Applying Learning

Theories to
Healthcare Practice
Presented by Group 3
Learning:
A relatively permanent change in mental processing, emotional functioning, and
behavior as a result of experience. It is the process by which individuals gain new
knowledge or skills and change their thoughts, feelings, attitudes, and actions.
Although people in every culture have beliefs about how teaching and learning
should occur, there are several major theories of learning that have been tested with
research. Learning allows individuals to adapt to demands and changing
circumstances and is crucial in health care—whether for patients and families
struggling with ways to improve their health and adjust to their medical conditions,
for students gaining the information and skills necessary to become a healthcare
professional.
Learning Theory:
A coherent framework of integrated constructs and principles that describe,
explain, or predict how people learn. It is a logical framework describing,
explaining, or predicting how people learn. Whether used singly or in
combination, learning theories have much to offer the practice of health care.
Increasingly, health professionals.
-This chapter reviews the psychological and motor learning theories that are useful to
health education and clinical practice. Behaviorist, cognitive, and social learning
theories are most often applied to patient education as an aspect of professional
nursing practice. This chapter also treats psychodynamic and humanistic perspectives
as learning theories because they encourage a patient-centered approach to care and
add much to our understanding of human motivation and emotions in the learning
process. Emotions and feelings, it is argued, are critical to understanding learning
(Goleman, 1995)
Contribution of learning theories:
• It provide 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
This section summarizes some of the basic
principles of the following:
• Behaviorist Learning Theory

• Cognitive Learning Theory

• Social Learning Theory

• Humanistic Learning Theory

• Psychodynamic Theory of Learning

BEHAVIORISM
Behaviorism refers to the school of psychology founded by John B. Watson based
on the belief that behaviors can be measured, trained, and changed. Behaviorism
was established with the publication of Watson's classic paper "Psychology as the
Behaviorist Views It"

Behaviorism, also known as behavioral psychology, is a theory of learning based

upon the idea that all behaviors are acquired through conditioning.
Conditioning occurs through interaction with the environment. Behaviorists believe
that our responses to environmental stimuli shape our actions
According to this theory ,behavior can be studied in a systematic
and observable manner with no consideration of internal mental
states. It suggests that only observable behavior should be
considered as cognition, emotion and moods are too subjective.
To encourage people to learn new information or to change their attitudes
and responses, behaviorists recommend altering conditions in the
environment and reinforcing positive behaviors after they occur. Motivation
is explained as the desire to reduce some drive (drive reduction), such as the
desire for food, security, recognition, or money. This is why individuals who
are satisfied or who have what they want may have little motivation to learn
new behaviors or change old behaviors. Getting behavior to transfer from
the initial learning situation to other settings is largely a matter of practice
(strengthening habits).
There are two ways to change behavior and
encourage learning using the behaviorist principles of
respondent conditioning and operant conditioning.
RESPONDENT CONDITIONING
First identified and demonstrated by Russian physiologist, Ivan Pavlov, respondent
conditioning (also termed classical or Pavlovian conditioning) emphasizes the importance
of stimulus conditions in the environment and the associations formed in the learning .

A neutral stimulus (NS)—a stimulus that has no particular value or meaning to the learner
—is paired with a naturally occurring unconditioned or unlearned stimulus (UCS) and
unconditioned response (UCR) . After a few such pairings, the neutral stimulus alone (i.e.,
without the unconditioned stimulus) elicits the same response. Often without thought or
awareness, learning occurs when the newly conditioned stimulus (CS) becomes associated
with the conditioned response (CR)
EXAMPLE: Someone without much experience with hospitals (NS)
may visit a relative who is ill. While in the relative’s room, the visitor
may smell offensive odors (UCS) and feel queasy and light-headed
(UCR). After this initial visit and later repeated visits, hospitals (now
the CS) may become associated with feeling anxious and nauseated
(CR), especially if the visitor smells odors similar to those
encountered during the first experience
Respondent conditioning highlights the importance of what is going on in
the environment in health care. Often without thinking or reflection,
patients and visitors make associations as a result of their hospital
experiences, providing the basis for long-lasting attitudes toward medicine,
healthcare facilities, and health professionals. Principles of respondent
conditioning may be used to get rid of or eliminate a previously learned
response, which is especially useful in teaching people to reduce their
anxiety or break bad habits.
Operant conditioning focuses on the behavior of the organism and
the reinforcement that occurs after the response. A reinforcer is a
stimulus or event applied after a response that strengthens the
probability that the response will be performed again. Praise, hugs,
money, and prizes are examples of positive reinforcers. When specific
responses are reinforced on the proper schedule, behaviors can be
either increased or decreased.
The best way to increase the probability that a response will occur again is to apply positive
reinforcement or rewards after the behavior occurs.
There are many different types of positive reinforcers that can be used to increase behaviors, but
it is important to note that the type of reinforcer used depends on the individual and the situation

