Behaviourist and Social Learning

With reference to chosen theory of learning (behaviourist, social learning) discuss its application to patient education in context of general nursing.

It may be said; why is psychology significant in nursing care and why do we use learning theories to assist in patient care? Well according to Walker et al (2007), in the caring profession nurses, spend most, if not all of their working lives interacting with other people. A key part of a nurse’s job is to promote healthful behaviour. When a patient is admitted to hospital it is often their physical illness that can cause a lot of emotional distress.This means gaining a better understanding of how people cope with illnesses whether acute or chronic.

Understanding health psychology will enable health care professionals to instigate healthful behaviours or ease stressful behaviours in patients. There are many evidence based behaviours that healthcare professionals can use to alleviate certain situations. Learning theory is a coherent framework of integrated constructs and principles that describe explain or predict how people learn.In this assignment the author will endeavour to discuss how behaviours and social learning theories are noteworthy in caring for people in hospital.

Bastable (2003) suggest behaviourism is concerned with learning. According to Brennan (2003) a person’s behaviour, including their personality, is learnt. As children we are tabula rasa, which means we do not have any innate behaviour, we learn these as a result of conditioning. Watson’s famous but highly unethical “little Albert experiment” highlights the influence of conditioning.Driscoll (2000) suggests that behaviourism offers a particular perspective on how learning occurs and how teaching impacts that process.

Green et al (2000) propose that only evident, measurable behaviour is the appropriate object for psychology. Bandura posits that people learn from one another by habituation, association and reward but also by observing others behaviour and imitating it. Another form of learning is social learning; this learning builds on previous experience and also acknowledges a cognitive element to learning. Bandura suggests humans are a product of learning.We are what we are because of the way we have been taught.

There are many things that influence our ability to learn; our biological make up, physical entity social status and one major influence is our cognitive ability. This cognitive ability is one which distinguishes behaviourists from cognitive theorists. Our physical entity and environment reciprocally influence each other and make us what we are. In this assignment the author will discuss the principles of behaviour; habituation, classical and operant conditioning and lastly social learning in regards to patient education.Walker et al (2007) suggest that there are four types of learning identified by the behaviourists. Each of these theories is highly relevant to healthcare particularly nursing not only for the development of the nurses but also for the people with whom they work.

All these theories are built on the principle that all behaviour is learnt. The four types of learning are: Habituation or habitual behaviour is when people do not think long and hard about something for example like brushing their teeth.Unfortunately as well as good habitual behaviours we can also acquire bad habits such as smoking or snacking on chocolate. These behaviours often become so automatic that it is hard to recognise that we are doing them. It can be concluded as suggested by Richard et al (2007) that habituation is the acknowledgement that people can “get used to” or accept elements in their environment.

Payne et al (2000) posit that the most important assumption is that behaviours are based upon a process of reasoning. Pg 33.Classical conditioning according to Richard et al (2007) is training the reflexes such as pain by association. Ivan Pavlov (1849-1936) first recorded and demonstrated accurately the phenomenon of classical conditioning during studies of the digestive systems of dogs.

He deciphered that dogs like humans salivate (reflex response) when they see food; it is a natural physiological reflex response. However he also demonstrated that a signal such as using a bell (stimulus) just before he gave the dog food would eventually lead the dog to salivate at the sound of the bell even if there was no food present.Pavlov verified by pairing or associating another stimulus (the bell) with food he could train the dogs to salivate. This theory could then be applied to people as well. According to Richard et al (2007) it was found that pairing one stimulus with another stimulus could also provoke a reflexive response in people. This is also called a stimulus – response theory of learning.

Operant conditioning according to Walker et al (2007) pg 86 refers to learning that involves changes in voluntary responses those over which we normally have conscious control. Operant conditioning was developed largely by B.F. Skinner (1974,1989).

According to Bastable (2003) pg 57 chap 3 operant conditioning focuses on the behaviour of the organism and reinforcement that occurs after the response. A reinforcer is a stimulus or event applied after a response that strengthens the probability that the response will be performed again. Skinner (1974) suggested that giving positive reinforcement i. e. (reward) greatly enhances behaviour and the likelihood that a response will be repeated in a similar circumstance. A second way to increase behaviour is by applying negative reinforcement after a response is made.

Bastable (2003) posits that operant conditioning techniques provide relatively quick and effective ways to change behaviour. Social Learning theory is largely the work of Albert Bandura (1977-2001) who mapped out a perspective on learning that includes consideration of the personal characteristics of the learner, behaviour patterns, and the environment. (Bastable, 2003). One of Banduras early observations was that individuals need not have direct experiences to learn, considerable learning occurs by taking more of other peoples behaviours and what happens to them.

Role modelling is a central concept of Banduras theory. Modelling according to Marie English notes pg 31 is important when attempting to change old or learn new behaviours. Walker et al (2007) pg 103 suggests that Bandura focuses on observational learning and self efficacy. Bandura discovered that observational learning could occur without an individual being rewarded.

However for this type of learning to be feasible it is important to be in an appropriate environment and with another person from whom to learn (Richard et al 2007).Richard et al posit that there are five cognitive components that influence the likelihood of learning from a situation. Attention, memory, rehearsal and organisation of memory imitation and motivation. It is also imperative that we have effective role models who are well thought of or respected socially, similar to imitate and are rewarded accordingly. Bandura conducted the “Bobo doll experiment” to conclude that children don’t just learn from the consequences of their own actions, but are capable of copying or modelling the behaviour of others. (Walker et al 2007).

