HEALTH EDUCATION REVIEWER Reinforcement
(Midterms) Escape Conditioning
PART I
Learning Theories
Learning
-defined as a relatively permanent change in
mental processing, emotional functioning, skill
and/or behavior as a result of exposure to different
experiences.
-lifelong dynamic process by which individuals
acquire new knowledge or skills that alter their
feelings, attitudes, and actions
Learning Theory
-coherent framework of integrated constructs and
principles that describe, explain, or predict how
people learn.
PSYCHOLOGICAL LEARNING THEORIES
 Behaviorist Learning Theory
o Directly Observable and a product of
(S) Stimulus and (R) Response
conditioning
o Respondent Conditioning
(association learning, classical
conditioning, Pavlovian
Conditioning)
 Emphasizes the importance
of stimulus conditions and
the associations formed in
the learning process
 Systematic Desensitization
o Technique used by psychologists o
reduce fear and anxiety
o Has been use to treat drug
addiction, phobias, and tension
headaches
 Stimulus Generalization
o Tendency of initial learning
experiences to be easily applies to
other similar stimuli
 Discrimination Learning
o Can differentiate the methods and
the environment
 Spontaneous Recovery
o Useful respondent concept that
needs to be given careful
consideration in relapse prevention
programs.
 Operant Conditioning
o Developed by B.F. Skinner
o Focuses on the behavior of the
organisms and the reinforcement
that occurs after the response
 Reinforcer- stimulus or event
applied after a response
strengthens the probability
that the response will be
performed again
Positive Reinforcement Application of a
pleasant stimulus
Reward Conditioning Pleasant stimulus is
applied following an
organism’s response
Negative Removal of an aversive
or unpleasant stimulus
Aversive stimulus is
applied, organism
makes a response that
causes unpleasant
stimulus to cease
Avoidance Anticipated by the
Conditioning organism
Non-reinforcement No action
Punishment Aversive stimulus that
is applied that an
organism cannot avoid
or escape
 Cognitive Learning Theory
o Jean Piaget
o One concern in the CLT is that it
neglects emotions
o Involves perceiving the information,
interpreting it based on what is
already known, and reorganizing the
information into new insights or
understanding
o METACOGNITION- understanding
the way of learning
o Gestalt Perspective- emphasizes
the importance of perception in
learning and lays the groundwork for
various other cognitive perspectives
o Information Processing-
emphasizes the thinking process,
thought, reasoning, and memory
function
o Cognitive Development-
perspective on learning that focuses
on qualitative changes in perceiving,
thinking, and reasoning
 Social Learning Theory
o Largely based on the work of Albert
Bandura
o Individuals must have a direct
experience to learn by watching
other people
o Significant others have a huge
impact on the learning
o Role Modeling- central concept of
social learning theory
o Vicarious reinforcement-
determinant whether role models are
rewarded of punished
o MODEL OF SLT
 Attentional Phase-Retention
Phase-Reproduction Phase-
Motivational Phase
 Psychodynamic Learning Theory
o Stresses on theory of motivation that
stresses on emotions rather than
cognitions or responses
o Based on Sigmund Freud
o Behavior may be conscious or
unconscious
o Primitive source of motivation is
libidinal energy (instincts) id: eros
(pleasure and sex; life force) &
 Thanatos (aggressive and 1. Learning Needs- what the learner needs
destructive impulses; death wish) and wants to learn
o Defense Mechanisms- activated 2. Readiness to learn- when the learner is
when ego is threatened receptive to learning
Intellectualization Avoiding any emotion 3. Learning Style- how the learner best learns
Displacement Aggression towards
another ASSESSING LEARNING NEEDS
Regression Returning to early (a) Learning Needs
maturity -gaps in knowledge that exist between a
Denial Ignoring desired level of performance and actual
Projection Reflecting one’s level of performance
mistake to others o Important steps in the assessment of
Reaction Formation Opposite of what they the learning needs:
really felt 1. Identify the learner
Sublimation Converting to socially 2. Choose the right setting
accepted action 3. Collect data about the learner
Compensation Making up 4. Collect data from the learner
weaknesses by 5. Involve members of the
excelling in other healthcare team
areas 6. Prioritize needs
Rationalization Excusing
Repression Keeping  Criteria for prioritizing
unacceptable learning needs:
thoughts from  Mandatory- for
conscious awareness survival or situations
for life and safety
o Erikson’s Stages of Life  Desirable- not life
o Resistance- indicator of underlying dependent but related
to overall well being
emotional difficulties, which must be
dealt with for them to move ahead  Possible- nice to
know but not required
o Humanistic Learning Theory
7. Determine availability of
o Every individual is unique and has a
educational resources
need to grow in a positive way
8. Assess the demands of the
o Highly motivational for the reason
organization
that they are influenced by society 9. Take time management issues
o Subjective desire to grow into account
o Abraham Maslow- major contributor
in the HLT with the hierarchy or METHODS TO ASSESS LEARNING NEEDS
needs 1. Informal Conversations
o Carl Rogers- argues that people 2. Structured Interviews
want unconditional positive self- 3. Focus Groups
regard (love without strings 4. Questionnaires
attached) 5. Tests
o Rather that being an AUTHORITY, 6. Observations
be a FACILITATOR 7. Documentation

