Running head: CONTRIBUTIONS OF LEARNING THEORIES IN NURSING
Contributions of Major Learning Theories in Shaping Nursing Education
A Paper
Submitted in Partial Fulfillment of the Requirements
For NURS 5327
In the College of Nursing
The University of Texas at Tyler
By
Kristi Burns, Stephanie Crowe, and Tracy Nash
June 16, 2014
CONTRIBUTIONS OF LEARNING THEORIES IN NURSING
2
Contributions of Major Learning Theories in Shaping Nursing Education
In order to understand how to be an effective teacher, it helps to understand how people
learn. There have been many theories on how the human brain learns and these theories have
evolved since the middle of the 19th century when people started to study learning. The major
theories of behaviorism, cognitivism, social cognitivism, humanism, constructivism, and brainbased learning have been studied and developed by some of the leading theorists of our time.
Psychology, medicine, nursing, and teaching have all benefited from the theories proposed by
Ivan Pavlov, B.F. Skinner, Abraham Maslow, Carl Rogers, and many others. In this paper we
will explore how their contributions and theories have helped shape what we know about
learning and specifically how this applies to educating nurses.
Six Major Nursing Theories
Social Cognitivism
Overview. Social Cognitivism was an expansion on Piaget’s cognitive theory and was
first proposed by Lev Vygotsky (Oermann, 2013). This theory emphasizes the idea that learning
is a social process and places value on a person’s cultural background, language, and human
interactions and how that impacts the way he or she learns (Oermann, 2013). The idea of “zone
of proximal development” explains the way students learn best by using their existing knowledge
of a subject, then expanding that knowledge to learn something new with the help of a teacher or
mentor (Oermann, 2013). Albert Bandura (1977) expanded on this idea of social cognitivism
and pointed to observational learning, imitation, and modeling as the major components in how
one learns (as cited in Oermann, 2013). In a sense, social cognitivism recognizes that humans
are social creatures and that we can not only learn from the actions we perform daily, but also by
interacting with others.
CONTRIBUTIONS OF LEARNING THEORIES IN NURSING
3
Using social cognitivism in nursing education is an idea that differs slightly from the way
we traditionally teach students. In a study of medical students working daily in a rural clinical
setting, Daly, Roberts, Kumar, & Perkins (2013) found that students progressed from a
theoretical learner to knowing clinical skills. In addition students reported more active
engagement socially and developed a stronger clinical identity. This study is an important
contrast in how we currently teach nursing and medical students with traditional lecture, then
separate clinical learning by department and short term clinical exposure. The study by Daly et
al. (2013) allowed students to use the geography of a rural clinical setting and their long-term
presence in the clinic to be exposed to many different clinical situations with expert supervision.
This encouraged students to take ownership in patient care.
Strengths and weaknesses. Social cognitivism has strengths and weakness in regards to
nursing education. The benefit of social interaction and hands on experience when learning a
new skill is valued in medicine and nursing. Seeing, repeating, and doing is a very effective way
to learn for many students and so much more applicable than just reading about it in a book.
Daley et al. (2013) indicate strengths of this method include students developing their own selfconfidence and self-efficacy. On the other hand, a weakness of using this method is the very fact
that it is a social relationship. Daly et al. (2013) admitted that learning is dependent on the
student -supervisor relationship and some variability was noted depending on the different
supervisor relationships. Social cognitivism is dependent on social interaction, so it is important
for mentor and student to have a good rapport. Oermann (2013) suggests activities such as
demonstration and return demonstration, observational learning, and role modeling as some
methods for teaching using the social cognitivism theory. The theory of social cognitivism is a
shift from the paradigm of cognitivism and seeing learning as just an internal process. Learning
CONTRIBUTIONS OF LEARNING THEORIES IN NURSING
4
can occur in different environments and is a constant flow of social interactions, knowledge and
pushing the boundaries of what one knows (Oermann, 2013).
