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  3. 3. BEHAVIORIST THEORY John B. Watson is the proponent of behaviorist theory which emphasizes the importance of observable behavior in the study of human beings. He defined behavior as muscle movement and it came to be associated with the Stimulus-Response psychology. He postulated that behavior results from a series of conditioned reflexes and that all emotions and thoughts are a product of behavior learned through conditioning. (de Young, 2003).
  4. 4. BEHAVIORIST THEORY  Learning, then is a result of the conditions or stimuli (S) in the environment and the learner’s response (R) that follow. This is known as the S-R model of learning or the stimulus-response theory.  Behavioral scientists usually observe the responses and then manipulate the environment to bring about the desired change. (Hilgard and Bower, 1996; Bigge and Shermis, 1992; Hill 1990).  To bring about the intended change in the attitudes and responses of the subject, some stimuli in the environment are altered or the effects or consequences of a response is changed.
  5. 5. BEHAVIORIST THEORY  Motivation to change is brought about by the desire to reduce some drive or DRIVE- REDUCTION. Consequence: Satisfied, complacent or satiated individuals have little motivation to change and learn.  For this behavior to be applied or transferred from the initial learning situation to other settings or circumstances is possible through practice or formation of habits.
  6. 6. Behaviorism started as a reaction against introspective psychology in the 19th century, which relied heavily on first-person accounts. J.J. Watson and B.F. Skinner rejected introspective methods as being subjective and unquantifiable. These psychologists wanted to focus on observable, quantifiable events and behaviors. They said that science should take into account only observable indicators. They helped bring psychology into higher relevance by showing that it could be accurately measured and understood, and wasn’t just based off opinions. HISTORY
  7. 7. Watson and Skinner believed that if they were given a group of infants, the way they were raised and the environment they put them in would be the ultimate determining factor for how they acted, not their parents or their genetics. Behaviorism focuses on the idea that all behaviors are learned through interaction with the environment. This learning theory states that behaviors are learned from the environment, and says that innate or inherited factors have very little influence on behavior. HISTORY
  8. 8. The most famous example of classical conditioning was Ivan Pavlov’s experiment with dogs, who salivated in response to a bell tone. Pavlov showed that when a bell was sounded each time the dog was fed, the dog learned to associate the sound with the presentation of the food.
  9. 9. Pavlov’s Dogs Then, he presented them with food, they salivated. The food was an unconditioned stimulus and salivation was an unconditioned response (innate response) He first presented the dogs with the sound of a bell; they did not salivate so this was a neutral stimulus. He then repeatedly presented the dogs with the sound of the bell first and then the food (pairing). After a few repetitions, the dogs salivated when they heard the sound of the bell. The bell had become the conditioned stimulus and salivation had become the conditioned response. 1 2 3 4 5
  10. 10. This is exactly what behaviorism argues- that the things we experience and our environment are the drivers of how we act. The stimulus-response sequence is a key element of understanding behaviorism. A stimulus is given, for example a bell rings, and the response is what happens next, a dog salivates or a pellet of food is given. Behavioral learning theory argues that even complex actions can be broken down into the stimulus-response.
  11. 11. Behavioral learning is based on respondent conditioning and operant conditioning procedures.
  12. 12. 1. Classical or Pavlovian Conditioning: -a process which influences the acquisition of new responses to environmental stimuli. A.1 RESPONDENT CONDITIONING
  13. 13. -a neutral stimulus (NS) elicits an unconditional response (UCR) through repeated pairings with an unconditioned stimulus (UCS).Aneutral stimulus (NS) is a stimulus that has no particular value, significance or meaning to the learner. When the NS is repeatedly paired with the unconditioned stimulus (UCS), there comes a time when the NS , even without the UCS, elicits the same UCR. A.1 RESPONDENT CONDITIONING
  14. 14. Principles of Classical Conditioning Neutral Stimulus (NS) Is a stimulus that initially does not evoke a response until it is paired with the unconditioned stimulus. For example, in Pavlov’s experiment, the bell was the neutral stimulus, and only produced a response when it was paired with food. Unconditioned Stimulus Is a feature of the environment that causes a natural and automatic unconditioned response. In Pavlov’s study the unconditioned stimulus was food.