PART II READINESS TO LEARN

Determinants of Learning Readiness to learn
(1) Needs of the Learner -time when the learner demonstrates an interest in
(2) State of readiness to learn learning the information necessary to maintain
(3) Preferred learning styles optimal health or to become skillful in a job
-occurs when the learner is receptive, willing, and
CHARACTERISTICS OF A LEARNER able to participate in the learning process.
o Age
o Education Level PEEK Scheme
o Culture and language P= Physical Readiness
o Learning Style o Measures of Ability
o Health Literacy o Complexity of Task
o Motivation o Gender
o Health Status o Environmental Effects
o Health Status
ASSESSMENT OF THE LEARNER E= Emotional Readiness
Assessment of the learner includes o Anxiety Level
attending to three determinants of learning  Fear is a major contributor in
(Haggard, 1989): anxiety
 o Support System
 Social support is important in
buffering the effects of
stressful events
 Reachable moments- time
when a nurse truly connects
with the client by directly
meeting the individual TEACHING METHODS AND SETTINGS
o Motivation Teaching Method
o Risk Taking Behavior -way information is taught that brings the learner
o Frame of Mind into contact to what is being learned
o Developmental Stage
 Teachable moment (a) Lecture
E=Experiential Readiness -Highly structured method by which the
o Level of Aspiration educator verbally transmits information
directly to a group of learners
o Past Coping Mechanism
-came from the latin word legere “to read”
o Cultural Background
-Five approaches to an effective lecture:
o Locus of Control
 Use opening and summary
o Internal Locus of Control statements
o External Locus of Control  Present Key terms
K=Knowledge Readiness  Offer examples
o Present Knowledge Base  Use analogies
o Level of Cognitive Ability  Use visual backups
o Existence of any Learning Disabilities -three main parts of a lecture:
o Preferred Style of Learning a. Introduction
b. Body
LEARNING STYLES c. Conclusion
-refers to the ways in which and conditions under -variables of speech:
which the learners most efficiently and most a. volume
effectively perceive, process, store, and recall b rate
-Cognitive, Affective, Physiological Factors c. pitch/tone
d. pronunciation
Right-Brain/ Left-Brain/ Whole Brain Thinking e. enunciation
o Left Brain is for the verbalization and f. proper grammar
analytical side. Reality based and logical g. avoiding annoying habits such the
thinking. use of “ums”
 Convergent -Body language:
o Right Brain is for the emotional, visual- a. Enthusiasm
spatial, and non-verbal side b. Frequent Eye contact
 Divergent c. Posture movement
o Corpus Callosum- connector between the d. Gestures
two brains  Distance Learning- an ideal way to
maximize resources an to transmit current
FIELD INDEPENDENT information to people separated by space
 Have internalized frames of reference such and time
as they experience themselves as separate
or differentiated from others and the (b) Group Discussion
environment -defined as the method of teaching whereby
 Less sensitive to social cues learners get together to actively exchange
 Not affected by criticisms information, feelings, and opinions with one
 Eager to test their ideas another and educator
-Group Size: major consideration and
FIELD DEPENDENT should be determined by the purpose or
 Externally focused and are socially oriented task to be accomplished
 More dependent on others for reinforcement
(c) Team based learning
DUNN AND DUNN LEARNING STYLES -enriches the students’ learning experience
1. Environmental elements through active learning strategies
2. Emotional elements -formation of heterogenous groups of 5-10
3. Sociological Patterns students
4. Physical elements
5. Psychological elements (d) Cooperative Learning
-methodology of choice for transmitting
foundational knowledge

