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Applying Learning Theories to Healthcare Practice

Portfolio 1 Learning Task 2

Devine S. Oclarit
College of Nursing: Visayas State University – Main Campus
K007 NuCM 102 Health Education
Instructor: Ciedelle Honey Lou D. Gapasin
April 8, 2021
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Motivation Questions

1. How do the environment and the internal dynamics of the individual influence learning?

The environment will have a significant effect on the internal dynamics of an individual in the learning
process. The existing social support from the family or friends can increase the level of the learner’s
ability to learn independently. In a family environment, one way the family can support the learner is to let
them solve their own problems.

Internal dynamic of a learner serves as the mediator of the importance of environmental factors in
his/her learning. The higher the interest and desire of the learner in learning will make them try
independently to pursue or achieve their desire independently.

2. Is the learner viewed as relatively passive or more active?

An individual can be passive or active learner. However, a learner is viewed as more active
because a learner is always curious and wanted to know more. In this case a learner will find a way and
try to explore or connect the topic how it is related to his/her current life.

3. What is the educator’s task in the learning process?

Despite multiple instructor contributions to the implementation of teaching and educational

programs, the primary role of the educator is education. Educators must also recognize that the essence
of education is a close relationship between an informed, responsible adult and a confident, motivated
learner. They recognize that their most important job is to get to know the factors that can affect the
learning of an individual so that they can understand his/her specific needs, learning style, social and
cultural context, interests, and skill. They are mentors in critical and creative thinking as learners develop
and mature, assisting them in integrating and intellectual development to understand and use what they
have learned. Educator’s task includes being a learner rather than seeing themselves merely as masters
of subject matter.

4. What motivates individuals to learn?

Some learners are motivated to learn because they are extrinsically motivated. It means they are
waiting and expecting a reward or praise when they meet the standards and gets punished when they
are not. Some get motivated because of their intrinsic desire to learn, which would lead them to greater
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commitment which leads to better levels of learner’s learning achievement and success. Other learners
get motivated because they perceived learning to survive, improve, and uplift their poverty life.

In another view, learners get motivated to learn when an educator provides project-based,
participatory, educational adventures. In this way, learners fully take ownership of their education,
understands that every learning curriculum is relevant to their lives, acknowledge learning experiences
that engage their natural interest, and tests that quantify actual achievements and being an essential part
of learning. When the learners received new information and knowledge, they start to think about where
they can apply or connect it to what matters to them.

5. What encourages the transfer of learning to new situations?

What encourages an individual to transfer learning to new situations is that when an individual
desires to keep his/her current skills. Also, to be able to apply this learning in real-world situations. Once
an individual learns how to transfer learning to different situations or contexts, he/she will be able to get
an opportunity to change profession or job while still applying the prior knowledge to the situations and
challenges he/she might encounter in his/her new role.

