HEALTH PROMOTION

NURSE AS EDUCATOR

Vicky Bayer, BSN, RN, NCSN

March 2015

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

HOW DO WE SEE OTHERS

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

The tendency of the body to maintain a sense

of balance or equilibrium while in the process

of changing

HOMEOSTASIS

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

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

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

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

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

Department of Health and Human Services

initiative for health promotion, health

protection, and health prevention strategies

HEALTHY PEOPLE 2020

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

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

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

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

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?

Infants: Breastfeeding, immunizations, bonding

Children: Safety, immunizations, nutrition

Adolescents: Body image, safety, peer influences

Older Adults: Sleep, mental health, fitness

HEALTH PROMOTION TOPICS

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

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

Pre-contemplation

Contemplation

Preparation

Action

Maintenance

Termination

6 STAGES IN BEHAVIOR CHANGE

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

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

Plans to take action in the immediate future

(1 month)

Start making small behavior changes

Starts to formulate plan for change

PREPARATION STAGE

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

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

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

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

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

QUESTIONS ON HEALTH

PROMOTION?

BREAK

NURSE AS EDUCATOR

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

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

Health promotion

Health protection

Health maintenance

Decreasing health risk

Increased wellness

Safety

WHAT DO NURSES TEACH?

Clients

Families

Community

Nurses

Other health professionals

WHO DO NURSE TEACH?

Educational background

Literacy level

Language skills

Culture of each learner

Learning need

Desire to know new knowledge, new skill, new

behavior

CONSIDERATIONS

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

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

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

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

What are

some

barriers to

learning?

Assess learning need

Form nursing diagnosis

Plan teaching strategy and set goals

Implement plan

Evaluate – goals and teaching techniques

TEACHING AND NURSING PROCESS

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

Is she ready to learn?

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

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

Determine teaching priority

Select teaching strategy

Determine setting

Develop teaching outcomes

Cognitive domain

Affective domain

Psychomotor domain

PLANNING

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

Group teaching

Computer

Client contracts

Rewards

Discovery/Problem solving

Behavior modification

OTHER LEARNING METHODS

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

BEHAVIOR CHANGE & TEACHING

QUESTIONS

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

THANK YOU