  15. 15. Principles of Classical Conditioning Unconditioned Response Is an unlearned response that occurs automatically when the unconditioned stimulus is presented. Pavlov showed the existence of the unconditioned response by presenting a dog with a bowl of food and measuring its salivary secretions. Conditioned Stimulus Is a substitute stimulus that triggers the same response in an organism as an unconditioned stimulus. Simply put, a conditioned stimulus makes an organism react to something because it is associated with something else. For example, Pavlov’s dogs learned to salivate at the sound of the bell.
  16. 16. Principles of Classical Conditioning Conditioned Response Is the learned response to the previously neutral stimulus. In Ivan Pavlov’s experiment in classical conditioning, the dog’s salivation was the conditioned response to the sound of a bell. Discrimination Is a process through which individuals learn to differentiate among similar stimuli and respond appropriately to each one. For example, eventually Pavlov’s dogs learn the difference between the sound of the two bells and no longer salivates at the sound of the non-food bell.
  17. 17. Cecilia Belle, a pretty and lively three year old, accidentally touched the flame (NS) of the candle. She felt intense pain (UCS) and quickly withdrew her hand (UCR). Two days later, the same experience happened and part of her finger was burned. Consequently, the flame of the candle (NS) came to be associated with the pain (UCS) that, even in its absence, just the sight of the flame makes her withdraw her hand. Hence, the neutral stimulus (NS), which is the flame, has now become the conditioned stimulus (CS) and the automatic withdrawal of her hand has become the learned response. SITUATIONAL ILLUSTRATION
  18. 18. Principles of respondent conditioning may also be used to extinguish a previously learned response: Learned responses may eventually be unlearned if the occurrence of a CS is not accompanied by the UCS for a long period of time or interval.
  19. 19. 2. Systematic desensitization: -is another technique based on respondent conditioning which is widely used in psychology and even in medicine to reduce fear and anxiety in the patient (Wolpe, 1982). A.1 RESPONDENT CONDITIONING
  20. 20. -this is based on the principle that repeated and gradual exposure to fear-inducing stimulus under relaxed and non-threatening circumstances will give the patient that sense of security that no harm will come so that he or she no longer fears the stimulus. A.1 RESPONDENT CONDITIONING
  21. 21. -this is also a stress-reducing strategy that is adapted to help pre-operative patients, rehabilitating drug addicts and tension headaches and phobias, among others (Bastable, 2003) A.1 RESPONDENT CONDITIONING
  22. 22. GOAL: -the goal of systematic desensitization is to become gradually desensitized to the triggers that are causing your distress. A.1 RESPONDENT CONDITIONING
  23. 23. -Systematic desensitization begins with imaginary exposure to feared situations. You can use your anxiety hierarchy to breakdown the feared situation into manageable components. A.1 RESPONDENT CONDITIONING
  24. 24. SITUATIONAL ILLUSTRATION For example: Let’s say you fear to go into large stores. You may have the least anxiety walking into the store and your anxiety likely intensifies as you get further from the exit doors. Standing in the checkout line represents your highest fear response. In this case, you would start the process by focusing on the action that causes the least amount of distress and then work your way up. The result is that you will gradually, or systematically, become desensitized to shopping in large stores.
  25. 25. 3. Stimulus Generalization -occurs when a previously unassociated or new stimulus that has similar characteristics to the previously associated stimulus elicits a response that is the same or similar to the previously associated response. In short, similar stimuli trigger similar responses when stimulus generalization is at work. A.1 RESPONDENT CONDITIONING
  26. 26. -Discrimination learning develops later when varied experiences eventually enable the individual to differentiate among similar stimuli. -Discrimination learning is often involved in professional education and clinical practice A.1 RESPONDENT CONDITIONING
  27. 27. SITUATIONAL ILLUSTRATION Fear is one of the most common classically conditioned responses experienced by humans. We will use the fear of snakes to illustrate how stimulus generalization works in classical conditioning. Imagine that a four-year-old child who is watching Nature show on TV sees a 20-feet long green tree python devour a cute little brown mouse. While this experience is perfectly natural in the jungles of South America, the child (who has a pet mouse) immediately imagines a snake coming into her bedroom and doing the same thing to her mouse! The thought of such a thing elicits a strong fear response, including increased heart rate, pupil dilation, and anxiety, which quickly becomes associated with the snake.
