Week 5 Flashcards
what is compliance
- extent to which the pts behavior coincides w clinical advice
- includes an authoritarian undertone
what are 2 concepts that affect compliance
- locus of control
- noncompliance
what is locus of control
- the extent to which an individual believes they have control over their life experiences & health
what is an internal locus of control
- belief that one has control over their health outcomes
- belief that health is a consequence of one’s actions
what is external locus of control
- belief that health is controlled by factors outside of one’s control
- unrelated to behavior
what can impact one’s locus of control (2)
- can change based off individual conditions
- may “give up” their locus of control if interventions are failing
what is noncompliance
- the resistance of the pt to follow the treatment plan
what is often associated w noncompliance (2)
- blaming
- labelling of the pt
what is adherence
- the extent to which a person’s behavior corresponds w agree recommendations from a HCP
- pt follows a care plan that was established in partnership w the HCP
what does adherence include
- reciprocity of responsibility & action
- plan agreed upon by pt and HCP
- commitment on part of the pt
- patient-centered and supports the pts right to choose to follow, or not, the treatment recommendations
what is nonadherence
- occurs when the pt doesnt follow treatment recommendations that have been mutually agreed upon
nonadherence can be…
- intentional
- nonintenional
what factors play a role in adherence (5)
- socioeconomics
- pt related
- condition related
- therapy related
- healthcare team and system related
what is motivation
- an internal state that arouses, directs, and sustains human behavior
- a willingness of the learner to embrace learning w readiness as evidence of motivation
- movement in a direction to meet a goal
what is motivation affected by
- internal & external factors
factors that influence motivation can serve as either…
- incentives or obstacles to achieving desired behaviors
- a motivational incentive for one, can be an obstacle for another
facilitating or blocking factors that shape motivation to learn be classified into 3 categories:
- personal attributes –> physical, developmental, and psychological components of the learner
- enviro influences –> surroundings and attitudes of others
- learner relationship systems –> so, family, community, teacher-learner interaction
what personal attributes can impact motivation (10)
- developmental stage
- age
- gender
- emotional readiness
- values & beliefs
- sensory functioning
- cognitive ability
- educational level
- actual/perceived state of health
- severity of illness
what environmental influences can impact motivation (4)
- can promote or detact ability to learn
- physical characteristics of enviro
- accessibility and availability of human & material resources (both physical and psychological)
- different types of behavioral rewards (internal & external)
what are axioms
- rules that set the stage for motivation
- an unprovable rule or first principle accepted as true bc it is self-evident or particularly useful
what are 5 axioms r/t motivation & goal setting
- state of optimal anxiety
- learner readiness
- realistic goal setting
- learner satisfaction/success
- uncertainty reducing or uncertainty maintaining dialogue
describe a state of optimal anxiety r/t motivation: what is the optimal amt, what does too high or too low cause
- learning occurs best w mod lvl of anxiety
- at high lvls –> become self absorbed and ability to perceive enviro, conc, and learn is reduced
- low lvls = not driven to act
how can we help reduce anxiety of pts (3)
- guided imagery
- use of humor
- words of reassurance
descrbie the impact nurses have on learner readiness
- desire cant be imposed on learner, but can be influenced by external forces & promoted by nurse –> make info relevant & stimulating
- incentives are specific to learner*
what are considered realistic goals
- goals within the pts grasp & possible to achieve
why is it imp to have realistic goals
- goals beyond reach can cause frustration and discouragement
what is important to consider when setting goals
- set realistic goals by determining what the learner wants to change –> motivating factors
describe the impact that learner satisfaction/success has on motivation
- learner is motivated by success
- focusing on success as means of positive reinforcements = learner satisfaction and instills sense of accomplishment
- affirm the small steps
describe the impact of uncertainty on motivation
- can be motivating factor
- many people are unsure what is going on in healthcare enviro
- less motivated if they are not sure if the strategy will work
what are the comprehensive parameters for motivational assessment of the learner (6)
- cognitive variables
- affective variables
- physiological variables
- experiental variables
- enviro variables
- educator-learner relationship system
what cognitive variables should be considered during motivational assessment (3)
- capacity to learn
- readiness to learn (expressed self-determination, constructive attitude, expressed desire)
- facilitating beliefs
