Module 2M - Health Education

Learning

Relatively permanent change in mental processing, emotional function, skill and/or behavior as a result of exposure to different experiences. Enables individuals to adapt to the demands and changing circumstances for patients and families.

Learning

It is a lifelong, dynamic process by which individuals acquire new knowledge or skills and alter their thoughts, feelings, attitudes, and actions.

Learning Theory

A coherent framework of integrated constructs and principals that describe, explain or predict how people learn.

Psychological Learning Theories

Provides alternative theories and perspectives on how learning occurs and what motivates people to learn and change. They are useful in acquiring information and in situations involving human thought, emotions, and social interaction.

Motor Learning

Branch of experimental psychology and can be differentiated from "verbal" learning. It is of particular interest to nurses as they try to help their patients and student acquire or learn skills.

Behaviorist Learning Theory

Focusing mainly on what is directly observable. It is the product of the stimulus conditions (S) and the responses (R) that follow. Closely observe responses to a situation and manipulate the environment to bring about intended change.

Respondent Conditioning

It is also termed association learning, classical conditioning or pavlovian conditioning. It emphasizes the importance of stimulus conditions and the associations formed in the learning process.

Neutral Stimulus (NS)

Stimulus that has no special value or meaning to the learner. It is paired with a naturally occurring unconditioned or unlearned stimulus (UCS) and unconditioned response (UCR)

Systematic Desensitization

A technique based on respondent conditioning that is used by psychologists to reduce fear and anxiety in their clients.

Stimulus Generalization

The tendency of initial learning experiences to be easily applied to other similar stimuli.

Discrimination Learning

Individuals learning to differentiate among similar stimuli.

Spontaneous Recovery

A useful respondent conditioning concept that needs to be given careful consideration in relapse prevention programs. A response may appear to be extinguished, it may at any time reappear when stimulus conditions are similar to the initial learning experience.

Operant Conditioning

It is developed by B.F. Skinner (1974, 1989). It focuses on the behavior of the organism and the reinforcement that occurs after the response.

Reinforcer

A stimulus or event applied after a response that strengthens the probability that the response will be performed again.

Reward Conditioning

A pleasant stimulus is applied following an organism's response.

Negative Reinforcement

Removal of an aversive of unpleasant stimulus.

Escape Conditioning

As an eversive stimulus is applied, the organism makes a response that causes the unpleasant stimulus to cease.

Avoidance Conditioning

An aversive stimulus is anticipated by the organism, which makes a response to avoid the unpleasant event.

Nonreinforcement

An organism's conditioned response is not followed by any kind of reinforcement (positive, negative, or punishment).

Punishment

Following a response, an aversive stimulus is applied that the organism cannot escape or avoid.

Cognitive Learning Theory

Stresses the importance of what goes on inside the learner. It is composed of sub theories and is widely used in education and counseling. The key to learning and changing is individual's cognition (perception, thought, memory, and ways of processing and structuring information.

Cognitive Learning Theory

Involves perceiving the information, interpreting it based on what is already known, and them recognizing the information into new insights or understanding.

Metacognition

Understanding of her way of learning. To promote transfer of learning, the learner must mediate or act on the information in some way.

Gestalt Perspective

Part of the Cognitive Learning Theory.

Emphasizes the importance of perception in learning and lays the groundwork for various other cognitive perspective. Psychological organization is directed toward simplicity, equilibrium, and regularity. Additionally, no one can attend to all possible surrounding stimuli at any given time, and what individuals pay attention to and what they ignore are influenced by a host of factors.

Information Processing

A cognitive perspective that emphasizes thinking process: thought, reasoning, the way information is encountered and stored, and memory functioning.

1st Stage of the Memory Process

Stage in the memory process involves paying attention to environmental stimuli; attention, then, is the key to learning.

2nd Stage of the Memory Process

The information is processed by the senses. It becomes important to consider the client's preferred mode of sensory processing (visual, auditory, or motor manipulation and to ascertain what hs any he or she has any sensory deficits).

3rd Stage of the Memory Process

The information is transformed and incorporated (encoded) briefly into short term memory, after which it suffers one of the 2 facets:

1) the information is disregarded and forgotten

2) it is stored in long term memory

4th Stage of the Memory Process

Involves the action or response that the individual undertakes based on how information was processed and stored.

9 Events That Activate Effective Learning

1. Gain the learner's attention (reception)

2. Inform the learner of the objectives and expectation (expectancy)

3. Stimulate the learner's recall of prior learning (retrieval)

4. Present information (selective perception)

5. Provide guidance to facilitate the learner's understanding (semantic encoding)

6. Have the learner demonstrate the information or skill (responding)

7. Give feedback to the learner (reinforcement)

8. Assess the learner's performance (retrieval)

9. Work to enhance retention and transfer through application and varied practice (generalization)

Cognitive Development

3rd perspective on learning that focuses on qualitative changes in perceiving, thinking and reasoning as individuals grow and mature. Conditions are based on how external events are conceptualized, organized and represented within each person's mental framework or scheme which is partially dependent on individual's stage of development in perception, reasoning, and readiness to learn.