  28. 28. SITUATIONAL ILLUSTRATION So what happens when the child goes outside to play and sees a harmless 18-inch long brown snake in the backyard? The conditioned fear response kicks in, and even though it is not a 20-feet long green tree python, the reaction is quite similar. This is stimulus generalization. The person who is afraid of snakes did not have to experience a snake of every size, shape, and color in the world. Associating the key characteristics of the snake, like long and skinny, slithery, rapid tongue protrusions form the mouth, and two eyes on the sides of the head, with the fear response is enough to learn that anything that possesses those characteristics is likely a snake.
  29. 29. 4. Spontaneous Recovery -is usually applied in relapse prevention programs (rpp) and may explain why it is quite difficult to completely eliminate “unhealthy habits and addictive behaviors” (alcoholism, drug abuse, smoking) which one may claim having successfully “kicked the habit” or extinguished it only to find out that it may recover or reappear any time, even years later. Spontaneous recovery is the re-emergence of a response that had been previously conditioned. A.1 RESPONDENT CONDITIONING
  30. 30. SITUATIONAL ILLUSTRATION Every day a dog is fed, his food bowl bangs against the ground. The bang makes the dog excited about food. For several weeks, the food bowl is banged against the ground with no food. The dog stops getting excited to be fed. A few weeks later when a food bowl is banged on the ground, the dog gets excited again. When a child hears the music of the ice cream truck, they run to the door because their parent usually buys them ice cream. After a few weeks of not getting ice cream, the child stops running to the door. A month later, they hear the ice cream truck jingle and run to the door. A student immediately stops talking during instruction when his teacher purses her lips and shakes her head. However, the student changes this behavior by not responding to the teacher’s expression. Then, weeks later, he begins to respond once again.
  31. 31. Technology is an effective tool that can make education more meaningful and engaging for teachers and students alike.
  32. 32. “Operant Conditioning” By Burrhus Frederic Skinner B.F. Skinner was an American psychologist, behaviorist, author, inventor, and social philosopher. He was a professor of psychology at Harvard University from 1958 until his retirement in 1974. Skinner referred to his own philosophy as 'radical behaviorism' and suggested that the concept of free will was simply an illusion. All human action, he instead believed, was the direct result of conditioning.
  33. 33. Operant Conditioning in Health Care Practices - Developed by B.F. Skinner which focuses on the behavior of the organism and the reinforcement that follows after the response (Alberto & Troutman, 1990). His theory was heavily influenced by the work of psychologist Edward Thorndike, who had proposed what he called the law of effect. Reinforcement- are events that strengthen responses. It is one of the most powerful tools or procedures used in teaching and is a major condition for the most learning to take place. A reinforcer is a stimulus or event that is given, applied or elicited after a response to strengthen or reinforce the possibility that the response will be repeated.
  34. 34. Skinner Box
  35. 35. Positive reinforcers – any consequence of behavior that leads to an increase that leads to an increase in the probability of its occurrence. Ways of Employing Positive Reinforcement:  Verbal ways  Non-verbal ways  Citing in class or Publishing
  36. 36. Classification of Educational Reinforcers (Tosti and Addison 1979): 1. Recognition 2. Tangible rewards 3. Learning activities 4. School responsibilities 5. Status indicators 6. Incentive feedback 7. Personal activities
  37. 37. “The Law of Effect” By Edward Thorndike Edward Lee Thorndike was an American psychologist who spent nearly his entire career at Teachers College, Columbia University. His work on comparative psychology and the learning process led to the theory of connectionism and helped lay the scientific foundation for educational psychology.
