health promotion nurse as teacher - weebly
TRANSCRIPT
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HEALTH PROMOTION
NURSE AS EDUCATOR
Vicky Bayer, BSN, RN, NCSN
March 2015
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To define holism and two types of homeostasis
To identify the framework of Healthy People 2020
To differentiate between the three levels of
prevention
To interpret the stages of behavior change
To apply the nursing process to health promotion and
health prevention
HEALTH PROMOTION OBJECTIVES
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HOW DO WE SEE OTHERS
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Looks at the person in their entirety
People are more than the sum of their parts
Consider
Relationships of individual to others
Relationships of individual with environment
Relationship of the person with self
Example: Grieving
Affects: appetite, sleep, energy, mood, sense of well -being
HOLISM
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The tendency of the body to maintain a sense
of balance or equilibrium while in the process
of changing
HOMEOSTASIS
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1. Self-regulation
2. Compensation
3. Tends to be negative feedback system (inhibits change)
4. Several feedback systems may be needed to correct
one imbalance
Example: Hypoxia (decreased 02)
Increased RBC’s
Increased HR
Hint: May need to look for help from environment
PHYSIOLOGICAL HOMEOSTASIS
BODY’S INTERNAL ENVIRONMENT
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Psychological needs of love, security, self -esteem
When needs are not met
Employ coping mechanisms from life and learned experiences
Healthy
Harmful
PSYCHOLOGICAL HOMEOSTASIS: EMOTIONAL BALANCE OR STATE OF WELL -BEING
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Needs Theories
Goal of self-actualization
Maximize potential and abilities
Realize abilities and qualities
Developmental Stage Theories
Categorize behaviors or abilities into an approximate
age range
THEORETICAL FRAMEWORKS
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Maslow
Physiological
Safety and security
Love and belonging
Self-esteem
Self-actualization
Kalish
Physiological
Stimulation
Sex, activity, exploration,
manipulation, novelty
Safety and security
Love and belonging
Self-esteem
Self-actualization
NEEDS THEORIES
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Typical behaviors within an age group
Majority of people
Not all inclusive
Does not include individual differences
Helps to compare clients to a similar group in
a similar situation
Theorists : Erickson, Freud, Havinghurst (Chapter 20)
DEVELOPMENTAL STAGE THEORY
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Department of Health and Human Services
initiative for health promotion, health
protection, and health prevention strategies
HEALTHY PEOPLE 2020
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Identify nationwide health improvement priorities
Increase public awareness
Provide measureable objectives & goals
Strengthen policies & improve health practices (EBP)
Identify research, evaluation, and data collection
needs
HEALTHY PEOPLE 2020 FRAMEWORK
Determinants of health Disease
Disability Opportunities for improvement
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Attain high quality longer lives free from Preventable disease
Disability
Injury
Premature death
Health equity: eliminate disparities
Create social and physical environments that
promote health
Promote quality of life and healthy behaviors
HEALTHY PEOPLE 2020
OVERARCHING GOALS
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Complementary processes affecting the
quality of health
Sometimes used interchangeably
HEALTH PROMOTION-HEALTH PROTECTION
Health Promotion Health Prevention
Not disease oriented
Preventing illness
Develop sense of well-being
“Be the best that you can be”
Limiting illness progression
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Primary Prevention: avoid the onset of a health
condition, including injuries
Precedes disease
Secondary Prevention: identifying and treating
those who have risk factors or a pre-clinical disease
Early detection of disease
Tertiary Prevention : once an illness is detected
Rehabilitate & restore to optimum level
LEVELS OF PREVENTION
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Teaching self-examination for breast and testicular
cancer
Secondary
Establishing bike and walking trails
Primary
Encouraging regular medical check-ups
Secondary
Referring a client to a support group
Tertiary
“Know your Number” campaign
Secondary
LEVEL OF PREVENTION?
