HEALTH E.

— Module 1
THEORIES IN LEARNING

Learning and Learning Theory

LEARNING
- Relatively permanent change in mental processing,
emotional functioning, skill/behavior as a result of
exposure to different experiences
- Acquisition of new knowledge and skills
- Unlearning in health care — To replace faulty
learning and behavior with more accurate information
and healthier behavior

LEARNING THEORY II. Systematic Desensitization

- Integrated constructs and principles that describe, - A technique used by PSYCHOLOGISTS to reduce
explain, or predict how people learn fear and anxiety in their clients
✴ Nurses are responsible in designing and implementing - Fear of certain stimulus can be learned and
plans and procedures for the improvements of health unlearned/extinguished
education and wellness (NCP) - STEPS:
✴ Emotions and feelings should be regarded/considered ✓ Fearful individuals are first taught w/ relaxation
techniques
in relation to learning
✓ Fear is gradually introduced @ non-threatening
level
Psychological Learning Theory ✓ Repeated pairings of repeated stimulus under
BEHAVIORIST LEARNING THEORY relaxed, non-frightening conditions
- Behaviorists — LEARNING = The product of the ✓ Indiv. learns no harm will come from the once
stimulus conditions and the responses that follow fear-inducing stimulus
‣ Observe responses to a stiuation + manipulation ✓ Client is able to confront the stimulus w/o being
anxious and afraid
of the environment in some way = intended
- EXAMPLES: Drug addiction, Phobias
changes
REMEMBER! This highlights the importance of
III. Stimulus Generalization
healthcare facility’s environment & culture w/c can
- Tendency of initial learning experience to be easily
affect patients, staff, and visitors
applied to other similar stimuli
- This theory directly address how to break or unlearn
- EXAMPLES: When listening to friends and
bad habits and correct faulty learning
relatives describe a hospital experience, it
becomes apparent that a highly positive or
I. Pavlovian Conditioning
negative personal encounter may color patient’s
- Also known as: Respondent Conditioning,
evaluations of their future hospital stays.
Association Learning, Classical Conditioning
- Emphasizes the importance of stimulus conditions
IV. Discrimination Learning
and the associations formed in the learning
- With more & varied experiences, individuals learn
process
to differentiate among similar stimuli
- EXAMPLE 1: During a hospital visit, a visitor may
- EXAMPLE: Patients who have been hospitalized a
smell offensive odors and feel nauseous and
number of times often have learned a lot about
lightheaded. After this initial visit and later repeated
hospitalization; they can already discriminate
visits, hospitals may become associated with
among stimuli (what various noises mean and what
feeling anxious and nauseated, especially if the
the various health professionals do)
visitor smells similar odors to those encountered
during the first experience.
V. Spontaneous Recovery
- EXAMPLE 2: Prescription drug advertisers employ
- A method used in relapse prevention programs
conditioning as happy and with improved lifestyles.
- Although a reponse may appear to be
- NURSING INTERVENTION: Helping patients relax
extinguished, it may recover and re-appear @ any
and reduce stress when applying medical
time
intervention – even a painful procedure – lessens
negative and anxious associations. ‣ When stimulus conditions are similar in initial
REMEMBER! This highlights the importance of learning experience
healthcare facility’s environment & culture w/c can
affect patients, staff, and visitors
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 - A principle that it is easier to learn a behavior than
to unlearn it
- EXAMPLES: Difficulty in eliminating completely
unhealthy habits and addictive behaviors such as
smoking, alcoholism, and drug abuse
VI. Operant Conditioning (B.F. Skinner)
- Focuses on the behavior of the organism and the
reinforcement that occurs after the response
- Positive Reinforcement
‣ “Reward Conditioning”
‣ A pleasant stimulus is applied following an
organism’s response = greatly enhances the
likelihood that responses will be repeated
‣ EXAMPLE: A patient moans and groans as he
attempts to get up and walk for the first time
after an operation, praise and encouragement
for his efforts at walking will improve the
chances that he will continue struggling toward
independence.
- Negative Reinforcement
‣ “Avoidance Conditioning”
‣ An aversive stimulus is anticipated by the
organism = makes a response to avoid the
unpleasant event
- Punishment — To decrease/extinguish the
probability of a response
‣ POINTS TO CONSIDER W/ PUNISHMENT:
✓ Should be administered immediately after
response
✓ Must be consistent and at highest
reasonable level
✓ Should not be prolonged
✓ PURPOSE: To decrease a specific behavior
and to instill self-discipline
- NURSING INTERVENTION 1: Carefully observe
individual’s responses to specific stimuli and then
select the best reinforcement procedures to change
a behavior.
