Learning Theory
... when they see the unusual food only, not the normal meal. This will not affect patient’s normal daily meal so that they can have normal energy intake from normal meal. Extinction, counter-conditioning, flooding, systematic desensitization are the techniques that can be used with classical conditioning to deal with patients. Extinction is keeping repeating giving the conditional stimulus without giving unconditional stimulus to eliminate the conditional response. Extinction often uses to overcome the fears, for example, some patients recovered from the cancer. At first, they may still fear about the trauma (which has been removed). In this case, trauma is unconditional stimulus, patients may overcome this feeling as they found that the trauma (unconditional stimulus) is completely removed and no longer exist, and therefore there is nothing for them to fear. (King and Remenyi, 1986, p.28) Counter-conditioning is a technique that using a desirable response to replace with the unwanted response, so that the desirable response can associate with the conditional stimulus. For instance, teaching patients to have relaxation to replace anxious when they facing the treatment (King and Remenyi, 1986, p.28). Flooding is continually exposed to the stimulus without escaping from the situation. Systematic Desensitization is a classical conditioning procedure that used to treat anxiety disorders. It is used to substitute the anxiety by giving relaxation training to patient. Patient will be taught another response by muscle relaxation and deep breathing. These two components can reduce patients’ anxious. In the treatment, a hierarchy of situations will be introduced, from low anxiety situation to extreme anxiety situation. Patients are required to expose these situations, while they overcome without any anxiety, they will move to the next situation, until they complete all the stages. Systematic desensitization is always associated with the counter-conditioning which relaxation response is associated with the stimulus that replaced the anxiety response. (Taylor, 1991, p.91; Walker et al, 2004, p.67) Sometimes, nurses use systematic desensitization to treat anorexia patient. These patients went to on diet, reduced many weights, but they are afraid of eating food because they afraid they will get fat again. Therefore when they see or eat food, they will vomit. Nurse can train them to be relaxed when they are fear to the food and several situations are set up in hierarchy series to deal with her treatment. First, they may just sit in front of the table that full of food, then when they overcome with this situation, then they may asked to eat a little bit of food and watch themselves in the mirror. As they overcome each session, they can eat complete meal and gain some weight. In this case, flooding and counter-conditioning are used, as the patients continuously exposed to the food while using a relaxation response to replace an anxiety response (Snyder, 1989, p.230) Operant conditioning Operant condoning is another kind of conditioning theory. Unlike classical conditioning, operant conditioning is involved in voluntary an action which is conscious. It is effect the occurrence of that behaviour(Walker et al ,204, p.67; Snyder, 1989, 215). Reinforcement and punishment are two important components of operant conditioning. Reinforcement is anything that increases the likelihood of repeating the behaviour which considered as reinforcer, for example, food, money, praise “Excellent!” “That’s great!”. There are primary reinforcer and secondary reinforcer. Primary reinforcer is the event that are basic reinforcer, for example, food, water. Secondary reinforcer is the sources which come from primary reinforcer often considered as feeling such as fear, happy. Reinforcement can be divided into positive reinforcement and negative reinforcement. Positive reinforcement is present a favorable event or positive reinforcer which increase the responses. Negative reinforcement is to remove an unpleasant event that can increase the frequency of the response. For example, some patients who experienced headache may take aspirin or panadol to remove the pain. Punishment is anything that reduce and weaken the frequency of the respond. However, it is not recommended that to use punishment when deal with behaviour modification because some people may just stop the behaviour temporary to avoid the punisher and situation which it is considered as unlearned (Walker et al, 2004, p.68; King and Remeni, 1986, p.29; Snyder, 1989, p.216) Extinction also occurs in operant conditioning, it happens when the reinforcement no longer exist and reduce the strength of the reinforced response. For example, patient who has chronically illness, extinction can be used to decrease the dependent behaviour. (King and Remenyi, 1986, p.29) The schedule of reinforcement is important in behaviour modification of patient . They can be given in a fixed time which is continuous reinforcement or in occasional time which is intermittent reinforcement. According to Jones (2003, p.70), reinforcement should be given continuously at first, then can be given in no particular pattern as behaviour change, it is best for maintaining behaviour. For example , nurse have to use continuous reinforcement to train stroke patient to prepare their own meal, but when patient return to home, intermittent reinforcement such as occasionally praise and encourage can maintain their independence to prepare their meal. (King and Remenyi, 1986, p.30) Some patients who have liver, kidney, gastrointestinal problems are required to stop abuse drinking alcohol in order to help them to recover. However, overuse of alcohol is a habit that is difficult to modify. Therefore, nurse should us...