Natural reinforcers Social reinforcers Tangible reinforcers Token reinforcers

occur directly as a involve expressing involve presenting are points or tokens
result of the approval of behavior, actual, physical rewards that are awarded
behavior. For such as a teacher, such as candy, treats, for performing
example, a student parent, or employer toys, money, and other
certain actions.
studies hard, pays saying or writing, desired objects. While
attention in class, These tokens can
"Good job" or these types of rewards
and does their "Excellent work." can be powerfully then be exchanged
homework. As a motivating, they should for something of
result, they get be used sparingly and value.
excellent grades. with caution.
For operant conditioning to be effective, it is necessary to assess which kinds of
reinforcement are likely to increase or decrease behaviors for each individual.
Not every client, for example, finds health practitioners’ terms of endearment
rewarding. Comments such as, “Very nice job, dear,” may be offensive to some
clients. A second issue involves the timing of reinforcement. The success of
operant conditioning procedures partially depends on when the reinforcement
is applied. According to this theory, in the early stages, learning needs to be
reinforced every time it occurs. Once a response is well established, however,
behavior needs to be reinforced only every so often, because the goal is for the
learner to internalize the response and build good habits without being
supervised.
Changing Behavior Using Operant Conditioning

To increase behavior To decrease behavior

Positive reinforcement Nonreinforcement
Negative reinforcement Punishment
(escape or avoidance
conditioning)
COGNITIVE LEARNING THEORY
It focuses on what goes on inside the mind of the learner. Cognitive theory is assumed to be
made up of a number of sub theories and is widely used in education and counseling.
According to this perspective, for individuals to learn, they must change their perceptions and
thoughts and form new understandings and insights. The individual largely directs the learning
process by organizing information based on what is already known, and then reorganizing the
information into a new understanding.
According to this theory ,the key to learning and changing behavior is the individual
cognition ,metacognition(perception, thoughts, memory and ways of processing and
structuring information)
To change behavior, work with the developmental stage and change cognitions, goals,
expectations, equilibrium, and ways of processing information.
Unlike behaviorists, cognitive psychologists maintain that rewarding people
for their behavior is not necessary for learning. More important are
learners’ goals and expectations, which create tensions that motivate them
to act. Teachers and those trying to influence the learning process must
recognize that any learning situation is influenced by learners’ past
experiences, perceptions, and ways of incorporating and thinking about
information in relation to their goals, expectations, and the social influences
on the situation. To promote remembering, the learner must think about or
act on the information.
One of the oldest psychological theories is the gestalt perspective, which
emphasizes the importance of perception in learning and laid the
groundwork for the various other cognitive perspectives that followed
(Kohler, 1947, 1969; Murray, 1995). Rather than focusing on individual
stimuli, gestalt refers to the configuration or patterned organization of
cognitive elements, reflecting the maxim that “the whole is greater than the
sum of its parts.” A principal assumption is that each person perceives,
interprets, and responds to any situation in his or her own way. While many
gestalt principles worth knowing have been identified (Hilgard & Bower,
1966), the discussion here focuses on those that relate to health care
Cognitive development, which is heavily influenced by gestalt psychology, is
a third perspective on learning. It focuses on advancements and changes in
perceiving, thinking, and reasoning as individuals grow and mature
(Crandell, Crandell, & Vander Zanden, 2012; Santrock, 2013). This approach
is especially useful to know when working with children and teenagers. How
information and experiences are perceived and represented depends on an
individual’s stage of development and readiness to learn. A principal
assumption is that learning is a sequential and active process that occurs as
the child interacts with the environment and makes discoveries, which are
interpreted in keeping with what she knows (schema) and is capable of
understanding.
Jean Piaget is the best known of the cognitive developmental theorists. His observations of
children’s perceptions and thought processes at different ages have contributed much to
our recognition of the special ways that young people reason, the changes in their abilities
to reason, and the limitations in their ability to understand, communicate, and perform
(Piaget & Inhelder, 1969). By watching, asking questions, and listening to children, Piaget
identified and described four successive stages of cognitive development (sensorimotor,
preoperational, concrete operations, and formal operations) that unfold sequentially over
the course of infancy, early childhood, middle childhood, and adolescence.
In practice, some children may learn more effectively by discovering and putting pieces
together on their own, whereas other children benefit from a more social and direct
approach. It is the nurse’s responsibility to identify the child’s or teenager’s stage of
thinking, to provide experiences at an appropriate level for the child to actively discover
and participate in the learning process, and to determine whether a child learns best
through language and social interaction or through perceiving and experimenting in his or
her own way.
SOCIAL LEARNING THEORY
Most learning theories assume the individual must have direct experiences in order to
learn. According to the social learning theory, much of learning occurs by observation—
watching other people and determining what happens to them. Learning is often a social
process, and other individuals, especially significant others, provide compelling examples
as role models for how to think, feel, and act

