CNUR 106 unit 2 notes PDF

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CNUR 106 university or Regina for SCBScN program, Kim's lecture...

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CNUR 106 notes Nurse’s role as a teacher  assessing problems or deficits  providing information in unique ways  identifying progress made  giving feedback and follow-up  reinforcing learning  evaluating learners’ abilities  most complex and essential intervention  apply highly skilled assessment and communication skills Underlying assumptions  each client serves as expert of self-knowledge  provider is expert of health knowledge  both responsible for the progression of knowledge in each other Information exchange  educator and learner roles continually adjust through the interaction  co-learning from one another  providers rely on information from client to develop treatment plan  span of influence o relationship between knowledge and power o clients with more information have a greater ability to influence their healthcare o span increases, the amount of effect on their situation increases o client must CLAIM and EXERCISE the power Role of RN Rn responsible to ensure the client receives the information (SRNA)  health status can interfere in processing information  clients have multiple barriers to leaning-pain, fear, separation  RN teaching styles can create a barrier  People have different preferences for learning  Designed to accommodate educational, cultural diversities and individual abilities  Interpret and adapt information based on the learner’s situation/needs Required skills  Misunderstandings can be devastating/fatal  Excellent communication  Recognise the uniqueness of the leaner  How to structure information so each person can receive, understand, remember and apply it Barriers to providing education

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Lack of time Unfamiliar with how to teach Unfamiliar with instructional design of materials Unskilled communication practices

Education process  Assessment: determine learning needs, readiness to learn  Planning: teaching plan based on mutually developed goals  Implementation: perform the act of teaching  Evaluation: determine behaviour changes in knowledge, attitudes, skills Movement of information  Begins with trust  Levelled power relationship  Information is shared and internalised by both parties o Integrate new information o Access it to make health decisions o Provider understands the uniqueness of the client Why is learner assessment important?  Most important-most neglected  Lack of assessment-repeat ineffective methods/materials  Individualised approach=better health outcomes  Minimizes stress  Best learning for client  Not wasting time  i.e. diabetic not living near a grocery store

Assessment of the learner and the determinants of learning  Learning needs o WHAT the learner needs to learn  Readiness to learn o WHEN the learner is receptive to learning  Learning style o HOW the learner best learns Criteria for prioritising learning needs:  Mandatory: o Survival, safety o Met immediately  Desirable:

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o not life-dependent but related to well being Possible: o Nice to know-not essential o Not connected to daily activities

Culture  Communication can be challenging  Different understandings of health and illness  Right to access and understand health  Information in a language and literacy level that can understand o Interactions with providers o Information/patient education materials o Navigating facilities and systems of care  Recognising culture increases accessibility and overall health literacy  Increases informed decision making Health promotion strategies  Health promotion o Overall levels of health can be improved o Many health problems can be prevented  Levels of prevention o Primary: reducing factors leading to health condition o Secondary: early detection and intervention in the possible development of a health problem o Tertiary: treatment of a health problem to lessen its effect to prevent further deterioration/recurrence Informational seasons:  Guide the RN in planning client information  Prepare information that considers the direct impact that people are currently experiencing because of their health status/diagnosis  Info shared fits with where the person is at in correlation to disease  Determine where the individual is on the continuum  Accommodates the client, not the provider Season 1: prehabilitation (primary prevention)  Education focuses on illness prevention/health promotion  Person is at risk of or likely develop a diagnosis or health condition  Motivation of the leaner is VIPo May not perceive there is a health risk-not yet reality o No knowledge of disease state-not happening therefore not relevant to them  RN: o Encourage behaviour change

Season 2: habilitation (secondary prevention)  Early detection and intervention in potential development/occurrence of health problem  Client is diagnosed with a disease or health condition  May or may not have symptoms  May want to develop new habits  May feel ambivalent about their diagnosis  May be grieving if feels well/vague or no symptoms  Actual/perceived loss of health/quality of life  Remain here until disease is no longer active or negative health outcomes  RN o Discover what the client knows  Might not be accurate o Compliance based on mutual understanding Season 3: rehabilitation (tertiary prevention)  Prevent further deterioration  Grief related loss – normalcy, self-image, fear of dying  Loss of independence – client and family  Shift focus from critical to preventing further outcomes  RN o Help client understand the WHY o Help client understand risk factors o Engage family members/supports Determinants of learning: models  Client/RN views may differ on what’s important to know  Influences: family, internet, TV, life experiences  RN responsibility: assess when, what they need or want to know and how to adapt content for each learner  Set objectives after meeting learner  Timing is key: learner must be willing to learn Determinant 1: what the client needs/wants to know (health belief model)  People’s beliefs about severity and their susceptibility to disease influenced their willingness to take preventative action  Explains and predicts people’s behaviours based on their beliefs about the health problem and health behaviour  Assumes that people will engage in health promoting behaviour if they highly value health  Three health belief model ideas o Individual perceptions  How susceptible am I?

