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Health Ed pt.3
| Question | Answer |
|---|---|
| There are many factors that influence learning, including | ability, motivation, and desire to learn. |
| Learner's characteristics include: | -Culture/ethnicity -Age -Socioeconomic status (income, education level, and occupation) |
| is a learned set of norms and practices of a particular group that direct thinking, decisions, and actions (Transcultural Nursing 2004) | Culture |
| affects health behaviors and the teaching-learning process. | Culture |
| influences gender roles, sexual behavior, diet, personal hygiene, body image (obesity, slimness, etc.) drug use (alcohol, coffee, tea) exercise, communication, and educational pursuits. | Culture |
| can affect the way people experience and describe illness and will therefore affect the educational approach. | Culture |
| teaching the older adults presents some challenges. They usually need more time to learn, educational sessions need to be longer durations or broken down into more sessions of shorter duration, covering less information. | Age |
| Older adults often enjoy learning in a group. This addresses not only socialization needs, it also provides opportunities to address issues of isolation, fear, and anxiety related to their disease state. | Age |
| with all learners, emotional or mental status should be acknowledged and taken into account when planning an educational intervention. Depression, stress, denial, fear and anxiety can impact the effectiveness of teaching. | Emotional Status |
| the impact of socioeconomic level on learning has more to do with being to use information being taught rather than the process of learning. It takes into account a number of factors including income, education level, and occupation or employment. | Socioeconomic Level |
| from the Latin word movere, means to set into motion. | Motivation |
| is defined as "an internal state that arouses, directs and sustains human behavior" (Glynn, Aultman, & Owens, 2005) and as a willingness of the learner to embrace learning, with readiness as evidence to motivation (Redman, 2007) | Motivation |
| Facilitating or blocking factors that shape motivation to learn can be classified into 3 major categories | 1. Personal Attributes - consist of physical, developmental, and psychological components of the individual learner. 2. Environmental influences, which include the physical and attitudinal climate. 3. |
| Facilitating or blocking factors that shape motivation to learn can be classified into 3 major categories | 1. 2. 3. Relationship systems, such as those of significant other, family, community and teacher-learner interaction. |
| Motivational Axioms - are rules that set the stage for motivation. They include: | 1. The state of optimal anxiety 2. Learner readiness 3. Realistic goal setting 4. Learner satisfaction/success 5. Uncertainty-reducing or uncertainty maintaining dialogue |
| Cognitive variables | -Capacity to learn -Readiness to learn Expressed self-determination Constructive attitude Expressed desire and curiosity Willingness to contact for behavioral outcomes -Facilitating beliefs |
| Affective Variables | -Expressions of constructive emotional state -Moderate level of anxiety |
| Physiological Variables | -Capacity to perform required behavior |
| Experiential Variables | -Previous successful experiences |
| Environmental variables: | -Appropriateness of physical environment -Social support systems: family, group, work -Educator Community resources -Educator-learner Relationship Prediction of positive relationship |
| -one contemporary nursing educational strategy suggested to promote motivation which enables the learner to integrate previous learning with newly acquired knowledge through diagrammatic or "mapping". | Concept mapping |
| One model developed by Keller (1987) known as the (ARCS) | A-Attention introduces opposing, case studies, and variable instructional precautions R-Relevance capitalizes on the learners' experiences, usefulness, needs, and personal choices |
| One model developed by Keller (1987) known as the (ARCS) | C-Confidence deals with learning requirements, level of difficulty, expectations, attribution, and sense of accomplishment S-Satisfaction pertains to timely use of a new skill, use Of Rewards, praise, and self evaluation. |
| is another motivational strategy the nurse educator can use with learners (Droppa & Lee, 2014) | Motivational Interviewing (MI) |
| A client-centered, directive counseling method in which clients' intrinsic motivation to change is enhanced by exploring and resolving their ambivalence toward behavior change (Miller & Rollnick, 2013) | Motivational Interviewing (MI) |
| 5 general principles of MI (Miller & Rollnick, 2013) READS | 1. Roll with resistance 2. Express empathy 3. Avoid argumentation 4. Develop discrepancy 5. Support self-efficacy |
| Specific strategies that the nurse can use for building motivation to change in the early phases of treatment and continuing throughout the treatment (Rollnick (2013) OARS | 1. Open-ended questioning 2. Affirmation of the positives 3. Reflective listening 4. Summaries if the interactions |