  38. 38. The Law of Effect  The law of effect principle developed by Edward Thorndike stated that those behavioral responses (R) that were most closely followed by a satisfactory result were most likely to become established patterns and to reoccur in response to the same stimulus (S). Conversely, if the situation is followed by discomfort, the connections to the situation will become weaker, and the behavior of response is less likely to occur when the situation is repeated. Thorndike’s Puzzle Box
  39. 39. There are two key aspects of the law of effect: 1. Behaviors immediately followed by favorable consequences are more likely to occur again. 2. Behaviors followed by unfavorable consequences are less likely to occur again.
  40. 40. Cognitive Theories of learning  More than knowledge acquisition.  It stresses that mental processes or cognition occurs between the stimulus (S) and the response (R).  It stresses the importance of “what goes on inside the learner” which involves the individuals cognitive processes of perception, thinking skills, memory and ways of processing and structuring information.
  41. 41. I. Gestalt- the configuration or patterned organization of cognitive elements reflecting the maxim that the “whole is greater than the sum of its parts.” Gestalt perspective emphasizes the importance of perception in learning which focuses on the configuration or organization of a pattern or stimulus. Perspectives of the cognitive learning theory
  42. 42. Some principles of gestalt which are related to healthcare: 1. Psychological organization is directed toward simplicity, equilibrium and regularity. 2. Perception is selective which means that no one can attend or pay attention to all the surrounding stimuli at the same time. 3. What individuals pay attention to or what they ignore may be affected by factors like needs, personal motives, past experiences and the particular structure of the stimulus or situation.
  43. 43. Implication to healthcare  Knowledge of this gestalt principle will help the health educator on how he/she approaches any learning situation with an individual or group II. Information-processing is a cognitive perspective that emphasizes the thinking processes like: a. Thought c. The way information is encountered and stored b. Reasoning d. Memory functioning
  44. 44. Stages in the memory process: 1st Stage: Paying attention to the environmental stimuli; Attention is the key to learning. 2nd Stage: Information is processed by the senses. 3rd Stage: Information is transformed and incorporated or encoded briefly into short-term memory. 4th Stage: Involves the action or response that the individual makes on the basis of how the information was processed and stored
  45. 45. Jean Piaget  Born August 9, 1896, Neuchâtel, Switzerland—died September 16, 1980, Geneva), Swiss psychologist who was the first to make a systematic study of the acquisition of understanding in children. He is thought by many to have been the major figure in 20th- century developmental psychology.
  46. 46. III. Cognitive Development is a third perspective that focuses on qualitative changes in perceiving, thinking and reasoning as individuals mature and grow. Jean Piaget  A Cognitive Development Theorist.  He found out that children’s perception at different ages.  He identified four sequential stages of cognitive development.
  47. 47. Piaget’s four major periods of cognitive or intellectual development 1. Sensorimotor Stage (Birth-2 yrs.) *Actual perception of the senses and the external or physical factors. 2. Abstract Thinking *Represents reality using symbols that can be manipulated mentally.
  48. 48. 3. In Formal Operations (“Perspective thought” or Relativism) *New perspective of other people possessing varied thinking on the same stimulus or situation. 4. Assimilation or Accommodation * Characterized by hypothesis testing before making conclusions, things must be tested with logical pieces of evidence in search for truth.
  49. 49. “Multiple Intelligence” By Howard Gardner An American cognitive psychologist and author, best known for his theory of multiple intelligences.
  50. 50. Theory of Multiple Intelligences - States that there are various types of talent or seven forms of intelligence. About three to four types may be possessed or developed by an individual or child and all learners have all the seven kinds of intelligence but in different proportion.