- NURSING INTERVENTION 2: Assess which kinds
of reinforcement are likely to increase or decrease
behaviors in an individual
✴ Not every or not all patient finds health
practitioners’ terms of endearment rewarding.
Cognitive Learning Theory
- Stress the importance of what goes on insider the
learner
- Used in EDUCATION & COUNSELING
- Key to Learning and Changing: The individual’s
cognition, including:
Perception Thought
Memory Ways of Processing
*Pag Mahal ka Talaga, Wag mo na Pakawalan
- Largely directed by the individual
- Involves processing the info + interpreting it =
reorganizing to new insights
- More important are learner’s goals and
expectations than reward
- METACOGNITION
‣ Individual’s understanding of her way of learning
‣ Being mentally ACTIVE when processing info
encourages its retention in long-term memory
‣ Have learners indicate how they believe they
learn
A. GESTALT PERSPECTIVE
- Emphasizs the importance of perception in learning
- A person responds to any situation in his own way
- Directed towards simplicity, equilibrium, and
regularity
- “LAW OF SIMPLICITY” — A school of thought that
believes all objects and scenes can be observed in
their simplest forms
- EXAMPLE 1: When giving pathophysiology to a
client
- PERCEPTION — It is selective; individuals attend to
certain features of an experience while ignoring other
features
- EXAMPLE 2: When giving health teachings while
client is in severe pain/thinking of bills - may not
attend to well-intentioned patient education info
- What individuals pay attention to and what they
ignore are influenced by a host of factors:
‣ Past experiences
‣ Needs
‣ Personal motives and attitudes
‣ Reference groups
- NURSING INTERVENTION: These factors have a
direct bearing on how a health educator
approaches any learning situation w/ an individual
or group - approach that is effective w/ one client
may not work w/ another client
B. INFORMATION PROCESSING
- Emphasizes thinking process; thought, reasoning, the
way info is encountered and stored, and memory
fxning
i. 4 Stages of Information-Processing Model of
Memory Functioning
1. Paying attention to environmental stimuli;
attention is the key to learning
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 ‣ EXAMPLE: If a patient is not attending to
what a nurse educator is saying, perhaps
bcoz the patient is weary/distracted
‣ NURSING INTERVENTION: It would be
prudent for the educator to try the
explanation at another time when the indiv. is
more receptive and attentive
2. Info is processed by the senses; consider
client’s preferred mode of sensory processing
(VISUAL, AUDITORY, MOTOR); check if client
has sensory deficits
‣ NURSING INTERVENTION: Presenting
material using multiple sensory modes aid
learning
3. Info is transformed and encoded briefly into:
a) SHORT-TERM MEMORY — Info is
disregarded and forgotten
b) LONG-TERM MEMORY — Info is enduring
Imagery Association
Rehearsal Breaking Info into Units
4. It involves the action/response that the
individual undertakes based on how info was
processed and stored
REMEMBER! Memory processing and the
retrieval of info are enhanced by organizing info
and making it meaningful
ii. 9 Events to Activate Effective Learning
- Gagne, Briggs, Wagner, 1992
1) Gain the learner’s attention (Reception)
2) Inform the learner of the objectives and
expectations (Expextancy)
3) Stimulate the learner’s recall of prior learning
(Retrieval)
4) Present information (Selective Perception)
5) Provide guidance to facilitate the learner’s
understanding (Semantic Encoding)
6) Have the learner demonstrate the
information/skill (Responding)
7) Give feedback to the learner
(Reinforcement)
8) Assess the learner’s performance (Retrieval)
9) Work to enhance retention and transfer
through application and varied practice
(Generalization)
REMEMBER! In emplying this model, teachers
must carefully analyze the requirements of the
activity; design and sequence the instructional
events; and select appropriate media to achieve
the outcomes
iii. Strategies to Aid in Learning
- Break material into small parts/chunks
- Use memory tricks and techniques (Mnemonic
