Learn — Psychology: scope, sensation, perception, learning & memory

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Psychology — definition, scope, methods and relevance to nursing

Psychology is the scientific study of behaviour and mental processes — what people do, think and feel, and why — pursued through observation, experiment, case study, survey, interview and psychological testing rather than through opinion. It belongs in the nursing syllabus because every act of nursing is done on and with a person whose perception, learning, emotion and motivation decide whether the care is accepted, and because the nurse's own behaviour under stress is part of the treatment.

The word comes from the Greek psyche (mind or soul) and logos (study); the early definitions — the science of the soul, then of the mind, then of consciousness — gave way to Watson's science of behaviour and today's science of behaviour and mental processes, which keeps both the observable act and the inner experience.
The schools to name: structuralism (Wundt, who opened the first laboratory at Leipzig in 1879, and Titchener — introspection of the elements of consciousness), functionalism (William James — what the mind is for), behaviourism (Watson, Pavlov, Skinner — only observable behaviour, learnt by conditioning), Gestalt (Wertheimer, Köhler — the whole is more than its parts), psychoanalysis (Freud — the unconscious) and humanistic psychology (Maslow, Rogers — growth and self-actualisation).
The branches a nurse meets: general, developmental, abnormal, clinical, social, industrial, educational and health psychology; the syllabus is 'applied psychology' because it asks how each principle is used at the bedside, not for its own sake.
Methods: introspection (looking into one's own experience — subjective), observation (naturalistic or controlled — the nurse's daily method), the experimental method (an independent variable manipulated, a dependent variable measured, with a control group — the only method that shows cause), the case study (one person in depth), the survey and interview, and psychological tests (standardised, reliable and valid instruments).
Behaviour has three faces studied together — cognitive (knowing: sensation, perception, learning, memory, thinking), affective (feeling: emotion, mood) and conative (doing: motivation, will, action) — and a good nursing assessment records all three.
Heredity sets the range and environment fills it: temperament, intelligence and susceptibility to illness are inherited as potential, while learning, culture, family and experience decide what the potential becomes; the nurse can change the environment, which is why health teaching works.
Relevance to nursing: understanding the patient's reaction to illness and hospitalisation, communicating and teaching effectively, motivating adherence, recognising anxiety, depression and abnormal behaviour early, managing pain and fear, working in a team, and protecting the nurse's own mental health from stress and burnout.

Sensation, attention and perception — illusions and hallucinations

Sensation is the raw registration of a stimulus by a sense organ — light, sound, touch, taste, smell, pain, position and balance — while perception is the brain's organisation and interpretation of those sensations into a meaningful whole, and attention is the selection of some stimuli for processing while others are ignored. They matter in nursing because the patient's account of pain or of what was said is a perception, not a recording, and because the failures of perception — illusion, hallucination, inattention — are the earliest signs of delirium, psychosis and sensory deprivation.

Sensation needs a stimulus above the absolute threshold (the smallest energy detected half the time) and a change above the difference threshold or just-noticeable difference (Weber's law — the change must be a constant fraction of the original); sensory adaptation is the fading of a constant stimulus, which is why a ward smell is noticed by visitors and not by staff.
The senses are more than five: vision, hearing, taste, smell and touch, plus pain, temperature, kinaesthesis (position and movement of the body) and the vestibular sense (balance); the receptors for each are specific, and damage to a receptor, its nerve or its cortical area removes the sensation.
Attention is selective, has a limited span (about seven items at once) and shifts; it is drawn by intensity, size, contrast, movement, novelty and repetition in the stimulus and by interest, need, mood and set in the person — the principles a nurse uses to make a health poster or a drug label noticed, and the reason a distracted patient does not hear an instruction.
Perception organises sensations by the Gestalt laws — figure and ground, proximity, similarity, closure, continuity — and is shaped by past experience, expectation, motivation and culture, so two people see the same X-ray differently; perceptual constancy keeps size, shape and colour stable as the retinal image changes.
An illusion is a misperception of a real stimulus (a rope seen as a snake, a coat on the door seen as a person by a feverish patient) and can be normal; a hallucination is a perception without any external stimulus (voices when no one speaks) and is abnormal — the distinction is asked constantly and is the basis of assessing delirium and psychosis.
Sensory deprivation (an isolation room, a bandaged eye, an intensive-care night) produces restlessness, anxiety, poor concentration, illusions and hallucinations within hours to days, and sensory overload (noise, lights, alarms, constant procedures) produces the same; the nurse orients, provides a clock, window, spectacles and hearing aid, a normal day-night rhythm and human contact.
Pain is a perception, gated at the spinal cord and modulated by attention, anxiety, meaning and past experience — distraction, relaxation, explanation and a calm environment lower pain because they change the perception, not because the pain was imaginary.

