PBL Exam Notes Final PDF

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PBL Exam NotesPromotion and Health Teaching:Key Terms:Health Education Involves changing people’s attitudes and values Health Promotion The process of enabling people to increase control over, and to improve their health. It moves beyond a focus on individual behaviour towards a wide range of social...

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PBL Exam Notes Promotion and Health Teaching: Key Terms: Health Education Health Promotion

Readiness to Learn

Involves changing people’s attitudes and values The process of enabling people to increase control over, and to improve their health. It moves beyond a focus on individual behaviour towards a wide range of social and environmental interventions. How likely a person is to seek out knowledge and participate in behaviour change, composed of 4 factors - emotional, intellectual, physical and developmental capabilities

Andragogy

Methods and principles used in adult education

Domains of Learning

Different levels of learning - Cognitive; all intellectual behaviours which require thinking (remembering, understanding, applying, analyzing, evaluating and creating) - Affective; concerns expressions of feeling and acceptance of attitudes, opinions or values (receiving, responding, valuing, organizing and characterizing) - Psychomotor; involves acquiring skills that require the integration of mental and muscular activity (perception, set, guided response, mechanism, complex overt response, adaptation, origination) 4 different classifications and the idea that people learn well in different environments. - Visual - Auditory - Read/Write - Kinesthetic The interactive process that promotes learning, where the learner presents a desire to learn and the teacher provides the means for the learner to engage in a desired change.

Learning Styles

Teaching Process

Develop a definition of health promotion and health education. -

Health Promotion: the process of enabling people to increase control over, and to improve their health

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Health Education: any combination of planned experiences based on sound theories that provide individuals, groups and communities the opportunity to acquire the information and skills needed to make quality health decisions.

Identify examples of health promotion strategies evidence at the public, community and individual (active/passive) levels. -

Public: o Looking at ways to change local, provincial, national laws and policies

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Community: o Looking at safe neighbourhoods, affordability of food, social norms/expectations etc.

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Individual:

Active Strategies Depends on the individual becoming personally involved in adopting a proposed program - Preforming daily exercise as part of a physical fitness plana and adopting a stress management program as part of daily living

Passive Strategies Individual as an inactive participant or recipient - Public health effects to maintain clean water and sanitary sewage systems to decrease infectious diseases and improve health These strategies must be used to promote the health of the public when individual participation might be low but the benefit to society is high

Example how the goals of patient education related to the primary, secondary and tertiary prevention. Provide examples of each. Leavell and Clark’s Three Levels of Prevention: Level of Prevention What? Nurse’s Responsibility Examples Primary Prevention

Secondary Prevention

Tertiary Prevention

aims to limit the incidence of disease and disability in the population. It does this by eliminating or reducing factors that reduce good health, and promoting factors that are protective of health

aims to prevent the progression of disease. It does this through early detection and/or intervention.

aims to reduce the consequences of established disease. It does this by reducing the progression of the disease and improving the individual's quality of life.

Be able to address the need to protect at-risk populations involved with organizations for health promotion

programs to discourage the uptake of smoking, immunisation programs and increasing opportunities for physical activity and healthy eating

Screening activities Clinical expertise Therapeutic limitation of existing disease

Targets the entire population, including health individuals. breast cancer screening programs and regular hearing tests for workers exposed to industrial noise

Ensure that disabled persons receives services which enable them to live and work at highest level of possible functioning

Targets involves who may show no symptoms, but are exposed to or have known risk factors for a particular condition self-management programs for those with chronic illness, or rehabilitation programs for those recovering from accident or illness Targets individuals with diagnosed illness and disease

Purpose of Comprehensive Patient Education: - Maintenance and promotion of health and prevention of illness - Restoration of health - Coping with impaired functioning

Differentiate and example the domains of learning; cognitive, affective and psychomotor. Learning occurs in 3 domains: cognitive (understanding), affective (attitudes) and psychomotor (motor skills) Cognitive Learning

Includes intellectual behaviours and requires thinking Remembering: ability to learn information and retrieve it from long term memory Understanding: ability to construct the meaning of the learned material Applying: the use of abstract, newly learned ideas in a practical situation Analysing: the breaking down of information into organized parts and determining how the parts relate to one another Evaluating: making judgments based on criteria and standards Creating: combining elements to form a coherent and functional whole Discussion (One on One or Group)

Promoting active participation and focus on topics of interest to patients Enhances application and analysis of new information

Storytelling

Cultural Relevance and Safety Enhances application of a new concept

into a familiar concept

Affective Learning

Psychomotor Learning

Lecture

More formal as it is teacher controlled Helps learners gain knowledge about new information

Question and Answer Session

Designed specially for the patient’s concerns Helps patients to implement their learning

Role Play and Discovery

Encourages patients to apply their knowledge in a controlled setting Promotes the synthesis of information and problem solving