Humanism
Overview. Within the humanist framework, learning is viewed as a personal act
necessary to achieve the learner’s full potential (Schunk, 2012). The goal of this approach is for
the learner to become autonomous and self-directed (Rostami & Khadjooi, 2010). Two major
contributors of humanism are Abraham Maslow and Carl Rogers. Maslow developed the
Hierarchy of Needs theory, determining that most human actions are based of hierarchical needs,
with lower order needs taking precedence over higher order needs (Oermann, 2013). Rogers
concluded that for people to grow, “they need an environment that provides genuineness,
acceptance, and empathy” (Oermann, 2013, p. 19). Examples of teaching methods based on
humanism include participatory and discovery methods, allowing students choices and
opportunities for their learning, and providing resources and encouragement for learning
(Oermann, 2013).
Strengths and weaknesses. A strength of this theory is that it permits the student and
teacher to work together as nurses typically do in clinical practice. It stresses the importance of
holistic learning, which can translate over to holistic care of the patient (Halarie, 2005). This
approach also promotes the opportunity for developing skills necessary for lifelong learning,
which are important to nursing students as they step into a career that is constantly changing
(Halarie, 2005). Moreover, it offers numerous opportunities to learn and develop skills on a daily
basis. This style of learning also has its weaknesses. One of the biggest criticisms is that it
fosters self-centeredness in learners and does not prepare students to appreciate the benefits of
constructive criticism (Butts & Rich, 2011). Throughout nursing education and a nursing career
CONTRIBUTIONS OF LEARNING THEORIES IN NURSING
5
we are faced with much criticism and need to be able to use that criticism to make our work
better.
Constructivism
Overview. Constructivism refers to learning as “an active, contextualized process of
constructing knowledge through experiencing and reflecting on the experience rather than
acquiring it” (Oermann, 2013, p. 20). Knowledge is developed from personal experiences and
inferences drawn from the environment (Oermann, 2013). Contributors to this theory include
John Dewey, Jean Piaget, David Kolb, and Roger Fry. Dewey’s idea of progressive education
maintains that students need to be invested in what they are learning, whereas Piaget concludes
that that learning is a developmental process where knowledge is created rather than learned
from a teacher (Oermann, 2013). Kolb and Fry advanced the Experiential Learning Model,
which is composed of four key elements: concrete experience, observation and reflection of
experiences, development of abstract concepts from reflections, and testing the new concept
(Oermann, 2013). A cycle of learning is composed of these four elements that typically begins
with concrete experience, although it can begin with any element (Oermann, 2013). Examples of
teaching methods based on constructivism include case studies, class discussions, field trips,
research projects, and simulation (Oermann, 2013).
Strengths and weaknesses. Constructivism has both strengths and weaknesses. A
weakness of this theory is that designing suitable activities requires careful planning, greatly
increasing preparation time. Activities must tease out the required concepts, which makes
learning the abstract difficult if examples are inadequate. Also, because lessons depend on
specific answers to questions, lessons must be tested and tweaked just before presentation
(Cooperstein & Kocevar-Weidinger, 2004). Although difficult and time consuming,
CONTRIBUTIONS OF LEARNING THEORIES IN NURSING
6
constructivist learning has many benefits. Carefully planned, structured, and directed activities
lead students to discover concepts and develop skills. Abstract concepts become meaningful,
transferable, and retained since they are attached to the performance of activities. Ultimately, the
activities lead to concepts where students have constructed the meanings and learning takes place
(Cooperstein & Kocevar-Weidinger, 2004).
Brain-based Learning
Overview. Brain-based learning (BBL) is the last major learning theory explicated in
this paper. Although BBL may be described as “the active engagement of strategies based on
principles derived from an understanding of the brain” (Jensen, 2008b, p. 4), it is most
commonly recognized by three terms: engagement, strategies, and principles (Jensen, 2008a).