| -The original HBM developed in 1950s from social psychology perspective to examine why people did not participate in health screening programs (Rosenstock, 1974) | Health Belief Model - (HBM) |
| -The model was modified by Becker et al. (1974) to address compliance with therapeutic regimens. | Health Belief Model - (HBM) |
| explains and predicts health behaviors based on the patients' belief about the health problem and health behavior. | Health Belief Model - (HBM) |
| HBM is grounded on the supposition that it is possible to predict health behavior given 3 major interacting factors: | 1. Individual perceptions 2. Modifying factors 3. Likelihood of action |
| originally developed by Pender in 1987 and revised in 1996. | Health Promotion Model (revised) HPM |
| The purpose of the model is to assist nurses to understand the major determinants of health behavior as a basis for behavioral counseling to promote healthy lifestyles (Pender, 2011) | Health Promotion Model (revised) HPM |
| describe the use of factors or components that influence perceptions that may lead to positive health outcomes. | HBM and HPM |
| engage in preventive health behavior | HBM |
| targets the likelihood of engaging in health promotion activities. | Revised HPM |
| Developed from a social-cognitive perspective, based on a person's expectations relative to a specific course of action (Bandura, 1977a, 1977b, 1986, 1997) | Self-Efficacy Theory |
| It is a predictive theory in the sense that it deals with the belief that one is competent and capable of accomplishing a specific behavior. | Self-Efficacy Theory |
| The belief of competency and capability relative to certain behavior is a precursor to expected outcomes. | Self-Efficacy Theory |
| According to Bandura (1986, 1997) self-efficacy is cognitively appraised and processed through 4 principal sources of information: | 1. Performance accomplishments - as evidenced in self-mastery of similar expected behaviors 2. Vicarious experiences, such as observing successful expected behavior through the modeling of others |
| According to Bandura (1986, 1997) self-efficacy is cognitively appraised and processed through 4 principal sources of information: | 3. Verbal persuasion by others, who present realistic beliefs that the individual is capable of the expected behavior 4. Emotional arousal, resulting from self-judgment of physiological states of distress. |
| has proved useful in predicting the course of health behavior. | Self-efficacy |
| concluded that self-efficacy was the best predictor in an employee physical activity program and could be used in occupational health nursing. | Kaewthummanukul and Brown (2006 |
| the use of this theory by the nurse as educator is particularly relevant in developing educational programs | self-efficacy theory |
| -explains behavioral change in terms of threat and coping appraisal (Prentice-Dunn & Rogers, 1986). | Protection Motivation Theory |
| -It is beneficial for understanding why individuals participate in behaviors that are unhealthy (MacDonnel et al, 2013) | Protection Motivation Theory |
| -A threat to health is considered a stimulus to protection motivation. | Protection Motivation Theory |
| -also known as transtheoretical model (TTM) of behavior change (Prochasca & DiClemente, 1982) | Stages of Change Model |
| -Originating from the field of psychology, this model was developed around addictive and problem behaviors. | Stages of Change Model |
| -Six distinct time-related stages of change, (Prochaska, 1996) | 1. Precontemplation 2. Contemplation 3. Preparation 4. Action 5. Maintenance 6. Termination |
| The theory of reasoned action (TRA) emerged from research program that began in the 1950s and is concerned with predicting and understanding any form of human behavior within a social context (Ajzen & Fishbein, 1980) | Theory of Reasoned Action and Theory of Planned Behavior |
| It is based on the premise that humans behave in a rational way that is consistent with their beliefs (Fishbein, 2008) | Theory of Reasoned Action and Theory of Planned Behavior |
| It suggests that a person's behavior can be predicted by examining the individual's attitudes about the behavior as well as the individual's beliefs about how others might respond to the behavior | Theory of Reasoned Action and Theory of Planned Behavior |
| The two-pronged linear approach, specific behavior is determined by: | 1. Beliefs, attitude toward the behavior, and intention. 2. Motivation to comply with influential persons (known as referents), subjective norm and intention. |
| -The TPB added a third element of the TRA model - the concept of perceived behavioral control. | The Theory of Planned Behavior (Ajzen, 1985) |
| The TRA and TPB are useful theories in predicting behaviors, which is particularly helpful for educators to understand the attitudinal context within which health behaviors likely to change. | The Theory of Planned Behavior (Ajzen, 1985) |
| A therapeutic alliance is formed between the caregiver and the care receiver in which the participants are viewed as having equal power. | Therapeutic Alliance Model (Barofsky, 1978) |
| The shift toward self-determination and control over one's own life is fundamental to this model. | Therapeutic Alliance Model (Barofsky, 1978) |
