BNUR1900F24 Behaviour Change BB Edition FNL PDF

BNUR1900 Nursing Fundamentals: Behaviour Change Presented by: Peter Kennedy RN, BScN, MBA November 14, 2024 Learning Objectives During this module, students will:  Develop an understanding of human motivation  Develop connect...

BNUR1900 Nursing Fundamentals: Behaviour Change Presented by: Peter Kennedy RN, BScN, MBA November 14, 2024 Learning Objectives During this module, students will:  Develop an understanding of human motivation  Develop connections between physical activity and health in the context of the older adult  Develop an understanding of the complexities of lifestyle/behaviour change  Examine the concepts of the Transtheoretical Model of Change  Apply the concepts of the Transtheoretical Model of Change to the older adult and physical activity  Clinician Entry to Practice 1.22 Incorporates knowledge from nursing science, social sciences, humanities, and Competencies health-related research into plans of care. Plan   Human behaviour is complex  Unhealthy behaviours, over long periods of time, have been linked to chronic health challenges and premature mortality Overview  Nurses must strive to understand what motivates people, what creates barriers to change, and how healthcare providers can support patients through changes  As with any aspect of nursing, we must see the patient holistically and take into account the social, personal, and contextual factors which influence behaviours It can take considerable time to change unhealthy behaviours Overview Remember: awareness and knowledge alone are not enough to make change! Change and Aging  Older adults are less adaptable to change  Reflect and share your thoughts on this statement   Transitions are an expected part of life  Transitions occur as part of developmental stages as well as part of life course stages  Whether expected or unexpected, Change - transitions can be challenging for individuals Transitions  Understanding how people adapt to change can support our role as educators within the healthcare system and ensure we can best support the people we care for  Long lasting behaviour change can be difficult to initiate and sustain Behaviour Understanding how people adapt to change can support our role as Change educators within the healthcare system Whenever an individual faces decisions regarding behaviour change, there are many factors that impact the choices that are made and the ability to implement those changes  Motivation  A person’s desire or willingness to learn, and influences a person’s behaviour  To be motivated means to be moved into action  What motivates you?  Social motives: need for connection, social approval, or self-esteem Task mastery motives: driven by the desire for achievement Stimuli for Motivation Physical motives: a desire to maintain and improve health Many people do not adopt new health behaviours unless they see a symptom, disease, or diagnosis as a threat and see any changes as beneficial  Questions  What are some of the common lifestyle changes that individuals may face?  Why are people hesitant to change?   There has been an increasing interest in the process of behaviour change in various fields with the hope that understanding will improve the services offered, particularly within  Health Behaviour  Education  Criminology Change  Behaviour change theories have gained recognition in health for their possible effectiveness in explaining health related behaviours and providing insight into methods that would encourage individuals to develop healthy habits and maintain healthy lifestyles What do we Know about Change?  Change is a cyclical process  Individuals typically move back and forth between stages, and cycle through stages at different rates  Movement may vary in relation to different behaviours or objectives  Some individuals may move through the stages quite rapidly; so much that it may be difficult to pinpoint where they are at  It is not uncommon for individuals to linger longer in the early stages of change   In theory, humans have control over their Behaviour and conduct/behaviour Public Health  Health-compromising behaviours can be eliminated by self-regulatory efforts and be adopting health enhancing behaviours Behaviours Diseases Behaviour Change  Smoking/alcohol/  Non-communicable/  Can lead to prevention of dietary/physical activity chronic diseases many health compromising  Sexual activity  STIs issues  Substance use  Mental health and  Healthy life/lifestyle  Unsafe driving addictions  Quality of life  Road traffic incidents Behaviour Change Theories  Social Cognitive Theory  Theory of Planned Behaviour  Self-Determination Theory  Transtheoretical Model of Change (TTM) In change theory, motivation or influence to change originates in a single person Behaviour modification occurs in stages, over time The stages describe an individual’s attitude Transtheoretical toward the change Model of Change The TTM frames change as a process that involves progress through six stages Our goal, as nurses, is to determine which stages the patient is in and support them in progressing through the stages  Enter Precontemplation Maintenance Contemplation Exit and Re-enter at any Stage Relapse Determination Transtheoretical Action Model of Change   Motivational interviewing is often used to assist in assessing the stage of change How can we Best  Motivational interviewers emphasize the need for change and increase Assess the Stage confidence that change can occur of Change? (Lewis & Osborn, 2004)  Let’s review some of the effective questions you might ask for each stage  What would have to happen in order for you to know that this was a problem? What would you consider What has this issue as warning signs that prevented you from would let you know that Precontemplation doing? this is a problem? Stage What do you think will What things have you happen if you don’t make tried to change in the any changes? past?   What are the pros and cons of changing?  What are the pros and cons of not changing? Contemplation  Why do you want to change at this time? Stage  What are the barriers today which are preventing you from changing?  What would help you at this time?   What barriers do you see ahead, and how can you minimize or eliminate them? Preparation  Who can you turn to for support? Stage  What kind of support do you feel you need the most, and where can you get that support? Action Stage  What actions have you taken?  What has helped/not helped you up to this point?  What might you do to replace things that have not helped?   