Devices)
- Relate new material to something familiar
- Have learners indicate how they believe they
learn
- Evaluate learner’s mistakes
✴ Applicable to: Health educ., brochures, 1on1
patient educ., CHN (community health nurse ata
to?), students
C. COGNITIVE DEVELOPMENT
a) Jean Piaget
- Focus: Qualitative changes in perceiving,
thinking, and reasoning as individuals grow and
mature
- Cognition is partially dependent on the
individual’s stage of development in:
Perception Reasoning Readiness to Learn
✴ Age and stage of life can affect learning
✴ Learning is developmental and sequential
✴ Piaget identified 4 sequential stages of cognitive
development:
‣ Sensorimotor (0-2 years old)
‣ Pre-operational (2-7 years old)
‣ Concrete operational (7-11 years old)
‣ Formal operational (11-15+ years old)
- NURSING INTERVENTION 1: Nurses need to
determine what children are perceiving and
thinking in a particular situation (ex.: concept of
death — ask God to give back the dead
persom)
- NURSING INTERVENTION 2: Provide
experiences at an appropriate level for the child
to activity discover and participate in the
learning process; children learn best through
language and social interaction, experimenting
Adult Learning
- Deal better w/ contradictions and integration
- With advanced level of reasoning — wisdom &
life experiences
- Others w/ lower stages of thinking — lack of
educ., presence of diseases, depression,
stress, medications
- Adults generally do better when offered
opportunities for SELF-DIRECTED LEARNING
‣ Learner control, autonomy, initiative
‣ With explicit rationale for learning
b) Lev Vygotsky
- Emphasizes the significance of language, social
interaction, adult guidance in the learning
process
- He advocates on giving clear, well-designed
instruction that is carefully structured to
advance each person’s thinking & learning
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D. SOCIAL CONSTRUCTIVIST APPROACH
- Ethnicity, social class, gender, family life, life history,
self-concept, and the learning situation itself, all
influence an individual’s perceptions, thoughts,
emotions, interpretations, and responses to info and
experiences
- Effective learning occurs through:
Social Interaction Collaboration Negotiation
E. ATTRIBUTION THEORY
- Focus: The cause-and-effects relationships and
explanations that individuals formulate to account for
their own and other’s behavior and the way in w/c the
world operates (STRONGLY INFLUENCED BY
CULTURAL VALUES & BELIEFS)
- EXAMPLE 1: Patients with certain religious views or a
type of parental upbringing may believe that their
disease is a punishment for their sins —
INTERNALIZING BLAME
- EXAMPLE 2: Other patients may attribute their
disease to the actions of others — EXTERNALIZING
BLAME
Cognitive Orientations and Emotions
- EMOTIONAL INTELLIGENCE — Entails an indiv.
managing his emotions, motivating himself, reading
the emotions of others, working effectively in
interpersonal relationships; more important than
cognitive intelligence
- SELF-REGULATION — Includes learners
monitoring their own cognitive processes,
emotions, and surroundings to achieve goals; the
ability to self-regulate has been found to be a key
factor in learning and studying.
Social Learning Theory (ALBERT BANDURA)
- Individuals do not need to have direct experiences
to learn
- Learning occurs by taking note of other people’s
behavior and what happens to them – LEARNING
AS A SOCIAL PROCESS
- Social learning theory extends the learning process
beyond the Educator
- EXAMPLES: RLE duties, Support groups in
community mental health settings
A. ROLE MODELLING
- Role models need to be enthusiastic, professionally
organized, caring, self-confident, knowledgeable,
skilled, and good communicators.
B. VICARIOUS REINFORCEMENT
- Determining whether role models are perceived as
rewarded or punished for their behavior.
- A learner may imitate the behavior of a role model
even when no reward is available to either the role
model or the learner.
- EXAMPLE: Difficulty in attracting health professionals
to geriatric care / CHN - community healty nursing (?)