| is "consultation that allows mutual respect for the patient's and professional's beliefs, and allows negotiation to take place about the best course of action for the patient (Hobden, 2006) | Concordance |
| Models for Health Education Selection of models for educational use can be made based on the following considerations: | 1. Similarities and dissimilarities 2. The nurse as educator's agreement with model conceptualizations 3. Functional utility |
| The Role of Nurse as Educator in Health Promotion | 1. Facilitator of Change 2. Contractor 3. Organizer 4. Evaluator |
| is generally defined as the ability to read and write and speak English (Andrus & Roth, 2002) | Literacy |
| NAP defined it as being able to demonstrate skills in reading, writing, basic math, interpreting speech and comprehending information as well as skills in numeracy – which implies an aptitude with basic probability and numerical concepts (Baur. 2011). | Literacy |
| is the ability to write and to read, understand, and interpret information written at the eighth-grade level or above | Literate |
| -is defined as being unable to read or write at all or having reading and writing skills at the fourth-grade level or above. | Illiterate |
| also termed marginally literate or marginally illiterate, refers to the ability of adults to read and write, and comprehend information between the fifth- and eighth-grade levels of difficulty. | Low literacy |
| -means that adults lack fundamental reading, writing, and comprehension skills that are needed to perform tasks of everyday life (giorgianni, 1998, Vagvolgyi, Coldea, Dresler, Schrader, & nuerk, 2016, Williams, Baker, Parker, & Nurss, 1998) | Functional Illiteracy |
| is defined by the Patient Protection and Affordable Care Act of 2010 | Health Literacy |
| As the “degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions” (Centers for Disease Control and Prevention, 2016) | Health Literacy |
| The CDC (2016) outlines the following common literacy challenges facing many people: | 1. They are not familiar with medical terms or how their bodies work. 2. They must be able to interpret or risks that could have health and safety consequences 3. They are scared and confused when diagnosed with serious illness. |
| The CDC (2016) outlines the following common literacy challenges facing many people: | 4. They have health conditions that require high levels of complicated self-care instructions. 5. They are voting on critical local issue affecting the community's health and are relying on unfamiliar technical information. |
| an individual's functional health literacy is likely to be significantly worse than his or her general literacy skills because of the complicated language used in the healthcare field. | Medicalese |
| (as concluded by the Ad Hoc Committee on Health literacy for the Council on Scientific Affairs of the American Medical Association (1999) | Medicalese |
| are terms frequency used when determining levels of literacy. | Reading, readability and comprehension |
| or word recognition as "the process of transforming letters into words and being able to pronounce them correctly. (Fisher, 1999) | Reading |
| the ease with which written or printed information can be read. It is based on a measure of several different elements within a given text of printed material, such as the level of language being used and the layout and design of the page | Readability |
| is the degree to which individuals understand what they read (Fisher, 1999, Koo, Krass, & Aslani, 2005) It is the ability to grasp the meaning of a message - to get the gist of it. | Comprehension |
| has been termed the "silent epidemic”, the "silent barrier", the silent disability", and "the dirty little secret". (Colin & Schumann, 2002, Doak & Doak, 1987, Kefalides, 1999, Wedgeworth, 2007) | Literacy |
| 1. Reacting to complex learning situations by withdrawal, complete avoidance, or being repeatedly noncompliant. | Assessment: Clues to Look for patients with Illiteracy or Low Literacy: |
| 2. Using the excuse that they were too busy, too tired, too sick, or too sedated with medication to maintain their attention span when given a booklet or instruction sheet to read. | Assessment: Clues to Look for patients with Illiteracy or Low Literacy: |
| 3. Claiming that they just did not feel like reading, that they gave the information to their spouse to take home, or that they lost, forgot, or broke their glasses. | Assessment: Clues to Look for patients with Illiteracy or Low Literacy: |
| 4. Camouflaging their problem by surrounding themselves with books, magazines, and newspaper to give the impression they can read. | Assessment: Clues to Look for patients with Illiteracy or Low Literacy: |
| 5. Circumventing their inability by insisting on taking the information home to read or having a family member or friend with them when written information is presented. | Assessment: Clues to Look for patients with Illiteracy or Low Literacy: |
| 6. Asking you to read the information for them under the guise that their eyes are bothersome, they lack interest, or they do not have the energy to devote to the task of learning. | Assessment: Clues to Look for patients with Illiteracy or Low Literacy: |
