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Applying Learning Theories to Healthcare
Practice
Dr. Belal M. Hijji, RN. PhD
February 21, 2012
Learning Outcomes
By the end of this lecture, students will be able to:
• Recognise the various theories underpinning human learning
• Discuss the key aspects of each theory
2
Introduction
• The learning theories are the behaviourist, cognitive, social
learning, psychodynamic, and humanistic learning theories.
• Each is discussed next.
3
Behaviorist Learning Theory
• Behaviorists focus mainly on what is directly observed and
measured
• To them, learning is a product of the stimulus conditions (S)
and the responses (R) that follow.
• This theory views the learning as simple and ignores what
goes inside an individual
• Learning is the acquisition of new behaviour through
conditioning. There are two types of conditioning:
– Respondent conditioning: In this model, a neutral stimulus (NS)
is paired with a naturally occurring unconditioned or unlearned
stimulus (UCS) and unconditioned response (UCR). After a few
such parings, the neutral stimulus alone elicits the same
response. For example, a person without experience with
hospitals (NS) visiting a sick friend may smell offensive odors
(UCS) and feel nauseated (UCR). In future visits, the hospital
(now the CS) may become associated with nausea and anxiety
(CR).
4
Behaviorist Learning Theory
– Respondent conditioning (Continued…): Often without thinking,
patients and visitors formulate association between CS and CR
as a result of their hospital experience, providing the basis for
long-lasting attitude s toward healthcare.
– Operant conditioning: This focuses on the behaviour of the
person and the reinforcement that occurs after the response. A
reinforcer is a stimulus applied after a response that strengthens
the probability of repeating the response. One method to
increase the probability of a response is positive re-inforcement
after a response occurs. For example, as the patient moans when
trying to move out of bed postoperatively, praise and
encouragement (reward) for his efforts at walking (response)
will improve the chances to continue struggling toward
independence. According to operant conditioning principles, a
behaviour maybe decreased through nonreinforcement or
punishment. For example, offensive jokes in workplace may be
handled by showing no reaction. After several such experiences,
the joke teller may stop using abrasive humor.
5
Cognitive learning theory
• This theory stresses the importance of what goes on “inside”
the learner.
• The key to learning and changing is the individual’s cognition
(perception, thought, memory, and ways of processing
information).
• Cognitive theorists maintain that reward is not necessary for
learning. Learner’s goals and expectations are more important
as these create disequilibrium, imbalance, and tension that
forces them to act.
• The cognitive learning theory has a number of well-known
perspectives that are discussed next
6
• The gestalt perspective: emphasises the importance of
perception in learning.
– A principal assumption is that each person perceives,
interprets, and responds to any situation in his/ her own
way.
– A basic principle is that psychological organisation is
directed toward simplicity, equilibrium, and regularity. An
example is the patients listening to detailed vague
explanation about their disease, when what they want is a
simple and clear explanation that settle their uncertainty.
– Another principle is that perception is selective, which has
several ramifications. First, a patient with severe pain may
not attend well-intentioned patient education information.
Second, what persons pay attention to and what they ignore
is a function of past experiences, needs, motives, and the
particular structure of the situation.
7
– Assessing these internal and external factors has a direct
effect on how a nurse approaches a learning situation with
patient(s).
8
Social learning theory
• Most learning theories assume that an individual must have
direct experiences to learn.
• Learning is often a social process and significant others
provide compelling examples or role models for how to think,
feel, and act.
• Role modeling is a central concept of the social learning
theory. For example, a more experienced nurse with desirable
professional attitudes and behaviours is sometimes used as a
mentor for a less experienced nurse.
• Bandura outlined a four-phase process that directs social
learning.
– The first is the attentional phase which is an essential
prerequisite for learning to occur. Role models with high status
and competence are more likely to be observed, although the
learner’s characteristics are important determinants of attention. 9
Social learning theory
– The second is the retention phase which involves storage and
retrieval of what was observed. What students need to know is
that ‘observation’ involves more than what we see through our
eyes; it is associated with the other four senses (hearing, touch,
smell, taste).
– The third is the reproduction phase where the learner copies the
observed behaviour. Mental rehearsal, immediate enactment, and
corrective feedback strengthen the reproduction of behaviour.
– The forth is the motivational phase which focuses on whether the
learner is motivated to perform certain type of behaviour.
Motivation is influenced by reinforcement or punishment.
10
Humanistic learning theory
• This theory assumes that each individual is unique and that all
individuals have a desire to grow in a positive way.
• Positive psychological growth may, however, be damaged by
some societal values and expectations (e.g., males are less
emotional than females, white people are superior to others) and
by adults’ mistreatment of their children and each other.
• Spontaneity, the importance of feelings and emotions, the right
of individuals to make decisions, and human creativity are the
cornerstones of a humanistic approach to learning.
• This theory is largely motivational, where motivation stems
from individual’s needs, subjective feelings about the self, and
the desire to grow.
11
• The transfer of knowledge is facilitated by curiosity, a positive
self-concept, and open situations where people respect
individuality and promote freedom of choice
• Maslow made major contribution to humanistic theory as he
identified the hierarchy of needs, which play an important role
in human motivation.
• At the bottom of Maslow’s hierarchy are physiological needs
(food, warmth, sleep). At the top of the hierarchy are selfactualisation needs which involves problem solving skills
which include cognitive needs (to know and understand).
• An assumption of the hierarchy is that basic-level needs must
be met before individuals can be concerned with learning.
Thus, patients who are hungry, tired, and in pain need to have
these issues resolved before showing interest in learning about
medications.
12
• However, research could not support Maslow’s hierarchy of
needs with much consistency. For example, a person’s unmet
basic need may engage in creative activities and enjoy
learning.
• The humanistic learning theory indicates that self-concept [the
idea that you have about the kind of person you are] and selfesteem are necessary considerations in any learning
experience. Experiences that are threatening, coercive, and
judgmental undermine the ability and enthusiasm of an
individual to learn.
• It is essential that those in position of authority convey a
fundamental respect for the people with whom they work. If a
nurse is prejudiced against AIDS patient, then little will be
therapeutic in her relationship with him/ her until she is
genuinely able to feel respect for the patient as an individual.
14