Learning theories related to Health Care Practice.

Operant Conditioning
Learning Ways of Employing Positive Reinforcement
-Is a permanent change in mental processing, emotional puncturing, skill 1. Verbal Ways
and behavior as a result of exposure to different experiences. -Saying phrases like "good", "well-done "when students respond.
-it is a lifelong dynamic process by which individuals acquire how -statements like, "that was a well-expressed opinion", or I like the way
knowledge or skills or alter their thoughts, feelings, attitudes, and you answered.
actions, or predict how people learn - gives recognition.

Learning Theory 2. Non-Verbal ways

-guidelines or principles that direct an individual the meaning of an event -nodding, smiling, looking pleased, giving the "thumbs up" sign writing
or situation. student's comments on the board.
- is a coherent framework of integrated constructs and principles that 3. Citing in class or publishing on the bulletin board exceptional
describe explain or predict how people learn, how learning scours and works or outputs.
what mutates people to earn and change.
Classification of Educational Reinforcers.
Contributions of learning theories 1. Recognition
1. Learning theories have helped us understand the process of teaching a. Praise certification of accomplishment
and knowing or how individual acquire knowledge and change the way b. Formal acknowledgement awards testimonials, letters of
they think feel and behave. recommendation.
2. In the practice of health care these theories have helped the health c. Informal acknowledgements- private conversations, pat on the back
professionals to employ sound methods and rationales in their health
education efforts involving patients/ clients, staff training and education 2. Tangible rewards
and in carrying out continuing health education and promotion programs. grades, food (free lunch), prizes

1) Behaviorist learning Theory 3. Learning activities.

-All behavior is learned. Learning is most influenced through -opportunity to desirable enrichment assignment (membership in
manipulation of the environment in which it occurs and the rewards "honors" class; more difficult clinical assignment.
provides to encourage it. - Continuation of Cognitive learning Theory
1. John B. Watson – pioneered the Behaviorism Theory -it involves preserving the information, interpreting it based on what is
emphasized the importance of observable behavior in the study of already known, and then reorganizing the Information into new insights
human beings. defined behavior as muscle movement; associated with or understanding
stimulus response (psychology) -It involves intelligence which is the ability to solve problems.
View learning as the result of stimulus conditions (5) in the environment -Focus on the internal learner environment (what goes Inside the
and the learner's responses (R) that follow. learner) and the mental structures of thinking.
Behaviorists: closely observe Reponses to a situation and then -The process of learning is affected by the learners.
manipulate the environment in a way to bring about the intended change.
METACOGNITION
2) Cognitive Learning theory -The learner understanding of her way to learning.
The learner's ability to solve problems rather than simply responding to Main Premise of Cognitive Learning Theories
stimuli. The key to learning and changing is the individual's cognition. -Cognitive theories define learning as an active, emulative, constructive
(perception, thinking, memory and ways of processing and structuring process that is goal oriented and dependent on the learner's mental
information) activities
-Learning is processing information, it is experiential and formed by a
3) B.F. Skinner Theory of Operant Conditioning person's experience of the consequence
Focuses on the behavior of the organism and the reinforcement (positive Social constructivism
and negative reinforcement) that occurs. We learn but when our actions -Learning and human development are richly colored by the social and
are reinforced cultural context; social factors.
Reinforcer - A stimulus or event applied after a response
TENETS -Influences, social interaction.
TYPES OF OPERANT CONDITIONING Effective learning occurs through social interaction collaboration and
A behavior is strengthened or weakened in response to positive or recognition.
negative consequent. Benefits of cognitive theory to healthcare
A. Positive reinforcement a. individuality
-application of a pleasant stimulus, they strengthen or increase the b. diversity.
frequency of behavior
ex. reward, recognition, praises Main Premise
B. Negative reinforcement People create their own meaning through experience.
-removal of an aversive or unpleasant stimulus; weakened the behavior Implication to Nursing Education.
by not reinforcing it. a. A learner constructs new knowledge by building on an internal
representation of existing knowledge through a personal interpretation
C. Punishment of experience, faculty coach and facilitate.
weakens a particular behavior through the consequence of experiencing b. Learner’s form elaborates, and test their mental structures until they
a negative condition. get one that is satisfactory.