- NURSING INTERVENTION: The nurse must find
ways to encourage patient’s feelings of competency to
promote wellness. Do not foster dependency,
helplessness, and feelings of low self-esteem
Psychodynamic Learning Theory
- It is a theory of motivation that stresses emotions
rather than cognition or responses
- It emphasizes the importance of conscious and
unconscious forces in guiding behavior, personality
conflicts, enduring effects of childhood experiences
on adult behavior
- Behavior may be conscious / unconscious –
individuals may or may not be aware of their
motivations and why they feel, think, and act as
they do
A. EGO DEVELOPMENT
- EGO — Operates on the reality principle
- HEALTHY EGO DEVELOPMENT
‣ EXAMPLES: Can cope with painful medical
treatment; they value enduring pain and comfort to
achieve outcome
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- WEAK EGO DEVELOPMENT
‣ EXAMPLES: Missed appointments and treatment;
work against healing and recovery
B. DEFENSE MECHANISMS
- Arises when ego is threatened; to protect the self
- For short-term use only
- If used for long term – individuals avoid reality;
becomes barrier to learning
- EXAMPLE: Terminally ill client — concept of death —
does not seek treatment
- Common Used Defense Mechanisms:
1. Denial — ignoring/refusing to acknowledge the
reality of a threat
2. Rationalization — substitution of a safe and
reasonable explanation for the true cause of
behavior
3. Displacement — re-direction of aggression onto a
powerless substitute target
4. Repression — withdrawal from consciousness of
an unwanted idea, affect, or desire by pushing it
down into the unconscious part of the mind
(hysterical amnesia)
5. Regression — ego reverts to an earlier stage of
development usually in response to stressful
situations
6. Intellectualization — allows to avoid thinking
about the stressful, emotional aspect of the
situation and instead focus only in the intellectual
component (diagnosed with terminal illness – focus
on learning everything about the disease in order to
avoid stress and remain distant from the reality of
the situation)
7. Projection — unwanted feelings are displaced
onto another person
8. Reaction Formation — a person goes beyond
denial and behaves in the opposite way to which
he/she thinks or feels (homosexuals)
9. Sublimation — similar to displacement; but takes
place when we manage to displace our
unacceptable emotions into behaviors which are
constructive and socially acceptable, rather than
destructive activities
10. Compensation — making up of for weaknesses by
excelling in other areas
C. ERIC ERICKSON’S 8 STAGES OF LIFE
- Adult behavior is derived from earlier childhood
experiences and conflicts
- EXAMPLES: Pre-schoolers (Initiative vs Guilt —
make them do things)
- NURSING INTERVENTION: When designing and
carrying out treatment regimens, communication,
and health promotoion — consider stage of
personality development
- RESISTANCE — Past conflicts (childhood) may
interfere with ability to learn or transfer learning
- EXAMPLE 1: Young pregnant teenager refuses to
engage in a serious conversation about sexuality
— giggles, express anger — underlying emotional
conflict that need to be addressed
- EXAMPLE 2: Uncompliance, trauma and losss
Humanistic Learning Theory
ABRAHAM MASLOW’S HIERARCHY OF NEEDS
- Assumption that every individual is unique and that
all individuals have a desire to grow in a positive way
- Importance of human creativity, emotions and feelings;
right to make own decisions are the cornerstones of
this approach
- Motivation is derived from each person’s needs and
subjective feelings
- Role of Abraham Maslow’s Hierarchy of needs and its
role in human motivation
- EXAMPLES: Clients who are hungry, tired, and in
pain are motivated to get first their biological needs
before they will be open to learning about their
illness, self-care, and health educ.
- What people want is unconditional positive self-regard
- Experiences that are threatening, coercive, and
judgmental undermine the ability and enthusiasm of
individuals to learn.
- EXAMPLES: Nurse is prejudiced against clients
with AIDS — little healing to clients
- Humanistic orientation is referred to as a LEARNER-
DIRECTED APPROACH (educator to serve as
facilitator; listening rather than talking; learners choose
what is to be learned; central focus is on learner’s
perceptions, desires, and decision making)
✴ The central approach of Humanistic Approach is not
mastery of info and facts
- “Tell me how you feel” rather than “Tell me what you
think”
- Foster curiosity, enthusiasm, initiative and
responsibility are more important
- EXAMPLE 1: Rather than playing health education
videos for hospitalized patients/distributing
pamphlets — it should be establishing rapport and
becoming emotionally attuned to patients and fam
members
- EXAMPLE 2: Applicability of this theory to self-help
groups, wellness programs, and palliative care
Neuropsychology and Learning
- Investigations into the physiological(?) and
nuerological foundations of thinking, learning, and
behavior
- Concerned with studying the brain and CNS’
structures, anatomy, chemistry, electrical activity,
hormones, and neurotransmitters as these affect
functioning and behavior.
- Learning is viewed as involving changes in the brain
and CNS that affect responses and behavior
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- Learning occurs at the cellular level and produces
structural changes in brain structure, wiring patterns,
and chemistry
- Brain processing is different for each learner (pace of
learning, attention, enhancing learning)
- Meaningful practice strengthens learning connections,
which may fade from lack of use; therefore, one-shot
patient education efforts are not likely to be effective in
permanently changing behavior
- Implications for teaching, learning, and memory
‣ Consider the physiological, mental, and emotional
condition of the learner, such as nutrition,
hydration, the need for stimulation or rest,
adequate time to process, store, and relate
information
‣ Organize and pace learning; be playful and explore
‣ Anchor new learning to something already known
or familiar
‣ Take breaks, including the opportunity to exercise
or shift focus, to allow learning to “sink in”
‣ It is true that we can teach old dogs, new tricks