what affective variables should be considered during motivational assessment (2)
- expressions of constructive emotional state
- mod lvl of anxiety
what physiological variable should be considered during motivational assessment
- capacity to perform required behavior
what should be considered regarding experiental variables in motivational assessment
- previous successful experiences
what enviro variables should be considered during motivational assessment (2)
- approp enviro
- social support systems (family, group, work, community)
what should be considered regarding educator-learner relationship in motivational assessment
- prediction of positive relationship
what are some motivational strategies for nurses as the teacher
- assess pt motivation
- decide what behavior, timeline, outcome, etc. is desirable for the pt
- reduce or eliminate barriers to achieve goals to help instill or maintain motivation
- consider hierarchy of needs
- when teaching occurs, clearly communicate directions and expectations
- make info meaningful to learner
- maniuplate enviro to make it conductive to learning
- provide positive verbal and nonverbal feedback
- provide opportunities for success
what is motivational interviewing (MI)
- caring, respectful tool used to promote behavior change
- an assessment strategy & intervention that support client self-esteem and self-efficacy thru emphasis on clients own reasons and values for change
- collaberative event where positive atmosphere is created thru partner-like relationship
- strategy that tries to enhance intrinsic motivation
- pt has more autonomy and nurse has less authority
- form of pt empowerment w goal of helpin pt gain control over most imp lifestyle management decisions affecting well-being
what are the 2 phases of MI
- nurse helps pt enhance internal motivation for change
- commitment to change is strengthened
- avoid telling the pt what to do, instead ask them what they think the benefits are of changing a behavior*
what acronym is used to represent the 5 general principles of MI
Roll w resistance Express empathy Avoid argumentation Develop discrepancy Support self-efficacy
describe what is meant by roll w resistance during MI
- refers to strategy of acknowledging that resistance to change is natural
- rather than oppose resistance, roll w it
- when pt displays resistance, nurse should activelt involve pt in process of problem solving and attempt to explore reasons behind resistance
why is it imp to express empathy during MI
- communicates to pt that they are understood and accepted –> helps facilitate change
- dont judge pt!
why should you avoid argumentation during MI
- decrease instances of confrontations, which makes pt feel defensive
- defensiveness = further resistance
- when urge to argue arises, nurse should change strategies to help pt self-identify imp. issues and problem areas
why is it imp to develop discrepancy during MI
- involves helping pts understand how current behavior is inconsistent w their goals & values
- the objective is set for pts to identify why change is necessary after seeing inconsistencies between behaviors and gals
what does supporting self efficacy involve
- building pts confidence that change is possible
what acryonym outlines specific strategies for MI
Open ended questions
Affirmations
Reflective statements
Summary statements
what is the importance of open ended questions in MI (2)
- facilitates discussion
- encourages pt to do most of talking about why change is necessary or desirable
what are affirmations r/t MI
- involves nurse making statements that support & encourage the pt, particularly in areas where pt may only see failure
- compliment efforts made
- acknowledge small successes
why are affirmations imp during MI (2)
- promotes self-efficacy
- reinforces the efforts the pt is making towards change
what does reflective statements during MI involve
- restating pts own comments in concise manner = demonstrates nurse understands what the pt is saying
what is the goal of reflective statements in MI
- keep convo going forwards so pt can see need for change and begin to move in that direction
what do summary statements in MI do
- link and reinforce info that has been discussed
- emphasized signif parts of discussion and reviews plan of action
what is a theory (4)
- set of concepts, definitions, and propositions
- systematic view of events or situations
- allows explanantions of events or situation
- explains and/or predicts
what are the models/theories for health behaviors of the learner (7)
- health belief model
- health promotion model
- self-efficacy theory
- protection motivation theory
- stages of change model
- theory of reasoned action
- therapeutic alliance model
what is the health belief model
- predicts preventative health behaviors based on pts belief about the health problem and behavior
what 3 components are involved in the health belief model
- individual perceptions
- modifying factors
- likelihood of action
what is included in individual perceptions in the health belief model (2)
- perceived susceptibility (persons subjective perception of risk of acquring illness or disease)
- perceived severity of disease (feelings on seriousness of contracting illness or disease –> medical and social consequences)
