Applying Learning Theories to Healthcare Practice

Dr. Belal M. Hijji, RN. PhDFebruary 21, 2012

*By the end of this lecture, students will be able to:Recognise the various theories underpinning human learningDiscuss the key aspects of each theory

Learning Outcomes

*IntroductionThe learning theories are the behaviourist, cognitive, social learning, psychodynamic, and humanistic learning theories.Each is discussed next.

*Behaviorist Learning TheoryBehaviorists focus mainly on what is directly observed and measuredTo 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 individualLearning 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).

*Behaviorist Learning TheoryRespondent 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.

*Cognitive learning theoryThis theory stresses the importance of what goes on inside the learner.The key to learning and changing is the individuals cognition (perception, thought, memory, and ways of processing information).Cognitive theorists maintain that reward is not necessary for learning. Learners 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

*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.

*Assessing these internal and external factors has a direct effect on how a nurse approaches a learning situation with patient(s).

*Social learning theoryMost 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 learners characteristics are important determinants of attention.

*Social learning theoryThe 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.

*Humanistic learning theoryThis 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 individuals needs, subjective feelings about the self, and the desire to grow.

*The transfer of knowledge is facilitated by curiosity, a positive self-concept, and open situations where people respect individuality and promote freedom of choiceMaslow 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 Maslows hierarchy are physiological needs (food, warmth, sleep). At the top of the hierarchy are self-actualisation 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.

*However, research could not support Maslows hierarchy of needs with much consistency. For example, a persons 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 self-esteem 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.