Chapter 3 Applying Learning Theories To Margaret M .
46436 CH03 051 090.qxd11/19/079:37 AMPage 51Chapter 3Applying LearningTheories toHealthcarePracticeMargaret M.BraungartRichard G.BraungartCHAPTER HIGHLIGHTSApplying Learning TheoriesBehaviorist Learning TheoryCognitive Learning TheorySocial Learning TheoryPsychodynamic Learning TheoryHumanistic Learning TheoryNeuropsychology and LearningComparison of Learning TheoriesCommon Principles of LearningHow Does Learning Occur?What Kinds of Experiences Facilitate orHinder the Learning Process?What Helps Ensure That Learning BecomesRelatively Permanent?State of the EvidenceKEY TERMS learninglearning theoryrespondent conditioningsystematic desensitizationstimulus generalizationdiscrimination learningspontaneous recoveryoperant conditioningescape conditioningavoidance conditioningmetacognitiongestalt perspective51information processingcognitive developmentsocial constructivismsocial cognitioncognitive-emotional perspectiverole modelingvicarious reinforcementdefense mechanismsresistancetransferencehierarchy of needstherapeutic relationship
46436 CH03 051 090.qxd5211/19/079:37 AMPage 52Chapter 3: Applying Learning Theories to Healthcare PracticeOBJECTIVESAfter completing this chapter, the reader will be able to1. Differentiate among the basic approaches to learning for each of the five learning theories.2. Define the principal constructs of each learning theory.3. Give an example applying each theory to changing the attitudes and behaviors of learners ina specific situation.4. Discuss how neuroscience research has contributed to a better understanding of learning andlearning theories.5. Outline alternative strategies for learning in a given situation using at least two differentlearning theories.6. Identify the differences and similarities in the learning theories specific to (a) the basic procedures of learning, (b) the assumptions made about the learning, (c) the task of the educator, (d) the sources of motivation, and (e) the way in which the transfer of learning isfacilitated.Learning is defined in this chapter as a relativelypermanent change in mental processing, emotional functioning, and/or behavior as a result ofexperience. It is the lifelong, dynamic process bywhich individuals acquire new knowledge orskills and alter their thoughts, feelings, attitudes, and actions.Learning enables individuals to adapt todemands and changing circumstances and iscrucial in health care—whether for patients andfamilies grappling with ways to improve theirhealth and adjust to their medical conditions,for students acquiring the information and skillsnecessary to become a nurse, or for nurses andother healthcare staff devising and learningmore effective approaches to educating andtreating patients and each other in partnership.Despite the significance of learning to each individual’s development, functioning, health andwell-being, debate continues about how learn-ing occurs, what kinds of experiences facilitateor hinder the learning process, and what ensuresthat learning becomes relatively permanent.Until the late 19th century, most of the discussions and debates about learning weregrounded in philosophy, school administration,and conventional wisdom (Hilgard, 1996).Around the dawn of the 20th century, the newfield of educational psychology emerged andbecame a defining force for the scientific studyof learning, teaching, and assessment (Woolfolk,2001). As a science, educational psychology restson the systematic gathering of evidence or datato test theories and hypotheses about learning.A learning theory is a coherent framework ofintegrated constructs and principles thatdescribe, explain, or predict how people learn.Rather than offering a single theory of learning,educational psychology provides alternative theories and perspectives on how learning occurs
46436 CH03 051 090.qxd11/19/079:37 AMPage 53Applying Learning Theoriesand what motivates people to learn and change(Hilgard & Bower, 1966; Ormrod, 2004;Snowman & Biehler, 2006).The construction and testing of learning theories over the past century have contributedmuch to our understanding of how individualsacquire knowledge and change their ways ofthinking, feeling, and behaving. Reflecting anevidence-based approach to learning, the accumulated body of research information can be usedto guide the educational process and has challenged a number of popular notions and mythsabout learning (e.g., “Spare the rod and spoil thechild,” “Males are more intelligent than females,”“You can’t teach an old dog new tricks.”). In addition, the major