Independent Projects (Computer Assisted Instruction) and Field Experience

Helps patients to assume responsibility for learning at their own pace Promotes analysis, synthesis and evaluation of new information and skills

Expressions of feelings and acceptance of attitudes, opinions or values Receiving: the willingness to attend to another person’s words Responding: active participation through listening and reacting verbally and nonverbally Valuing: attachment of worth to an object, concept or behaviour demonstrated by the learner’s actions Organizing: development of a value system by identifying and organizing values and resolving conflicts Characterizing: action and response with a consistent value system Role Play

Encourages the patient to express values, attitudes and feelings

Discussion (Group)

Helps the patient to receive support from their peers Helps patients to learn from other people’s experiences Promotes responding, valuing and organizing

Discussion (One to One)

Helps with the discussion of personal, sensitive topics of interest

Acquiring skills that require the integration of mental and muscular activity (ie. eating with a utensil or the ability to walk) Perception: awareness of objects or qualities through the use of sense organs Set: a readiness (mental, physical or emotional) to take a particular action Guided Response: the performance of an act under the guidance of an instructor Mechanism: a higher level of behaviour by which a person gains confidence and skill in performing a behaviour that is more complex or involves several more steps than a guided response Complex Overt Response: the smooth and accurate performance of a motor skill that requires a complex movement pattern Adaptation: the ability to change motor response when unexpected problems occur Origination: use of existing psychomotor skills and abilities to perform a highly complex motor act that involves creating new movement patterns Demonstration

Provides a presentation of procedure or skills by the nurse Encourages patients to model the nurse’s behaviour Allow nurse to control questioning during demonstration

Practice

Helps the patient to practice the skill in a controlled environment Encourages repetition

Return Demonstrations

Helps the patient to perform the skill and the nurse observes Helps with feedback and reinforcement

Independent Projects and Games

Requires a teaching method that promotes adaptation and initiation of psychomotor learning Enables learners to learn new skills

Identify factors that contribute to the ability to learn and motivation to learn Learning depends on the learning environment and on the individual’s ability to learn, learning style and motivation to learn. - Takes place in formal learning sessions and teachable moments Learning Environment: should occur in a well-lit, well ventilated room with minimal distractions. - Some patients like having their close relatives with them during the learning processes while others do not - In hospitals, learning environments can be achieved by closing cubicles and/or curtains - In home settings, it should happen in quiet room with or without the family Ability to Learn: depends on emotional, intellectual and physical capabilities on the developmental stage. - Emotional Capability: help to aid or prevent learning. Mild anxiety helps patients to focus, however extreme levels of anxiety can create an inability to attend to anything other than relieving the anxiety. Nurses must first assess anxiety levels, and if they are high they must find ways to alleviate the anxiety - teaching relaxation techniques before attempting to teach a task - Intellectual Capability: Assess a patient’s knowledge and intellectual level before beginning a teaching plan. (ie. measuring liquid requires a degree of mathematical calculations) - Physical Capability: Assessing a patient’s physical health. To learn psychomotor skills, a patient must possess the necessary strength, coordination and sensory acuity. The following physical attributes are needed for performing psychomotor skills o Size: proper height and weight o Strength: ability for a patient to follow a strenuous exercise program o Coordination o Sensory Acuity: 5 senses needed to receive and respond to messages which are taught -

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Any physical condition (hunger, fatigue or pain) which depletes energy can also impair the ability to learn Developmental Stage: dependent on the age and stage of development affects the ability to learn o Learning in Children: information should be easy to understand, and the expected outcome should be realistic to achieve and based on the child’s developmental stage o Adult Learning: Use past experiences to teach new learning. Assess what the patient already knows, teach what the patient what they want to know and setting mutual goals will help to improve the outcomes of care and education Attentional State: the mental state that allows the learner to focus and comprehend a learning activity

Learning Style and Preference: - When developing teaching plans, you should assess the favored learning style and preferences of the patient - In groups it may be difficult to address every patient’s preferences, however using a combination of approaches to meet multiple learning styles can ensure that most people’s learning preferences are met Motivation to Learn: Motivation is a person’s desire or willingness to learn, and it influences a person’s behavior - Social Motives: reflect a need for need for connection, social approval or self-esteem (ie. the motivation of exercising may be linked to the social aspects of the exercise activities)

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Task Mastery Motives: driven by the desire of achievement (ie. high school students with diabetes would check their diabetes level before leaving home. The desire to live independently and manage the disease provides the motivation to mask the task or skill) Physical Motives: desire to maintain or improve health. Patients motivated by need to survive/overcome hardship> wish to simply improve health People do not adopt new health behaviors or change unhealthy behaviors unless they feel a disease is a threat Social Learning Theory; when people believe that they can execute a particular behaviour they are more likely to perform the behavior consistently and correctly. Based on the concept of self efficacy- is a person’s perceived ability to successfully complete a task. Beliefs about self-efficacy arise from 4 sources: o Verbal Persuasion; nurse teaching a boy with asthma how to use his inhaler expressing positive reinforcement o Vicarious Experiences: nurse demonstrating how to use the inhaler o Enactive Mastery Experiences; the boy successfully uses his inhaler himself o Physiological and Affective States; as the boy uses his inhaler properly the nurse further enhances his confidence to use the inhaler by positive feedback

