Chapter 3

Applying Learning
Theories to
Healthcare Practice
 Learning
• Learning: a relatively permanent change
in mental processing, emotional
functioning, and behavior as a result of
experience
• Learning Theory: a coherent framework
of integrated constructs and principles
that describe, explain, or predict how
people learn
 Contribution of Learning
Theories
• 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
 Application Questions to Keep
in Mind
• How does learning occur?
• What kinds of experiences facilitate or
hinder the process?
• What helps ensure that learning becomes
permanent?
 Behaviorist Theory
• Concepts: stimulus conditions,
reinforcement, response, drive
• To change behavior, change the stimulus
conditions in the environment and the
reinforcement after a response.
 Behaviorist Dynamics
• Motivation: drives to be reduced,
incentives
• Educator: active role; manipulates
environmental stimuli and
reinforcements to direct change
• Transfer: practice and provide similarity
in stimulus conditions and responses
with a new situation
 Respondent Conditioning
• Also called association learning or
classical/Pavlovian conditioning
• Learning occurs as the organism
responds to stimulus conditions and
forms associations.
• A neutral stimulus is paired with an
unconditioned stimulus–unconditioned
response connection until the neutral
stimulus becomes a conditioned stimulus
that elicits the conditioned response.
Respondent Conditioning (cont’d)
• Other respondent-conditioning concepts
used in psychology and healthcare
– Systematic desensitization
– Stimulus generalization
– Discrimination learning
– Spontaneous recovery
 Operant Conditioning
• Learning occurs as the organism
responds to stimuli in the environment
and is reinforced for making a particular
response.
• A reinforcer is applied after a response,
strengthening the probability that the
response will be performed again under
similar conditions.
 Changing Behavior Using
Operant Conditioning
• To increase behavior
– Positive reinforcement
– Negative reinforcement (escape or
avoidance conditioning)
• To decrease behavior
– Nonreinforcement
– Punishment
 Cognitive Learning Theory
• Concepts: cognition, gestalt, perception,
developmental stage, information-
processing, memory, social
constructivism, social cognition,
attributions
• To change behavior, work with the
developmental stage and change
cognitions, goals, expectations,
equilibrium, and ways of processing
information.
 Cognitive Dynamics
• Motivation: goals, expectations,
disequilibrium, cultural and group values
• Educator: organize experiences and make
them meaningful; encourage insight and
reorganization within learner
• Transfer: focus on internal processes and
provide common patterns with a new
situation
 Gestalt Perspective
• Perception and the patterning of stimuli
(gestalt) are the keys to learning, with
each learner perceiving, interpreting, and
reorganizing experiences in her/his own
way.
• Learning occurs through the
reorganization of elements to form new
insights and understanding.
• Perception is selective.
 Information-Processing
Perspective
• The way individuals perceive, process,
store, and retrieve information from
experiences determines how learning
occurs and what is learned.
• Organizing information and making it
meaningful aids the attention and storage
process; learning occurs through
guidance, feedback, and assessing and
correcting errors.
 Cognitive Development
Perspective
• Learning depends on the stage of
cognitive functioning with qualitative,
sequential changes in perception,
language, and thought occurring as
children and adults interact with the
environment.
• Recognize the developmental stage and
provide appropriate experiences to
encourage discovery.
 Social Constructivist
Perspective
• 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 Cognition Perspective
• An individual’s perceptions, beliefs, and
social judgments are affected strongly by
social interaction, communication,
groups, and the social situation.
• Individuals formulate causal explanations
to account for behavior that has
significant consequences for their
attitudes and actions (attribution theory).
 Cognitive-Emotional
Perspective
• Efforts to incorporate emotional
considerations within a cognitive
framework
– Empathy and moral emotions in moral
development and prosocial behavior
– Memory storage and retrieval and decision
making involves cognitive and emotional
brain processing.
– Emotional intelligence
– Self-regulation
 Social Learning Theory
• Concepts: role modeling, vicarious
reinforcement, self-system, self-
regulation
• To change behavior, utilize effective role
models who are perceived to be
rewarded, and work with the social
situation and the learner’s internal self-
regulating mechanisms.