learning theories have wide applicability and form the foundation of not only thefield of education but also psychological counseling, workplace organization and human resourcemanagement, and marketing and advertising.Whether used singly or in combination,learning theories have much to offer the practiceof health care. Increasingly, health professionals must demonstrate that they regularlyemploy sound methods and a clear rationale intheir education efforts, patient and client interactions, staff management and training, andcontinuing education and health promotionprograms (Ferguson & Day, 2005).Given the current structure of health care inthe United States, nurses, in particular, are oftenresponsible for designing and implementingplans and procedures for improving health education and encouraging wellness. Beyond one’sprofession, however, knowledge of the learningprocess relates to nearly every aspect of daily life.Learning theories can be applied at the individual, group, and community levels not only tocomprehend and teach new material, but also to53solve problems, change unhealthy habits, buildconstructive relationships, manage emotions,and develop effective behavior.This chapter reviews the principal psychological learning theories that are useful to healtheducation and clinical practice. Behaviorist, cognitive, and social learning theories are most oftenapplied to patient education as an aspect of professional nursing practice. It is argued in thischapter that emotions and feelings also needexplicit focus in relation to learning in general(Goleman, 1995) and to health care in particular(Halpern, 2001). Why? Emotional reactions areoften learned as a result of experience, they playa significant role in the learning process, andthey are a vital consideration when dealing withhealth, disease, prevention, wellness, medicaltreatment, recovery, healing, and relapse prevention. To address this concern, psychodynamicand humanistic perspectives are treated as learning theories in this review because they encourage a patient-centered approach to care and addmuch to our understanding of human motivation and emotions in the learning process.The chapter is organized as follows. First,the basic principles of learning advocated bybehaviorist, cognitive, social learning, psychodynamic, and humanistic theories are summarized and illustrated with examples frompsychology and nursing research. With thecurrent upsurge and interest in neuroscienceresearch, brief mention is made of the contributions of neuropsychology to understandingthe dynamics of learning and sorting out theclaims of learning theories. Next, the learningtheories are compared with regard to: Their fundamental procedures forchanging behavior
46436 CH03 051 090.qxd5411/19/079:37 AMPage 54Chapter 3: Applying Learning Theories to Healthcare Practice The assumptions made about the learner The role of the educator in encouraginglearning The sources of motivation for learning The ways in which learning is transferred to new situations and problemsFinally, the theories are compared and then synthesized by identifying their common features andaddressing three questions: (1) How does learningoccur? (2) What kinds of experiences facilitate orhinder the learning process? (3) What helps ensurethat learning becomes relatively permanent?While surveying this chapter, readers are encouraged to think of ways to apply the learning theories to both their professional and personal lives.The goals of this chapter are to provide a conceptual framework for subsequent chapters inthis book and to offer a toolbox of approachesthat can be used to enhance learning and changein patients, students, staff, and oneself. Althoughthere is a trend toward integrating learning theories in education, it is argued that knowledge ofeach theory’s basic principles, advantages, andshortcomings allows nurses and other health professionals to select, combine, and apply the mostuseful components of learning theories to specificpatients and situations in health care. After completing the chapter, readers should be able toidentify the essential principles of learning,describe various ways in which the learningprocess can be approached, and develop alternative strategies to change attitudes and behaviorsin different settings.Learning TheoriesThis section summarizes the basic principlesand related concepts of the behaviorist, cognitive, social learning, psychodynamic, and humanistic learning theories. While reviewingeach theory, readers are asked to consider the following questions: How do the environment and the internal