This experiment also highlighted the importance and influence of the social environment on behaviour. He also refers to self efficacy which is how we learn to monitor our own performance and reward by internal praise for good performance. Walker et al (2007) suggests that Bandura believed our sense of self esteem is based primarily on our beliefs in our ability to achieve control either individually or collectively over our everyday life. Having outlined the theories above and how they influence people the author will turn to the behaviourist application in the nursing environment.Wyatt et al (1999) suggest that patient education and instructional technology are based on social and behavioural science theories.

The nurse’s goal is to educate patients; we can do this in many ways, through our behaviour as well as social skills. In order for a nurse to educate a patient it is necessary to determine those factors that motivate an individual. We must be vigilant to promote healthy behaviours through empowerment that are not contradictory with the patient’s values. Barker (2007) suggests that habituation behaviour is where a person becomes accustomed to the presence of a stimulus.Nurses frequently have to carry out patient admissions.

In many conditions it may be in very noisy environments, for example near where the ambulances pull in and the siren may be constantly blaring. However after awhile we become accustomed to the noise and it doesn’t distract and we carry on with our admission. A patient may also be so used to a nurse coming around with the blood pressure machine to take their heart rate and observations. Oftentimes they already have their arm out ready for the nurse to apply the blood pressure cuff.

This is a good example of habituation in the hospital environment. Barker (2007) posits that operant conditioning is behaviour where a person will do one thing rather than the other in order to receive an award. According to Payne (1996) operant conditioning takes place as a result of the consequences or outcomes of voluntary (as opposed to reflex) behaviour. The early behaviourist view was that operant conditioning was that of the bond of attachment to the mother occurred because she provided reinforcement in the form of food and comfort.

However Harlow as cited in Walker (2007) demonstrated that a rhesus monkey preferred soft physical contact from an inanimate object even though it did not deliver milk. In order for a nurse to employ health behaviours in a patient it is important to determine those factors that motivate an individual. Operant conditioning is used by the nurse on a daily bases in healthcare settings. As nurses it is important to interact with patients in a holistic level as this gives us the ability to carefully observe patients responses to certain stimuli while determining the best reinforcements to change a particular behaviour.

According to Walker et al (2007) classical conditioning fear and anxiety responses are troublesome and difficult to treat. Therefore prevention is always better than cure. In the hospital environment the nurse can alleviate the patient’s fears through better patient preparation for planned procedures and also good communication. When a nurse meets a patient for the first time he/she may have to help the patient relax on admission. The patients fears may be due previous admissions or after listening to friends and neighbours describe their hospital experiences.Bastable (2003) suggests that a highly positive or negative personal encounter may colour a patients evaluations of their hospital stays as well as their subsequent feelings about having to be hospitalised again.

When a nurse admits the patient they could use a technique called systematic desensitization. If the patient has a terrible fear of having her blood taken the nurse could ease his/ her fears by teaching the patient techniques of relaxation and controlled breathing. Then the patient can learn to apply these techniques when they feel anxious about the nurse coming to take blood.Another widely recognised approach to learning is operant conditioning as discussed at the beginning of this assignment.

For example a patient on a surgical ward may moan and groan when he is getting up for a walk for the first time after his hip operation but with some encouragement (reward) and positive reinforcement for his efforts at walking (response) he will improve his chances of continuing the struggle toward independence. According to Bastable (2003) the key for the nurse is to carefully observe individuals responses to specific stimuli and then decide the best reinforcement procedures to use to change the behaviour.Bastabale (2003) also suggests that operant conditioning techniques provide relatively quick and effective ways to change behaviour. Carefully planned programs can assist the nurse within the healthcare settings and support the emotional and psychological needs of the patient. Another behaviourist approach that can be used by the nurse in the hospital environment is the social learning theory. People oftentimes learn through observation depending on their cognitive ability and how much they learn is up to them.

Nurses are in the perfect position to be role models for their patients.As Bastable (2003) suggests nurses need to look at the healthcare setting as a social situation. When a patient is diagnosed with asthma for the first time, this is a disease of the lungs; the nurse can use all four phases of the social learning theory to demonstrate to the patient how to cope with the disease. The first phase is attentional phase where the patient observes the nurse, e. g.

the nurse will demonstrate to the patient how to use an inhaler for the first time. Second phase is retention phase; this is where the patient will process all the information the nurse has given about the use of the inhaler.Third is the reproductive phase when the patient copies the observed behaviour of how to use the inhaler. Fourth phase is when the patient is motivated to use the inhaler by the nurse and his/her family.

The social learning theory in the context of the hospital environment, responsibility is placed on the nurse to act as exemplary role model and to choose socially healthy experiences for individuals to observe and repeat. According to Bastable pg69(2003) nurses have successfully used the social learning theory principles successfully when working with teenage mothers.One major downside of the social learning theory according to Bastable (2003) is that the theory is complex and not easily operationalised, measured and assessed. However according to Bastable (2003) one of the shortcomings of behaviour modification which the author feels is important is that when the patient goes back to their environment their changed behaviour may deteriorate over time and therefore the cycle begins again. Also research evidence supporting behaviourist theory is often based on animals studies the results which may not be applicable to human behaviour.In many circumstances for example social learning theory may not work as the nurse had to be there and be the role model to demonstrate to the patient and this may not always be feasible.

Also reinforcement does not always work in operant conditioning. Many times giving to much encouragement may negate the overall effective you want to impose. Richard et al (2007) suggest that nurses can use psychological research theories to enhance their nursing practice and most nursing practice has a foundation in psychology, sociology or biology.In a nurses everyday work they will most probably use a behaviourist modification or theory to assist in the holistic care of their patients.

They are comparative and imperative in giving a patient independence and self esteem. The author feels that however each of the theories are complex in there own way they each individually provide a wealth of complimentary strategies and alternative options for nurses and healthcare providers. As nurses the author feels we are in the perfect position to put these theories into action.