  51. 51. 8 Intelligences
  52. 52. 1. Visual-Spatial Intelligence -People who are strong in visual-spatial intelligence are good at visualizing things. These individuals are often good with directions as well as maps, charts, videos, and pictures. Strengths Visual and spatial judgment Characteristics People with visual-spatial intelligence: • Read and write for enjoyment • Are good at putting puzzles together • Interpret pictures, graphs, and charts well • Enjoy drawing, painting, and the visual arts • Recognize patterns easily
  53. 53. 2. Linguistic-Verbal Intelligence -People who are strong in linguistic-verbal intelligence are able to use words well, both when writing and speaking. These individuals are typically very good at writing stories, memorizing information, and reading. Strengths Words, language, and writing Characteristics People with linguistic-verbal intelligence: • Remember written and spoken information • Enjoy reading and writing • Debate or give persuasive speeches • Are able to explain things well • Use humor when telling stories
  54. 54. 3. Logical-Mathematical Intelligence -People who are strong in logical-mathematical intelligence are good at reasoning, recognizing patterns, and logically analyzing problems. These individuals tend to think conceptually about numbers, relationships, and patterns. Strengths Analyzing problems and mathematical operations Characteristics People with logical-mathematical intelligence: • Have excellent problem-solving skills • Enjoy thinking about abstract ideas • Like conducting scientific experiments • Can solve complex computations
  55. 55. 4. Bodily-Kinesthetic Intelligence -Those who have high bodily-kinesthetic intelligence are said to be good at body movement, performing actions, and physical control. People who are strong in this area tend to have excellent hand-eye coordination and dexterity. Strengths Physical movement, motor control Characteristics People with bodily-kinesthetic intelligence: • Are skilled at dancing and sports • Enjoy creating things with his or her hands • Have excellent physical coordination • Remember by doing, rather than hearing or seeing
  56. 56. 5. Musical Intelligence People who have strong musical intelligence are good at thinking in patterns, rhythms, and sounds. They have a strong appreciation for music and are often good at musical composition and performance.5 Strengths Rhythm and music Characteristics People with musical intelligence: • Enjoy singing and playing musical instruments • Recognize musical patterns and tones easily • Remember songs and melodies • Have a rich understanding of musical structure, rhythm, and notes
  57. 57. 6. Interpersonal Intelligence -Those who have strong interpersonal intelligence are good at understanding and interacting with other people. These individuals are skilled at assessing the emotions, motivations, desires, and intentions of those around them.5 Strengths Understanding and relating to other people Characteristics People with interpersonal intelligence: • Communicate well verbally • Are skilled at nonverbal communication • See situations from different perspectives • Create positive relationships with others • Resolve conflicts in group settings
  58. 58. 7. Intrapersonal Intelligence Individuals who are strong in intrapersonal intelligence are good at being aware of their own emotional states, feelings, and motivations. They tend to enjoy self- reflection and analysis, including daydreaming, exploring relationships with others, and assessing their personal strengths. Strengths Introspection and self-reflection Characteristics People with intrapersonal intelligence: • Analyze their strengths and weaknesses well • Enjoy analyzing theories and ideas • Have excellent self-awareness • Understand the basis for his or her own motivations and feelings
  59. 59. Naturalistic Intelligence Naturalistic is another facet of intelligence and the most recent addition to Gardner’s theory and has been met with more resistance than his original seven intelligences. It refers to flora and fauna, has green thumb, enjoys pets, enjoys nature or classifies species, discriminates among plants and animal. Strengths Finding patterns and relationships to nature Characteristics People with naturalistic intelligence: • Are interested in subjects such as botany, biology, and zoology • Categorize and catalog information easily • Enjoy camping, gardening, hiking, and exploring the outdoors • Dislikes learning unfamiliar topics that have no connection to nature
  60. 60. “Social Learning Theory” By Albert Bandura Albert Bandura is an influential social cognitive psychologist who is perhaps best known for his social learning theory, the concept of self- efficacy, and his famous Bobo doll experiments
  61. 61. Social Learning Theory • Emphasize the importance of environment or situational determinants of behavior and their continuing intersection. Reciprocal Determinism by Albert Bandura states that “environmental conditions, shape behavior through learning and the person’s behavior, in return, shapes the environment.” Modeling or observational learning occurs vicariously, even in infants, where the individual learns of the consequences of a behavior by observing another person undergoing the experience.
  62. 62. 4 Operations involve in Modeling are: 1. Attentional processes - determine what a person can do and what he or she can attend to. 2. Retentional processes - determine hoe experiences is encoded or retained in memory. 3. Motor reproduction processes - determine what a behavior can be performed. 4. Motivational & reinforcement processes – determine the circumstances under which learning is translated into performance.