D. Extinction
-weakens a particular behavior through the Consequence of not
experiencing either positive or negative Condition.
Developmental Stages of the Learner Late adolescence – 16 to 19 y/o

Growth is the increase in physical size or structure that is measurable. 5. Adulthood – 20 to 60 y/o
Young Adult - 20 to 40 y/o
Development is an increase in skill and capacity to function occurring Middle Adult – 41 to 64 y/o
in orderly fashion. Old adult – 64 years old and older

Maturation is increase in competence or ability to function at a higher DEVELOPMENTAL STAGES

level 1. Erik Erikson’s Psychosocial Stage
2. Piaget’s Cognitive Theory of Development
Fundamentals Domains of Development: 3. Sigmund Freud’s Psychosexual Theory of Development
1. Physical 4. Lawrence Kohlberg’s Moral Development Theory
2. Cognitive
3. Psychological [Link] Erikson’s Psychosocial Stages of Human Development
Chronological age is not the only predictor of learning ability - characterizes development from cradle to grave.
- believes that the psychological development of individuals depends
Developmental Stage on the social relations established at various points in life.
Human growth and development are sequential but not always
specifically age-related. Stages of psychological development:
1. infant: trust vs mistrust
When is the best time to teach the learner? 2. toddler: autonomy vs shame & doubt
Teach when the learner is ready 3. preschooler: initiative vs guilt
4. grade schooler: industry vs inferiority
Teachable moment 5. teenager: identity vs role confusion
The point in time when the learner is most receptive to a teaching 6. young adult: intimacy vs isolation
situation. 7. middle age: generatively vs stagnation
8. older adult: integrity vs despair
Assess readiness to learn:
1. establish interpersonal relationship [Link] Piaget Cognitive Developmental Stage
2. master prerequisite knowledge and skills Children think due to coordination of sensory input and motor
3. exhibits motivation responses. Intelligence is non-verbal or non-symbolic, and has not
4. plan for teaching matches the learner’s development level. developed language yet.

Developmental Characteristics Cognitive development

Three phases of learning (maturity continuum) 1. sensorimotor (birth to 2 years)
1. dependence – infant and young adult 2. pre-operational (2 to 7 years)
2. independence – children 3. concrete operational (7 to 11 years)
3. interdependence – adults 4. formal operational (12 years and up)

