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
1
 - A principle that it is easier to learn a behavior than - Key to Learning and Changing: The individual’s
to unlearn it cognition, including:
- EXAMPLES: Difficulty in eliminating completely
unhealthy habits and addictive behaviors such as Perception Thought
smoking, alcoholism, and drug abuse
Memory Ways of Processing
VI. Operant Conditioning (B.F. Skinner) *Pag Mahal ka Talaga, Wag mo na Pakawalan
- Focuses on the behavior of the organism and the - Largely directed by the individual
reinforcement that occurs after the response - Involves processing the info + interpreting it =
- Positive Reinforcement reorganizing to new insights
- More important are learner’s goals and
expectations than reward
- METACOGNITION
‣ Individual’s understanding of her way of learning
‣ “Reward Conditioning” ‣ Being mentally ACTIVE when processing info
‣ A pleasant stimulus is applied following an encourages its retention in long-term memory
organism’s response = greatly enhances the ‣ Have learners indicate how they believe they
likelihood that responses will be repeated learn
‣ EXAMPLE: A patient moans and groans as he
attempts to get up and walk for the first time A. GESTALT PERSPECTIVE
after an operation, praise and encouragement - Emphasizs the importance of perception in learning
for his efforts at walking will improve the - A person responds to any situation in his own way
chances that he will continue struggling toward - Directed towards simplicity, equilibrium, and
independence. regularity
- Negative Reinforcement - “LAW OF SIMPLICITY” — A school of thought that
‣ “Avoidance Conditioning” believes all objects and scenes can be observed in
‣ An aversive stimulus is anticipated by the their simplest forms
organism = makes a response to avoid the - EXAMPLE 1: When giving pathophysiology to a
unpleasant event client
- Punishment — To decrease/extinguish the - PERCEPTION — It is selective; individuals attend to
probability of a response certain features of an experience while ignoring other
‣ POINTS TO CONSIDER W/ PUNISHMENT: features
✓ Should be administered immediately after - EXAMPLE 2: When giving health teachings while
response client is in severe pain/thinking of bills - may not
✓ Must be consistent and at highest attend to well-intentioned patient education info
reasonable level - What individuals pay attention to and what they
✓ Should not be prolonged ignore are influenced by a host of factors:
✓ PURPOSE: To decrease a specific behavior ‣ Past experiences
and to instill self-discipline
- NURSING INTERVENTION 1: Carefully observe ‣ Needs
individual’s responses to specific stimuli and then ‣ Personal motives and attitudes
select the best reinforcement procedures to change ‣ Reference groups
a behavior. - NURSING INTERVENTION: These factors have a
- NURSING INTERVENTION 2: Assess which kinds direct bearing on how a health educator
of reinforcement are likely to increase or decrease approaches any learning situation w/ an individual
behaviors in an individual or group - approach that is effective w/ one client
✴ Not every or not all patient finds health may not work w/ another client
practitioners’ terms of endearment rewarding.
B. INFORMATION PROCESSING
Cognitive Learning Theory - Emphasizes thinking process; thought, reasoning, the
- Stress the importance of what goes on insider the way info is encountered and stored, and memory
learner fxning
- Used in EDUCATION & COUNSELING i. 4 Stages of Information-Processing Model of
Memory Functioning
1. Paying attention to environmental stimuli;
attention is the key to learning