  63. 63. HOW BEHAVIOR OCCURS There are 3 interrelated determinants of behavior which are antecedents, consequences, and cognitive factors. Behavior is based on the past (antecedents) as we have seen it, but it is also influence by its results (consequence) and how we are motivated (cognitive factor). Bandura assumes that all actual behavior patterns must be learned through traditional learning (by reinforcement) and observational learning (by modeling). Behavior is shaped by people’s expectation.
  64. 64. The social learning theory approach to personality focuses directly on a person’s behavior (what did he do?) and not on his motives. A relatively enduring quality or characteristic is called a trait. Instead of trait, Walker Mischel (1993) dealt with cognitive variables: a. Competencies – which refer to various skills like intellectual abilities, social and physical skills and other special abilities. b. Encoding strategies and personal constructs - experience that are retained and categorized by the individual. c. Subjected values – what a person considers as worth having or accomplishing. d. Self-regulating systems or plans – people have different standards and rules for regulating their behavior
  66. 66. Abraham Maslow  Abraham Harold Maslow, also called Abraham H. Maslow, (born April 1, 1908, New York, U.S.—died June 8, 1970, Menlo Park, California), American psychologist and philosopher best known for his self- actualization theory of psychology, which argued that the primary goal of psychotherapy should be the integration of the self.
  67. 67. Maslow’s Theory of Motivation and Needs This theory was proposed by Abraham Maslow (1943), people are motivated based on a variety of needs which he categorized into five basic groups: 1. Physiologic needs- are the lowest level of Maslow's hierarchy of needs. They are the most essential things a person needs to survive. These includes the biological basic needs. 2. Safety needs-hierarchy refer to the need for security and protection.
  68. 68. 3. Social needs- refer to the need to have relationships with others once the physiological and safety needs have been fulfilled. 4. Esteem needs- refer to people's desires to have a stable and realistically positive evaluation of themselves. 5. Self-actualization needs- represented as one of the key stages in achieving contentedness or self- actualization.
  69. 69. Criteria for Prioritizing Learning Needs (Healthcare Education Assoc, 1985):  Mandatory- learning needs that must be immediately met since they are life threatening or are need for survival.  Desirable- learning needs that must be met to promote well-being and are not life-dependent.  Possible- “nice to know”, learning needs which are not directly related to daily activities
  70. 70. Methods in Assessing Learning Needs (Bastable, 2003)  A. Informal Conversations or Interview  B. Structured Interviews  C. Written pretest  D. Observation of health behaviors over a period of different times
  71. 71. Importance of Motivation in Learning  It is important to get the learner into a state of readiness to learn for it increases alertness, vigor, and wholeheartedness of learning.  Continuous motivation is needed to help learners concentrate on the lessons to be learned.
  72. 72. Moral/ Spiritual
  73. 73. Nursing as an ethical practice requires courage to be moral, taking tough stands for what is right, and living by one’s moral values. Nurses need moral courage in all areas and at all levels of nursing. Along with new interest in virtue ethics in healthcare, interest in moral courage as a virtue and a valued element of human morality has increased. Nevertheless, what the concept of moral courage means in nursing context remains ambiguous.
  74. 74. 1. True Presence 2. Moral Integrity 3. Responsibility 4. Honesty 5. Advocacy 6. Commitment and Perseverance 7. Personal Risk 7 Core Attributes of Moral Courage:
  75. 75. Antecedents were ethical sensitivity, conscience, and experience. Consequences includes personal and professional development and empowerment.
  76. 76. • Spirituality may be a dynamic in the patient's understanding of the disease. • Religious convictions may affect health care decision making • Spirituality may be a patient need and may be important in patient coping. • An understanding of the patient's spirituality is integral to whole patient care. Advantages of Becoming Familiar with Patient’s Spirituality
  77. 77. • Practicing compassionate presence—i.e., being fully present and attentive to their patients and being supportive to them in all of their suffering: physical, emotional, and spiritual • Listening to patients' fears, hopes, pain, and dreams • Obtaining a spiritual history • Being attentive to all dimensions of patients and their families: body, mind, and spirit • Incorporating spiritual practices as appropriate ASPECTS OF SPIRITUAL CARE