 How bad do I think this is? o Modifying factors  Demographics (age, gender, culture, etc)  Sociopsychological variables (social class)  Structural variables (knowledge of disease, prior contact with disease) o Likelihood of action  Perceived benefits of preventative action minus perceived barriers to preventative action

Determinant 2: readiness to learn (peek, stages of change)  Learner is: receptive, willing, and able to participate  Information movement: “ingestion to digestion” o Information is received then broken down o Info is separated, stored and discarded based on if the body will need it or use it o Personal values & beliefs help interpret the information Determinant 3: learning styles (Vark model)  Not all teachers and students learn in the same way  Effectively communicate information, must meet each other’s needs  Understanding learning styles Learning styles:  Visual: (show me) o Use sight to remember information o Diagrams, flowcharts, graph, symbols o 55% population  Kinesthetic (tactile): let me do it o Second most common

o Hands on activities, role play o Return demonstration o Manipulation of objects  Aural (verbal/auditory): let me listen o Listen to lectures o Discuss topics 1:1 o May appear uninterested but rare o Actively listening o 15% population  read/write: read it, write it down o written word o handouts, reading o additional references Stages of change and exercise example

Methods to assess learning needs:  Informal conversations  Structured interviews  Questionnaires

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Observations Documentations

Four types of readiness to learn: P= physical readiness  Measures of ability  Complexity of task  Environmental effects  Health status  gender E= emotional readiness  anxiety level  support system  motivation  risk-taking behavior  frame of mind  developmental stage E= experiential readiness  level of aspiration  past coping mechanisms  cultural background  locus of control  orientation K= knowledge readiness  present knowledge base  cognitive ability  learning disabilities  learning styles Learning style instruments  Kolb Learning Style Inventory (LSI)  Gardner’s Eight types of Intelligence o Linguistic o Musical o Spatial o Bodily-kinesthetic o Logical-mathematical o Intrapersonal o Interpersonal o Naturalistic  VARK Learning styles

Compliance: submission or yielding to predetermined goals through regimens prescribed or established by others. Manipulative undertone that can attempt to control the learner’s right to decision-making Adherence: commitment or attachment to a prescribed, predetermined regimen Noncompliance: nonsubmission or resistance of an individual to follow a prescribed, predetermined regimen Compliance/Adherence  Observable  Can be measured  Healthcare provider viewed as authority  Learner viewed as submissive  Refers to the ability to maintain health-promoting regimens  Outcomes determined largely by healthcare provider Concepts affecting compliance  Locus of control  Noncompliance Motivation: to set it motion; a physiological force that moves a person toward some kind of action, positive or negative  Movement in the direction of meeting a need or reaching a goal  All behavior is not motivated  Motivational factors: o Personal attributes o Environmental influences o Learner relationship systems  Motivational axioms: o Moderate anxiety is optimum for learning o Learner readiness o Setting realistic goals o Learner satisfaction/success o Uncertainty reduction or maintenance  Motivational strategies: o Clarify directions and expectations o Make information meaningful to learner o Manipulate environment to make it conducive to learning o Provide positive verbal and nonverbal feedback o Provide opportunities for success Motivational/models

o Maslow’s hierarchy of needs (ARCS model)  Attention  Relevance  Confidence  Satisfaction Comprehensive parameters for motivational assessment of the learner  Cognitive variables  Affective variables  Physiological variables  Experiential variables  Environmental variables  Educator-learner relationship system Cognitive variables:  Capacity to learn  Readiness to learn o expressed self-determination o constructive attitude o expressed desire and curiosity o willingness to contract for behavioral outcomes  Facilitating beliefs Affective variables:  Expressions of constructive emotional state  Moderate level of anxiety Physiological variables:  Capacity to perform required behaviour Experiential variables:  Previous successful experiences Environmental variables:  Appropriateness of physical environment  Social support systems o family o group o work o community resources Models/theories for the health behaviors of the learner  health belief model  health promotion model (revised)

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self-efficacy theory protection motivational theory stages of change model theory of reasoned action therapeutic alliance model

Self-efficacy theory Focuses on a person’s expectations relative to a specific course of action  mode of induction  source of efficacy  cognitive processes  competency perceptions  expected outcomes...