 Social Learning Dynamics
• Motivation: compelling role models
perceived to be rewarded, self-system
regulating behavior, self-efficacy
• Educator: model behavior and
demonstrate benefits; encourage active
learner to regulate and reproduce
behavior
• Transfer: similarity of setting, feedback,
self-efficacy, social influences
Psychodynamic Learning Theory
• Concepts: stage of personality
development, conscious and unconscious
motivations, ego-strength, emotional
conflicts, defense mechanisms
• To change behavior, work to make
unconscious motivations conscious,
build ego-strength, and resolve
emotional conflicts.
 Psychodynamic Dynamics
• Motivation: libido, life force, death wish,
pleasure principle, reality principle,
conscious and unconscious conflicts,
developmental stage, defenses
• Educator: reflective interpreter; listen
and pose questions to stimulate insights
• Transfer: remove barriers such as
resistance, transference reactions, and
emotional conflicts
 Humanistic Learning Theory
• Learning occurs on the basis of a
person’s motivation, derived from needs,
the desire to grow in positive ways, self-
concept, and subjective feelings.
• Learning is facilitated by caring
facilitators and a nurturing environment
that encourage spontaneity, creativity,
emotional expression, and positive
choices.
 Humanist Dynamics
• Motivation: needs, desire to grow, self-
concept
• Educator: act as facilitator who respects
learner’s uniqueness and provides
freedom to feel, express, and grow
creatively
• Transfer: positive or negative feelings
and choices as well as freedom to learn,
promote, or inhibit transfer
Neuropsychology and Learning
• Physiological and neurological bases of
thinking, learning, and behavior
• Neurological conditions, mental health
issues, and learning disabilities
• Relationship between stress and learning
• Integration of learning theories
Generalizations about Learning
• Learning is a function of physiological and
neurological developmental changes.
• Brain processing is different for each learner.
• Learning is active, multifaceted, and complex.
• Meaningful practice strengthens learning
connections.
• Stress can interfere with or stimulate learning.
 Motor Learning
• Motor learning is useful in addition to
theories of psychological learning.
• Examples of skills taught
– Walking with crutches
– Putting on a colostomy bag
– Operating sophisticated medical equipment
 Stages of Motor Learning
• Cognitive stage
– Learner works to develop cognitive map.
• Associative stage
– More consistent performance, slower gains,
fewer errors
• Autonomous stage
– Automatic stage, achieving advanced level
 Motor Learning Variables
• Prepractice
– Motivation, attention, goal setting,
understanding of task goals, modeling/
demonstration
• Practice
– Massed vs. distributed, variability, whole vs.
part, random vs. blocked, guidance vs.
discovery learning, mental
Motor Learning Variables (cont’d)
• Feedback
– Intrinsic (inherent) feedback
– Sensory and perceptual information that
arises when a movement is produced
– Extrinsic (augmented or enhanced) feedback
– Provided to learner from outside source
(nurse, biofeedback)
Common Principles of Learning
• Knowledgeable educator
• Relate new information to learner’s past
experiences
 Learning Hindrances
• Ignoring common considerations may
hinder learning.
• Other learning hindrances
– Lack of clarity and meaningfulness to what is
being learned
– Fear, neglect, or harsh punishment
– Negative or ineffective role models
 Learning Hindrances (cont’d)
• Other learning hindrances (cont’d)
– Inappropriate materials for learner’s ability,
readiness to learn, or stage of development
– Detrimental socialization experiences
– Nonstimulating environment
– Lack of goals or realistic expectations
 Making Learning Permanent
• Enhance the likelihood of learning
– Organize the learning experience.
– Make learning experiences meaningful and
pleasurable.
– Recognize the role of emotions in learning.
– Pace the teaching session appropriately with
the learner’s ability to process information.
 Making Learning Permanent
(cont’d)
• Practice new knowledge or skills
(mentally and physically) under varied
conditions.
• Learner may need incentives and rewards
but not always.
• Assess and evaluate learner on skills soon
after session as well as at later times to
evaluate knowledge transfer.
State of the Research Evidence
• Tests and modifies theories, methods,
and assumptions
• Challenges conventional wisdom and
myths
• Interdisciplinary focus is beneficial
• Lack of resources is hindrance