According to this theory , learning is heavily influenced by the culture and occurs as a
social process in interaction with others.

A person’s knowledge may not necessarily reflect reality, but through collaboration and
negotiation, new understanding is acquired.
Social learning theory is largely based on the work of Albert Bandura (1977, 2001), who
mapped out a perspective on learning that includes consideration of the personal
characteristics of the learner, behavior patterns, and the environment. In early discussions of
this theory, Bandura emphasized behaviorist features and the imitation of role models; later,
the focus shifted to cognitive considerations, and more recently, Bandura’s attention has
turned to the impact of social factors and the social context within which learning and
behavior occur. According to Bandura, personality is shaped by interaction among cognitive
factors, behaviors, and environmental factors. This interaction is termed reciprocal
determinism.
Cognitive factors § Behavioral factors § Environmental factors §
Our dispositional Our skills, practice Our social, political, and
factors: beliefs, and self efficacy § Self cultural influences and
expectations, values, efficacy: Similar to personal learning
intentions, social roles, confidence. The belief experiences
emotional makeup and that one is capable of
biological and genetic performing a certain
influences behavior to attain a
certain goal
Role modeling is a central Vicarious reinforcement is another concept
from social learning theory and involves
concept of the social viewing other people’s emotions and
learning theory. As an determining whether role models are perceived
example, a more as rewarded or punished for their behavior.
Reward is not always necessary, however, and a
experienced nurse who learner may imitate the behavior of a role
demonstrates desirable model even when no reward is available to
either the role model or the learner.
professional attitudes and
Nevertheless, in many cases, whether the
behaviors sometimes serves model is viewed by the observer as rewarded or
as a mentor for a less punished may have a direct influence on
learning. This relationship may be one reason
experienced nurse, while
why it is difficult to attract health professionals
medical students, interns, to geriatric care. Although some highly
and residents are mentored impressive role models work in this field,
geriatric health care is often accorded lower
by attending physicians.
status with less pay in comparison to other
specialty areas
 -It emphasizes the importance of the individual and the individual's
perceptions of his/her personal capabilities as key determinants of successful
outcomes. Self-efficacy theory, and the broader social cognitive theory in
which self-efficacy is encompassed, therefore clearly endorses a democratic
ideal that suggests that all individuals are competent and capable of being
successful, provided they have the opportunities and self-efficacy necessary to
pursue their goals.
•People learn through •The most human behavior is •Social learning theory explains human
observing others’ learned observation-ally through behavior in terms of continuous
behavior, attitudes and modeling: from observing others, reciprocal interaction between cognitive
outcomes of those one forms an idea of how new behavioral and environmental influences.
behaviors. behaviors are performed, and on The social learning theory has sometimes
later occasions this coded been called a bridge between behaviorist
information serves as a guide for and cognitive learning theories because it
action” (Bandura) encompasses attention, memory and
motivation.
 Factors that may influence learning