(e) Case Studies

 -Lead to the development of analytical and c. Physiological Variables
problem-solving skills, exploration of d. Environmental Variables
complex issues, and application of new e. Educator-Learner Relationship System
knowledge and skills in clinical practice f. Experiential Variables
arena

(f) Seminars
-consists of several sessions in which group
of staff nurses or students facilitated,
discuss questions and issues that arise from
readings
(g) One to One Instruction
-may be given formally or informally,
involves face to face delivery of information
specifically designed to meet the needs of
the individual learner
(h) Simulation
-a trial and error method of teaching
whereby an artificial experience is created
that engages the learner in an activity that
reflects real life conditions but without risk-
taking consequences of an actual situation
-Simulation is a technique and not
technology
Asynchronous
-allows users to work in concert with one another
but not necessarily simultaneously
Traditional Learning
I. Lecturing
-conveying of facts, information, and ideas that
would not be readily obtained elsewhere.
 Parker’s loss of novel stimulation (1993)
-people are engaged in the first times, but
they become immune to it.
LECTURE FRAMEWORKS
(1) Hierarchal or classical format
-info. is grouped; simplest form of lecture
(2) Problem-centered format
-problem is introduced and varied
hypothesis are created

o Types of simulations: (3) Comparative framework

Written Simulations -objective is to differentiate to identities
Clinical Simulations
Model Simulations (4) Thesis format
Computer Simulations -taking a side and then justifying with logic

