Learning Theories in Nursing

Learning theories refers to theoretical frameworks which try to explain how people and animals learn, thereby helping us understand the inherently complex process of learning. Learning refers to “a persisting change in human performance or performance potential brought about   as a result of the learner’s interaction with the   environment”. There are three main categories of learning theories: behaviorism, cognitivism, and humanism.

BEHAVIORISM

Thorndike originally advanced behaviorism. His major contribution that applied to teaching is that learning should be based on the learner’s behavior and what is directly observable. In addition to Thorndike, major behaviorism theorists include Pavlov, Skinner, and Bandura. 
In the behaviorist school of thought, an act is called a response when it can be traced to the effects of a stimulus. Behaviorists closely observe responses and then manipulate the environment to bring about the intended change. Thus, to modify a person’s attitude and response, a behaviorist would either alter the stimulus condition in the environment or change what happens after a response occurs. Skinner’s and Pavlov’s work focused on conditioning behavioral responses to a stimulus that causes the response or behavior. To increase the probability of a response, Skinner introduced the importance of positive reinforcement (e.g., a pleasant experience such as praise and encouragement) in fostering repetition of an action. Bandura, however, claims that most learning comes from observational learning and instruction rather than trial-and-error behavior. Bandura’s research focuses on imitation, the process by which individuals copy or reproduce what they have observed, and modeling, the process by which a person learns by observing the behavior of others.

Nurses using the behaviorist theory identify what is to be taught, and they immediately identify and reward correct responses. However, the theory is not easily applied to complex learning situations and limits the learner’s role in the teaching process. In summary, nurses applying behavioristic theory will:

• Provide sufficient practice time including both immediate and repeat testing and return demonstration.

• Provide opportunities for learners to solve problems by trial and error.

• Select teaching strategies that avoid distracting information and that evoke the desired response.

• Praise the learner for correct behavior and provide positive feed- back at intervals throughout the learning experience.

• Provide role models of desired behavior. 

COGNITIVISM

Cognitivism depicts learning as a complex cognitive activity. In other words, learning is largely a mental or intellectual or thinking process. The learner structures and processes information. Perceptions are selectively chosen by the individual, and personal characteristics have an impact on how a cue is perceived. Cognitivists also emphasize the importance of social, emotional, and physical contexts in which learning occurs, such as the teacher–learner relationship and the environment. Developmental readiness and individual readiness (expressed as motivation) are other key factors associated with cognitive approaches.

Major cognitive theorists include Piaget, Lewin, and Bloom. Piaget’s five major phases of cognitive development include the sensorimotor phase, the preconceptual phase, the intuitive thought phase, the concrete operations phase, and the formal operations phase. According to Lewin, learning involves four different types of changes: change in cognitive structure, change in motivation, change in one’s sense of belonging to the group, and gain in voluntary muscle control. His widely known theory of change has three basic stages: unfreezing, moving, and refreezing. As previously mentioned, Bloom identified the three domains of learning. Users of cognitive theory recognize the developmental level of the learner and acknowledge the learner’s motivation and environment. However, some or many of the motivational and environmental factors may be beyond the teacher’s control. Nurses applying cognitive theory will:

• Provide a social, emotional, and physical environment conducive to learning.

• Encourage a positive teacher–learner relationship.

• Select multisensory teaching strategies because perception is influenced by the senses.

• Recognize that personal characteristics have an impact on how cues are perceived and develop appropriate teaching approaches to target different learning styles.

• Assess a person’s developmental and individual readiness to learn and adapt teaching strategies to the learner’s developmental level.

• Select behavioral objectives and teaching strategies that encompass the cognitive, affective, and psychomotor domains of learning.

HUMANISM

Humanistic learning theory focuses on both the cognitive and affective qualities of the learner. Prominent members of this school of thought include Abraham Maslow and Carl Rogers. According to humanistic theory, learning is believed to be self-motivated, self-initiated, and self- evaluated. Each individual is viewed as a unique composite of biologic, psychological, social, cultural, and spiritual factors. Learning focuses on self-development and achieving full potential; it is best when it is relevant to the learner. Autonomy and self-determination are important; the learner identifies the learning needs and takes the initiative to meet these needs. The learner is an active participant and takes responsibility for meeting individual learning needs. Using humanistic learning theory, the nurse focuses on the feelings and attitudes of learners, on the importance of the individual in identifying learning needs and in taking responsibility for them, and on the self-motivation of the learners to work toward self-reliance and independence. Nurses applying humanistic theory will:

• Convey empathy in the nurse–client relationship.

• Encourage the learner to establish goals and promote self-directed learning.

• Encourage active learning by serving as a facilitator, mentor, or resource for the learner.

• Use active learning strategies to assist the client’s adoption of new behavior.

• Expose the learner to new relevant information and ask appropriate questions to encourage the learner to seek answers.

Being aware of the focus and limitations of the various learning theories allows the nurse to use one or more of them when developing a teaching plan for a client. Knowing what is important (e.g., knowledge, motivation, feelings, attitudes) assists the nurse in choosing the appropriate learning theory or theories. The nurse also needs to be aware of the different factors that can affect the client’s learning.

Source: Berman, A., Snyder, S., & Frandsen, G. (2016). Kozier & Erbs fundamentals of nursing: Concepts, practice, and process. Boston: Pearson.