Learning Theories - DOC

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					                                                                CHAPTER II Using Health Education in the Community                                 195

•• Theories of Learning
 Theory                  Focus                                            Method
 Behavioral              Change behavior                                  Rei nforcemen tJpun ishment
 Cognitive               Change thought patterns                          Variety of sensory input and repetition
 Critical                Increase depth of knowledge Consider             Ongoing dialogue and open inquiry
 Developmental           human developmental stage Utilize                Educational opportunities match readiness to learn
 Humanistic              feelings and relationships Change                Learners will do what is best for themselves (self-determination) Link
 Social learning         expectations and beliefs                         information, beliefs, and values

Modified from Dembo MH: Applying educational psychology, ed 5, White Plains, NY, 1994, Longman; Driscoll MP: Psychology of learning for
instruction, Boston, 1994, Allyn & Bacon; Knowles MS, Holton III EF, Swanson RA: The adult learner: the definitive classic in adult education and
human resource development, ed 5, Houston, 1998, Gulf.

community-based educational intervention was established                       The behavioral approach is useful when the educator has full
(Stopka, Chapman, and Perez-Escamilla, 2002).                              control over the rewards and consequences environment-that is, the
                                                                           feedback system. This approach is also useful when the learner has
  EDUCATION AND LEARNING                                                   cognitive limitations, because the behavioral approach requires
                                                                           only the most basic use of cognition (Dobbins, 2001; Driscoll,
Learning health information enables individuals to improve their           1994).
 decision-making abilities and thereby change their behavior.                  For example, using Healthy People 2010 as a guide, a nurse
 There is a difference between education and learning (Knowles,            working in a school system might want to decrease the number of
 Holton, and Swanson, 1998; Palazzo, 2001). Education is the               adolescent deaths associated with alcohol use. The nurse identifies
 establishment and arrangement of events to facilitate learning,           the target behavior as use of a designated driver. The nurse works
 including the providing of knowledge and skills. Learning is              to increase the use of designated drivers to transport students from
 defined in many ways. Most definitions of the learning process            school-related functions where adolescents may consume alcohol
 include measurable change in behavior that continues over time.           before the event or illicitly during the event. Therefore after every
 Thus learning is the process of gaining knowledge and expertise.          school-related sporting or social event, four trained adults sit at the
 Once an individual has learned or gained specified knowledge              exit doors, evaluate the sobriety of designated drivers, and :assign
 and expertise, the process is complete and behavioral change              designated drivers to cars. Designated drivers each receive $10 for
 results (Driscoll, 1994; Knowles, Holton, and Swanson, 1998;              gasoline, have their names printed in the weekly school newspaper,
 Palazzo, 2001).                                                           and become eligible for a weekly prize drawing of $25.

                                                                           COGNITIVE THEORY
  THEORIES OF LEARNING                                                      Cognitive theory emphasizes that the way knowledge is organized,
 Although many theories and principles related to lea'rning are             connected, and retrieved is important in learning. By changing
                                                                            thought patterns and providing information, learners' behavior
 applicable to nursing in community health practice, samples of
                                                                            will change. Cognitive theory says that people's thought patterns
 only the most useful and readily adaptable ones are included here.
                                                                            constantly change as they interact with their environment. Thus the
 Theories of learning help nurses to understand how people learn
                                                                            nurse educator provides information in a variety of ways that will
 and to design and implement client education. Table 11-1
                                                                            change clients'
 provides an overview of six major theories of learning that
                                                                          .. th<2ught patterns and ultimately lead to changes in behavior
 provide options for nurses. Often it is useful to combine parts of a
                                                                             (Dembo,1994; Dobbins, 2001; Driscoll, 1994).
 number of these theories in the education process (Driscoll,
                                                                                For example, if a group of women do not do monthly breast
                                                                            self-examinations (BSEs), the nurse working with them instructs
 BEHAVIORAL THEORY                                                          them to begin doing so. The nurse seeks to
                                                                           _change their thought patterns by providing information about
 Behavioral theol'y approaches the study of learning by con-
                                                                             BSEs in a variety of ways. First, the nurse tells the women about
 centrating on behaviors that can be observed and measured. The
                                                                             the procedure, explains the reasons for doing BSEs, and shows
 goal of these approaches to learning is behavioral change. A
                                                                             them a video. Next, the nurse watches each woman practice breast
 target behaviOl; which the nurse educator seeks to either increase
                                                                             examinations on a. breast model. Finally, the nurse gives each
 or decrease, is identified. To increase a behavior, the nurse
                                                                             woman a handout with the procedure wlitten and diagrammed on it
 identifies and consistently uses a reinforcer to modify the target
                                                                             and instructs the women to hang the handout next to the bathroom
 behavior. To decrease a behavior, the nurse identifies and                  mirror to remind them to do monthly BSEs. By using a variety of
 consistently uses withdrawal of a reinforcer (punishment) to
 modify the target behavior (Dembo, 1994; Dobbins, 2001 ;
 Driscoll, 1994).
196          PART III Conceptual Frameworks Applied to Nursing Practice in the Community