Learning — classical and operant conditioning, trial and error, insight

Learning is a relatively permanent change in behaviour or knowledge that results from experience or practice, as distinct from the changes that come from maturation, fatigue, drugs or illness. Its theories — classical conditioning, operant conditioning, trial and error, insight and observational learning — are the tools of every health-education session, every rehabilitation programme and every habit a patient must break or make, and they are among the most-asked items in the applied psychology paper.

Classical conditioning (Pavlov, dogs, bell and food): a neutral stimulus paired repeatedly with an unconditioned stimulus comes to evoke the response on its own — the sight of the injection tray making a child cry, or nausea at the smell of the chemotherapy ward; extinction follows when the pairing stops, spontaneous recovery may occur, and stimulus generalisation and discrimination explain fear of all white coats or of one nurse.
Operant or instrumental conditioning (Skinner, the Skinner box; Thorndike's law of effect): behaviour followed by a satisfying consequence is repeated and behaviour followed by an unpleasant one is not; positive reinforcement adds a reward, negative reinforcement removes something unpleasant (both strengthen behaviour), punishment weakens it, and reinforcement given intermittently produces behaviour that lasts longest — the basis of token economies, praise for a diabetic's records, and the persistence of gambling.
Trial and error (Thorndike's cats in the puzzle box): random attempts, with the successful one gradually selected; the laws of readiness, exercise and effect describe it, and it is how a patient learns to use crutches or a mother learns to attach the baby — practice with feedback, not explanation alone.
Insight learning (Köhler's chimpanzees, the boxes and the banana): a sudden reorganisation of the whole problem into a solution — the 'aha' — which needs the elements to be in view and the learner to be ready; it explains why a diagram of the insulin pen works where a list of steps did not.
Observational or social learning (Bandura, the Bobo doll): behaviour is learnt by watching a model, especially one who is liked, powerful or rewarded, and a child learns hand-washing from a parent's hands more than from a lecture; the nurse is a model whether she intends it or not.
Laws and conditions that speed learning: motivation and readiness, the whole-to-part method for meaningful material and part learning for long skills, spaced practice over massed, active recall over passive reading, immediate knowledge of results, meaningful association, and the transfer of training — positive when an old skill helps a new one, negative when it interferes (a nurse who learnt one glucometer misreads the next).
Applying it to a patient: assess readiness, set small achievable goals, demonstrate and have the patient return the demonstration, reinforce every correct step at once, space the sessions, use the senses the patient has, and involve the family as models; a plateau in learning is normal and ends with continued practice.

Memory and forgetting — stages, types and improving retention

Memory is the process by which what has been learnt is registered, retained and later retrieved, in three stages — encoding, storage and retrieval — and in three stores of increasing duration: sensory memory of a second or two, short-term or working memory of about 20 to 30 seconds and seven items, and long-term memory of years. Forgetting is the failure of any of these stages, and the nurse meets it twice — in the patient who cannot remember the discharge instructions, and in the assessment of memory loss that separates normal ageing from dementia and delirium.

Sensory memory holds an exact image or echo for under a second (iconic) to a few seconds (echoic); short-term memory holds about seven plus or minus two items for 20 to 30 seconds unless rehearsed, and is enlarged by chunking (a ten-digit number as three groups); long-term memory is effectively unlimited and organised by meaning.
Long-term memory divides into declarative or explicit memory — episodic (events: the day of the operation) and semantic (facts: the dose of paracetamol) — and procedural or implicit memory (skills: giving an injection), which is why a person with amnesia can still ride a bicycle and a patient with dementia can still knit.
Retrieval is recall (producing the material without cues — an essay), recognition (identifying it among alternatives — a multiple-choice paper, which is why recognition is easier than recall) and relearning (the savings when material is learnt again).
Theories of forgetting: decay of the trace with time when it is unused; interference — proactive when old learning blocks new (the old drug chart's layout) and retroactive when new learning blocks old; retrieval failure when the cue is missing (the tip-of-the-tongue state); motivated forgetting or repression of painful material (Freud); and organic amnesia from head injury, alcohol (Korsakoff), dementia or electroconvulsive therapy — retrograde for events before the injury, anterograde for events after.
Ebbinghaus's forgetting curve shows most forgetting happens in the first hours after learning and then slows, which is the argument for teaching a patient shortly before discharge, repeating the key points, and giving them in writing.
Improving memory: attention and intention to remember, meaningful organisation, association and imagery, mnemonics (the acronym, the method of loci), chunking, spaced repetition, active recall, sleep after learning, and reducing anxiety — the same rules apply to a patient's medicine schedule and a candidate's revision.
Assessment at the bedside: registration (repeat three words), short-term recall (the three words after five minutes), remote memory (date of marriage), and orientation; sudden memory loss with clouding of consciousness is delirium, gradual loss with a clear consciousness is dementia, and loss confined to a period around a head injury is post-traumatic amnesia.

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