what modifying factors are considered in the health belief model (3)
- demographic variables
- sociophyschological variables
- structural variables
which influence the subcomponents of perceived threat of a specific disease
what is considered w likelihood of action r/t health belief model (2)
- perceived benefits of preventative action (perception of effectiveness of actions to reduce threat of illness or disease)
- perceived barriers to preventative action (
what is the health promotion model
- helps to provide an understanding of whether or not people choose to engage in health-promoting behaviors
- helps people reach health goals thru approach behaviors rather than avoidance-of disease behaviors
- Health-promoting behavior is the desired behavioral outcome
what are the major components of the health promotion model (3)
- individual characteristics and experiences –> each persons unique charfacteristics and experiences affect their actions
- behavior-specific cognitions and affect
- behavioral outcome = health promoting behavior
what does the health promotion model support
- a collaborative partner relationship between the HCP and pt
what is the difference between health belief model and the health promotion model
HBM = targets likelihood of engaging in preventative health behaviors
HPM = targets likelihood of engaging in health promotion activities that lead to positive outcomes
what is an important determinant of participation in health-promoting behavior
- self-efficacy
what is the self-efficacy theroy based on
- person’s expectations relative to a specific course of action
- deals w belief that one is competent and capable of accomplishing a specific behavior
- individuals belief that they can execute a certain behavior
self efficacy is derived from 4 sources of info:
- performance accomplishments –> self-mastery of similar behaviors
- vicarious experiences –> observing successful expected behavior thru modeling of others and comparing it
- verbal persuasions –> by others who present realistic beliefs that the indiv is capable of the expected beavior, encouragement and discouragement
- emotional arousal –> ex. depression or anxiety may = less self efficacy
what is the most influential source of efficacy info
- previous performance accomplishments
what is the protection motivation theory
- threat to health is a stimulus to protection motivation –> leads to intent and action
who is the protection motivation theory approp for
- programs that target high-risk individuals or groups
the stages of change model was developed around…
- addictive and problem behaviors
what are the 6 distinct time-related stages of change
- precontemplation
- contemplation
- preparation
- action
- maintenance
- termination
what is the precontemplation stage of the stages of change model
- individuals have no current intention of change in the foreseeable future (within next 6 mo)
- may be unaware that their behavior is problematic or produces negative consequences
- underestimate pros of change behavior and place too much emphasis on the cons
what is the contemplation stage of the stages of change model
- individuals accept/realize that they have a problem and begin to seriously think about changing it
- may still feel ambivalent abt changing their behavior
what is the prep stage of the stages of change model
- plan to take action within 1 month
- have concrete plan
- start to taken small steps towards behavior change
- believe changing their behavior will lead to healthier life
describe the action stage of the stages of change model
- there is visible improvement of behaviors and committment to longterm change
- people have recently change their behavior and intend to keep moving forward w that behavior change
describe the maintenance stage of the stages of change model
- difficult stage to achieve
- adherence to an established behavior over the longterm (more than 6 months)
- work to prevent relapse to earlier stages
what are some common challenges to the maintenance stage of the stages of change model
- overconfidence
- daily temptation
- relapse
describe the termination stage of the stages of change model
- does not always occur
- occurs when the problem no longer presents an temptation
- no desire to return to their unhealthy behaviors
- when a pt quits a behavior
what is the theory of reasoned action & theory of planned behavior
- focuses on prediction and understanding of human behavior within a social context
- based on the idea that humans behave in a rational way that is consistent w their beliefs
what are the predictors of behavior in the theory of reasoned action (5)
- beliefs
- attitudes towards the behavior
- motivation to comply w subjective norms, influrential persons
- perceived behavioral control
- intention
what is the therapeutic alliance model
- addresses a shift in power from the provider to a learning partnership in which collaboration and negotiation w the pt is key
- based on the theory that a therapeutic alliance must be formed
- each viewed as having equal power
what are the components of the therapeutic alliance lvl (3)
- compliance
- adherence
- therapeutic alliance
