1. Pavlov’s Theory of Learning: Classical Conditioning Julie Kalendek RN Lisa Little RN Nattallie Masso BSN, RN Wilmington University, MSN6501

2. Ivan Pavlov (1849-1936) Russian psychologist Nobel Prize winner 1904 for work on digestion Was heavily influenced by Darwin, and recognized that the ability to learn new associations is crucial to adaptation First to study classical conditioning First type of learning to be studied systematically In his famous experiments with dogs, he showed that a desired response can be elicited when paired repeatedly with a stimulus

3. Classical Conditioning Three Phases Phase 1 – Before conditioning occurs Unconditioned Stimulus – elicits response; does not depend on prior learning (food) Unconditioned Response – reflexive or automatic response (salivation) Neutral Stimulus – acquires significance through pairing (tone) NO response (No salivation)

4. Classical Conditioning….. Phase 2 – Conditioning Occurs Conditioned Stimulus is paired with Unconditioned Stimulus… Tone (CS) + Food (US) The tone is sounded then the food is presented.

5. Classical Conditioning….. Phase 3 – Conditioning Complete Conditioned Stimulus elicits Conditioned Response. CS (Tone) CR(Salivation) The dog salivates after hearing tone = Acquisition (initial learning of CR)

6. Across Disciplines…. Therapy Techniques Systematic Desensitization – to treat phobias Advertising Promote consumers positive attitudes about products Food and Taste Aversion Example : a food that made you sick, then you avoid that food. Chemotherapy Anticipatory nausea : classically conditioned response to chemotherapy triggered by previous neutral conditioned stimulus.

7. Nursing Research Broome & Endsley (1987) Studied children’s responses to painful situations Sullivan, Taborsky-Barba, Mendoza, Itano, Cotman, Payne & Lott (1991) Researched olfactory response in neonates, showed that within 48 hours of birth conditioned responses to odors could be elicited Asplund, Norberg, Adolfsson & Waxman (1991) Researched responses in Alzheimer’s patient’s with complex facial expressions and how they are affected by a stimulus condition Eckert (2001) Explored factors that may prevent anticipatory nausea in chemotherapy patients Olney (2005) Research about hypertension vs. stress stimulus, and how massage therapy can elicit lower blood pressure and decrease stress

8. Applied to Personal Practice I recently cared for a patient who was blind and profoundly developmentally disabled. I knew from report that he did not like to be touched. When it was time for me to give him his evening medications, I spoke with him and approached him and touched his arm. He jerked away and pulled the blankets over his head. I continued to talk, but he was not responding. For some reason, I shook the pills in the cup, and as soon as I did this he opened his mouth. When the time for his morning medications came, I talked to him again (but did not touch him this time), shook the cup, and he opened his mouth for his pills. Robert had been conditioned to know that the sound of pills in the medicine cup meant that he needed to open his mouth and swallow them. Robert was 80 years old, and I wondered about all of the nurses and caregivers who had come before me and looked after him, and then silently thanked them for their efforts. (Julie Kalendek) Working in an Oncology Unit we get plenty of patient’s that deal with anticipatory nausea. There was one patient who, when she even saw a nurse from the hospital that she got chemo, she became nauseous. That is the one way Pavlov’s Theory is shown in the field of oncology. Another way I try and use Pavlov’s Theory is when there was a patient that I took care of who was nonverbal, and did not open his eyes when talked to. No one new how to find out if this person was in pain or not. While taking care of him I decided to try to use touch to have him explain what his pain level was. I held this person’s hand and stated to him if he was in a pain of 1 to squeeze once, and to go up to 10 times if it was at a level 10 of pain. I squeezed his hand to explain to him while speaking. After explaining, the patient squeezed my hand 4 times which gave me something to go off of for what kind of pain he was in. Every four hours I would go into his room and hold his hand, and waited to see if he squeezed to let me know he was in pain. (Nattallie Masso) Working on the Cardiac Surgical Intensive Care unit presents many challenges. A big challenge for the nurse is teaching the patient’s to use their “heart” pillow to protect their sternum after surgery. We start as soon as the patients are extubated. They can barely move their arms to hold the pillow. Every time they move or cough, we promptly place the pillow on their chest and remind them to hold it tight and splint their sternum. The pillow becomes the conditioned stimulus. When they see the pillow they remember they are to use it to splint their sternum (conditioned response) and avoid pain and other complications. After the 1 st day of surgery, patients have their pillows at their sides at all times (acquisition.) (Lisa Little)

10. References Broome, M. E. & Endsley, R. C. (1987). Group preparation of young children for painful stimulus [Electronic version]. Western Journal of Nursing Research, 9(4), 484-503. Eckert, R. (2001). Understanding anticipatory nausea. Oncology Nursing Forum, 28(10), 1553. Retrieved from Academic Search Premier database. Kosslyn, S. M. & Rosenberg, R. S. (2007). Fundamentals of psychology in context. Boston, MA: Pearson Education, Inc. McEwen, M. & Wills, E. M. (2007). Theoretical basis for nursing (2 nd ed.). Philadelphia: Lippincott Williams & Wilkins. Sullivan, R. M., Taborsky-Barba, S., Mendoza, R., Itano, A., Leon, M., Cotman, C. W., Payne, T. F. & Lott, I. (1991). Olfactory classical conditioning in neonates. Pediatrics, 87(4), 511-518. Retrieved April 7, 2010, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1952659/