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Infants: Breastfeeding, immunizations, bonding
Children: Safety, immunizations, nutrition
Adolescents: Body image, safety, peer influences
Older Adults: Sleep, mental health, fitness
HEALTH PROMOTION TOPICS
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Community
programs Bicycle safety programs
Smoking cessation
Fire prevention
programs
Medical programs Immunization clinics
Classes on stress
reduction
Support group
Limiting x-ray exposure
School programs Dental care
Nutrition
Sexuality “the talk”
Work programs Back-saver programs
Injury prevention
Health screenings
Wellness programs
HEALTH PROMOTION ACTIVITIES
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Motivational source for behavior change
Approach or competence oriented
Based on individual’s value of change
How does the client perceive the benefit of change
What are the barriers
Self-efficacy (can I do it?)
HEALTH PROMOTION MODEL
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Pre-contemplation
Contemplation
Preparation
Action
Maintenance
Termination
6 STAGES IN BEHAVIOR CHANGE
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Action is greater than 6 months away
Does not want to consider changing
May have tried before and failed
May feel it is hopeless
Avoids learning about or even thinking about
behavior
PRE-CONTEMPLATION
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Acknowledges “I have a problem”
Considers changing behavior
Plans to change within 6 months
Starts to collects information
Tells people they are planning on changing
May not be quite ready to commit to change
May stay in this stage for months or years
CONTEMPLATION
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Plans to take action in the immediate future
(1 month)
Start making small behavior changes
Starts to formulate plan for change
PREPARATION STAGE
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Actively starts to change behavior
Uses cognitive strategies to stop previous
health risk behaviors
Develops and adopts new healthier behaviors
Takes commitment
Takes time
Takes energy
ACTION STAGE
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Try to prevent relapse
Integrate new behaviors into lifestyle
Stage lasts until the health risk behavior is no
longer a temptation (usually 6 months to 5
years)
MAINTENANCE STAGE
If relapse occurs usually returns to
pre-contemplation or contemplation stage
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No longer any temptation
Behavior is no longer a threat
As if behavior never existed
New behavior is automatic
Experts are unsure if some behaviors can ever
reach this stage (goal may have to be adjusted
to maintenance)
TERMINATION STAGE
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Information dissemination Books, pamphlets, media
Health risk appraisal Wellness assessment programs: BP checks, questionnaires
Assist in lifestyle and behavior changes Community programs: exercise, stress management,
nutrition
Environmental control programs Helps to decrease contaminants: food, water, air
Work with clients (facilitator or coach)
NURSES ROLE IN HEALTH PROMOTION
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Assessment
Health risks, H & P, lifestyle, spiritual health, social support,
culture, life change index (Chapter 16)
Diagnosis: NANDA wellness diagnoses
Readiness for enhanced….nutrition, self -health
management
Planning
Identify health goals, behaviors, stage of change
Develop strategies, explore resources
Interventions
Provide education, support, model behavior
Evaluate
Collaborative effort – client and nurse
NURSING PROCESS
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QUESTIONS ON HEALTH
PROMOTION?
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BREAK
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NURSE AS EDUCATOR
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Define three learning domains
List three behavior theories
Discuss factors that affect learning
Construct a teaching plan using the nursing
process
Discover personal perceptions and bias when
assessing
NURSE AS EDUCATOR OBJECTIVES
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Nursing function
Legal and professional responsibility
Included in Patient’s Bill of Right
Included in state nurse practice acts
Joint Commission expanded education to
include family and significant others
EDUCATION
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Health promotion
Health protection
Health maintenance
Decreasing health risk
Increased wellness
Safety
WHAT DO NURSES TEACH?
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Clients
Families
Community
Nurses
Other health professionals
WHO DO NURSE TEACH?
