BSNC 1000 - Module 3 Latest Update Graded A

BSNC 1000 - Module 3 Latest Update Graded A Capacity building - the process of empowering others and strengthening their capabilities - nurses develop trusting partnerships - focus on autonomy Scope of capacity building - families - groups - communities - systems *focus is on health promotion Attributes of capacity building - respect and valuing pre-existing capacities - partnership - collaboration - advocacy - equity - social justice - responding to context and tailoring approaches - developing well-planned and integrated strategies Concept of client education - sub-concept of capacity building - clients learn health-related behaviours that can be applied to daily life - includes: counselling, support, and coordination of services Learning domains - cognitive domain (factual knowledge and intellectual understanding) - psychomotor domain (action or skills) - affective domain (attitudes, beliefs and values) Application of all three learning domains A client with paralysis and neurological impairment needs to learn how to self-catheterize: - Psychomotor: perform the skill - Cognitive: understand the physiological principles - Affective: assist the client in coping with this lifestyle change Cognitive learning - includes all intellectual behaviour and requires thinking - goes from simplest (remembering) to most complex (creating) Affective learning - expressions of feelings and acceptance of attitudes, opinions or values - goes from simplest receiving (attending to other's words) to characterizing (action and response with a consistent value system) Psychomotor learning - acquiring skills that require the integration of mental and muscular activity - goes from simplest perception (awareness through use of senses) to organisation (perform a complex motor act) Teaching method for cognitive domain - discussion - storytelling - question-and-answer session - role play and discovery - independent projects and field experience Teaching method for affective domain - role play - group discussion - one-on-one discussion Teaching methods for psychomotor domain - demonstration - practice - return demonstrations - independent projects and games The 5 As - assessment technique that can be used to help educate clients 1. Assess 2. Advise 3. Agree 4. Assist 5. Arrange Assess - knowledge skills, confidence, the importance the client assigns to health issue, their supports, the presence of barriers and risk factors - e.g., "How important do you think it is to check your blood glucose before breakfast each day?" - "How confident are you that you can control any symptoms or health problems you have so that they do not interfere with the things you want to do?" Advise - provide specific personalized information about health risks and benefits of change - ask the client to restate what you said. Agree - collaboratively set goals based on the client's interests and confidence in their ability to change the behaviour. - if their self-rated confidence is low, the goal may need to be changed Attributes of client education - client must demonstrate a readiness to learn (client motivation) - planning, goal-setting Health promotion - the process of empowering people to increase control over and improve their health - activity: empowerment Health literacy - a patient's ability to find, access, read and understand reliable health information - their ability to use this information to make informed health decisions Literacy is linked to - income - education - health status - community involvement - health literacy Limits on health literacy - have less than a high-school education level - chronic health conditions - vision and hearing impairments Consequences of poor health literacy - poorer health - less attention to health info - poorer compliance with instructions - increased hospitalizations - increased health care costs Methods of client education - the 5 As - teach-back method - ask-tell-ask approach Teach back method - allows the patient to repeat back key concepts from teaching session to confirm understanding - if unable to do it, explain again and re-check Elements of the teach back method - use a caring tone and attitude - display comfortable body language and eye contact - use plain language - ask the patient to explain back, using their own words - use non shaming, open-ended questions - avoid yes or no answer questions - emphasize that the responsibility is on you to explain clearly - explain again and re-check if they're unable to do it - use reader-friendly print materials Strategies to enhance learning in older adults - make sure that they are ready to learn - be sensitive to cultural, language, or other differences - provide adequate time for learning - create a shame-free environment - provide regular positive feedback - emphasize concrete rather than abstract material - use written material to supplement verbal instruction (list format with 14-16 font) - sit facing the person so they can watch your lips - speak slowly with a low tone - have shorter sessions with breaks - encourage the use of mnemonic devices Literacy a person's ability to read or write Example of a cognitive intervention Ask the patient what they believe they need to know before their discharge Example of a affective intervention Encourage the client to verbalize their feelings and fears about their change in health status Example of a psychomotor intervention Ask the client to demonstrate dressing changes Learning depends on Learning environment, ability to learn Ideal learning environment - well Lit - good Ventilation - appropriate Furniture - proper Temperature Factors impacting ability to learn - emotional capability (e.g., anxiety) - intellectual capability - physical capability (e.g., coordination is important for psychomotor skills) - developmental stage Teaching methods for older adults - teach when patient is alert and rested - involve adult in discussion or activity - focus on wellness and person's strength - use approached to enhance sensorially impaired patient reception of stimuli - keep teaching sessions short - Social learning theory - the theory that we learn social behavior by observing and imitating and by being rewarded or punished - concept: self-efficacy (a person's perceived ability to successfully complete a task) Transtheoretical Model of Change 1. Precontemplation - unaware of need for change and no intention of changing behaviour 2. Contemplation - aware of need for change 3. Preparation - alters behaviours in minor ways 4. Action - modifies behaviours in substantial ways to make sustainable change 5. Maintenance - focus on not reverting to previous behaviour Patient-centred care - a standard of care that positions the patient as the focus of care delivery and as a partner in the delivery of care - nurses need to use the social learning theory and nursing process LEARNS model - provides a nursing process framework incorporating social learning theory that facilitates a patient-centred approach 1. Listen to patient needs 2. Establish therapeutic partner relationships 3. Adopt an intentional approach to every learning encounter 4. Reinforce health literacy 5. Name new knowledge via teach-back 6. Strengthen self-management via links to community resources Steps of the teaching process - assessment: gather info about learning needs, motivation, ability to learn, environment - analysis: identify learning needs in 3 domains - planning: learning objectives - implementation: - evaluation: determine outcomes of the teaching-learning process Ask-Tell-Ask method - individual learns best when provided with information that they are interested in learning" (as opposed to a lecture from the provider). - e.g., Provider: ASKS— "What do you know about ____? "Patient: TELLS- " I know that ___ is..." Provider: ASKS— "What else would you like to knowabout ___? Closing the loop - asking the patient to restate the instructions provided by the practitioner" (this confirms mutual understanding) - Provider: "Just to confirm that we are on the same page, can you explain the instructions back to me?"Patient: patient explains instructions Characteristics of chronic disease management - self-management - decision support - delivery system design/reorient health services - information systems - health public policy - supportive environments - community action