2
 ‣ EXAMPLE: If a patient is not attending to - Relate new material to something familiar
what a nurse educator is saying, perhaps - Have learners indicate how they believe they
bcoz the patient is weary/distracted learn
‣ NURSING INTERVENTION: It would be - Evaluate learner’s mistakes
prudent for the educator to try the ✴ Applicable to: Health educ., brochures, 1on1
explanation at another time when the indiv. is patient educ., CHN (community health nurse ata
more receptive and attentive to?), students
2. Info is processed by the senses; consider
client’s preferred mode of sensory processing C. COGNITIVE DEVELOPMENT
(VISUAL, AUDITORY, MOTOR); check if client a) Jean Piaget
has sensory deficits - Focus: Qualitative changes in perceiving,
‣ NURSING INTERVENTION: Presenting thinking, and reasoning as individuals grow and
material using multiple sensory modes aid mature
learning - Cognition is partially dependent on the
3. Info is transformed and encoded briefly into: individual’s stage of development in:
a) SHORT-TERM MEMORY — Info is
Perception Reasoning Readiness to Learn
disregarded and forgotten
b) LONG-TERM MEMORY — Info is enduring ✴ Age and stage of life can affect learning
Imagery Association ✴ Learning is developmental and sequential
✴ Piaget identified 4 sequential stages of cognitive
Rehearsal Breaking Info into Units development:
‣ Sensorimotor (0-2 years old)
4. It involves the action/response that the
‣ Pre-operational (2-7 years old)
individual undertakes based on how info was
‣ Concrete operational (7-11 years old)
processed and stored
‣ Formal operational (11-15+ years old)
REMEMBER! Memory processing and the
- NURSING INTERVENTION 1: Nurses need to
retrieval of info are enhanced by organizing info
determine what children are perceiving and
and making it meaningful
thinking in a particular situation (ex.: concept of
death — ask God to give back the dead
ii. 9 Events to Activate Effective Learning
persom)
- Gagne, Briggs, Wagner, 1992
- NURSING INTERVENTION 2: Provide
1) Gain the learner’s attention (Reception)
experiences at an appropriate level for the child
2) Inform the learner of the objectives and
to activity discover and participate in the
expectations (Expextancy)
learning process; children learn best through
3) Stimulate the learner’s recall of prior learning
language and social interaction, experimenting
(Retrieval)
4) Present information (Selective Perception)
Adult Learning
5) Provide guidance to facilitate the learner’s
- Deal better w/ contradictions and integration
understanding (Semantic Encoding)
- With advanced level of reasoning — wisdom &
6) Have the learner demonstrate the
life experiences
information/skill (Responding)
- Others w/ lower stages of thinking — lack of
7) Give feedback to the learner
educ., presence of diseases, depression,
(Reinforcement)
stress, medications
8) Assess the learner’s performance (Retrieval)
- Adults generally do better when offered
9) Work to enhance retention and transfer
opportunities for SELF-DIRECTED LEARNING
through application and varied practice
(Generalization) ‣ Learner control, autonomy, initiative
REMEMBER! In emplying this model, teachers ‣ With explicit rationale for learning
must carefully analyze the requirements of the
activity; design and sequence the instructional b) Lev Vygotsky
events; and select appropriate media to achieve - Emphasizes the significance of language, social
the outcomes interaction, adult guidance in the learning
process
iii. Strategies to Aid in Learning - He advocates on giving clear, well-designed
- Break material into small parts/chunks instruction that is carefully structured to
- Use memory tricks and techniques (Mnemonic advance each person’s thinking & learning
Devices)
3
 - EXAMPLES: RLE duties, Support groups in
community mental health settings

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: A. ROLE MODELLING
- Role models need to be enthusiastic, professionally
Social Interaction Collaboration Negotiation
organized, caring, self-confident, knowledgeable,
skilled, and good communicators.
E. ATTRIBUTION THEORY
- Focus: The cause-and-effects relationships and B. VICARIOUS REINFORCEMENT
explanations that individuals formulate to account for - Determining whether role models are perceived as
their own and other’s behavior and the way in w/c the rewarded or punished for their behavior.
world operates (STRONGLY INFLUENCED BY - A learner may imitate the behavior of a role model
CULTURAL VALUES & BELIEFS) even when no reward is available to either the role
- EXAMPLE 1: Patients with certain religious views or a model or the learner.
type of parental upbringing may believe that their - EXAMPLE: Difficulty in attracting health professionals
disease is a punishment for their sins — to geriatric care / CHN - community healty nursing (?)
INTERNALIZING BLAME - NURSING INTERVENTION: The nurse must find
- EXAMPLE 2: Other patients may attribute their ways to encourage patient’s feelings of competency to
disease to the actions of others — EXTERNALIZING promote wellness. Do not foster dependency,
BLAME helplessness, and feelings of low self-esteem

Cognitive Orientations and Emotions Psychodynamic Learning Theory

- EMOTIONAL INTELLIGENCE — Entails an indiv. - It is a theory of motivation that stresses emotions
managing his emotions, motivating himself, reading rather than cognition or responses
the emotions of others, working effectively in - It emphasizes the importance of conscious and
interpersonal relationships; more important than unconscious forces in guiding behavior, personality
cognitive intelligence conflicts, enduring effects of childhood experiences
- SELF-REGULATION — Includes learners on adult behavior
monitoring their own cognitive processes, - Behavior may be conscious / unconscious –
emotions, and surroundings to achieve goals; the individuals may or may not be aware of their
ability to self-regulate has been found to be a key motivations and why they feel, think, and act as
factor in learning and studying. they do