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Educational background
Literacy level
Language skills
Culture of each learner
Learning need
Desire to know new knowledge, new skill, new
behavior
CONSIDERATIONS
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Cognitive Domain
Thinking (knowing, comprehending, applying,
analyzing, synthesizing, evaluating)
Affective Domain
Feeling (feelings, attitudes, interests,
appreciations)
Psychomotor Domain
Skill (fine and gross motor skills)
LEARNING DOMAINS
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Behaviorism
Based on behavior, observable
Pavlov's dog, Skinner
Cognitivism
Learning is an thinking or intellectual process
Environment where learning takes place matters
Learner-teacher relationship matters
Piget, Lewin
Humanism
Thinking and feeling
Learning is self-motivated, self-initiated, & self-evaluated
Each person is unique: biological, psychosocial, social,
cultural, spiritual – Focus on full potential
BEHAVIOR THEORIES
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Age and developmental
stage
Readiness to learn
Active involvement – is the
learner “on board”
Active involvement/Passive
involvement
Relevance
Feedback
Non-judgmental Support
Simple to complex
Repetition
Timing
Environment
Emotions
Physiological events
Cultural aspects
Psychomotor ability
FACTORS THAT AFFECT LEARNING
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Acute illness
Pain
Prognosis
Biorhythms – circadian rhythm
Emotions – anxiety, grief, denial, depression
Language
Age
Older adults – hearing and vision problems, decrease motor ability
Children – short attention span, vocabulary
Resources
Internet knowledge, internet access
BARRIERS TO LEARNING
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What are
some
barriers to
learning?
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Assess learning need
Form nursing diagnosis
Plan teaching strategy and set goals
Implement plan
Evaluate – goals and teaching techniques
TEACHING AND NURSING PROCESS
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Nursing H & P
Support system
Readiness to learn –
motivation
Literacy level
Stage of change
Barriers to change
Beliefs, culture,
economical factors,
spirituality
Developmental level
Learning style How do you best learn new
things?
How comfortable are you
with computers?
Health literacy Understanding health
information
ASSESSMENT
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Is she ready to learn?
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Possible indicators of literacy problems
Errors in self care or medications
Insisting they already know
Forms completed incorrectly
Does not want to read instructions – “I’ll read it later”
Withdrawn when being instructed
Strategies
Plain language
Return demonstration
2-3 important pieces of information
Use drawings or models
LITERACY - HEALTH LITERACY
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Identity learning need
NANDA
Deficient Knowledge
Medication information related to newly prescribed
medication
Readiness for Enhanced Knowledge
Nutrition and exercise to reduce risk of heart disease
Noncompliance
With daily medication plan related to insufficient finances
NURSING DIAGNOSIS
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Determine teaching priority
Select teaching strategy
Determine setting
Develop teaching outcomes
Cognitive domain
Affective domain
Psychomotor domain
PLANNING
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Be Flexible
Revise as needed
Guidelines
IMPLEMENTING/INTERVENTIONS
Respect Communicate
clearly & concisely
Client
participation
Use previous
learning
Use lay vocabulary
Teaching aids
Pick a good time Watch pace (too
fast, too slow)
Repetition
Learning
environment
Equipment
needed
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Group teaching
Computer
Client contracts
Rewards
Discovery/Problem solving
Behavior modification
OTHER LEARNING METHODS
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Measure against predetermined outcomes
Revise (as needed)
Diagnosis
Outcomes
Document teaching and client response
What did they say?
What did they do?
Evaluate own teaching
Did you leave resources?
EVALUATING
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BEHAVIOR CHANGE & TEACHING
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QUESTIONS
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Berman, A. & Snyder, S. J. (2012), Kozier & Erb’s
fundamentals of nursing: Concepts, process and practice (9th
ed.). Upper Saddle River, New Jersey: Pearson
Kovner, A.R., & Knickman, J.R. (Ed.). (2011 ). Jonas & Kovner’s
health care delivery in the United States (10th ed.). New York,
NY: Springer Publishing Company.
REFERENCES
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THANK YOU