Pedagogy – art and science of helping children to learn Cognitive development

Andragogy – adults - The manner in which people learn to think, reason, and use
Geragogy – elderly language
- And orderly, sequential process.
Stages of growth and development
1. Prenatal Period – Conception to birth Sensorimotor Stage (birth – 2 years)
Germinal – conception to 10 days gestation - is determined basically on actual perception of the senses and
Life span of egg –7 days; sperm – 48-72 hrs. the external or physical factors.
Embryonic – 10 days – 8 weeks gestation. - Children think due to coordination of sensory input and motor
responses.
Organ systems of the body develop during this period - Intelligence is non-verbal or non-symbolic
Fetal Period – 2 months gestation – birth (after 40 weeks/280 days after - has not developed language yet.
conception) - “object permanence” – what & where it is seen for the first time
will still exist even though it disappears.
“NEO” means new; “NATAL” means birth. The newborn child is called
NEONATE. Intuitive or Preoperational Stage (2 – 7 years)
- Cognitive process during this stage increases the ability to
2. Infancy Period – birth to one year store words and language structures.
Newborn/neonatal period – birth to 1 month/first 28 days/ 4 weeks - There is the capacity to understand and make use of the
Infancy – 1 month to 12 months words.
- Abstract thinking – represents reality using symbols that can
3. Childhood Period – one -12 years old be manipulated mentally
Toddler - 1- 2 y/o - This is the age adults communicate with the children.
Early childhood/preschool – 3 to 5 y/o - It is significant in language development when adults talk,
Middle childhood/ school age – 6 to 11 y/o teach, read, and even sing to the
children.
4. Adolescence - 12 -19 y/o - Children imitate, and try various sounds and words.
Early adolescence - 12 to 16 y/o
 - They are able to fantasize, dream, imagine, and free - Id seeks pleasure, the ego tests reality, and the superego
association with others. - Concerned with themselves, they strives for perfection.
talk to toys, tell wild stories, and have imaginary friends. - Superego develops in response to parental rewards and
punishments. It incorporates all the actions for which the child
Concrete Operational Stage (7 – 11 years) is punished or reprimanded as well as all the actions for which
- Concrete operations develop logical thinking (more the child is rewarded.
systematic; uses scientific method) in relation to function.
- Children begin to wonder what is happening around them. Fixation is immobilization or the inability of the personality to proceed to
- Their minds are full of questions wanting to be answered. the next stage because of anxiety
- They are puzzled between what is taught to them and what
they experience. Erotic zones that can be the focus of both sexual pleasure and
frustration depending on the child’s experience.
Formal Operational Stage (11 and above)
(assimilation and accommodation) Psychosexual stages (pregenital stage)
- this stage is characterized by hypothesis testing. a. oral – the mouth: sucking, swallowing, etcc
- Before making conclusions, things must be tested with logical b. anal – the anus: withholding or expelling feces
pieces of evidence. c. phallic latent genital – penis or clitoris: masturbation
- There is awareness on different views rather than on one little or no sexual motivation present
single thought. It understands and recognizes individuals
having their own and different interests, knowledge and ways 1. Oral Stage (0-1 ½ y/o)
of thinking. during this period, infants derive pleasure from nursing and sucking;
- “Experience is the best teacher” indeed, they will put their thumbs or anything else they can reach into
their mouth.
[Link] Freud’s Psychosexual Theory of Development
Psychoanalytic theories explore the private personality 2. Anal Stage (1 ½ - 3)
Personality – the unconscious motives that direct behavior. children have their first experience with imposed control in the form of
Unconscious mind – the mental life of a person which is unaware toilet training. Gratification is presumably derived from withholding or
- Defense mechanism expelling feces.

Freud compared the human mind to an ICEBERG 3. Phallic Stage (4-7)

children begin to derive pleasure from fondling their genitals. They
Conscious – above the surface of the water observe the differences between male and females and may direct their
Unconscious – below the water level (storehouse of impulses, awakening sexual impulses toward the parent of the opposite sex.
passions, and inaccessible memories that affect our thoughts and
behavior). 4. Latency Stage (7-puberty)
follow the end of the phallic stage, during which children become less
Personality Structure concerned with their bodies and turn their attention to the skills needed
1. The ID for coping with the environment.
- unconscious, the most primitive part of the personality,
present in the newborn infant, from which the ego and the 5. Genital Stage (puberty)
superego later develop. occurs during adolescence. Youngsters begin to turn their sexual
- consists of the basic biological impulses (or drives): the need interests toward others and to love in a more mature way.
to eat, drink, eliminate wastes, avoid pain, and gain sexual
pleasure. Kohlberg’s Theory of moral development
- A young child, operates on the pleasure principle: it endeavors - Focuses on the reasons on individuals makes a decision
to avoid pain and obtain pleasure regardless of the external
circumstances. Level one: pre conventional level (younger than 6 years)
Step 1: punishment and obedience orientation. Individuals obey rules to
2. The EGO avoid punishment.
- impulses cannot always be immediately gratified (like hunger, Step 2: naïve hedonism individually confirms to get rewards and to have
satisfaction of relieving bladder/bowel pleasure favors returned
- Certain impulses – hitting someone or playing with the
genitals may be punished. Level two: conventional level (7 to 11 years)
- A new part of the personality, the ego, develops as the young Step 3: good boy/girl morality individuals confirm to avoid disapproval or
child learns to consider the demands of reality. dislike by others
- The ego obeys the reality principle: the gratification of Step 4: confirms to avoid censure by authorities’ individuals confirm to
impulses must be delayed until the appropriate environmental avoid criticism from those in authority
conditions are found.
- The ego mediates among the demands of the id, the realities Level three: postconventional level (11 years)
of the world, and the demands of the superego Step 5: confirms to maintain communities’ emphasis on individual rights.
Individuals confirm to maintain social order and respect individual rights.
3. The SUPEREGO Step 6: individual principles of conscience, individuals are guided by
- is the internalized representation of the values and morals of their own ethical principles and conscience.
society as taught to the child by the parents and others.
- the individual’s conscious.
- judges whether an action is right or wrong.
DEVELOPING A HEALTH EDUCATION PLAN 3 behavioral styles
BEHAVIORAL OUTCOMES - Auditory
- Visual
TAXONOMY DOMAINS - cognitive, affective, psychomotor. - Kinesthetic

