Final exam Flashcards
Literacy
“Ability to understand and use reading, writing, speaking and other forms of communication as ways to participate in society and achieve one’s goals and potentials.”
Health literacy
“The degree to which an individual has the capacity to obtain, communicate, process and understand basic health information and services to make appropriate health care decisions.”
who on average has lower health literacy skills
seniors, immigrants and unemployed
what percent of people find it difficult to judge when to go to the doctor
54%
Links to health literacy
- access (to info on health)
- Comprehend (ability to understand)
- Evaluate (interpret info)
Communicate (make informed decision about health issues)
Can someone be literate and not have health literacy
yes
WHO facets of health literacy
community health literacy, health literacy development, health literacy of an individual, health literacy responsiveness
How can low health literacy effect Health
poorer overall health
misuse of medication
misunderstanding of health information
preventable use of ER
wait longer to seek medical attention - crisis state
Signs of low health literacy
Patient may not follow instructions of recommendations for self care
* High frequency of visits or missing scheduled appointments
* Unable to self-manage condition even after being provided instruction over several visits * May not look at pamphlets or information provided, or may say no when they are offered * When given forms, may decline- “I left my reading glasses at home”
* May bring a family member to visits and defer to them to answer questions
* Noticeable language barrier
* Observing non-verbal signs of lack of understanding (nod and agree)
people with low income are more likely to
attempt suicide, have diabetes, Hep C, teen birth, infant die, immunize less
Health disparities that play a large role
overall health, income, education, employment
what is a big goal of nurses when it comes to the enviornemnt we set
we have to have a supportive and respectful environment
Patient education hierarchy
top:
Self determination
problem solving
treatment: genera and specific
understand disease and pathology
safety
what is the patient education hierarchy
Tool to help prioritize patient’s knowledge needs.
* Moving up the pyramid means more mastery and self determination = more control over health care.
* Safety needs met first
* RN’s approach/interactions directly influence how a patient will move through the stages
client is expert of
self
Provider is expert on
health
Health promotion and education: Roel of RN
-minimize health disparities
-work toward conditions that promote equity and social justice
-support people in gaining control over their health care experience
-provide health info
-teach in a way that meets the need of the individual
StandardII:KnowledgeBasedPractice:
The registered nurse practices using the evidence informed knowledge, skills and judgement from diverse sources of knowledge and ways of knowing
Documentation of education should include
- Document formal and informal teaching
- Description of methods/materials used
- Involvement of patient/family
- Outstanding issues requiring follow-up
- Evaluation of objectives/Pt and Family Comprehension
The following should be recorded by the RN in the client’s health record:
A clear and concise statement of the client’s status (physical, psychological and spiritual);
– All relevant assessment data (including client and family comments as appropriate);
– All ongoing monitoring and communications;
– The care provided to the client including interventions (treatments, advocacy, counseling, consultation, client and family teaching); and,
– Evaluation of the care provided, including the client’s response and any impact for discharge planning. “
3 factors that influence learners assessment
- learning needs
- readiness to learn
- learning styles
methods to teach patients with low health literacy
-have a friend sit in
-simple clear language.
-open ended questions
-teach back
-summarize 1-3 key points
-write down main things
-offer educational materials
nurse barriers to teaching
System barriers (lack of time, space, privacy)
* Low importance placed on client education
* Unfamiliar with HOW to teach
* unfamiliar with instructional
design of materials
* unskilled communication practices
Patient barriers to learning
System barriers
* Lack of knowledge about body
* Communication issues (language, level of information provided)
* Pain,fear,grief
* Poor health literacy
* No motivation to learn
Low end of education spectrum
telling a patient about their medication. Prep for how to teach this learned in school and practiced so many times it will become rout. Is quick and follow up is often complete by other staff, which makes charting essential
Middle of education spectrum
discharge care plan teaching. Reviewing this with the patient, potentially over a few sessions to ensure understanding
End of the education spectrum
clinical nurse educator, public health nurse, their job is teaching
what is the education process
Assessment
Planning
Implement
Evaluate
Assessment
Determine learning needs, readiness to learn
Planning
Teaching plan based on mutually developed goals
Implement
Peform the act of teaching
Evaluate
Determine behaviour changes in knowledge, attitude, skills
Essentail elements of clinical communication
-Communication problems in medical practices are important and common.
-Patients feel anxiety and dissatisfaction related to uncertainty and lack of information, explanation, and feedback.
-Professionals often misperceive the amount and type of information the patient wants to receive.
-Psychological distress is less when patients perceive they have received adequate information.