Consistency. The Identification: The learner Liking: The more we

model (the person can identify with the model like the model, the
the learner is more likely we are to
imitating) behaves imitate his or her
in a way that is Rewards/punishment. We can behavior
consistent across learn from the consequences
situations of the model’s behavior.
(vicarious learning)
 BOBO DOLL THEORY
§Children watched a
§Children imitated the model were
model being aggressive
to a bobo doll aggressive to the bobo doll

• As a matter of fact, the Bobo doll experiment is the empirical

demonstration of one of his most famous theories: Social Learning
Theory. This theory states that humans mostly learn by being in
contact with their social environment. By observing others, we
acquire certain knowledge, skills, strategies, beliefs, and attitudes.
HUMANISTIC LEARNING THEORY
Underlying the humanistic learning theory is the assumption that each individual is unique and that all
individuals have the desire to grow in a positive way. Unfortunately, say the humanists, positive
psychological growth may be damaged by some of society’s values and expectations (e.g., males are less
emotional than females, some ethnic groups are inferior to others, making money is more important than
caring for people), and by adults’ mistreatment of their children and one another (e.g., inconsistent or harsh
discipline, humiliation, and belittling, abuse and neglect).

Humanistic theory is especially compatible with nursing’s focus on caring and patient-centeredness—an
orientation that is increasingly being challenged by the emphasis in medicine and health care on science,
technology, cost efficiency, for-profit medicine, bureaucratic organization, and time pressures. Like the
psychodynamic theory, the humanistic theory is largely a motivational theory. From a humanistic
perspective, the motivation to act stems largely from each person’s needs, feelings about the self, and the
desire to grow in positive ways. Remembering information and transferring learning to other situations are
helped by encouraging curiosity and a positive self-concept, as well as having open situations where people
respect individuality and freedom of choice. Under such conditions, flexibility in problem-solving and
creativity is enhanced.
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To summarize, humanistic theory suggests the
following principles of learning:
• Focus on the learner’s desire for positive growth, subjective feelings, needs,
selfconcept, choices in life, and interpersonal relationships.

• The teacher’s role is to assess and encourage changes in the learner’s needs,
selfconcept, and feelings by providing support, freedom to choose, and
opportunities for spontaneity and creativity
Applying Learning Theories to Health Care
In practice, psychological learning theories can be used singly or in combination to help
nurses and other health professionals teach patients or themselves to acquire new
information and alter behavior. As an example, patients undergoing painful procedures are
first taught relaxation exercises (behaviorist) and while experiencing pain or discomfort are
encouraged to employ imagery, such as thinking about a favorite, beautiful place or
imagining the healthy cells gobbling up the unhealthy cells (cognitive). Staff members are
highly respectful, upbeat, and emotionally supportive of each patient (humanistic) Waiting
rooms and lounge areas for patients and their families are designed to be comfortable,
friendly, and pleasant to facilitate conversation and interaction, while support groups may
help patients and family members learn from one another about how to cope with illness
or disability and how to regulate their emotions so that their health is not further
compromised (social learning).
PSYCHODYNAMIC LEARNING THEORY