TEACHING PLAN --a blueprint to achieve the goal and the objectives Cone of learning
that have been developed. - Edgar scale

should indicate the purpose, content, methods, tools, timing, and BEHAVIORAL OUTCOMES - statements that communicate who will do
evaluation of instruction. what under which conditions and how well, how much, or when.

TAXONOMY - the ordering of the behaviors based on their type and Elements
complexity. A - audience (who)
B-behavior (what)
pertains to the level of knowledge to be learned, the kind of behaviors C-condition (under which circumstance
most relevant and attainable for the learner. D-degree (how well, to what extent, within what time frame)

BLOOM'S TAXONOMY In writing Behavioral Objectives

- use precise actions and verbs

- it clearly states what a learner must demonstrate for mastery
in KSA

Performance - may be visible or audible (to list) or invisible (to identify,

solve)

Not recommended (too abstract, not measured) - to know, understand,

appreciate, enjoy, feel, think, learn

Do's in writing objective

1. Describe what the learner is expected to do, than the teacher

2. Use one verb only per statement.
3. Include all the four components.
4. Use a specific performance verb.
5. Write SMART.
TAXONOMY OF OBJECTIVE ACCORDING TO LEARNING 6. Relate the objective to the goal.
DOMAINS. 7. Be specific on the expected behavior to be achieved.
- organized into categories or levels; arranged into hierarchical order
from simplest to complex behaviors. Determinants of learning
- outcomes should be stated as concrete and active verbs. 1. the needs of the learner –what the learner needs and wants to learn
2. state of readiness to learn - when the learner is receptive to learning
1. COGNITIVE (Knowledge) 3. preferred learning styles for processing information- how the learner
2. AFFECTIVE (attitude) best learns or prefers to learn
3. PSYCHOMOTOR (skills)
The Educator’s Role in Learning
GOAL-the final outcome to be achieved at the end of teaching and -The role of educating others is one of the most essential interventions
learning process, global, broad, long-term. that a nurse performs
-To do it well, the nurse must both identify the information learners need
At the end of the semester.... and consider their readiness to learn and their styles of learning.
OBJECTIVE- Objective-statement of specific, single, concrete, one- -The learner—not the teacher—is the single most important person in
dimensional behavior; short-term. the education process
-Educators can greatly enhance learning when they serve as facilitators
SMART by:
[Link] the learner become aware of what needs to be known
[Link] knowing is valuable
[Link] how to be actively involved in acquiring information