Definition of Terms
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 Respondent conditioning – This form of learning is also knowns as classical conditioning or
Pavlovian conditioning, after Ivan Pavlov. This conditioning occurs when a neutral stimulus (NS)- a
stimulus that has no extraordinary worth or significance to the learner is linked or paired to naturally
occurring unconditioned or inborn stimulus (UCS). The neutral stimulus will evoke the same
unconditioned response following a few such pairings. Consequently, learning happens the newly
conditioned stimulus (CS) becomes paired with a conditioned response (CR)- an interaction that may
well happen without cognizant idea or mindfulness.
 Systematic desensitization - It is a strategy pioneered by a psychologist named Joseph Wolpe.
This is anchored on respondent conditioning used by psychologists to alleviate fear and anxiety in
their clients. Its assumption is that clients could conquer their fears to certain stimuli or learned
situations by gradual and systematic exposure. For a reason that fear is learned; therefore, it also
can be unlearned.
 Stimulus generalization – It occurs when a previously reinforced reaction occurs for the first time in
the existence of a structurally identical stimulus. For example, if an individual encountered an
interaction with a certain context like vaccination his/her evaluation as well as own's subsequent
feelings about needing a vaccine again can be influenced by his/her extremely positive or negative
experiences. If an individual often experiences negative reinforcement, the individual may create a
sophisticated distinction. It when the discrimination learning happens.
 Spontaneous recovery – It discusses why it is so unlikely to control away from the negative habits
and addictive behaviors like smoking, alcoholism, and substance abuse. It is much easier to learn a
behavior than it is to unlearn it. Spontaneous recovery can be defined as the recurrence of the
thought extinct behavior.
 Operant conditioning – It emphasizes an individual’s manners and the reinforcement that happens
after the response. An individual’s behavior will be more likely to be maintained if it is being
reinforced. However, when it is prompted with punishment, it is less likely to be repeated. Any new or
ongoing patterns will have an impact on new or sustained habits.
 Escape conditioning – It is a form of conditioning in which a person learns to resist aversive or
undesirable stimuli. When an aversive stimulus is applied, the person responds by attempting to
escape the stimulus situation.
 Avoidance conditioning – In avoidance conditioning, the negative stimulus is expected rather than
implemented explicitly. When a cue or warning signal is perceived by an individual, he/she is
conditioned to respond to an anticipated unpleasant event by avoiding the aversive stimulus.
A. Behaviorist Learning Theory
Using Behavioral Theory to Enhance Occupational Safety and Health: Applications to
Health Care Workers
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Individuals employed in medical care and social services are at a high risk of injury and illness
because of their employment. This article proposed that social and behavioral science theories may be
useful tools for developing approaches to reduce occupational accidents and illnesses, as well as a
guide for investigating different factors that can hinder or promote worker safety and health. Specifically,
using behavioral theory to determine individual-level behavioral change that could affect health care
workers' work and safety outcomes.
This article (1) gives a short outline of broadly utilized, individual-level behavior change theories
and instances of their application to occupational safety and health (OSH)– related intervention that
include the medical services community; (2) presents a coordinated theory of behavior change and its
application to advancing the OSH of medical care workers; and (3) discusses about promising
circumstances for use of individual-level behavior change theory to OSH exploration and practice
exercises including medical services.
The use of behavioral change theories in primary care settings and in injury prevention has been
encouraged and these theories hold promise for designing programs and practices to prevent OSH-
related injury and illness in health care settings.
Health Belief Model is one of the most widely used theories in health behavior that was
developed in the 1950s. It proposes that behaviors are an element of whether an individual (1) feels
undermined, (2) believes that a specific type of change will result in a beneficial outcome at a reasonable
cost, (3) experiences an extrinsic stimulus (such as instructional knowledge or a reminder system), and
(4) feels capable of overcoming potential obstacles and effectively participating in or carrying out the
operation or action in question. HBM was effective in developing and evaluating an educational
intervention. Infection management techniques were taught to emergency responders, and the model
could be used in potential approaches for this high-risk category of staff. Sadeghi and colleagues
demonstrated this by conducting a quasi-experimental review of infection control procedures to prevent
the spread of blood-borne illness among 100 emergency room staff in Iran.

The Theory of Reasoned Action has been shown to explain a significant proportion of the
variation in intention to perform a variety of health behaviors. According to TPB, attitude, subjective
standards, and perceived behavioral control all seem to have a direct effect on a person's intention to
participate in a behavior. It proposes that the most significant indicator of a person's actual actions is
behavioral intention. An example of the TPB is used in examining the frequency of safe manual patient-
handling practice. Specifically, behavior under investigation was the use of hoist among 189 health care
workers in United Kingdom to move patients with reduced physical function from the bed to the chair.
The study assessed at the effect of social-cognitive variables from the TPB about the plan to use the
hoist system.
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Transtheoretical Model (TTM) or also called as stages of change model proposed that people are
at different levels of readiness to adopt such health behaviors and behavior change is a process
involving several, often non-linear steps to achieve long-term behavior change. Prochaska et al. outline
six steps: precontemplation, contemplation, preparation, action, adoption, and termination. Six transition
processes were also expressed to define and predict the factors that promote a person's progression
from one step of the model to the next. Workplace abuse in medical-surgical units at a large suburban
medical center in Maryland is one example of how the TTM was used in an OSH-related study among
health care staff.

