Learning Theories in Healthcare

• Learning is defined as a relatively permanent change in thinking, emotional functioning, skill and/or behavior that results from experience.
• It helps individuals gain new knowledge or skills and change their thoughts, feelings, attitudes and actions.
• Learning theory is a logical framework describing, explaining, or predicting how people learn.
• It helps the practice of healthcare.

Behaviorist Learning Theory

• Focuses on connections between environmental stimuli (S) and individual responses (R), known as the S-R model.
• Behaviorists suggest altering environmental conditions and reinforcing positive behavior to encourage learning or change attitudes.
• Respondent conditioning (Ivan Pavlov) emphasizes the importance of environmental stimuli and associations in learning.
• Operant conditioning (B.F. Skinner) focuses on the behavior of the organism and the reinforcement after the response.
• Modeling (Albert Bandura) involves learning by observing and imitating others.

Cognitive Learning Theory

• Focuses on internal mental processes.
• Individuals must change their perceptions and thoughts to form new understandings and insights to learn .
• Cognitive psychologists emphasize learner's goals and expectations creating motivations for learners.
• Gestalt Perspective emphasizes the importance of perception in learning ("the whole is greater than the sum of its parts").
• Information Processing emphasizes thinking, reasoning, memory, and how information is encountered and stored.
• The stages of Information Processing includes:
  • Attention: Focusing on specific information while ignoring other information.
  • Processing: Using one or more senses to process information, considering the client's preferred sensory mode (visual, hearing, touch, or motor skills).
  • Memory Storage: Transforming information into short-term memory, then either disregarding it or storing it in long-term memory. -Action: Responding based on how the information was processed and stored.
• Cognitive Development is influenced by gestalt psychology, focuses on changes in perceiving, thinking, and reasoning as individuals mature.
• Social Cognition emphasizes the effects of social factors on perception, thought, and motivation.
• Social and cultural experiences causes differing perceptions, interpretations, and responses in healthcare settings.

Social Learning Theory

• Much of learning occurs by observing others (Albert Bandura).
• Learning includes consideration of personal characteristics, behavior patterns, and the environment.