The educator plays a crucial role in the learning process by doing

the following:
1. Assessing the learner’s problems, supports, deficits, and abilities
2. Providing important best evidence information and presenting it in
unique and appropriate ways
3. Identifying progress being made
4. Giving feedback and follow-up
5. Reinforcing learning in the acquisition of new knowledge, skills, and
attitudes
6. Determining the effectiveness of education provided
A. Assessment of the Learner Formal and Informal Requests
Often staff are informally asked for ideas for educational programs, and
Learning needs – gaps in knowledge that exist between a desired level responses to these requests reflect what they perceive as needs.
of performance. When conducting a formal educational program, the educator must
verify that the input received is congruent with the needs of other staff
- Nurses are taught that any nursing intervention should be preceded by members.
an assessment
Quality Assurance Reports
Steps in the assessment of the learning needs Trends found in incident reports indicating safety violations or errors in
1. Identify the learner. procedures are a source of information in establishing learning needs of
2. Choose the right setting. staff that in service continuing education can address.
3. Collect the data about the learner.
4. Collect data from the learner. Chart Audits
5. Involve members of the healthcare team. Educators can identify trends in practice through chart auditing. Does
6. Prioritize needs. the staff have a learning need in terms of the actual charting? Is a new
7. Determine availability of educational resources. intervention being implemented? Does the record indicate some
inconsistency with implementation of an intervention?
Methods to Assess Learning Needs
Rules and Regulations
Informal Conversations A thorough knowledge of hospital, professional, and healthcare
Often learning needs are discovered during impromptu conversations requirements helps to identify possible learning needs of staff and
that take place with other healthcare team members involved in the care students.
of the client and between the nurse and the patient or their family or
significant other. Self-Assessment
Self-assessment is a technique that can be used by staff nurses to
Structured Interviews identify their learning needs so the data yielded can assist educators in
Most commonly used to solicit the learner’s point of view. The nurse planning for continuing education and professional development
educator asks the learner direct and often predetermined questions to programs.
gather information about learning needs. Self-assessment by nursing students is an important method to
consider because it stimulates reflection on practice and critical thinking
Focus Groups as a means to identify their learning needs
Focus groups involve getting together a small number (4 to 12) of
potential learners, including the facilitator, to determine areas of Gap Analysis
educational need by using group discussion to identify points of view or Gap analysis is an organized method of collecting data to identify
knowledge about a certain topic. differences between desired and actual knowledge