This theory that emerged in the 1980s focuses on the brain’s chemical, biological, and
physiological dynamics (Cardoza, 2011). According to BBL, as the brain’s cortical neurons
increase the rate of signaling, more synapses are created in the areas of the brain that are
stimulated (Oermann, 2013). Repeated firing and exposure to chemicals such as serotonin and
adrenalin increase the number of neurons (Oermann, 2013). Ultimately, the number of
neocortical areas engaged in the process are directly proportional to the longevity of learning that
takes place (Sousa, 2011). Examples of teaching methods using brain-based learning include
providing frequent feedback, encouraging peer support, allowing students time to practice prior
to testing, maintaining a variety of teaching methods to support different learning styles, and
preexposing learners to content prior to examinations (Oermann, 2013).
A few primary contributors to the BBL theory include Jensen and Sousa (Oermann,
2013). Their work to disseminate neurological research helped uncover the role of brain
chemistry in the acquisition of knowledge. The core principles of the BBL theory are delineated
CONTRIBUTIONS OF LEARNING THEORIES IN NURSING
7
by two other contributors, Caine and Caine (1997), and include the following focuses: the brain
is a uniquely organized parallel processor, stores information in multiple areas, and has many
memory and neutral pathways; learning is a mind-body experience; the search for meaning is
innate and comes through patterning; emotions drive our attention and are critical to patterning;
learning involves focused attention; memory may be rote or spatial, but natural spatial memory is
best for understanding; complex learning is constrained by stress and enhanced by challenge; and
learning is developmental (as cited in Wilson, 2013). The BBL theory additionally incorporates
several learning concepts, which include experiential learning, cooperative learning, practical
simulations, learning styles, and problem-based learning (Wilson, 2013).
Strengths and weaknesses. The strengths from utilizing these core principles and
learning concepts in nursing education include the promotion of learning in accordance with the
way the brain is naturally designed to work (Degen, 2014), instruction that can conform to a
variety of types of learners, active participation of students in the learning process, increased
retention of information (Jensen, 2008b), better insights into learning behavior, and the
application of critical thinking (Cardoza, 2011). Contrarily, some weaknesses of BBL include
time-intensive projects, an increase cost with hands on activities (e.g., simulation labs), and
greater educator participation that may not be feasible in all class environments (McCarthy,
2010). Overall, many benefits are provided through BBL, however, more time-honored theories
may be more appropriate depending on class size and time constraints.
Conclusions
The relevance of how six major learning theories can be applied in nursing education to
benefit student learning outcomes were explored. Adapting learning theories to analyze how
concepts can be shared and how students can best assimilate knowledge are important skills for
CONTRIBUTIONS OF LEARNING THEORIES IN NURSING
8
all nurse educators to embrace. This paper provides an overview of some major theories that
have helped shape our knowledge about learning and provides suggestions about how nursing
faculty can teach students different ways to learn based on their personal needs.
Behaviorism is one theory that looks at learning as trained or learned behaviors that are
augmented by positive or negative reinforcements. Oermann (2013) discusses how behaviorism
is being used in nursing education in traditional methods, such as lecture without active
discussion and skills exercises. Cognitive learning focuses on learning as purely an internal
process. Oermann (2013) points out that this differs from behaviorism, since learning must occur
internally before a behavior change is noted. One extension of cognitivism is social cognitivism.
