if
they aren’t
 Avoid “sir” and ma’am”, which they may take
as an insult
 Respect their experience
Older people
Do’s and Don’ts
All printed material should be clear, easy to read,
large enough font.
Provide a summary of topics and goals.
Be pleasant, personal but not too intimate.
Don’t put them on the spot. Give them time to
prepare.
If you’re a 20-something trainer…
Get coaching from someone older to understand
the mindset of this generation.
Invite someone with a little more gray hair to be a
guest presenter in your class, to help with
credibility.
Show respect for age and experience.
Generational Styles- Gen Xers
born 1961- 1981
 Flexible
 Independent
 Can multitask well
 Pessimistic
 Used to change
 Want to get job done
 Visual & dynamic
 State of art technology & know how to
use it
 Only read when they have to!
Generational Styles- Gen Y
born 1981- 2003
 Accept authority & follows rules
 Balance work & personal life
 Direct & Vocal
 Optimistic
 Socially aware & involved
 Team player
 Technology expected
 Active-let them move around
 Frequent and instantaneous feedback
 ARE readers—provide backup info