Transtheoretical Model of Change; Five stages involved in behavior change - Precontemplation: unaware of need for change and no intention to change (NO) - Contemplation: aware of need for change and intends to change the behavior sometime in the future (MAYBE) - Preparation: alters behavior in minor ways with the intention to make larger changes in the near future (YES BUT - Action: modifies behavior and experiences in order to make larger changes (YES AND) - Maintenance: focuses on not reverting to previous behavior and solidifying new behavior Patient-Centered Approach to Patient Education; when you try to put the patient as the center of focus and partner in the delivery of care - Nurses must use social learning theory and the nursing process - L.E.A.R.N.S ; provides a nursing process framework which includes the Social Learning Theory o Listen to patient needs o Establish therapeutic partnership relationships o Adopt an intentional approach to every learning encounter o Reinforce health literacy o Name new knowledge via teach-back

Describe the aspects/activities of the teaching process as they relate to: assessment, planning, implementation and evaluation. -

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Like the nursing process, the teaching process requires assessment, nursing diagnosis, planning, implementation and evaluation Nursing process is broader, whereas teaching process is focused on data sources that reveal the patient’s learning needs, willingness and ability to learn, and available teaching resources and more useful for teaching large group Nurse must set specific learning objectives (ie. what the learner will be able to do after successful instruction) and implements the teaching plan by using teaching and learning principles to ensure that the patient acquires knowledge and skills Teaching process also involves evaluation of learning, which is based on the learning objectives (did the patient achieve their learning objective or not)

Assessment: -

The nurse works with the patient to determine the patient’s healthcare needs. The patient may indicate a need for healthcare information, or the nurse may identify a need for education

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By conducting an effective assessment, the nurse is able to individualize instructions for each patient

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Learning Needs: Effective questioning and assessment tools will help the nurse to identify the learning needs of the patient. Use both open and closed ended questions. During the assessment phase, the nurse should look out for the following things: ◦

Information or skills needed by the patient to perform self-care and to understand the implications of a health problem (Teaching a teenage boy how to do a testicular self-examination)

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Patients experiences which influence the need to learn

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Information that family members or significant others require to support the patient’s needs

Learning Needs ◦

Information or skills needed by the patient in order to address their needs

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Patients experiences that influence the need to learn

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Information that the family members or significant others require to support the patient’s needs

Ability to Learn ◦

Body temperature, electrolyte levels, O2 Stat and glucose levels may affect

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Need to consider physical strength, sensory, reading, developmental level and cognitive functioning

Teaching Environment: ◦

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Remove Directions

Resources for learning ◦

Patients willingness to have family members involved

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Family members perceptions and understandings of the illness and its implications

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Resources at the home

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Teaching tool

Planning: - After identifying a patient’s learning needs and identifying a nursing focus, the nurse develops a teaching plan Developing Learning Objectives: learning objectives identify the expected output of instruction and establish learning priorities - Short Term Objectives: meet the patient’s immediate learning needs, such as needing knowledge about an upcoming test - Long Term Objectives: helps a patient to adapt to a long term challenge, these are often broader - Learning objectives, which will guide the teaching plan, include the same criteria as outcomes in a nursing care plan - Singular Behaviours - Observable or measurable content - timing or conditions under which the objective is measured - goal mutually set by the nurse and patient - Behaviour Objectives; contains an active verb describing what the learner will do after the objective is met. They are measurable and observable and indicate how learning will be evidenced Setting Priorities: - teaching plan is prioritized according to the patients’ immediate needs, nursing diagnosis, ;earning objectives, main concerns anxiety level and the time available to teach Timing: - Nurses can assess a patient’s level of concentration by observing nonverbal cues such as poor eye contact or slumped posture - teaching sessions should be held often enough to document the patient’s learning progress

Organizing Teaching Material: - essential content should be taught first because people are more likely to remember information that is taught earlier - repetition reinforces learning - summarizing key points help the learner to remember important information Writing Teaching Plans: - nurse is responsible for developing the teaching plan which includes all the important information - instructions - resources - teaching booklets Nursing Diagnosis: -

Developing learning strategies

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Singular Behaviors

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Observable or measurable content

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Timing or conditions under which the objective is measured

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Goals mutually set by the nurse and the patient

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Setting priorities

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Timing

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Organizing teaching material

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Maintaining attention and promoting participation

Implementation: -

Teaching Approaches o Telling o When limited information must be taught o Outline the task to be done and the patient’s role and give instructions

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Selling o Two-way...