Social cognitivism builds upon learning as an internal process, but is also affected by social
interactions and the learner’s environment and cultural influences. Some examples of using
cognitivism and social cognitivism in teaching are role modeling, observation, and
demonstration (Oermann, 2013). The humanistic method of learning focuses on Maslow’s
Hierarchy of Needs and learning as a person achieving his or her highest potential. Kleiman
(2007) gives examples of the humanistic theory of learning and the value of the relationship
between student, teacher, and patient as it develops through dialogue. Constructivism is a theory
that is seen utilized in online courses. Online learning is being used more frequently for many
undergraduate and graduate level students. Kala, Isaramalai, and Pohthong (2010) discuss the
constructivism theory of e-learning based on the student’s interaction with their facilitators and
provided resources. In this method students build knowledge based on previous knowledge and
experiences. Although a popular learning method, Kala et al. (2010) point out a few downfalls,
such as lessons that are too structured and students with limited computer skills. Finally, brainbased learning is a method of teaching based on how the brain learns from a physiological
CONTRIBUTIONS OF LEARNING THEORIES IN NURSING
9
perspective. Oermann (2013) discusses several teaching methods, including teaching in-depth
concepts, early exposure of the learner to content, allowing student feedback, and using different
teaching methods to address a variety of learning styles.
Nursing educators need to familiarize themselves with all of these theories and how they
can be used for teaching content to nursing students. Although each theory offers different
advantages, teachers must consider their students’ personal learning demands. Learning is a
complex process and each individual learns best in a variety of ways. Overall, knowledge of
these theories can help the educator determine the most effective teaching method to employ in
an online or traditional classroom.
CONTRIBUTIONS OF LEARNING THEORIES IN NURSING
10
References
Butts, J., & Rich, K. (2011). Philosophies and Theories for Advanced Nursing Practice.
Sudbury, MA: Jones & Bartlett Learning.
Cardoza, M. P. (2011). Neuroscience and simulation: An evolving theory of brain-based
education. Clinical Simulation in Nursing, 7(6), e205-e208.
doi:10.1016/j.eens.2011.08.004
Cooperstein, S., & Kocevar-Weidinger, E. (2004). Beyond active learning: A constructivist
approach to learning. Reference Services Review, 32(2). 141-148.
Daly, M., Roberts, C., Kumar, K., & Perkins, D. (2013). Longitudinal integrated rural
placements: A social learning systems perspective. Medical Education, 47(4), 352-361.
doi:10.1111/medu.12097
Degen, R. (2014). Brain-based learning: The neurological findings about the human brain that
every teacher should know to be effective. Amity Global Business Review, 915-23.
Halarie, E. (2005). Pragmatism and humanism in nursing education: A chance for change?
ICUs & Nursing Web Journal, 24, 1-8.
Jensen, E. P. (2008a). A fresh look at brain-based education. Phi Delta Kappan, 89(6), 408-417.
Jensen, E. P. (2008b). Brain-based learning: The new paradigm of teaching (2nd ed.). Thousand
Oaks, CA: Corwin Press.
Kala, S., Isaramalai, S., & Pohthong, A. (2010). Electronic learning and constructivism: A model
for nursing education. Nurse Education Today, 30(1), 61-66.
doi:10.1016/j.nedt.2009.06.002
Kleiman, S. (2007). Revitalizing the humanistic imperative in nursing education. Nursing
Education Perspectives, 28(4), 209-213.
CONTRIBUTIONS OF LEARNING THEORIES IN NURSING
11
McCarthy, A. (2010, April 11). Fundamentals of curriculum: Brain-based learning. [Web log
comment]. Retrieved from http://rowanclass09.blogspot.com/2010/04/brain-basedlearning.html
Oermann, M. H. (2013). Teaching in nursing and the role of the educator: The complete guide to
best practice in teaching, evaluation, and curriculum development. New York, NY:
Springer Publishing Company.
Rostami, K., & Khadjooi, K. (2010). The implications of behaviorism and humanism theories in
medical education. Gastroenterology and Hepatology from Bed to Bench, 3(2). 65-70.
Schunk, D. H. (2012). Learning theories: An educational perspective. Boston, MA: Pearson.
Sousa, D. (2006). How the brain learns (3rd ed.). Thousand Oaks, CA: Corwin Press.
Wilson, L. O. (2014). The second principle. Retrieved from
http://thesecondprinciple.com/optimal-learning/brainbased-education-an-overview/