environmental cues and sensory input, the women's thought                HUMANISTIC THEORY
patterns can pe changed, thereby influencing their behavior related      Humanistic theory describes the influence that feelings,
to BSEs.                                                                 emotions, and personal relationships have on behavior.
                                                                         Humanistic theorists think that learners should be encouraged to
CRITICAL THEORY                                                          examine their feelings and engage in various forms of se(f-
Critical theory approaches learning as an ongoing dialogue. An           exjJression. Humanists also think that people need to be aware of
individual holds a belief about a health matter. Nurse educators         and able to clarify their values. If people are given free choice,
attempt to change this belief by questioning the learner. As learners    they will do what is best for them. Humanists encourage nurse
answer the questions, their beliefs begin to change, new questions       educators not to be overly controlling and restrictive with-learners
arise, and they begin to ask the educator questions. The educator        but rather to help them grow and develop according to their natural
responds to these' questions. Tllis process of discourse ultimately      inclinations (Dembo, 1994; Driscoll, 1994; Knowles, Holton, and
changes thinking and behavior (Driscoll, 1994).                          Swanson, 1998).
     For example, the nurse would like a newly diagnosed group of            For example, if members of a retirement community want to
 diabetic clients to be able to manage their diabetes. The nurse asks    develop a health promotion program, they may invite the nurse to
 them what they know about diabetes. The clients demonstrate that        schedule meetings to assist them to meet this goal. At the
 they can check their own blood sugar and prepare their own insulin      meetings, the nurse encourages group discussion about the goals
 injections. However, on further questioning, the nurse learns that      and strategies of the program and provides a variety of handouts
 the clients do not know about the long-term complications of            related to health promotion. Finally, the nurse answers questions
 diabetes. The nurse then educates them about these complications.       and encourages members as they develop their own health
 Next, the clients raise questions about what they can do to prevent     promotion program.
 long-term complications. As a result of this discussion and
 exchange of information, the clients begin to go to an oph-             SOCIAL LEARNING THEORY
 thalmologist every year and to check their feet daily for alterations
                                                                         Social learning theory builds on the principles of behavioral
 in skin color or integrity.
                                                                         theory by stating that behavior is a function of an individual's
                                                                         expectations about tile value of an outcome (Do I want the
DEVELOPMENTAL THEORY                                                     outcome?) or self-efficacy (Can I achieve the outcome?). If clients
According to developmental theory, learning happens in concert           believe that an outcome is desired and attainable, they are more
with developmental stages that occur from infancy to old age:            likely to change their behavior to achieve that goal. Thus nurse
Each stage is a major transformation from the previous stage;            educators may use this theory to change behaviors by enabling
therefore learning occurs quite differently in each developmental        clients to change either their expectations about the value of a
period. Knowledge is invented and reinvented as individuals              certain outcome or their ability to achieve the desired outcome, or
develop and interact with their world. Readiness to learn depends        both (Bandura, 1986; Dembo, 1994).
on each individual's developmental stage (Deinbo, 1994; Driscoll,            For example, if the nurse wants to help a group of obese
1994).                                                                   women lose weight, the nurse instructs them to eat less, select
    For example, to help a family with a toddler prevent accidents       healthful foods, and exercise more. By presenting credible and
in the home, nurses educate parents about safety practices. They         clear information about balanced eating and the positive effects of
also discuss with the parents how to teach the toddler simply and        exercise, the nurse helps the women develop the expectation that
clearly about safety according to the child's developmental stage        decreased food intake and increased exercise will result in weight
and readiness to understand concepts and to change behavioral            loss. Through case study presentations and before-and-after
patterns. The, n~lrses recognize that the parents' and the toddler's     photos, the nurse helps the women change their expectations about
levels of readiness to learn are quite different. Because the toddler    their power to achieve the goal of weight loss. Without the belief
cannot reach the stove top, teaching about the dangers of a hot          in their power to change, the women may be unable to remain
stove at this stage of physical development is unnecessary.              motivated to change their target behaviors.
However, the toddler is at risk for accidental pc:isoning. Although
the parents may teach the' toddler not to open bottles and jars            EDUCATIONAL PRINCIPLES
without their help, all poisons must be removed from the toddler's
possible reach as a necessary precaution. The risk of poison             A variety of educational principles can be used to guide the
ingestion is incomprehensible to the toddler because of the child's      selection of health information f?r individuals, families,
language and cognitive development. Thus the parents and the             communities, and populations. Three of the most useful categories
toddler receive different information depending on their                 of educational principles include those associated with the nature
developmental stages.                                                    of learning, the events of instruction, and guidelines for the
                                                                         effective educator.

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