Social Constructivism

Individuals formulate or construct their own version of reality and that learning and human development are richly colored by the social and cultural context in which people find themselves.

Social Cognition

Reflects a constructivist orientation and highlights the influence of social factors on perception, thought, and motivation.

Attribution Theory

Focuses on the cause-and-effect relationships and explanations that individuals formulate to account for their own and others' behavior and the way in which the world operates.

Cognitive-Emotional Perspective

Empathy and the moral emotions (guilt, shame, distress, moral outrage) play significant role in influencing children's moral development and in motivating people's prosocial behavior, activism and ethical responses. Memory and retrieval, as well as moral decision making, involve both cognition and emotional brain processing, especially in response to situations that directly involve the self and are stressful.

Emotional Intelligence (EI)

Entails an individual managing his emotions, motivating himself, reading the emotions of other, and working effectively in interpersonal relationships.

Self-Regulation

Includes learners monitoring their own cognitive processes, emotions and surroundings to achieve goals.

Social Learning Theory

Is largely based on the work of Albery Bandura (1977, 2001) who mapped out a perspective on learning that includes consideration of the personal characteristics of the learner, behavior patterns, and the environment.

Role Modeling

Armstrong (2008) emphasized that to facilitate learning, role models need to be enthusiastic, professionally organized, caring and self confident, knowledgeable, skilled, and good communicators.

Vicarious Reinforcement

Involves determining whether role models are perceived as rewarded or punished for their behavior.

Attentional Phase

1st Phase of the Social Learning Theory

Role models with high status and competence are more likely to be observed, although the learner's own characteristics (needs, self esteem, competence) may be the more significant determiner of attention.

Retention Phase

2nd Phase of the Social Learning Theory

Involves the storage and retrieval of what was observed.

Reproduction Phase

3rd Phase of the Social Learning Theory

Where the learner copies the observed behavior.

Motivational Phase

Focuses on whether the learner is motivated to perform a certain type of behavior.

Psychodynamic Learning Theory

Based on the work of Sigmund Freud and his followers. A theory of motivation that stresses emotions rather than cognition or responses.

Psychodynamic Learning Theory

Emphasized the importance of conscious and unconscious forces in guiding behavior, personality conflicts, and the enduring effects of childhood experiences on adult behavior. Behavior may be conscious and unconscious. Individuals may or may not be aware of their motivations and why they feel, think, and act as they do.

Eros

The desire for pleasure and sex, sometimes called the lifeforce.

Thanatos

Aggressive and destructive impulses, or the death wish.

Super Ego

Involves the internalized societal values and standard, or the conscience.

Ego

Based on the reality principle. Rather than insisting on immediate gratification, people learn to take the long road to pleasure and to weigh the choices or dilemmas in the conflict between the ID and superego.

Defense Mechanism

When ego is threatened may be employed to protect self.

Denial

One of the ego defense mechanisms.

Ignoring or refusing to acknowledge the reality or threat.

Rationalization

One of the ego defense mechanisms.

Excusing or explaining away a threat.

Displacement

One of the ego defense mechanisms.

Taking out hostility and aggression on other individuals rather than directing anger at the source of the threat.

Repression

One of the ego defense mechanisms.

Keeping unacceptable thoughts, feelings or actions from conscious awareness.

Regression

One of the ego defense mechanisms.

Returning to an earlier (less mature, more primitive) stage of behavior as a way of coping with a threat.

Intellectualization

One of the ego defense mechanisms.

Minimizing anxiety by responding to a threat in a detached abstract.

Projection

One of the ego defense mechanisms.

Seeing one's own acceptable characteristics or desires in other people.

Reaction Formation

One of the ego defense mechanisms.

Expressing or behaving the opposite of what is really felt.

Sublimation

One of the ego defense mechanisms.

Converting repressed feelings into socially acceptable actions.

Compensation

One of the ego defense mechanisms.

Making up for weakness by excelling in other areas.

Resistance

An indicator or underlying emotional difficulties, which must be dealt with for them to move ahead emotionally and behaviorally.

Transference

Occurs when individuals projects their feelings, conflicts, and reactions - especially those developed during childhood with significant other such as parents - into authority figures and other individuals in their lives.

Humanistic Learning Theory

The assumption that every individual is unique and that all individuals have a desire to grow in a positive way. Spontaneity, the importance of emotions and feelings, the right of individuals to make their own choices, and human creativity are the cornerstones of this theory.

Hierarchy Needs

Plays an important role in human motivation. At the bottom are psychological needs (food, warmth, sleep); then come safety needs, then the need for belonging and love, followed by self esteem. At the top are self-actualization needs (maximizing one's potential). Additional considerations include cognitive needs ( the desire to know and understand) and for some individuals, aesthetic needs (the desire for beauty).

Carl Rogers (1961, 1994)

Argued that what people want is unconditional positive self-regard (the feeling of being love without string attached).

Neuropsychology

The scientific study of psychological behavior based on neurological assessments of the brain and central nervous system. It is not a theory but a body of research that may be applied to psychological aspects of a behavior, including learning.