dynamics of the individual influencelearning? Is the learner viewed as relatively passive or more active? What is the educator’s task in the learning process? What motivates individuals to learn? What encourages the transfer of learning to new situations? What are the contributions and criticisms of each learning theory?Behaviorist Learning TheoryFocusing mainly on what is directly observable,behaviorists view learning as the product of thestimulus conditions (S) and the responses (R)that follow—sometimes termed the S-R modelof learning. Whether dealing with animals orpeople, the learning process is relatively simple.Generally ignoring what goes on inside theindividual—which, of course, is always difficultto ascertain—behaviorists closely observeresponses and then manipulate the environmentto bring about the intended change. Currentlyin education and clinical psychology, behaviorist theories are more likely to be used in combination with other learning theories, especiallycognitive theory (Bush, 2006; Dai & Sternberg,2004). Behaviorist theory continues to be considered useful in nursing and health care.To modify people’s attitudes and responses,behaviorists either alter the stimulus conditionsin the environment or change what happensafter a response occurs. Motivation is explainedas the desire to reduce some drive (drive reduction); hence, satisfied, complacent, or satiated
46436 CH03 051 090.qxd11/19/079:37 AMPage 55Learning Theoriesindividuals have little motivation to learn andchange. Getting behavior to transfer from theinitial learning situation to other settings islargely a matter of practice (strengtheninghabits). Transfer is aided by a similarity in thestimuli and responses in the learning situationrelative to future situations where the responseis to be performed. Much of behaviorist learning is based on respondent conditioning andoperant conditioning procedures.Respondent conditioning (also termed classical orPavlovian conditioning) emphasizes the importance of stimulus conditions and the associationsformed in the learning process (Ormrod, 2004).In this basic model of learning, a neutral stim-ulus (NS)—a stimulus that has no particularvalue or meaning to the learner—is paired witha naturally occurring unconditioned or unlearnedstimulus (UCS) and unconditioned response(UCR) (Figure 3–1). After a few such pairings,the neutral stimulus alone, without the unconditioned stimulus, elicits the same unconditionedresponse. Thus, learning takes place when thenewly conditioned stimulus (CS) becomes associated with the conditioned response (CR)—aprocess that may well occur without consciousthought or awareness.Consider an example from health care.Someone without much experience with hospitals (NS) may visit a sick relative. While in theFigure 3–1 Respondent conditioning model of learning.BASIC MODEL OF LEARNINGUCSUCRNS UCSUCR(Several pairings)UCRNSorCSwhere:CRNS Neutral stimulusUCS Unconditioned stimulusUCR Unconditioned responseCS Conditioned stimulusCR Conditioned responseEXAMPLEOffensive odors(UCS)Hospital Offensive odors(NS)(UCS)Queasy feeling(UCR)Queasy feeling(UCR)(Several pairings of Hospitals Offensive odorsHospital(CS)55Queasy feeling(CR)Queasy feeling)
46436 CH03 051 090.qxd5611/19/079:37 AMPage 56Chapter 3: Applying Learning Theories to Healthcare Practicerelative’s room, the visitor may smell offensiveodors (UCS) and feel queasy and light-headed(UCR). After this initial visit and later repeatedvisits, hospitals (now the CS) may become associated with feeling anxious and nauseated (CR),especially if the visitor smells odors similar tothose encountered during the first experience(see Figure 3–1). Respondent conditioning highlights the importance of the atmosphere and itseffects on staff morale in health care. Often without thinking or reflection, patients and visitorsformulate these associations as a result of theirhospital experiences, providing the basis forlong-lasting attitudes toward medicine, healthcare facilities, and health professionals.Besides influencing the acquisition of newresponses to environmental stimuli, principlesof respondent conditioning may be used toextinguish a previously learned response. Responses decrease if the presentation of the conditioned stimulus is not accompanied by theunconditioned stimulus over time. Thus, if thevisitor who became dizzy in one hospital subsequently goes to other hospitals to see relativesor friends without smelling offensive odors, thenher discomfort and anxiety about hospitals maylessen after several such experiences.Systematic desensitization is a