Nursing Learning Theories Guide

Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 17
Learning Theories

Learning Theories
• Teaching is one of the most important roles of nurses.
• Teaching is the intentional act of communicating
information; facilitation of learning.
– Must be aware and attend to how people learn

Learning Theories—(cont.)
• Learning—a change in behavior or change in mental or
emotional functioning
• Learning occurs as individuals interact with their
environment, incorporating new information into what
they already know.

• Learning is the means by which skills, values,
knowledge, attitudes, and emotions are acquired.
• Learning creates a change within the individual.
• Learning can describe a process, a product, or a
function.

• Three basic types of categories of learning
– Affective learning (change in feelings, values, beliefs)
– Cognitive leaning (acquiring information)
– Psychomotor learning (skills, physical abilities)

• Learning theories describe processes used to bring
about changes in how we understand information
and/or change in how we perform tasks or skills.
• Many theories of learning can be useful for nurses.
• Main categories
– Behavioral learning theories
– Cognitive learning theories
– Adult learning theory

Behavioral Learning Theories
• Among the first and most widely used
• Focus on what is directly observable in learners
• Based on the works of Pavlov and Thorndike
– Behavior (response) is the result of a stimulus.
– Stimulus–response (S–R) models of learning
• Thorndike—original S-R framework
• Pavlov—classical conditioning
• Skinner—operant conditioning
• Watson—behaviorism
• Hull—S–R + reinforcement

Behavioral Learning Theories—(cont.)
• Behavioral theories are concerned with observable and
measurable aspects of behavior.
• Behaviors can be controlled through rewarding desirable
behavior and ignoring or punishing undesirable behavior.
• Reinforcing the behavior increases its recurrence in the
future.

Question
Use of behavioral theory in learning does which of the
following?
A. Reinforces learning
B. Rewards positive responses
C. Conditions responses
D. All of the above

Answer
D. All of the above
Rationale: Behavioral learning theories, behavior, or
response is viewed as the result of stimulus to certain
conditions. The response is the learned behavior, which
becomes conditioned and can be reinforced in multiple
ways.

Cognitive Learning Theories
• Behavioral learning theories fail to consider thoughts,
feelings, and cognitive processes of the learner.
• Cognitive theories consider the learner’s own goals,
thoughts, expectations, motivations, and abilities.
• Became popular in the 1960s; focus on how people
learn and how to change behaviors

Cognitive Learning Theories—(cont.)
• Cognitive-field (Gestalt) theories
– Learning is closely related to perception.
– Learning is reorganization of the learner’s
perceptual or psychological world (i.e., his or her
field).
– Learning is the process of discovering and
understanding relationships among people,
things, and ideas in the field.
– Self-actualization is a driving force that motivates
human behavior.

Cognitive Learning Theories—(cont.)
• Cognitive-field (Gestalt) theories—(cont.)
– Perceptions of reality and experience are unique
to each individual.
– Thoughts influence actions.
– Kurt Lewin was a major gestalt theorist.

Cognitive Development/Interaction
Theories
• Behavior, mental processes, and the environment are
interrelated.
• Assumes learning is a sequential process and takes
place over time
• Stresses the importance of experiential interaction
with the environment
• Focus on conditions that promote learning

Theories: Piaget
• Cognitive development occurs in stages:
sensorimotor, preoperational, concrete operational,
and formal operational.
• Stages are universal to persons everywhere.
• Must be able to assimilate new information into
existing cognitive structures to learn
• Assimilation and accommodation processes are
critical to development and learning.

Theories: Gagne
• To be successful, learning requires varying conditions.
• Learning outcomes are divided into five categories:
intellectual skills, verbal information, cognitive
strategies, motor skills, and attitudes.
• Also believed there are eight types of learning that
are sequential and hierarchical (e.g., involuntary
responses to problem solving)
• Teaching involves arranging conditions external to the
learner to enhance learning.

Question
Gagne categorizes learning outcomes as intellectual skills,
verbal information, cognitive strategies, attitudes, and:
A.Accommodation
B.Behavioral intention
C.Learning needs
D.Motor skills

Answer
D. Motor skills
Rationale: Motor skills are one of the learning outcomes
needed in many circumstances.