PATIENT AND FAMILY CENTERED CARE
Acknowledge people as experts on their own lives
* Encourage open and honest conversations
* Support pts to understand their options and make decisions about their care
* Look for ways to improve care based in the needs of each pt
Communication skills
misunderstandings can be devastating-fatal
* recognize uniqueness of the learner
* structure information so each person can receive, understand, remember and apply it
what is VARK used for
learning styles
what does VARK stand for
-visual
-Aural
-written
-Kinesthetic
(logical, social, solitary)
should nurses only take 1 approach when teaching
no use multiple
What can a nurse do to cater to their clients needs
-give them options
-provide oppurtunity for feedback
-assess by direct observation
-cevome familiar with learning models
UDL (universal design for learning)
a framework to improve and optimize teaching and learning for all people based on scientific insights into how humans learn”
recognizing culture influences health care increases:
-accessibility to healthcare and overall health literacy
-informed decision making
Cultural awareness
-first step to enhance health literacy and reduce inequities
-developing sensitivity/awareness to differences
-not assigning judgement to cultural differnence
cultural reflection
Provider realizes importance of culture when providing information
cultural aware ness in action
Practitioner creates language appropriate written materials
CULTURAL COMPETENCY
focus is on skill of PRACTITIONER not client
*integrating and transforming your own health knowledge based on knowledge found in other cultures
*reduce long standing inequities
* improvesaccess,qualityof
service, outcomes
* risk-do’sanddon’tscanleadto assumptions based on traits or attributes
why do we educate on health promotion
Help people maintain and improve their health
Reduce disease risk
Manage chronic illness
Primary prevention
“Activities aimed at reducing factors that are known to lead to health problems; prevent the occurrence of disease or injury”
Examples of primary prevention
Safe sex education
Annual check-up
Immunization
Secondary prevention
“Activities that seek to detect a disease early in its progression, before signs and symptoms occur, to made a diagnosis and begin treatment; Early detection of and intervention in the potential development or occurrence of a health problem”
Examples of secondary prevention
HIV screening for injection drug users
Mammogram, PAP test
Accurate blood glucose testing: diabetes
tertiary prevention
The effects of disease become obvious; goals are to interrupt the disease course, to lessen its effects and to prevent further deterioration/recurrence.”
Examples of tertiary prevention
Therapy group for mentally ill adults
Physical therapy program for person with spinal cord injury
Walking programs post heart attack
Methods to assess the learner
Informal conversation
Structured interview
Observations- ongoing assessment during caregiving
Documentation
Survey tools/questionnaires (not always available or practical)
what you need to know prior to teaching
- WHO is your learner?
Developmental stage
Culture
Meaning of the illness (heart to heart) - What do they know already?
- What do they need to know?
- How do they like to learn?
- What are the BARRIERS that prevent their learning?
- What is their MOTIVATION?
- What is MOST important?
- Who will participate? (may include family)
- How does the learner like to learn? ask questions!!
- Understand team goals- involve others
Prioritize needs (pt. education hierarchy) - Choose the right setting
What resources do I have?
How much time do I have?
Inform patient ahead of time
Minimize distractions
RN responsibility with needs
assess when, what they need or want to know and how to adapt content for each learner.
Patients responsibility with learner needs
determine what they want to know and adapt the learning based on premise of adult learning
No matter how important the information is perceived to be by the nurse, it will not be retained by the client if they are not ready to learn.
Time wasted if you set the objectives before connecting with your learner
what is a very important component of learner needs
Timing is vital- anything affecting physical or emotional comfort will affect a learner’s willingness and ability to learn.
Adherence
“The extent to which a person’s behaviour (taking meds, following recommendations, making lifestyle changes) corresponds with agreed recommendations from a health care provider.”
Motivation
“Internal state that arouses, directs and sustains behaviour and a willingness to embrace learning.”