Although not typically treated as a learning theory, some of the constructs from
psychodynamic theory (based on the work of Sigmund Freud and his followers) have
significant implications for learning and changing behavior (Hilgard & Bower,1966; Slipp,
2000). Largely a theory of motivation that stresses emotions rather than cognition or
responses, the psychodynamic perspective emphasizes the importance of conscious and
unconscious forces in guiding behavior, personality conflicts, and the enduring effects of
childhood experiences. As Pullen (2002) points out, negative emotions are important to
recognize and assess in nurse–patient-physician–family interactions, and psychodynamic
theory can be helpful in this regard.
 A central principle of this theory is that behavior may be conscious or unconscious
—that is, individuals may or may not be aware of their motivations and why they
feel, think, and act as they do. According to the psychodynamic view, the most
primitive source of inspiration comes from the id. It is based on libidinal energy (the
basic instincts, impulses, and desires humans are born with), which includes two
components: eros (the desire for pleasure and sex, sometimes called the “life
force”) and Thanatos (aggressive and destructive impulses, or death wish). Patients
who survive or die despite all predictions to the contrary provide illustrations of
such primitive motivations. The id, according to Freud, operates based on the
pleasure principle—to seek pleasure and avoid pain. For example, dry, dull lectures
given by nurse educators who go through the motions of the presentation without
much enthusiasm or emotion inspire few people (patients, staff, or students) to
listen to the information or heed the advice given. This does not mean, however,
that only pleasurable presentations are acceptable
 The id (primitive drives) and superego (internalized societal values and standards,
or the conscience) are mediated by the ego, which operates on the basis of the
reality principle—rather than insisting on immediate gratification, people learn to
take the long road to pleasure and to weigh the choices or dilemmas in the conflict
between the id and the superego. Healthy ego (self) development, as emphasized
by Freud’s followers, is an important consideration in healthcare fields. For
example, patients with ego strength can cope with painful medical treatments
because they recognize the long-term value of enduring discomfort and pain to
achieve a positive outcome. Patients with weak ego development, in contrast, may
miss their appointments and treatments or engage in short-term pleasurable
activities that work against their healing and recovery. Helping patients develop ego
strength and adjust realistically to a changed body image or lifestyle brought about
by disease and medical interventions is a significant aspect of the learning and
healing process.
 Health professionals also require personal ego strength to cope with the numerous
predicaments in the everyday practice of delivering care as they face conflicting
values, ethics, and demands. Professional burnout, for example, is rooted in an
overly idealized concept of the healthcare role and unrealistic expectations for the
self in performing the role. Malach-Pines (2000) notes that burnout may stem from
nurses’ childhood experiences with lack of control. When the ego is threatened, as
can easily occur in the healthcare setting, defense mechanisms may be employed to
protect the self. The short-term use of defense mechanisms is a way of coming to
grips with reality. The danger arises from the overuse or long-term reliance on
defense mechanisms, which allows individuals to avoid reality and may act as a
barrier to learning and transfer.
As an example of defense mechanisms in health
care, Kübler-Ross (1969) points out that many
terminally ill patients’ initial reaction to being
told they have a severe threat to their health
and well-being is to employ the defense
mechanism of denial. Patients typically find it
too overwhelming to process the information
that they are likely to die. Although most
patients gradually accept the reality of their
illness, the dangers are that they may not seek
treatment and care if they remain in denial. If
their condition is contagious, they may not
protect others against infection. In turn, a
common defense mechanism employed by
healthcare staff is to intellectualize the
significance of disease and death rather than to
deal with these issues realistically at an
emotional level.
This defense mechanism may contribute to the
reported tendency of oncologists to often ignore,
rather than address, the emotions that patients
express during communication (Friedrichsen & Strang,
2003; Friedrichsen, Strang, & Carlsson, 2000; Pollak et
al., 2007). One study found that oncologists, in
responding to patients expressing fear, more often
addressed the topic causing the anxiety rather than
addressing the emotion itself (Jennifer et al., 2009).
Telford, Kralik, and Koch (2006) report that nurses may
strive to buttonhole terminally ill patients within a
denial–acceptance framework too quickly and, as a
result, may not listen to patients as they attempt to
tell their stories and interpret their illness experiences.
Protecting the self (ego) by dehumanizing patients and
treating them as diseases and body parts rather than
as whole individuals (with spiritual, emotional, and
physical needs) is an occupational hazard for other
health professionals.
For example, some staff members and patients feel an inordinate need to control the self, other people, and
certain social situations. This behavior may be rooted in their inability to resolve the crisis of trust versus mistrust
According
at the to the
earliest stage of life.psychodynamic
In working with these view, personal
individuals, difficulties
it is essential to buildarise andrelationship
a trusting learning and
is to
encourage them to gradually relinquish , past conflicts, especially during childhood, may interfere with the ability
limited when individuals become fixated or stuck at an earlier stage of personality
to learn or to transfer learning. What people resist talking about or learning—a process termed resistance is an
development.
indicator of underlyingTheyemotionalthendifficulties,
must work whichthrough their
must be dealt previously
with unresolved
for them to move crises to
ahead emotionally and
developFor
behaviorally. and mature
instance, emotionally.
if a young, pregnant teenager refuses to engage in a serious conversation about
sexuality (e.g., changes the subject, giggles, looks out into space, expresses anger), this behavior indicates that
she has underlying emotional conflicts that need to Be addressed.