technique basedon respondent conditioning that is used by psychologists to reduce fear and anxiety in theirclients (Wolpe, 1982). The assumption is thatfear of a particular stimulus or situation islearned, so it can, therefore, be unlearned orextinguished. Fearful individuals are first taughtrelaxation techniques. While they are in a stateof relaxation, the fear-producing stimulus isgradually introduced at a nonthreatening levelso that anxiety and emotions are not aroused.After repeated pairings of the stimulus underrelaxed, nonfrightening conditions, the indi-vidual learns that no harm will come to him orher from the once fear-inducing stimulus.Finally, the client is able to confront the stimulus without being anxious and afraid.As examples from healthcare research, respondent conditioning has been used to extinguish chemotherapy patients’ anticipatorynausea and vomiting (Stockhurst, Steingrueber,Enck, & Klosterhalfen, 2006), while systematicdesensitization has been used to treat drugaddiction (Piane, 2000), phobias (McCullough& Andrews, 2001), tension headaches (Deyl &Kaliappan, 1997), and to teach children withADHD or autism to swallow pills (Beck,Cataldo, Slifer, Pulbrook, & Guhman, 2005). Asanother illustration, prescription drug advertisers regularly employ conditioning principles toencourage consumers to associate a brand namemedication with happy and improved lifestyles;once conditioned, consumers will likely favorthe advertised drug over the competitors’ medications and the much less expensive genericform. As a third example, taking the time tohelp patients relax and reduce their stress whenapplying some medical intervention—even apainful procedure—lessens the likelihood thatpatients will build up negative and anxiousassociations about medicine and health care.Certain respondent conditioning concepts areespecially useful in the healthcare setting.Stimulus generalization is the tendency of initiallearning experiences to be easily applied to othersimilar stimuli. For example, when listening tofriends and relatives describe a hospital experience, it becomes apparent that a highly positiveor negative personal encounter may colorpatients’ evaluations of their hospital stays aswell as their subsequent feelings about havingto be hospitalized again. With more and variedexperiences, individuals learn to differentiate
46436 CH03 051 090.qxd11/19/079:37 AMPage 57Learning Theoriesamong similar stimuli, and we say that discrimination learning has occurred. As an illustration,patients who have been hospitalized a numberof times often have learned a lot about hospitalization. As a result of their experiences, theymake sophisticated distinctions and can discriminate among stimuli (e.g., what the variousnoises mean and what the various health professionals do) that novice patients cannot. Much ofprofessional education and clinical practiceinvolves moving from being able to make generalizations to discrimination learning.Spontaneous recovery is a useful respondent conditioning concept that needs to be given carefulconsideration in relapse prevention programs.The principle of the concept operates as follows:Although a response may appear to be extinguished, it may recover and reappear at any time(even years later), especially when stimulus conditions are similar to those in the initial learning experience. Spontaneous recovery helps usunderstand why it is so difficult to completelyeliminate unhealthy habits and addictive behaviors such as smoking, alcoholism, or drug abuse.Another widely recognized approach tolearning is operant conditioning, which was developed largely by B. F. Skinner (1974, 1989).Operant conditioning focuses on the behavior ofthe organism and the reinforcement that occursafter the response. A reinforcer is a stimulus orevent applied after a response that strengthensthe probability that the response will be performed again. When specific responses are reinforced on the proper schedule, behaviors can beeither increased or decreased.Table 3–1 summarizes the principal waysto increase and decrease responses by applyingthe contingencies of operant conditioning.Understanding the dynamics of learning presented in this table can prove useful in assessing57and identifying ways to change individuals’behaviors in the healthcare setting. The key is tocarefully observe individuals’ responses to specific stimuli and then decide the best reinforcement procedures to use to change a behavior.Two methods to increase the probability of aresponse are to apply positive or negative reinforcement after a response occurs. According