| 7. Showing nervousness because of feeling stressed by the possibility of getting caught or having to confess to illiteracy. | Assessment: Clues to Look for patients with Illiteracy or Low Literacy: |
| 8. Acting confused, talking out of context, holding reading materials upside down or expressing thoughts that may seem totally irrelevant to the topic of conversation. | Assessment: Clues to Look for patients with Illiteracy or Low Literacy: |
| 9. Showing a great deal of frustration and restlessness when attempting to read, often mouthing words aloud (vocalization) or silently (subvocalization, substituting words they cannot decipher (decode) with meaningless words, pointing to words or | Assessment: Clues to Look for patients with Illiteracy or Low Literacy: |
| 9. or phrases on a page, or exhibiting facial signs of bewilderment or defeat. | Assessment: Clues to Look for patients with Illiteracy or Low Literacy: |
| 10. Standing in a location clearly designated for authorized personnel only. 11. Listening and watching very attentively to observe and memorize how things work. | Assessment: Clues to Look for patients with Illiteracy or Low Literacy: |
| 12. Demonstrating difficulty with following instructions about relatively simple activities such as breathing exercise or operating the TV, electric bed, | Assessment: Clues to Look for patients with Illiteracy or Low Literacy: |
| 12. call light, and other simple equipment, even when the operating instructions are clearly printed on them. | Assessment: Clues to Look for patients with Illiteracy or Low Literacy: |
| 13. Failing to ask any questions about the information they received. 14. Turning in registration forms or health questionnaires that are incomplete, illegible, on not attempted. | Assessment: Clues to Look for patients with Illiteracy or Low Literacy: |
| 15. Revealing a discrepancy between what is understood by listening and what is understood by reading | Assessment: Clues to Look for patients with Illiteracy or Low Literacy: |
| 16. Missing appointments or failing to follow up with referrals 17. Not taking medications as prescribed or being noncompliant. | Assessment: Clues to Look for patients with Illiteracy or Low Literacy: |
| 2 tests are often used to measure patient literacy: | 1. The REALM (Rapid Estimate of Adult Literacy in Medicine) 2. The WRAT (Wide Range Achievement Test) |
| Both test measure the basic reading skill of decoding words (recognizing letters that form words and pronouncing the words correctly) | 1. The REALM (Rapid Estimate of Adult Literacy in Medicine) 2. The WRAT (Wide Range Achievement Test) |
| is a reading test that requires patient to pronounce common medical and anatomical words. | REALM |
| The test “contains 66 words arranged in 3 columns in ascending order of number of syllables and increasing difficulty" (Murphy, Davis, Long, Jackson, & Decker, 1993) | REALM |
| To administer the REALM test, perform the following: | 1. Ask the patient to read the words aloud, starting at the top of the first list and continuing through all three lists. 2. Allow the patient five seconds to pronounce each word. |
| To administer the REALM test, perform the following: | 3. If the patient gets stuck on the portion of the list, ask him or her to look down each list to see if he or she can pronounce any additional words. 4. Score the test by adding up the total number of words pronounced correctly. |
| To administer the REALM test, perform the following: | 0 -18 - third grade and below 19- 44 - fourth to sixth grades 45 - 60 - seventh to eighth grades 61 - 66 - ninth grade and above |
| Fat Flu Pill Dose Eye Stress Smear Nerves Germs Meals Disease Cancer Caffeine Attack Kidney Hormones Herpes Seizure Bowel Asthma Rectal Incest | List 1 |
| Fatigue Pelvic Jaundice Infection Exercise Behavior Prescription Notify Gallbladder Calories Depression Miscarriage Pregnancy Arthritis Nutrition Menopause Appendix Abnormal Syphilis Hemorrhoids Nausea Directed | List 2 |
| Allergic Menstrual Testicle Colitis Emergency Medication Occupation Sexuality Alcoholism Irritation Constipation Gonorrhea Inflammatory Diabetes Hepatitis Antibiotics Diagnosis Potassium Anemia Obesity Osteoporosis Impetigo | List 3 |
| Whether developing a brochure, a pamphlet, or an instruction sheet, the guidelines for maintaining a low readability level and attractiveness for low-literate person are the same. | Readability of Printed Educational Materials |
| Consider the organization of the information, the linguistics, and the appearance (Dixon, & Park, 1990, Doak et al., 1996; Eyles et al., 2003) | Readability of Printed Educational Materials |
| Organizational Factors | 1. Include a short but descriptive title. 2. Use a brief headings and subheadings. 3. Incorporate only one idea per paragraph, and be sure the first sentence is the topic sentence. |
| Organizational Factors | 4. Divide complex instruction into small steps. 5. Consider using a question-answer format. 6. Address no more than three or four main points 7. Reinforce main points with a summary at the end. |
| Linguistic Factors | 1. Keep the reading level at grade 5 or 6 to make the material understandable to most low-literate persons. 2. Use mostly one or two syllables words and short sentences. |