One study explored psychodynamic sources of resistance among nursing students and examined how they engaged
with or resisted the learning process. A number of factors requiring consideration surfaced in this research,
including childhood struggles, a history of over adaptation, self-image, and learning climate (Gilmartin,
2000).Serious problems in miscommunication can occur in health care as a result of childhood learning
experiences. For example, some physicians and nurses may have had the childhood experience of standing
helplessly by watching someone they loved and once depended on endure disease, suffering, and death. Although
they could do little as children to improve the situation, they may be compensating for their childhood feelings of
helplessness and dependency as adults by devoting their careers to fending off and fighting disease and death.
These motivations, however, may not serve them well as they attempt to care for, communicate with, and educate
patients who are dying and their families.
The concept of transfer has special meaning to psychodynamic theorists.
Transference occurs when individuals project their feelings, conflicts, and reactions
—especially those developed during childhood with significant others such as
parents—onto authority figures and other individuals in their lives. The danger is
that the relationship between the health professional and the patient may become
distorted and unrealistic because of the biases inherent in the transference
reaction. For example, because patients are sick, they may feel helpless and
dependent and then regress to an earlier stage in life when they relied on their
parents for help and support. Their childhood feelings and relationship with a
parent—for better or worse may be transferred to medical professionals or
physician taking care of them. While sometimes flattering, the love and
dependency that patients feel may operate against the autonomy and
independence they need to get back on their feet. A particular patient may also
remind a staff member of someone from his past, creating a situation of
countertransference.
The psychodynamic perspective is
helpful in more fully understanding
learning and teaching, however,
because it highlights a number of
underlying considerations and
subtleties in the process, such as
motivations, emotional development,
and conflicts in learning, and focuses
on identifying problems in learning or
with the teacher-learner relationship.
Principles of Learning
1. Focusing 6. Imitation
2. Organization 7. Active participation
3. Repetition 8. Motivation
4. Association 9. Individual styles
6. Learner control 10. Spacing
 Laws of learning By
Edward Torndike (1932)
1.) Law of effect
 Learning is strengthened
when accompanied by a
pleasant or satisfying
feeling.
 Learning is a weaken when
associated with an
unpleasant feeling.
 Learning takes place
properly when it results in
satisfaction and the learner
derives pleasure out of it.
4.) Law of primacy
 Things learned first create a strong
impression "What is THOUGHT
must be RIGHT the FIRST TIME."
2.) Law of exercise 5.) Law of recency
 Things most often  Things most recently learned
repeated are best are best remembered
remembered
 Students do not learn
6.) Law of intensity
complex task in a single
 The more intense the material
session.
taught the more it is likely
learned
3.) Law of Readiness
 Individuals learn best
when they are physically, 7.) Law of freedom
mentally and emotionally  Thing freely learned are best
ready to learn learned
Q1. In what factor Our skills, practice and self efficacy Self-efficacy: Similar to confidence. The belief that
one is capable of performing a certain behavior to attain a certain goal?
Answer: Behavioral Factor

Q2. In what factors our dispositional factors: beliefs, expectations, values, intentions, social roles, emotional
makeup and biological and genetic influences?

Answer: Cognitive Factors

Q3. What factors our social, political and cultural influences and personal learning experiences?

Answer: Environmental factors

Q4. It focuses on the behavior of the organism and the reinforcement that occurs after the response.

Answers: Operant Conditioning

Q5. In what theory continues to be considered useful in nursing practice for the delivery of health care?

Answer: Behaviorist Theory

Q6. Give the factors that may influence learning:

Answers: Consistency
Identification
Rewards/punishment
Liking
THANK YOU!
GROUP MEMBERS:
DEOCARIZA, VINCE ARYL
DE VERA, DANIELLA MARIE
DEXINE, JUDEL
DOLINDO, JOYCEE
ESCOBAR, KATHLEEN
FUELLAS, FRINCELYN
GARRIDO, MARCO