toSkinner (1974), giving positive reinforcement(i.e., reward) greatly enhances the likelihoodthat a response will be repeated in similar circumstances. As an illustration, although apatient moans and groans as he attempts to getup and walk for the first time after an operation,praise and encouragement (reward) for hisefforts at walking (response) will improve thechances that he will continue struggling towardindependence.A second way to increase a behavior is byapplying negative reinforcement after a responseis made. This form of reinforcement involves theremoval of an unpleasant stimulus througheither escape conditioning or avoidance conditioning. The difference between the two typesof negative reinforcement relates to timing.In escape conditioning, as an unpleasant stimulusis being applied, the individual responds in someway that causes the uncomfortable stimulation tocease. Suppose, for example, that when a memberof the healthcare team is being chastised in frontof the group for being late and missing meetings,she says something humorous. The head of theteam stops criticizing her and laughs. Because theuse of humor has allowed the team member toescape an unpleasant situation, chances are thatshe will employ humor again to alleviate a stressful encounter and thereby deflect attention fromher problem behavior.In avoidance conditioning, the unpleasant stimulus is anticipated rather than being applied
46436 CH03 051 090.qxd5811/19/079:37 AMPage 58Chapter 3: Applying Learning Theories to Healthcare PracticeTable 3–1 Operant Conditioning Mod
Chapter 3 Applying Learning Theories to Healthcare Practice Margaret M. Braungart Richard G. Braungart KEY TERMS learning information processing learning theory cognitive development respondent conditioning social constructivism systematic desensitization social cognition stimulus generalization cognitive-emotional perspective discrimination learning role modeling
Part One: Heir of Ash Chapter 1 Chapter 2 Chapter 3 Chapter 4 Chapter 5 Chapter 6 Chapter 7 Chapter 8 Chapter 9 Chapter 10 Chapter 11 Chapter 12 Chapter 13 Chapter 14 Chapter 15 Chapter 16 Chapter 17 Chapter 18 Chapter 19 Chapter 20 Chapter 21 Chapter 22 Chapter 23 Chapter 24 Chapter 25 Chapter 26 Chapter 27 Chapter 28 Chapter 29 Chapter 30 .
TO KILL A MOCKINGBIRD. Contents Dedication Epigraph Part One Chapter 1 Chapter 2 Chapter 3 Chapter 4 Chapter 5 Chapter 6 Chapter 7 Chapter 8 Chapter 9 Chapter 10 Chapter 11 Part Two Chapter 12 Chapter 13 Chapter 14 Chapter 15 Chapter 16 Chapter 17 Chapter 18. Chapter 19 Chapter 20 Chapter 21 Chapter 22 Chapter 23 Chapter 24 Chapter 25 Chapter 26
SOCIAL PSYCHOLOGY 63-81 Learning Objectives 63 Key Terms 63 Role Theories 65 Motivational Theories 67 Learning Theories 69 Cognitive Theories 73 Symbolic Interaction Theories 75 Socio-Cultural Theories 77 Evolutionary Theories 78 Summary and review 80 review QueStionS 81 4. SELF AND IDENTITY 82-107
DEDICATION PART ONE Chapter 1 Chapter 2 Chapter 3 Chapter 4 Chapter 5 Chapter 6 Chapter 7 Chapter 8 Chapter 9 Chapter 10 Chapter 11 PART TWO Chapter 12 Chapter 13 Chapter 14 Chapter 15 Chapter 16 Chapter 17 Chapter 18 Chapter 19 Chapter 20 Chapter 21 Chapter 22 Chapter 23 .
18.4 35 18.5 35 I Solutions to Applying the Concepts Questions II Answers to End-of-chapter Conceptual Questions Chapter 1 37 Chapter 2 38 Chapter 3 39 Chapter 4 40 Chapter 5 43 Chapter 6 45 Chapter 7 46 Chapter 8 47 Chapter 9 50 Chapter 10 52 Chapter 11 55 Chapter 12 56 Chapter 13 57 Chapter 14 61 Chapter 15 62 Chapter 16 63 Chapter 17 65 .
2 S o c i a l T h e o r i e s Theories can be used to study society—millions of people in a state, country, or even at the world level. When theories are used at this level they are referred to as macro-level theories, theories which best fit the study of massive numbers of people (typically Conflict and Functional theories).
About the husband’s secret. Dedication Epigraph Pandora Monday Chapter One Chapter Two Chapter Three Chapter Four Chapter Five Tuesday Chapter Six Chapter Seven. Chapter Eight Chapter Nine Chapter Ten Chapter Eleven Chapter Twelve Chapter Thirteen Chapter Fourteen Chapter Fifteen Chapter Sixteen Chapter Seventeen Chapter Eighteen
This standard employs the principles of API 650; however, storage tank owner/operators, based on consideration of specific construction and operating details, may apply this standard to any steel tank constructed in accordance with a tank specification. This standard is intended for use by organizations that maintain or have access to engineering and inspection personnel technically trained .