| Linguistic Factors | 3. Use a personal and conversational style. (You should weigh yourself everyday") 4. Define technical terms if they must be used. |
| Linguistic Factors | 5. Use words consistently throughout the text. 6. (Use consistently the word pill rather than switching between pill and medicine) 7. Use graphics and language that are culturally and age relevant for intended audience. |
| Linguistic Factors | 8. Use active rather than passive voice. Take one pill every morning rather than a pill should be taken every morning. 9. Incorporate examples and simple analogies to illustrate Concepts. |
| Appearance Factors | 1. Avoid a cluttered appearance by including enough white space. 2. Include simple diagrams or graphics that are well labeled 3. Use upper and lowercase letters. All capitals are difficult for everyone to read. |
| Appearance Factors | 4. Use 12 to 14 point type in a plain font. 5. Place emphasized words in bold or underline them, but do not use capitals because they are difficult to read. 6. Use lists when appropriate. |
| Appearance Factors | 7. Try to limit line length to no more than 50 to 60 characters. |
| -The formulas that are used most frequently that do not require any equipment are the: | Readability Formulas |
| was developed by Rudolph Flesch (1948) and can be applied to materials that fall between the 5th and 12th grade reading levels. | Flesch Reading Ease formula |
| was developed by Gunning in the 1970s (Spadero, 1983). It can be used to determine readability from fourth grade to college, and assumes that 75% of people reading at the grade level should be able to read the tested material (Davis et al. 1990) | Fog Index |
| was developed by Mclaughlin (1969) to simplify the process of measuring readability. | Smog formula was |
| in 1992 and in 2003 conducted literacy test included items that measured the ability to read prose and formal documents as well as quantitative skills.(NALS 2006) | The US National Adult Literacy Survey (NALS) |
| The results were classified into 4 levels: | Level 1 - Below basic: Ranges from non literate in English to the ability to find simple information in a prose text. Can perform simple math such as addition. |
| The results were classified into 4 levels: | Level 2 - Basic: Understands information in short prose texts with everyday language. Can use numbers to solve simple one step arithmetic problems such as comparing two prices. |
| The results were classified into 4 levels: | Level 3 - Intermediate: Understands and can locate information in fairly dense prose and documents and can make simple inferences from them. Can solve quantitative problems even the necessary steps are not obvious. |
| The results were classified into 4 levels: | Level 4 - Proficient: Understand complex prose and analyzes complex documents. Can solve multistep arithmetic problems. |
| Several studies conducted in health care settings have found that patients often read two to three grade levels below the last completed year of school (Baumann, 1997, Cooley, Moriarty, Berger, Selm-Orr, Coyle, & Short, 1995; Davis et al, 1994) | Reading Levels |
| It is important for health care practitioners to be aware of this discrepancy between reading level and grade level so that they do not assume that if a person has a grammar school education, for example, he or she is reading at the eighth grade level. | Reading Levels |
| Assessing reading ability is only the first step in the process of health education for people with low-literacy skills. -The second step is planning an approach to teaching that will best meet the needs of individual in this group. | Teaching People with Low-literacy Skills |
| 1. It is important to set objectives that are realistic for the person's level of understanding. Objectives should focus on basic essential skills that must be achieved if safety is to be maintained. | Teaching People with Low-literacy Skills |
| The objectives should be shaped by what the person already knows about the topic as well as by what he or she still needs to learn. | Teaching People with Low-literacy Skills |
| 2. Choose information that will meet the objectives and pare it down to the minimum amount that is necessary. Information overload must be avoided when teaching people with low literacy. Teach limited amounts of material during each session. | Teaching People with Low-literacy Skills |
| 3. Keep instructions simple by breaking them down into smaller units. | Teaching People with Low-literacy Skills |
| 4. If possible, use more than one teaching method to reinforce the learning. | Teaching People with Low-literacy Skills |
| 5. In the process of teaching, use examples and analogies with which the person can relate. Use familiar illustrations and pictures that are culturally relevant. Use repetition at appropriate times | Teaching People with Low-literacy Skills |
| 6. Be creative in the way you evaluate learning. Verbal quizzes may not work well with low-literate people. Instead, ask them to repeat what you have said in their own words and ask return demonstrations. | Teaching People with Low-literacy Skills |
| 6. If you give them PEMs, you may ask them to underline the most important information. | Teaching People with Low-literacy Skills |
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