Development Stages of the Learners Across Lifespan

• Infancy (First 12 months of Life)
  • Cognitive Stage: Sensorimotor
  • General Characteristics: Dependent on environment, needs security, explores self and environment, and natural curiosity.
  • Teaching Strategies: Orient teaching to caregiver, use repetition and imitation of information, stimulate all senses, provide physical safety and emotional security, allow play, and manipulation of objects.
• Toddlerhood (1-2 years of age)
  • Cognitive Stage: Sensorimotor
  • General Characteristics: Dependent on environment, needs security, explores self and environment, and natural curiosity.
  • Teaching Strategies: Orient teaching to caregiver, use repetition and imitation of information, stimulate all senses, provide physical safety and emotional security, allow play, and manipulation of objects.
• Early childhood (3-5 years old)
  • Cognitive Stage: Preoperational
  • General Characteristics: Egocentric, thinking precausal, concrete, literal, believes illness self-caused and punitive, limited sense of time, fears bodily injury, cannot generalize, animistic thinking, separation anxiety, motivated by curiosity, active imagination, and prone to fears.
  • Teaching Strategies: Use warm, calm approach, build trust, use repetition of information, allow manipulation of objects and equipment, give care with explanation, reassure not to blame self, explain procedures simply and briefly, provide safe, secure environment, use positive reinforcement, encourage questions to reveal perceptions/feelings, use simple drawings and stories, use play therapy, with dolls and puppets.
• Middle and Late Childhood (6-11 years old)
  • Cognitive Stage: Concrete Operations
  • General Characteristics: More realistic and objective, understands cause and effect, deductive/inductive reasoning, wants concrete information, able to compare objects and events, variable rates of physical growth, reasons syllogistically, understands seriousness and consequences of actions.
  • Teaching Strategies: Encourage independence and active participation, be honest, allay fears, use logical explanation, allow time to ask questions, use analogies to make invisible processes real, establish role models, use subject-centered focus, use play therapy, provide group activities, use drawings, models, dolls, painting, audio and videotapes.
• Adolescence (12-19 years old)
  • Cognitive Stage: Formal Operations
  • General Characteristics: Abstract, hypothetical thinking, can build on past learning, reasons by logic and understand scientific principles, future orientation, motivated by desire for social acceptance, peer group important, intense personal preoccupation, appearance extremely important (imaginary audience), feels invulnerable, invincible/immune to natural laws.
  • Teaching Strategies: Establish trust, authenticity, know their agenda, address fears/concerns about outcomes of illness, identify control focus, include in plan of care, use peers for support and influence, negotiate changes, focus on details, make information meaningful to life, ensure confidentiality and privacy, arrange group sessions, use audiovisuals, contracts, reading materials, provide for experimentation and flexibility.
• Young Adulthood (20-40 years old)
  • Cognitive Stage: Formal Operations
  • General Characteristics: Autonomous, self-directed, uses personal experiences to enhance or 6 pages interfere with learning, intrinsic motivation, able to analyze critically, makes decisions about personal, occupational, and social roles, competency-based learner.
  • Teaching Strategies: Use problem-centered focus, draw on meaningful experiences, focus on immediacy of application, encourage active participation, allow to set own pace, be self-directed, organize material, recognize social role, apply new knowledge through role playing and hands-on practice.
• Middle-aged Adulthood (41-64 years old)
  • Cognitive Stage: Formal Operations
  • General Characteristics: Sense of self-developed, concerned with physical changes, at peak in career, explores alternative lifestyles, reflects on contributions to family and society, reexamines goals and values, questions achievements and successes, has confidence in abilities, desires to modify unsatisfactory aspects of life
  • Teaching Strategies: Focus on maintaining independence and reestablishing normal life patterns, assess positive and negative past experiences with learning, assess potential sources of stress caused by midlife crisis issues, provide information to coincide with life concerns and problems.
• Older adulthood (65 years and over)
  • Cognitive Stage: Formal operations
  • General Characteristics: Decreased ability to think abstractly, process information, decreased short-term memory, increased reaction time, increased test anxiety, stimulus persistence (afterimage), focuses on past life experiences
  • Teaching Strategies: Focus on maintaining independence and reestablishing normal life patterns, assess positive and negative past experiences with learning, assess potential sources of stress caused by midlife crisis issues, provide information to coincide with life concerns and problems.

Principles of Teaching

• Credibility: Communicated messages must be perceived as trustworthy, consistent with scientific knowledge, local culture, educational system and social goals.
• Interest: Health teaching should address the people's interests and real health needs so the education becomes “people's program".
• Participation: A lot of participation creates involvement, personal acceptance and decision -making, giving feedback.
• Motivation: Awakening the fundamental desire to learn.
  • Primary motives are forces initiating action.
  • Secondary motives arise from outside forces. -Motivation is contagious and incentives are the first step to change
• Comprehension: Effective health education requires understanding the audience's level of understanding, education, and literacy, and communicating in a language they understand.
• Reinforcement requires repetition of messages at intervals.
• Learning by Doing is the best way of learning(Chinese proverb: "I hear, I forget; if I see, I remember; if I do, I know")
• Known to Unknown involves building from concrete examples to abstract concepts, from simple to complex, and using existing knowledge as a foundation for new learning.
• Setting an Example involves health educators setting a good example.
• Good Human Relations requires sharing information, ideas, and feelings between people who have a good relationship.
• Feedback involves health educators modifying their approach based on audience feedback for effective communication.
• Leaders act as agents of change and can be utilized in health education.
  • Attributes of a leader includes understanding community needs, providing guidance, being receptive, identifying with the community, being selfless, honest, accessible, able to control and compromise, and possessing skills for cooperation and coordination.

Principles of Learning

• Readiness: Individuals learn best when physically, mentally, and emotionally ready.
• Exercise: Repetition and meaningful practice are key to remembering information.
• Effect: Learning is strengthened by pleasant feelings and weakened by unpleasant feelings.
• Primacy: First impressions are important, so the initial learning experience should be positive and functional.
• Recency: Information learned most recently is best remembered.
• Intensity: Intense, clear, dramatic experiences lead to better retention.
• Freedom: Freely learned information is better retained compared to when someone if forced to learn.