Social Learning Theory (ALBERT BANDURA) A. EGO DEVELOPMENT

- Individuals do not need to have direct experiences - EGO — Operates on the reality principle
to learn - HEALTHY EGO DEVELOPMENT
- Learning occurs by taking note of other people’s ‣ EXAMPLES: Can cope with painful medical
behavior and what happens to them – LEARNING treatment; they value enduring pain and comfort to
AS A SOCIAL PROCESS achieve outcome
- Social learning theory extends the learning process
beyond the Educator
4
- WEAK EGO DEVELOPMENT - EXAMPLE 1: Young pregnant teenager refuses to
‣ EXAMPLES: Missed appointments and treatment; engage in a serious conversation about sexuality
work against healing and recovery — giggles, express anger — underlying emotional
conflict that need to be addressed
B. DEFENSE MECHANISMS - EXAMPLE 2: Uncompliance, trauma and losss
- Arises when ego is threatened; to protect the self
- For short-term use only Humanistic Learning Theory
- If used for long term – individuals avoid reality; ABRAHAM MASLOW’S HIERARCHY OF NEEDS
becomes barrier to learning - Assumption that every individual is unique and that
- EXAMPLE: Terminally ill client — concept of death — all individuals have a desire to grow in a positive way
does not seek treatment - Importance of human creativity, emotions and feelings;
- Common Used Defense Mechanisms: right to make own decisions are the cornerstones of
1. Denial — ignoring/refusing to acknowledge the this approach
reality of a threat - Motivation is derived from each person’s needs and
2. Rationalization — substitution of a safe and subjective feelings
reasonable explanation for the true cause of - Role of Abraham Maslow’s Hierarchy of needs and its
behavior role in human motivation
3. Displacement — re-direction of aggression onto a - EXAMPLES: Clients who are hungry, tired, and in
powerless substitute target pain are motivated to get first their biological needs
4. Repression — withdrawal from consciousness of before they will be open to learning about their
an unwanted idea, affect, or desire by pushing it illness, self-care, and health educ.
down into the unconscious part of the mind - What people want is unconditional positive self-regard
(hysterical amnesia) - Experiences that are threatening, coercive, and
5. Regression — ego reverts to an earlier stage of judgmental undermine the ability and enthusiasm of
development usually in response to stressful individuals to learn.
situations - EXAMPLES: Nurse is prejudiced against clients
6. Intellectualization — allows to avoid thinking with AIDS — little healing to clients
about the stressful, emotional aspect of the - Humanistic orientation is referred to as a LEARNER-
situation and instead focus only in the intellectual DIRECTED APPROACH (educator to serve as
component (diagnosed with terminal illness – focus facilitator; listening rather than talking; learners choose
on learning everything about the disease in order to what is to be learned; central focus is on learner’s
avoid stress and remain distant from the reality of perceptions, desires, and decision making)
the situation) ✴ The central approach of Humanistic Approach is not
7. Projection — unwanted feelings are displaced mastery of info and facts
onto another person - “Tell me how you feel” rather than “Tell me what you
8. Reaction Formation — a person goes beyond think”
denial and behaves in the opposite way to which - Foster curiosity, enthusiasm, initiative and
he/she thinks or feels (homosexuals) responsibility are more important
9. Sublimation — similar to displacement; but takes - EXAMPLE 1: Rather than playing health education
place when we manage to displace our videos for hospitalized patients/distributing
unacceptable emotions into behaviors which are pamphlets — it should be establishing rapport and
constructive and socially acceptable, rather than becoming emotionally attuned to patients and fam
destructive activities members
10. Compensation — making up of for weaknesses by - EXAMPLE 2: Applicability of this theory to self-help
excelling in other areas groups, wellness programs, and palliative care

C. ERIC ERICKSON’S 8 STAGES OF LIFE Neuropsychology and Learning

- Adult behavior is derived from earlier childhood - Investigations into the physiological(?) and
experiences and conflicts nuerological foundations of thinking, learning, and
- EXAMPLES: Pre-schoolers (Initiative vs Guilt — behavior
make them do things) - Concerned with studying the brain and CNS’
- NURSING INTERVENTION: When designing and structures, anatomy, chemistry, electrical activity,
carrying out treatment regimens, communication, hormones, and neurotransmitters as these affect
and health promotoion — consider stage of functioning and behavior.
personality development - Learning is viewed as involving changes in the brain
- RESISTANCE — Past conflicts (childhood) may and CNS that affect responses and behavior
interfere with ability to learn or transfer learning
5
- 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