NRS-429 Topic 1 DQ 2
Describe a health promotion model used to initiate behavioral changes. How does this model help in teaching behavioral changes? What are some of the barriers that affect a patient’s ability to learn? How does a patient’s readiness to learn, or readiness to change, affect learning outcomes?
NRS-429 Topic 1 DQ 2
Patient Engagement through using every available resource is a Health Promotion Model that assists nurses with implementing behavioral changes in patients. This model has been found to be effective due to the actual patient and caregiver experience of participating in all of the actual steps of the procedure or process that they are asked to complete.
Engagement and “hands on” experience assists the patient and caregiver in developing confidence in performing the new skill or task.NRS-429 Topic 1 DQ 2
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Behavioral changes can occur when a patient and caregiver first see everything they need to do. The second part of this process involves using their hands to touch the new equipment and to perform the new skill, with a nurse acting as a coach to provide anticipatory guidance.
The nurse essentially models the behavior or skill and asks the patient or caregiver to repeat the skill. This is known as a “return demonstration.” NRS-429 Topic 1 DQ 2.The return demonstration allows a nurse to assess for any knowledge gaps and areas that the patient may need further instruction or reinforcement of education. (Smith and Zsohar, 2013.)
There can be multiple barriers to a patient’s ability to learn. In the Emergency Room setting where I work, sometimes a barrier can be that no new learning can take place due to a patient’s high stress level about their condition. NRS-429 Topic 1 DQ 2, There are times where I have to give a patient some time to process what has happened to them.
As an astute nurse, I have to always look for windows of opportunity when the patient is ready and also capable of learning something new.NRS-429 Topic 1 DQ 2
Other barriers that patients may face include the following: Educational level, life experience level, emotional maturity level, distraction level, preoccupation with stressors not related to or exacerbating the health condition, and Caregiving for others.
These barriers can often be assessed on admission to the department, and they often become apparent when a nurse tries to teach her patient about their condition. This is an important reason to begin discharge planning on admission. (Winters and Echeverri, 2012.)
A patient’s readiness to learn is related to their overall level of motivation and concern. In my experience, most patients have a strong desire to learn about their conditions and improve their outcomes. They welcome the information and resources that I provide as a Complex Care Manager. However, not all patients are in a place where they are ready to learn.
NRS-429 Topic 1 DQ 2
Some of them have been told about the need to make changes, and they are not quite ready to make those changes for reasons they do not always share with me. Some of the reasons could be that they are in denial about their condition, or they do not want to be “bothered” with the tasks they need to complete.
They may be role-overloaded or have a temperament which is fearful and avoidant. People cope in a variety of ways, and some coping skills and styles are maladaptive. (Thompson, et al. 2010.)
NRS-429 Topic 1 DQ 2
The skilled nurse’s duty is to inform, but she cannot always convince patients to do the right thing. In every case, we are tasked with providing patients with a complete understanding of what they need to do, along with a demonstration of any new skills or tasks to complete, where possible.
Patient education packets and “kits” are very helpful in assisting nurses in performing demonstrations and patients in performing return demonstrations. The nurse is responsible for ensuring a thorough understanding of medical care needed, and for setting patients up for success.
NRS-429 Topic 1 DQ 2
Patients then have the freedom of choice about whether they will adhere to the plan or become noncompliant with care. A follow-up call can be an effective way to assess if teaching strategies are working in the context of the patient’s daily environment.
- Smith, Jackie A. PhD; Zsohar, Helen PhD, RN. Patient-education tips for new nurses. Nursing: October 2013 – Volume 43 – Issue 10 – p 1-3 doi: 10.1097/01.NURSE.0000434224.51627.8a
- “Teaching Strategies to Support Evidence-Based Practice,” by Winters and Echeverri, from Critical Care Nurse (2012).
- Thompson RJ, Mata J, Jaeggi SM, Buschkuehl M, Jonides J, Gotlib IH. Maladaptive coping, adaptive coping, and depressive symptoms: variations across age and depressive state. Behav Res Ther. 2010 Jun;48(6):459-66. doi: NRS-429 Topic 1 DQ 210.1016/j.brat.2010.01.007. Epub 2010 Feb 10. PMID: 20211463; PMCID: PMC2872051.
Trans-theoretical health promotion model helps initiate a behavioral change by helping to account for the individual’s readiness to accept change and make and sustain the changes in the behavior (Scott & Andrewes, 2021). NRS-429 Topic 1 DQ 2. The health promotion model is helpful for health promotion planners to design sustainable health programs to determine the readiness, motivation, and ability to complete the health promotion.