Strategies: Maintenance  Develop a coping plan Stage  Develop a plan for follow-up support   Regular physical activity and exercise contribute to a persons physical and emotional well-being  Functional decline can result from illness Physical Activity and deconditioning associated with and Exercise inactivity  It is important that nurses understand the benefits of regular physical activity and support patients in incorporating movement into daily life Benefits of Exercise  Cardiovascular system: Increased cardiac output, improved myocardial contraction, decreased resting HR, improved venous return  Pulmonary system: Increased respiratory rate and depth followed by a quicker return to resting state, improved alveolar ventilation, decreased work of breathing  Metabolic system: Increased BMR, increased use of glucose and fatty acids, increased triglyceride breakdown, increased gastric motility  Musculoskeletal system: Improved muscle tone, increased joint mobility, improved muscle tolerance to physical activity, possible increase in muscle mass, reduced bone loss  Activity tolerance: Improved tolerance, decreased fatigue  Psychosocial factors: Improved tolerance to stress, reports of ‘feeling better’, reports of decrease in illness (e.g., cold, flu)   Individuals of all ages are more inclined to incorporate a physical activity regime into Physical Activity their lives if it is supported by family, friends, and the Older and their healthcare provider Person  Older persons may need assessment of current mobility and use of aids prior to beginning a new exercise routine Considerations for Exercise and Older Persons  As people age, they often experience a progressive loss of bone mass leads to weaker bones and an increased risk of fractures  Similarly, a progressive loss of muscle mass (sarcopenia) results in decreased strength and endurance  Older persons tend to take smaller strides resulting in a decreased base of support which may increase the risk of falls  Proprioception may be impacted by medications or chronic conditions  Additional age-related changes that may be relevant: tendons, ligaments, joints dry and harden (less flexible), lean muscle mass replaced by adipose tissue, thinning of vertebral discs Canadian Physical Activity Guidelines for Older Adults Canadian 24-Hour Movement Guidelines for Adults 65 Years or Older  These 24-Hour Movement Guidelines are relevant to adults aged 65 years or older, irrespective of gender, cultural background, or socio-economic status. These Guidelines may not be appropriate for adults aged 65 years or older living with a disability or a medical condition; these individuals should consider consulting the Get Active Questionnaire, disability/condition-specific recommendations, or a health professional for guidance.  Following the 24-Hour Movement Guidelines is associated with these health benefits:  a lower risk of mortality, cardiovascular disease, hypertension, type 2 diabetes, several cancers, anxiety, depression, dementia, weight gain, adverse blood lipid profile, falls and fall- related injuries; and  improved bone health, cognition, quality of life and physical function. Benefits of Physical Activity for Older Persons  Decreases risk of:  Loss of function  Loss of independence  Functional status – single most important factor for independent living   Physically  Vertebrae become softer and long shaft bones become more resistant to Factors that may bending Impact Regular  Muscle fibres shrink and have reduced tone and contractility Physical Activity  Strength and endurance change for Older Persons  Fatigue occurs more readily  Overall energy is reduced  Risk of falls increases   Socially/emotionally Factors that may  Cognitive decline Impact Regular  Loneliness  Lack of transportation Physical Activity  Fear for Older Persons  Embarrassment of decreased coordination, sight, hearing Factors that may  Financially Impact Regular  Lower or fixed income  Lack of transportation Physical Activity  Poor access to facilities for physical for Older Persons activity Summary of Physical Activity and Older Persons  Critical for maintaining optimal function  Activity does not need to be a ‘workout’  Consistency is important to maintain benefits  Benefits include:  Maintenance or increase of mobility  Increased socialization  Maintenance of cognitive status  Protective health measures Application of the TTM to Physical Activity in Older Persons  TTM has been shown to be useful approach for increasing physical activity with older persons  Numerous studies show that adults over 65 are the least physically active out of the population  Sedentary lifestyle is a primary risk factor for non-communicable diseases  TTM has been shown to be the most effective model for behaviour change, particularly in the promotion of physical activity   Jenny has been very concerned with her dad’s Perpetual diagnosis and continues to fret about Jay’s well- being. She is finding that she has been using Case Study unhealthy food as a way to manage her stress and anxiety.  Robert is concerned that she is putting her own health and the health of their unborn baby at risk. Whenever he says anything to her about her eating habits, she tells him that the ‘baby will take what he/she needs from her, so it will be fine’, she also states that people who eat much worse than her are still alive and well and also have healthy children.  Sandra is finding that she is also very worried about her husband and son. She is looking for ways to manage her stress. She indicates that knitting and crafts used to be her hobbies.  Answer the following questions based on the Perpetual information you have about the family, and your knowledge from today, and previous classes. Case Study What would have to Apply the TTM to Jenny’s situation. Identify what stage happen in order for you to know that this she is currently at and provide rationale for your answer. was a problem? Use all stages of the TTM, along with some relevant What would you questions, to assist Jenny in acknowledging the need for What has this issue consider as warning prevented you from signs that would let you know that this is a behaviour change. doing? problem? Sandra might benefit from physical activity to manage her stress. While any hobby can be of benefit, there are What do you think What things have additional benefits that come from physical activity. will happen if you don’t make any you tried to change in the past? Describe what you would say to Sandra about the changes? benefits of PA for the older adult. Provide her with the Canadian guidelines for PA of the older adult.   Nurses play a significant role in health teaching  Nurses use education, adult learning techniques, and behaviour change theories every day in their practice Summary  There are many reasons/factors that impact the ability or readiness of an individual to initiate behaviour change  Consider these theories when you hear others using language such as ‘non-compliant’