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1. Overview (what, how, why is it important, implication to nursing practice)

● Behaviorism is a school of psychology that focuses on observable behaviors and what
one can do externally to bring about behavior changes.
● Seeks to explain human behavior by analyzing the antecedents and consequences present
in the individual's environment and the learned associations he has acquired through
experience.
● Behavior can be changed through a system of rewards and punishments.

●
● Can be helpful in a clinical setting, since observing behavior is easier than analyzing
emotions. Commonly used applications by a behaviorist include: positive reinforcement,
negative reinforcement, punishment, token economy, self management, extinction,
shaping, contracts,time out, and systematic desensitization. Many mental health
professionals use approaches based upon behaviorist ideas. For instance, cognitive
behavioral therapy (CBT) attempts to change behavior by addressing unhealthy or
inaccurate thoughts. Rather than discussing the past or endlessly analyzing emotions,
clients relying on CBT identify unhealthy thought patterns, gain an understanding of the
 connections between thoughts and behavior, and then perform assignments designed to
change their thoughts and, therefore, their behavior.
● Types of learning: 1) Ivan Pavlov’s Classical Conditioning and B.F Skinner’s Operant
Conditioning

2. Pavlov's Classical Conditioning

2.1 Classical Conditioning- behavior that can be changed through conditioning with external or
environmental conditions known as stimuli, these stimuli result in responses which is evidence
that there are changes in the behavior of individuals. This theory started when a russian
physiologist investigated the digestive process of his dog and suggested that the salivation of the
dog is a learned response. Using a different stimulus, Pavlov was able to observe that the dog is
providing different responses through different stimuli and this is where Pavlov furtherly focused
on how exactly these conditioned responses are learned or acquired.
● Important Terminologies:
1. Unconditioned Stimulus- automatic/natural response.
2. Unconditioned Response- automatic response to a stimulus.
3. Neutral Stimulus- stimulus that at first elicits no response.
4. Conditioned Stimulus- stimulus that can trigger a conditioned response.
5. Conditioned Response- learned or acquired response.

2.2 Example

The principles of Ivan Pavlov’s classical conditioning theory that was originated from the
relation of dogs, meat, and salivation far reach beyond what it was. In the modern world,
classical conditioning can be observed in various fields and principles, one of which includes the
nursing practice.

Here is an example of Classical Conditioning in the field of nursing:

A boy named Michael attended the barangay’ general check-up drive for young children ages
five, with the aim to determine and possibly solve the growing population of malnutrition in the
community.

It was determined that he was severely malnourished and one of the primary reasons his parents
were pointing out was his stern displeasure in drinking milk even as a child.

A story behind this was when michael was 3 years old, he accidentally drank a three-day-old
spoiled milk and suffered stomach aches for days as a result. After that incident, he never liked
to drink milk again.
In this scenario, Michael associated the bacteria in the milk as the causative factor of his stomach
ache. The unconditioned stimulus was the bacteria in the spoiled milk while the unconditioned
stimulus was the boy being sick. As he associated the bacteria to all milk, the boy had a feeling
of being sick upon drinking milk in general; spoiled or not.

2.3 Application to nursing practice

A case of classical conditioning has been applied to a case of a patient suffering from systemic
lupus erythematus, an autoimmune disease that attacks one’s own tissue and organs causing
widespread inflammation in the body.
In 1992, a group of researchers established that the human immune system may be classically
conditioned, demonstrating that an 11-year-old girl with lupus was able to reduce her symptoms
significantly without the need of immunosuppressive medicines. This allowed them to treat their
patient's condition while avoiding the cyclophosphamide's harmful side effects.

The researchers used a solution containing "Compound CS" that tasted like cod liver oil and
smelled like roses for their experiment. For a year, they combined Compound CS with
cyclophosphamide treatments on six times. The researchers did not deliver cyclophosphamide
every other month of treatment, instead giving their patient compound CS. Despite receiving half
the regular dose of the immunosuppressant medicine, the 11-year-old patient nevertheless
showed signs of immunosuppression and continued to do well following a 5-year follow-up.

3. Skinner's Operant Conditioning

3.1 Definition
● Operant Conditioning - people acquire their behaviors from experiences
 - Especially those that have been reinforced frequently.
● B.F. Skinner - American psychologist
- Did not deny the existence of feelings and wants
- Limited the perspective of his theory to what could be observed, researched, or
learned and unlearned.
- He claimed, that if behavior is altered, ideas, wants and feelings follows.

Skinner’s Box

Experimental chamber, a small box. A lever protrudes from one side and there is a tube that
empties into the food cup next to the lever. Is there aren't that many things to do in a skinner box
that rat eventually presses the lever. A pellet of food (a reinforcing stimulus) immediately drops
down the tube into the food cup. The rat pounces on the food, and conditioning has begun.

3.2 Principles (Behavior modification, systemic desensitization)

3.2 Example (per principle)
1.
2.

3. Behavior that is rewarded with reinforcers tends to recur.

● Reinforcers: responses that increase the probability of repeating a behavior.
● In positive reinforcement which was described by BF Skinner, rewards are a reinforcing
stimulus that strengthens a person’s behavior.
4. Positive reinforcers that follow a behavior increase the likelihood that the behavior will
recur.
● Positive reinforcement leads to the repetition of desired behavior.
● Reinforcers condition a person.

Positive Reinforcement in the Nursing Practice

5. Negative reinforcers that are removed after a behavior increase the likelihood that the behavior
will recur.
● The behavior will recur due to the removal or avoidance of the negative consequence.
● Negative reinforcement should not be thought of as punishment.
● Negative reinforcement increases the behavior.
● Punishment decreases the behavior.

(Ma palagyan ng X sa gilid neto)

(Tas check sa gilid netong last 2) tnxxx mwa

6. Continuous reinforcement (a reward every time the behavior occurs) is the fastest way to
increase that behavior, but the behavior will not last long after the reward ceases.
● The desired response is reinforced every time it occurs.
● Reinforcement results in fast learning but also a rapid extinction of the desired
behavior once the reinforcer disappears.
● Positive and negative reinforcement may be involved, with the goal of encouraging
certain actions.
● “Every time I do this, I get what I am after!”
● Example: the client receives one bite of preferred food following each bite of
nonpreferred she accepts.
(Ma dito sa 3 pics, palagay me nung dalawang kumakain sa loob nung cloud. Tas may arrow sa
gitna nung 2 pics. Salamat piiii)

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7. Random intermittent reinforcement (an occasional reward for the desired

behavior) is slower to produce an increase in behavior, but the behavior
continues after the reward ceases.

3.3 Application to nursing practice

**last paragraph can be used for example or application