After evaluating all theories and their explanatory dimensions, consensus was reached on eight
factors that tend to account for most variation in health-related behaviors: (1) intentions, (2) contextual
constraints, (3) abilities, (4) outcome expectancies (or attitudes), (5) social norms, (6) self-standards, (7)
emotional responses, and (8) self-efficacy.

In general, one or more of the following must occur for an individual to perform a given action.
They: (1) Make a clear positive purpose or a promise to carry out the behavior, (2) Possess the abilities
needed to carry out the behavior, (3) Perceive more social (normative) pressure to engage in the
behavior than to refrain from engaging in the behavior, (4) Believe that carrying out the action is more
associated with the self-image than inconsistent, or that its success does not breach personal
expectations or norms that evoke negative emotions or consequences, (5) Believe that carrying out the
action is more associated with their self-image than inconsistent, or that its success does not breach
personal expectations or norms that evoke negative emotions or consequences.

We can also apply these notions to a specific workplace injury–control behavior for nursing
students in laboratory classes: wearing protective googles when there is the possibility of contact with
harmful chemicals. If I am a nursing student who is committed to always wearing protective goggles, has
ready access to goggles when needed, and has the skills needed to successfully wear the goggles, then
there is a high probability that I will perform the behavior.

Theories truly serve as a valuable road map for researching factor that both impede and
encourage workplace safety and health. Theory is a necessary system of thinking and organizing ideas
to comprehend public health problems and accurately assess the effectiveness of strategies designed to
resolve these issues.

B. Cognitive Learning Theory

Cognitive Learning Theory for Clinical Teaching

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Cognition is the act of understanding, perceiving, and processing knowledge, focusing on brain
functioning and mental processes. Thus, cognitive learning is the use of thought to learn, and this
thinking can be influenced by both external and internal influences. The author of this article discussed
six central aspects of cognitive learning theory, as they apply to health professional education and
clinical teaching. The six clinical teaching practices-related concepts are retrieval practice, spaced
learning, interleaving, self-practice, reflection, and elaboration.

In a much fitting situation as we embark on the new normal education setting, during virtual
classes, where slides kept on flashing while the instructor discusses the management of cancer patients.
Nonetheless, the learners are trying to keep up with the teaching points and finding that, despite having
heard and read about the subject previously, they are having trouble remembering some key points.
When an instructor asks a group of learners to present a case during clinical the instructor finds that they
are grappling with salient points that have already been covered. As part of the educational leadership
team, the instructor must review the learners' scores from a training examination and noticing low scores
for certain topics but seems that the topics are more than adequately covered in teaching sessions.
Despite the repetition, the students are not retaining the details.

Evaluating how a learner attends to, processes, and stores the information provided, as well as
finding ways to facilitate the retention and retrieval processes, are all part of education. Cognitive
learning theory can then be used to assist learners with the retention and translation of medical
knowledge.

The two aspects of cognitive learning theory-retrieval and reflective practice can be employed by
allowing learners to review learning points and questions at the beginning as well as at the end of every
session. Using questions to revisit essential learning points in a clinical setting help learner to remember
key learning points from a teaching or clinical session. Periodically developed quizzes based on prior
learning points and cases on a regular basis can also be integrated. This is a form of interleaving
strategy that enables learners to establish connections to previously taught content, promoting retention
and a deeper understanding of new material. Learning is improved when a learner must respond to a
given question or problem. According to the study, when learners test themselves rather than simply
learning without testing, they recall approximately 50% more data. Retrieval practice will help to avoid the
normal memory decay that we all encounter. Furthermore, spaced learning, also known as asynchronous
learning, has been shown to significantly improve long-term retention without the need for extra time.