DELIVERY OF THE LECTURE

COMPLIANCE, MOTIVATION, AND HEALTH (1) Controlling anxiety
BEHAVIORS OF THE LEARNER (2) Spontaneity
Compliance (3) Voice Quality
-defined as the “extent to which the patient’s (4) Body Language
behavior coincides with the clinical advice (5) Speed of Delivery
-act or process of complying to a desire, demand, (6) Getting off on the right foot
proposal, or regimen (7) Clarifying during the lecture
-It has an authoritative undertone (8) Facilitating retrieval from memory:
-Healthcare provider is seen as the authority a. Repetition
b. Elaboration
Adherence c. Imagery
-extent to which a person’s behavior corresponds
with the agreed recommendations from a health II. Discussion
care provider -talk between two or more people about a subject,
-steady or faithful attachment usually the exchange of ideas to reach a
conclusion.
Perspectives on Compliance
1. Biomedical Theory- depends on the TYPES OF DISCUSSIONS
client’s medication, demographics, severity (1) Formal Discussion
of disease -topic is announced in advance and ask the
2. Behavioral/Social Learning Theory- on class to prepare
the motivation
3. Communication Models- communication (2) Informal Discussion
between patient and health care provider -takes place at the end of the class
4. Rational Belief Theory- cost benefit
analysis III. Questioning
5. Self-regulatory systems- patient is seen -strategy of which the origin if traced way back from
as a problem solver Socrates in which every question of a student is
6. answered with a question
LEON POINTS TO PONDER
LEVELS OF QUESTIONS:
ASSESSMENT OF MOTIVATION (1) Convergent or Divergent
a. Cognitive Variable Convergent Questions
b. Affective Variables
 o Require learners to recall or
integrate information they have
learned; short expected answers
Divergent Questions
o Asks the learner to generate new
ideas and to form a new perspective
(2) Lower order or Higher order of questioning
Lower Order
o Require learners to recall info.
Higher Order
o Have to think critically
(3) Bloom’s Taxonomy
-qs that elicit levels of knowledge,
comprehension, application, analysis,
synthesis, and evaluation
TYPES OF QUESTIONING
1. Factual Questions
2. Probing Questions
a. Extension Probes
b. Clarification
c. Justification
d. Prompting
e. Redirection
3. Multiple Choice Questions
4. Open Ended questions
5. Discussion-Stimulating Questions
IV. Using Audiovisuals
-address all three modes of learning:
cognitive, affective, and psychomotor.
TYPES OF TRADITIONAL
AUDIOVISUALS:
a. Handouts-communicates facts,
figures, and concepts; ensures
that everyone has the same
information
b. Chalkboards and Whiteboards-
writing on only 2/3 of the board
and allowable for math, spelling,
and new material
c. Overhead Transparencies -
sheets and acetates placed on
overhead projector that enlarges
ad projects the image onto a
screen
d. Videotapes- used to film
students while they role play,
interview, communicate and
counsel; motion enhances the
realism of the situation
e. Digital Video/Versatile Discs
(DVDs)- smaller and portable
than videotapes
Activity Based Learning
Case Study
-analysis of an incident or situation in which
characters and relationships are described, factual,
or hypothetical events transpire, and problems
need to be resolved.
-Started in Harvard School
Virtual Reality
-computer based simulate three dimensional
environment in which interaction happens in the
virtual world
Distance Learning
-is a type of learning that studies from a distance
but still has communication likened to a classroom
setting
a. Synchronous Class- interact in real time
electronically via the internet
b. Asynchronous Class- materials and
prescribed activities are located on a web
page that can be accessed anytime at the
learner’s convenience
Teaching Psychomotor Skills
-are action-oriented that requires neuromuscular
coordination and that promote patient healing and
comfort
Stage 1: Getting the ideas of the movement
-initial step is to have a goal.
 Regulatory Stimuli- conditions that influence
the performance
 Non regulatory Stimuli- does not influence
the performance
 Open Skill- performance in changing
conditions
 Closed Skill- performance in non-changing
conditions
Motor Plan
-learner studies to choose the right action to takes
or movement that is necessary
Stage 2: Fixation/Diversification
-if the performance is successful, this is the next
stage
 Fixation- practicing the skill in the same way
to fix a reproducible
 Diversification- practicing the skill in a
variety of ways so it can be reproduced in a
modified way to meet changing
environments
Feedback
-may be extrinsic or intrinsic
 Intrinsic Feedback- originates with the
learner
 Extrinsic Feedback- supplied by the teacher
and other sources
Practice
-motor pattern that is practiced and refined as the
learner attempts to reach an adequate skill level
-essential in order to fix the sequential order of
movements in the learner’s memory
Massed Practice
-practice that has no rest or little intervals
Distributed Practice
-planned rest periods that are longer or equal to the
trial

Mental Practice
-known as mental imagery, mental rehearsal,
guided imagery and visualization
Haggard, 1989 stated the determinants of learning

1. Learning needs—what the learner

needs and wants to learn.
2. Readiness to learn—when the learner
is receptive to learning.
3. Learning style—how the learner
best learns

Lewin, 1935
-an early field theorist, conceptualized motivation
in terms of positive or negative movement toward
goals. Once an individual’s equilibrium is
disturbed, such as in the case of illness, forces of
approach and avoidance may come into play.
Lewin noted that if avoidance endured in an
approach–avoidance conflict, there would be
negative movement away from a goal. His theory
implies the existence of a critical time factor
relative to motivation. This time factor, however, is
generally not a serious consideration in
motivational models of health behavior or
motivational research.