Questionnaires B. Readiness to Learn

Nurse educators can obtain learners’ written responses to questions -the time when the learner demonstrates an
about learning needs by using questionnaires. Checklists are one of the interest in learning
most common forms of questionnaires.
4 Types of Readiness to Learn (PEEK)
Tests
Giving written pretests prior to instruction can help identify the P Physical readiness
knowledge levels of learners about certain subjects to ascertain their a. Measures of ability
specific learning needs. b. Complexity of task
This approach prevents the educator from repeating already known c. Environmental effects
material in the teaching plan. d. Health status
e. Gender
Observations E Emotional readiness
Observing health behaviors in several different time periods can help a. Anxiety level
the educator draw conclusions about established patterns of behavior b. Support system
that cannot and should not be drawn from a single observation. c. Motivation
d. Risk-taking behavior
Documentation e. Frame of mind
Nurse educators need to follow a consistent format for reviewing medical f. Developmental stage
records by looking at initial assessments, progress notes, nursing care E Experiential readiness
plans, staff notes, and discharge planning forms that can provide a. Level of aspiration
valuable information about the learning needs of patients. b. Past coping mechanisms
c. Cultural background
Assessing the Learning Needs of Nursing Staff d. Locus of control
Written Job Descriptions K Knowledge readiness
A written description of what is required to effectively carry out job a. Present knowledge base
responsibilities can reflect the potential learning needs of staff. b. Cognitive ability
Such information forms the basis for establishing content in an c. Learning disabilities
orientation program for new staff, for example, or for designing d. Learning styles
continuing education opportunities for experienced staff members.
C. Learning Styles -They like writing, telling stories, spelling words, and reading, and they
-the ways in which and conditions under which learners most efficiently can recall names, places, and dates
and most effectively perceive, process, store and recall what they are -These children learn best by verbalizing, hearing, or seeing words
attempting to learn;
- preferred approaches to different learning tasks. 2. logical-mathematical - intelligence involves both sides of the brain.
The right side of the brain deals with concepts, and the left side
Determining Learning Styles remembers symbols.
1. Observation - The children who are strong in this intelligence explore patterns,
2. Interviews categories, and relationships.
3. Administration of learning style instruments - They enjoy strategy board games such as chess and checkers.
1. Observation - observing the learner in action, the educator can
ascertain how the learner grasps information and solves problems 3. Spatial
2. Interviews – the educator can ask the learner about preferred ways of
learning as well as the environment most comfortable for learning 4. musical - related to the right side of the brain
- Musically intelligent children can be found singing a tune, indicating
Learning Style Models and Instruments when a note is off key,
[Link]-Brain/Left-Brain- Brain Preference Indicator (BPI) playing musical instruments with ease, dancing to music, and keeping
-Roger Sperry and his research team established that, in many ways, time rhythmically.
the brain operates as two brains: - musically intelligent children learn best with music playing in the
Left hemisphere of the brain was found to be the vocal and analytical background
side, which is used for verbalization and for reality-based and logical
thinking. 5. Bodily-kinesthetic - involves the basal ganglia and cerebellum of the
Right hemisphere was found to be the emotional, visual, spatial, and brain in addition to other brain structures
nonverbal side, with thinking processes that are intuitive, subjective, - Children with this type of intelligence
relational, holistic, and time free. learn by processing knowledge through bodily sensations, such as
moving around or acting things out.
Two instruments are used to measure right- and left-brain - They are good at sports and have highly developed fine-motor
dominance coordination.
1. Brain preference indicator (BPI), consists of a set of questions used
to determine hemispheric functioning 6. Interpersonal intelligence - involves the prefrontal lobes of the
2. Herrmann Brain Dominance Instrument (HBDI) model brain.
incorporates theories on growth and development and considers - Children with high interpersonal intelligence understand people,
learning styles as learned patterns of behavior notice others’ feelings, tend to have many friends, and are gifted in social
skills.
-Rita Dunn and Kenneth Dunn set out to develop a user friendly model - They learn best in groups and gravitate toward activities that involve
that would assist educators in identifying characteristics that allow others in problem solving.
individuals to learn in different ways
7. Intrapersonal intelligence - involves the prefrontal lobes of the
-Model includes motivational factors, social interaction patterns, and brain.
physiological and environmental elements. - Children with this type of intelligence have strong personalities, prefer
the inner world of
3. Kolb’s Experiential Learning feelings and ideas, and like being alone.
- it is a cumulative result of past experiences, heredity, and the demands - They tend to be self- directed and self-confident. They learn well with
of the present environment. independent, self-paced instruction.
-these factors combine to produce different individual orientations to
learning 8. Naturalistic intelligence- refers to sensing abilities in making
- Kolb’s model, known as the cycle of learning, includes four modes of patterns and connections to elements in nature.
learning that reflect two major dimensions: perception and processing. - Children with high naturalistic intelligence can distinguish and
categorize objects or phenomena in nature
Howard Gardner's theory of multiple intelligence - They enjoy subjects, shows, and stories that deal with animals or
-He identified eight kinds of intelligence located in different parts of naturally occurring phenomena and are keenly aware of their
the brain: surroundings and subtle changes in their environment.
1. linguistic
2. logical-mathematical
3. spatial
4. musical
5. bodily-kinesthetic
6. interpersonal
7. intrapersonal
8. naturalistic.
-Each learner possesses all eight kinds of intelligence, albeit in different
proportions.

1. linguistic - reside in Broca’s area of the left side of the brain. Children
with a tendency to display this type of intelligence have highly developed
auditory skills and think in words