Cognitive theorists maintain that the more important are learner’s goals and expectations rather
than a reward. Through setting the expectation that the group will be asked to revisit two key teaching
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points about managing cancer patients at the end of clinical or a didactic session is an effective way as
well to improve long-term retention and promote interest.

When adults teach children, their role is to respond to and explain the children's actions. It is the
educator's responsibility in a clinical setting to recognize the learner's stage of learning and to provide
opportunities at an acceptable level for the learner to discover and engage in the learning process.
Through observing and tracking learners directly ‘in action' when conducting a history and physical
evaluation or counseling a patient about their care plan allows for clear and timely feedback to help
learners achieve their goals. Also, encouraging learners to identify any confusion and uncertainty that
may arise at the end of a clinical encounter by asking them questions to promote self-reflection. Offering
the time and the opportunity to actively think, educators are building a healthy environment for learners to
incorporate their thinking, making connections, and recognize gaps that must be filled. Through self-
reflection, it allows learners to solidify their learning.

In promoting a better understanding of new knowledge and improving learner’s ability to apply,
analyze and synthesize the prior knowledge or to past experiences learners are challenged to answer
‘why’ and ‘what if’ questions. The learners will be pushed through elaboration that can expand their
mental cues for recall and transfer of information. Educators must also encourage the learners to teach
in a clinical setting as “effective learning occurs through social interaction, collaboration, and negotiation
(Shapiro, 20002).”

As a medical learner in this new normal education setting, it is undeniably overwhelming and
difficult to keep track, reflect, revisit, and retain all the acquired information as we all encounter memory
decay. As we must do self-directed learning, collaborative learning is minimized by which helps us to
develop a higher level of thinking, oral communication, and increase learning retention. Educators'
methods of posing open-ended questions about our learning help us learn to gauge our development
and recognize areas that need to be revisited. It inspires and guides us to think about our learning by
employing cognitive learning theory. Since it can include students of all ages. Using this principle in a
clinical environment will significantly improve information retention and improving implementation of that
knowledge can eventually translate into improved patient care.

C. Social Learning Theory

Social Learning Theory: Its Application in The Context of Nurse Education

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The purpose of this article is to critically examine the concepts of Social Learning Theory,
considering their importance and implementation in the context of nurse education. It also considers the
component processes that, other than reinforcement, will decide the outcome of observed behavior, as
defined by Bandura, namely attention, retention, motor reproduction, and motivation.
Role modeling is the core concept of social learning theory. This allows the student to observe a
skilled nurse, allowing the student to promote the professional role. This includes not only the acquisition
of clinical skills but also the acquisition of professional behaviors and experiences with patients and other
members of the multidisciplinary team. Bandura (1977a) presents a variety of component mechanisms
involving factors other than reinforcement that will decide the result of observed actions. (1) attentional;
(2) retention; (3) motor reproduction; and (4) motivation.

In the past, student nurses were socialized into the nursing profession by staying in the nurse's
housing, attending lectures in uniform, and becoming an important part of the workforce, creating a
sense of belonging to the community. Peers for nursing students are other university students from
various disciplines, and their identity is that of an undergraduate student. The hospital's nursing school
offered theoretical guidance, which was supplemented by practical instruction on the ward. Students
must pay attention to the significant features of a member of staff's modeled behavior, the consistency of
which was constrained by that individual's experiential experience. In the attentional process, it
demonstrates that higher-level and valued role models are bound to be observed, even though the
student's characteristics may be a huge determiner of consideration.

Retention of knowledge has a major effect in learning. When an individual anticipated to carry out
an observed duty can learn to retain information by imaginative and verbal structures, which will be
supplemented by practice and repeated exposure. The student’s ability to retain may be reduced due to
conflict between the student and the model. Coding modeled events in concise symbols and meaningful
verbal codes can be a very effective way of retaining observed knowledge. However, inaccurate coding
and processing of knowledge may result in difficulties accessing and retrieving knowledge. Repeating
new events with the important aspects highlighted will aid retention; however, repetition alone, while
increasing the number of memory traces, is not as successful as rehearsal since it requires the
application of memory strategies.