According to the trans-theoretical model, individuals are expected to move through six stages of change. The trans-theoretical model shows that behavioral change in individuals happens when they move through a series of steps and not through a single event that appears to be sudden (Scott & Andrewes, 2021). NRS-429 Topic 1 DQ 2
This means that change in behavior for individuals needs to be a process and not an event. The focus of this behavioral health promotion model is to help individuals achieve higher than their initial well-being. According to Mansuroğlu & Kutlu, the behavioral health promotion model encourages the behavioral professional to provide the assistive resources and environment to initiate and sustain the change (2022).
NRS-429 Topic 1 DQ 2
According to the trans-theoretical health promotion model, the common barriers that hinder behavioral change include time, lack of access to the right resources, or affordance (Scott & Andrewes, 2021). In addition, according to the health promotion model, social environment and cultural norms also dictate interpersonal influences to model behavioral change.
According to the trans-theoretical model, patients that exhibit readiness to learn or change as they progress through the stages of modeling behavior will find it easy to be receptive to the teachings and the lessons (Mansuroğlu & Kutlu, 2022). This means that when the willingness to learn and change is present, patients will have an effort to change their behavior.
Mansuroğlu, S., & Kutlu, F. Y. (2022). The Transtheoretical Model-based psychoeducation’s effect on healthy lifestyle behaviors in schizophrenia: A randomized controlled trial. Archives of Psychiatric Nursing, 41, 51-61. https://doi.org/10.1016/j.apnu.2022.07.018
Scott, L., & Andrewes, T. (2021). Using the transtheoretical model of behavior change to analyze the impact of stopping exercise: a reflection. British Journal of Nursing, 30(20), 1203-1205. https://doi.org/10.12968/bjon.2021.30.20.1203
A health promotion model used to initiate behavioral changes is Pender’s health promotion model. “Pender’s model focuses on three areas: individual characteristics and experiences, behavior-specific cognitions and affect, and behavioral outcomes.
The theory notes that each person has unique personal characteristics and experiences that affect subsequent actions.” (Nursing Theory, 2020, p.1) The model also states that health care professionals can impact/influence patients through nursing interventions.
“Obstacles that prevent easy delivery of health care information include literacy, culture, language, and physiological barriers. It is up to the nurse to assess and evaluate the patient’s learning needs and readiness to learn because everyone learns differently.” (Beagley, 2011, p.1) Just as Pender’s model states, each person is unique, therefore nurses must work with the patient to find the right method of teaching.
Another barrier to learning is the patient’s readiness to learn and change. No matter how much a nurse tries, if a patient is not ready to learn or change there will be no change. The patients learning outcomes rely on the nurse communicating and the patient being willing to change and learn. If either side of the equation is lacking, then the learning outcome will be affected negatively.
Pender’s Health Promotion Model. Nursing Theory. (2020, July 21). Retrieved September 30, 2022, from https://nursing-theory.org/theories-and-models/pender-health-promotion-model.php
Beagley, L. (2011). Educating patients: Understanding barriers, learning styles, and teaching techniques. Journal of PeriAnesthesia Nursing, 26(5), 331–337. https://doi.org/10.1016/j.jopan.2011.06.002
The transtheoretical model considers an individual’s readiness to make and maintain behavioral changes as well as the process of behavior change. Planners can use this model to design programs that are based on an individual’s readiness, motivation, and ability.
There are 5 stages in this model, and they include:
Precontemplation — in this stage, the individual has no intention to change behavior within the next six months. The individual may lack knowledge or may have been unsuccessful with previous attempts at a change.
Contemplation: At this point, a person is considering making a change in behavior within the next six months. However, ambivalence may prevent the individual from moving on to the next stage.
Preparation: During this phase, the individual works towards implementing a change within the next thirty days.
Action: An individual is at this stage when their behavioral change is obvious and noticeable for 6 months or less
Maintenance: The individual enters the final stage, called the maintenance stage. At this point the behavioral change has lasted more than 6 months.
Many factors influence a person’s willingness to learn. These may include language, literacy, culture, physiological and psychological factors. It’s always important to assess an individual’s barriers or readiness to learn
References Purdue Extension. (Vicki Simpson) Health and human sciences. https://extension.purdue.edu/extmedia/hhs/hhs-792–w.pdf
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