Learning

Viewed as involving changes in the brain and nervous system that affect responses and behavior. It occurs at the cellular level and produces structural changes in the brain structure, wiring patterns and chemistry.

Emotions

Has been found to play a key role in Pavlovian conditioning, information processing, memory, and motivation. They are considered to interact with cognitive factors in any learning situations, suggesting that they cannot be ignored when teaching, learning, reasoning, or making decisions.

Learning

Physiological and neurological developmental changes that are ongoing and dynamic.

Motor Learning

A set of processes associated with practice or experience leading to relatively permanent changes in the capability for movement.

Motor Performance

Involves initial acquisition of a skill but not necessarily longer term retention of that skill.

Cognitive Stage

First stage of motor learning. The learner works to develop an overall understanding of the skill, called the cognitive map (cognitive plan) - basically solving the problem of "what is to be done".

Associative Stage

Second stage of motor learning. Entails more consistent performance, slower gains, and fewer errors. It focuses on "how to do" the skill.

Autonomous Stage

The automatic and third stage of motor learning, during which speed and efficiency of performance gradually improve and which requires little attention and conscious information processing.

Assessment of the Learner

Includes attending to the three determinants of learning: (1) learning needs, (2) readiness to learn, (3) learning style

Learning Needs

Defined as gaps in knowledge that exist between a desired level of performance and the actual level of performance. It is essentially a gap between what someone knows and what someone needs or wants to know.

Steps in the Assessment of Learning Needs

1. Identify the learner

2. Choose the right setting

3. Collect the data about the learner

4. Collect data from the learner

5. Involve members of the healthcare

6. Prioritize needs

7. Determine availability of educational resources

8. Assess the demands of the organization

9. Take time-management issues into account

Criteria for Prioritizing Learning Needs

1. Mandatory

2. Desirable

3. Possible

Methods to Assess Learning Needs

1. Informal conversations

2. Structured interviews

3. Focus groups

4. Questionnaires

5. Tests

6. Observations

7. Documentation

Assessing the Learning Needs to Staff Nurses

1. Written Job Descriptions

2. Formal and Informal Requests

3. Quality Assurance Reports

4. Chart Audits

5. Rules and regulations

6. Self- Assessment

7. Gap Analysis

Readiness to Learn

Can be defined as the time when the learner demonstrates interest in learning the information necessary to maintain optimal health or to become more skillful in a job.

4 Types of Readiness to Learn

"PEEK"

- physical

- emotional

- experimental

- knowledge

P = Physical Readiness

Measures of ability,

Complexity of task,

Environmental effects,

Health status,

Gender

E = Emotional Readiness

Anxiety Level,

Support system,

Motivation,

Risk-taking behavior,

Frame of mind,

Developmental stage

E = Experimental Readiness

Level of aspiration,

Past coping mechanism,

Cultural background,

Focus of control

K = Knowledge Readiness

Present knowledge base,

Cognitive ability,

Learning disabilities,

Learning styles

Learning Styles

Refers to the ways in which and conditions under which learners most efficiently and most effectively perceive, process, store, and recall what they are attempting to learn.

Learning Style Models and Instruments

Right-Brain/Left Brain and Whole-Brain Thinking,

Field-Independent/Field-Dependent Perception,

Dunn and Dunn learning styles (1978),

Jung and Myer-Briggs Typology- Carl Jung(1921/1971)

Kolb's Experiential Learning Model (1984)

Believed that knowledge is acquired through a transformational process, which is continuously created and reacted.

Developmental Stages of the Learner

Musinski (1999) describes 3 phases of learning: Dependence, Independence, and Interdependence

Pedagogy

The art and science of helping children to learn.

Andragogy

Term used by Kowels (1190) to describe his theory of adult learning, is the art and science of teaching adults.

Young Adulthood

- Emerging adulthood

- INTIMACY vs ISOLATION

- 20 and 34 years of age - millennial generation

- 35 to 40 -Generation X

- Physical abilities are at their peak and the body is at its optimal functioning capacity

- Cognitive capacity is fully developed, but with maturation, they continue to accumulate new knowledge and skills from expanding reservoir of formal and informal experiences.

Middle-Aged Adulthood

- 41 to 64 years

- GENERATIVITY vs SELF ABSORPTION and STAGNATION

- Transition period between young adulthood and older adult

- Labeled the baby-boom generation, the best educated, most affluent generation in history

- Stage of maturation, physiologic changes begin

- Physical changes affect middle-aged adults' self image, ability to learn and motivation.

Older Adulthood

- 65 years of age and older

- EGO INTEGRITY vs DESPAIR

- Patient education needs are generally greater and more complex

- With advancing age, so many physical changes occur that it becomes difficult to establish normal boundaries

Gagne's Conditions of Learning (1970)

1. Signal Learning

2. Stimulus-Response Learning

3. Chaining

4. Verbal Association

5. Discriminating Learning

6. Concept Learning

7. Rule Learning

8. Problem Solving

Signal Learning

The person develops a general diffuse reaction to stimulus.

Stimulus-Response Learning

Involves developing a voluntary response to a specific stimulus or a combination of a stimuli.

Chaining

The acquisition of a series of related conditioned response or stimulus-response connection.