The reproduction process in observational learning is based on translating symbolic

representations into behavior, which does not occur in nursing until the student is eligible. Since
individuals are unable to observe their results, they must rely on informative feedback provided by the
model to make self-corrective changes. Since the development stage is inextricably linked to the
person's delivery of expertise, so guided preparation is needed if complex practices are to be made.
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More complex components can be introduced as simpler ones are mastered. Nurses must understand
how observational learning works and how to improve it because they also teach patients practical skills.

For example, when teaching diabetic children to inject their insulin or teaching tracheotomy
patients to care for their equipment. The effectiveness of the learning connection will have a significant
effect on that individual’s quality of life. Even though the symbolic representation of learning is there,
there might be actual constraints in organizing the variety of activities required. As a result, learners must
establish a rapport with the model based on shared understanding and support to identify individual
strengths and shortcomings in applying practice-based knowledge.

Motivational process examines whether the learner is inspired to engage in a particular type of
action. The motivation to perform is given by three sources: external, vicarious, and self-created.
External incentives incorporate prize when modelled behavior is met with esteemed results, yet negative
input will inhibit performance. Based on our standards of behavior, each of us responds to our behaviors
through self-reward or self-punishment. This normal behavior will be used to compare to other results.
When success is attributed to our skill and effort, it creates a deep sense of pride; moreover, when
success is attributed to external factors, self-satisfaction fails.

According to Bandura, the primary component of social learning theory is the individual’s
vicarious acquisition of knowledge by observing a variety of model. In my nursing education journey,
how I perceive my role models (i.e., instructor, professor, clinical instructor) will play an important factor.
It depends on how I perceived and code the meaningful events I encounter every learning session to
effectively retain my observed knowledge. However, if I will misinterpret the behavior or the actions
shown by my role models, it is I who will have difficulty accessing and retrieving my knowledge. As I
seek self-awareness of cognitive states and processes, I must practice metacognitive process. It
includes planning, monitoring, and regulating my learning process.

The advantage of social learning theory in nurse education is its focus on the social aspect of
learning appropriate to education, which takes place in a social environment, acknowledging the
complexity of the environment and the person. Cognitive theories are also crucial in problem solving and
understanding and applying concepts in a variety of situations.

D. Psychodynamic Learning Theory

The Importance of Psychodynamic Approach During COVID-19 Pandemic

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The World Health Organization (WHO) forced solid measures to end the infection's spread.
Unfortunately, numerous individuals ignored the seriousness of the COVID-19 pandemic. To
comprehend why these individuals have not changed their behavior, verifying the complex contents of
the unconscious is vital. Psychodynamic approaches to dealing with dysfunctional behavior center
around a range of factors that can affect symptoms, such as early childhood experiences (especially
level of connection to guardians), current relationships, and the things individual do (often unconsciously)
to defend themselves from upsetting thoughts and feelings that result from witnessing a disturbing
experience.
Unlike cognitive-behavioral theory, psychodynamic theory places a strong focus on defensive
mechanisms and the unconscious mind, which houses disturbing emotions, desires, and ideas that are
too difficult to confront directly. Even if we are not conscious of these unpleasant feelings and emotions,
they continue to affect our actions in a variety of ways.

Our problems occur, and learning is limited, according to the psychodynamic perspective, when
we are fixated or disturbed at an earlier stage of personality. Thus, to help an individual during the global
threat of the coronavirus, the authors introduce psychodrama as a tool. Since psychodrama emerged
from psychodynamic principles such as transference and countertransference, defense mechanisms,
object relations theory, and so on. Psychodrama is to let oneself in the shoes of another person, thing, or
phenomenon to see and experience oneself and others from a different viewpoint. Role-playing also
means finding openings, experimenting with new scenarios, and making choices during an event - all of
which are great ways to exercise social skills. The goal of psychodrama is to establish personal control
over the situation through empowerment strategies while avoiding re-traumatization.