Personal attributes
Environment
Relationships
Prioritizing learner needs
mandatory: Survival safety
Desirable: not life dependant but related to well being
Possible: nice to know but not essential not connected to daily activity
learner readiness
The time when the learner demonstrates interest in learning the information necessary to maintain optimal health”
PEEK model
a model that can help determine the patients readiness
P stands for
Physical readiness
(health status, complexity of task, gender, environmental effects) is the patient at the place in their health journey they have the capability to learn. Do they have the capability
The first E stands for
emotional readiness
Anxiety
Motivation for learning
Available support systems
Risk taking behaviour
Frame of mind
Developmental Stage
The second E in Peek stands for
Past experiences
Cultural influences
Coping and control mechanisms
Cultural background/context
Locus of control
Orientation
K in peek stands for
Level of individual’s current knowledge
Cognitive ability
Learning disabilities
Learning style
Health belief model ideas
- Individual perception (how susceptibleam I, how bad do I think this is)
- Modifying factors (demographics, age. culture, gender, socio-psychological, structural variable, knowledge of disease, prior contact)
- Likelihood of actions (perceived benefits of preventative actions minus perception)
approach for pre contemplation stage
increase awareness of need for change personalize info about risk and benefits
stages of change
pre contemplation, contemplation, preparation, action, maintenance, relapse
approach for contemplation stage
motivate encourage making specific plans
approach for Preparation
assist with developing and implementing concrete action plans help set gradual goals
approach for action
assist with feedback problem solving social support and reinforcement
approach for maintenance
assist with coping reminders finding alternatives avoiding slips
approach for termination
end well recount the success plan for maintenance over long period of time
accommodate the learners needs not the
providers needs
Model should be:
logical
consistent with everyday observations
similar to those used in previous successful programs
supported by past research in the same area or for related ideas.
8 basic elements of a teaching plan
- The purpose
- The statement of the overall goal
- List of objectives
- Outline of content to be covered
- Instructional method chosen
- Time allotted for each objective
- Instructions resources chosen
- Methods used to evaluate learning
where to start with patient teaching
Develop a teaching/learning plan with the patient that contains goals and objectives.
it is the RN’s responsibility to determine:
WHAT needs to be taught
◦ WHEN to teach
◦ HOW to teach
◦ WHO the focus of teaching should be (consider developmental stage)
what is the point of goals and objectives
they provide direction as to how to arrive at a specific destination
what are objective
they are the steps toward meeting your goal. They are short term and very specific. They are measurable
Goal
outcomes to be achieved at the end of teaching and learning process. Broad, global, long term target. Reaching a goal means meeting several objectives.
Things to consider with goals and objectives
Need to have internal consistency (Bastable, 2017, pp. 366)
* Need to be clear, concise, realistic and learner centered
* Set realistic goals as unrealistic goals can discourage the pt and sets them up for failure
* Mutual involvement of RN and pt * Learner readiness, motivation
WRiting behavioural objectives
-performance objectives
-statements that describe what the learner will be able to do once they successfully complete a unit of instruction
-do not describe what the RN will do describe what the patient will do
-must be specific, measurable, and clearly stated
ABCD model
audience, behaviour, condition, degree
Audience
who is your client? literacy, health literacy, context, determinants of health
what is their developmental stage?
behavioural
what the learner is expected to be able to do to demonstrate the skill has been learned
observable/visible: written down nonvisible - identify or recall something
precise action words (verbs) as labels that are open to few interpretations
Condition
situation under which the behaviour will be observed or performance expected to occur
Degree
how well?
to what extent?
within what time frame?
what is helpful about behavioural objectives
they provide guidance on selecting instructional material, teaching methods, using technology, assessment methods.
They help patents understand what they are expected to learn and understand how they will be assessed
step 1 of writing clear leaning objectives
Learning objectives begin with a consistent phrase: “The learner will” “The student will” “By the end of this session”
Step 2 of writing learning objectives
Connect step one using an action verb which communicates the performance by the learner. Use verbs which describe an action that can be observed and that are measurable within the teaching time.
Step 3 of writing learning objectives
Conclude with the specifics of what the learner will be doing when demonstrating achievement or mastery of the objectives. Stress what the participant will walk away from the activity with
Performance words should be
specific
taxonomy
Way to categorize things according to how they are related to one another.
blooms taxonomy
top:
create
evaluate
analyze
apply
understand
remember
taxonomy 3 learning domain
Cognitive, affective, psychomotor
Cognitive domain
“HEAD”: Thinking
*learning information based on intellect and
thinking
*traditional focus of most teaching
*prerequisite for affective and psychomotor skills
Cognitive action verbs
compose, examine, estimate, illustrate, summarize, recall
cognitive hierarchy
top:
Evaluation
synthesis
analysis
application
comprhension
knowledge
Affective domain
The “heart”- feelings
*“learning is values driven & subjective
*internalizing information involves degree to which feelings/attitudes are incorporated into one’s personality or value system
*explore & clarify learner feelings, emotions, & attitudes
Affective action verbs
Discriminate Integrate Complete Participate Observe
Affective hiarchery
Top:
characterization, organization, valuing, responding, receiving
Psychomotor domain
doing it with your hands and neuromuscular coordination, asking questions. Practice and repetition is key
Psychomotor action verbs
formulation, replace, demonstrate, organize, practice, prepare, describe
Psychomotor heierarchy
top:
origination
adaption
complex overt response
mechanism
guided response
set
perception