Theories: Bandura
• Bandura—social learning theory
– Concerned with social influences that affect learning
(culture, ethnicity)
– Environment, cognitive factors, and behavior interact
reciprocally.
– Emphasis on self-efficacy

Theories: Bandura—(cont.)
– Focus is on how people learn from one another.
– Concepts of observational learning, imitation,
and modeling (vicarious learning)
– Cognition plays a role in learning.

– Self-efficacy is the competence to perform a specific
task or range of tasks.
– People are more likely to engage in behaviors they
can perform successfully—those with high self-
efficacy.
– Teaching efforts should focus on developing self-
efficacy.

• Bandura social learning theory—Implications
– Learners learn by observing others.
– Modeling can help teach new behavior/s.
– Teachers must model appropriate behaviors.
– Students must believe they are capable of learning—
self-efficacy.

• Bandura’s work is widely used in nursing.
• Many citations relate to research.
– Self-efficacy of abused women
– Education program for patients who receive an
implantable cardioverter defibrillator
– Nurses’ perceived cultural self-efficacy
– Self-efficacy and physical activity in elders
– Self-efficacy training for people with ESRD

Adult Learning Theory (Andragogy)
• Malcolm Knowles initially presented his work on adult
learning principles in the 1970s.
• Coined the term “andragogy” as a process model to
describe how adults learn
Knowles

Adult Learning Theory (Andragogy)—
(cont.)
• Knowles believed that adult learning did not follow the
principles of traditional pedagogy in which teachers are
responsible for deciding what, where, when, and how
information will be learned.
• Believed because adults are more self-directed, they
should control their own learning.

Adult Learning Theory—Assumptions
• Need to know: Adults need to know why they need to
learn something.
• Self-concept: Maturity moves self-concept from
dependence to being self-directed.
• Experience: Maturity increases experience that can be
helpful in learning.

Adult Learning Theory—Assumptions—
(cont.)
• Readiness to learn: Life problems or situations
create a readiness to learn.
• Orientation to learning: need to recognize
application of information (need to relate what they
are learning to personal/professional experiences)

Adult Learning Theory—Assumptions—
(cont.)
• Motivation: Adults are primarily motivated by a desire to
solve immediate and practical problems.
• Motivation is often internal rather than external.

Adult Learning Theory—Implications—
(cont.)
• Learners should be motivated and ready to learn.
• Learners should be involved in planning and evaluation of
instruction.
• Instruction should be problem centered rather than
content oriented.

Adult Learning Theory—Implications
• Learners should be explained why they are studying
something.
• Instruction should be task oriented and should consider
range of background of learners.
• Learners should be able to relate subject to
personal/professional experiences.

Adult Learning Theory—Application
• Knowles work has been used by nurses in
– Practice (patient education)
• Model of andragogy for osteoporosis education
• Approach to cardiac in-patient education
• Facilitating self-management in diabetes
education
– Education
• Graduate education curriculum design
• Use of journaling in an RN-BSN program
• Continuing education—computer learning needs

Learning Styles
• Most individuals have a preferred style of learning—how
they interact with instructional circumstances to enhance
learning.
– Visual
– Auditory
– Tactile/kinesthetic
• May prefer “global” or analytic view

Question
Tell whether the following statement is true or false:
All information should be presented in the same method to
patients.

Answer
False
Rationale: Every learner is different; this includes patients.
The APN or RN providing education should assess the
individual for best learning style and use the method of
learning to suit the learner.

Basic Principles of Learning
• Learning may be emotional as well as intellectual.
• Learning is highly unique—People learn in different ways.
• Learning can be painful.

Basic Principles of Learning—(cont.)
• Learning is facilitated when
– Moving from simple to complex, concrete to abstract,
and known to unknown
– Information is personal and individualized.
– Relevant to learners’ needs and problems
– The individual is attentive.
– Feedback is provided promptly.

Nursing Learning Theories Guide

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