In changing the behavior an individual also remains in touch with the therapist and “working
through” the painful unconscious feeling. The therapist will help the patient recognize the defensive
mechanisms that are being used, why they are being used (to suppress unpleasant feelings in the
unconscious mind caused by a traumatic experience), and communicate with and properly release
certain feelings and thoughts that were previously avoided. Therapists and patients should work to gain
insight into the root issue. With this understanding, the patient will continue to work through those
unpleasant emotions more happily and appropriately.

Our choice of defense mechanisms is involuntary, but so-called “mature defenses” (e.g.,
sublimation and humor) are opposed to “immature defenses” (e.g., projection and hypochondriasis) can
make a tremendous effect on our mental health resilience. The creation to resolving the crucial issues is
to use empathy, restorative justice, and mentalization to understand the other party what implies that
both or all sides have values, attitudes, and actions have meaning.
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The authors emphasize that the psychodynamic viewpoint is useful in better understanding
learning and teaching because it emphasizes a variety of factors of underlying considerations and
complexities in motivations, emotional development, and internal conflicts related to learning are
examples of processes. It also draws attention to concerns with learning or the teacher-learner
relationship. As a result, they believe that integrating a psychodynamic approach into the national public
and mental health emergency framework would empower Croatia and the rest of the world during (and
after) the COVID-19 pandemic crisis.
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Comparative Summary of the Five Learning Theories

Learning Theory Learning Process Assumptions Educator’s Task Source of Transfer of

about the Learner Motivation Learning

Behaviorist Examining how Relatively passive Dynamic educator, Desire to reduce Transferring actions
people respond to a and easily support positive or some drive (drive from the initial
situation and then manipulated. negative reduction). learning situation to
alter the reinforcements to other environments is
environment in direct behavior primarily a matter of
some way to change and learning. familiarity
achieve the best (reinforcing habits)
behavior. and a similarity in
stimuli and behaviors
Influenced solely by between the learning
direct observable, situation and future
physical variables scenarios where the
such as response is to be
environmental or performed.
material
reinforcement.

Cognitive Individual’s learning Active learner Active educator More crucial are Utilization of
and change are recognizes patterns recognizes factors the goals and previously acquired
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dependent on and integrates that affects learning expectations of and current
cognition (reflection, knowledge and familiar with the the learners, knowledge or
perception, memory, acquired from learner's way of which cause expertise (physical or
and ways of interactions with processing disequilibrium, mental activity) in
interpreting and people and the information. Structure imbalance, and new learning and
structuring environment. meaningful stress. determining how to
information) experiences that learn furthermore.
partake individual’s
reorganization of
cognition.
Social Learning A learning viewpoint Active learner Active educator, Gained Role model’s
takes into account observes role exemplary role, experiences with behavior and
the learner's models and powerful socialization, role similarity of setting
attributes, behavior translate symbolic communicator, models, and self-
patterns, and role representations competent with the reactive factors
models. To modify into behavior. skilled organization to (self-observation,
behavior, adjust role empower support goal setting, and
models, perceived reinforcement and reinforcement of
reinforcement, and impact student self- performance).
the learner's internal regulation.
mechanisms.
Psychodynamic The conscious and Active learner's Educator as mediator Libidinal energy; Identity conflict,
unconscious forces way of living, past reflects and interprets eros (desire for resistance, and
guide actions, and present learner's character sex and conveyance of
personality conflicts, encounters, and and motivation by pleasure), thanos related to learning
ego strength and the prevailing actively listening and (desire for death), conditions may
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long-term effects of emotional conflicts asking questions to defense hinder the transfer of
childhood all affect what is increase conscious mechanism and learning.
experiences learned, as well as perception, personal
influence learning how it is perspective, and ego development.
and change in remembered and strength
behavior. To change done.
behavior, modify
interpretations, and
make implicit
motivations explicit.
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