Sean Whitfield NURS 3000 - Active Learning Guide 12 - Complete.pdf

NURS 3000 - Professional Nursing Psychosocial Needs Psychosocial Needs - Teaching and Learning Needs, Wellness and Illness: Growth and Development Harding University - Active Learning Guide, Module 12 Name: Instructions Complete the module active learning guide as you work through the module content...

NURS 3000 - Professional Nursing Psychosocial Needs Psychosocial Needs - Teaching and Learning Needs, Wellness and Illness: Growth and Development Harding University - Active Learning Guide, Module 12 Name: Instructions Complete the module active learning guide as you work through the module content. Take notes, answer the questions on the guide, and respond to any case studies and client scenarios. All of these activities will assist in your preparation for exams, help you plan and implement care in the clinical setting, and facilitate your development as a Christian nurse servant. You will submit your completed guide to the instructor at the end of the week. The completed learning guide will be worth a maximum of 10 points. If you have questions or are unsure about your answers; or you may email your instructor for clarification. Note: The Active Learning Guide provides a general outline of topics covered in this module; it is not all inclusive of all information needed for the exam. You are responsible for all content in readings and activities throughout the module. I. Teaching and Learning Needs: Chapter 17: Teaching 1. Teaching is defined as: is a system of activities intended to produce learning. The teaching process is intentionally designed to produce specific learning. 2. Learning is defined as: is a change in human disposition or capability that persists and that cannot be solely accounted for by growth. Learning is represented by a change in behavior. 3. How can teaching occur without learning? Describe an example of this. 4. How can learning occur without teaching? Describe an example of this. 5. Discuss the andragogical principles about adult learners which nurses should consider when teaching adult clients.  Adults need to know why they need to learn something before learning it.  The self-concept of adults is heavily dependent on a move toward self-direction.  The prior experiences of the learner provide a rich resource for learning.  Adults typically become ready to learn when they experience a need to cope with a life situation or perform a task.  Adults have a life-centered orientation to learning; education is a process of developing increased competency levels to achieve their full potential.  The motivation for adult learners is internal rather than external. NURS 3000 - Professional Nursing Psychosocial Needs 6. Describe and give an example of each of the three learning domains.  Cognitive: the “thinking” domain, includes six intellectual abilities and thinking processes: “remembering, understanding, applying, analyzing, evaluating, and creating” (Miller & Stoeckel, 2016, p. 228).  Affective: known as the “feeling” domain, relates to the client’s attitudes, interests, attention, awareness, and values (Miller & Stoeckel, 2016, p. 228).  Psychomotor: the “skill” domain, includes physical movement and coordination, such as giving an injection. 7. Why do you think the nurse is legally bound to teach? Nurses need to provide client education that will ensure the client’s safe transition from one level of care to another and make appropriate plans for follow-up education in the client’s home. Discharge plans must include information about what the client has been taught before transfer or discharge and what remains for the client to learn to perform self-care in the home or another residence (see Chapter 7). Do you believe the nurse is ethically bound to teach? Explain. 1. Beneficence: This principle refers to actions that promote the well-being of others. By educating patients, nurses are directly contributing to their well-being, helping them to understand their health conditions, the treatments they are receiving, and how to manage their health effectively. This knowledge empowers patients to make informed decisions, potentially leading to better health outcomes. 2. Autonomy: Respecting a patient's autonomy means acknowledging their right to make informed decisions about their own health care. Education is a key component of this, as patients cannot make truly informed decisions without understanding their health status, the implications of various treatments, and the potential outcomes. Nurses, through education, provide the information necessary for patients to exercise autonomy. 3. Nonmaleficence: This principle dictates that healthcare providers should do no harm. By educating patients on how to avoid health risks, manage their conditions, and understand potential side effects of treatments, nurses help minimize the chances of harm. 4. Justice: This involves treating individuals fairly and providing equitable care. Part of this fairness is ensuring that all patients have access to the information they need to understand their health and treatment options, regardless of their background or circumstances. Nurses play a critical role in delivering this information in a way that is accessible and understandable to each patient. 5. Fidelity: Refers to the obligation to keep promises and be committed to the patient's welfare. This includes the commitment to provide thorough and accurate information, enabling patients to follow through with their care plans effectively. 8. List and discuss the factors which affect learning. NURS 3000 - Professional Nursing Psychosocial Needs  Age/Development: The nurse needs to consider the age and developmental stage of the learner because they influence the client’s ability to learn. Three major factors that influence a client’s learning needs across the lifespan are biological characteristics, developmental tasks, and psychosocial stages. These factors must be considered at each developmental period throughout the lifecycle (Miller & Stoeckel, 2016, p. 144). Furthermore, The Joint Commission mandates that healthcare agencies provide teaching plans that address developmental stage–specific competencies of the learner.  Motivation: to learn is the desire to learn. It greatly influences how quickly and how much an individual learns. Motivation is generally greatest when an individual recognizes a need and believes the need will be met through learning. It is not enough for the need to be identified and verbalized by the nurse; it must be experienced by the client. Often, the nurse’s task is to help the client personally work through the problem and identify the need. Sometimes clients or support people need help identifying information relevant to their situation before they can see a need. For instance, clients with heart disease may need to know the effects of smoking before they recognize the need to stop smoking. Adolescents may need to know the consequences of an untreated sexually transmitted infection before they see the need for treatment.  Readiness: to learn is the demonstration of behaviors or cues that reflect the learner’s motivation to learn at a specific time. Readiness reflects not only the desire or willingness to learn but also the ability to learn at a specific time. For example, a client may want to learn self-care during a dressing change, but if the client experiences pain or discomfort, the client may not be able to learn. The nurse can provide pain medication to make the client more comfortable and more able to learn. The nurse’s role is often to encourage the development of readiness.  Active Involvement: When the learner is actively involved, learning becomes more meaningful. If the learner actively participates in planning and discussion, learning is faster, and retention is better (Figure 17.1). Active learning promotes critical thinking, enabling learners to solve problems more effectively. Clients who are actively involved in learning about their healthcare may be more able to apply the learning to their own situation. For example, clients who are actively involved in learning about their therapeutic diets may be more able to apply the principles being taught to their cultural food preferences and their usual eating habits. Passive learning, such as listening to a lecture or watching a film, does not foster optimal learning.  Relevance: The knowledge or skill to be learned must be personally relevant to the learner. Clients learn more easily if they can connect the new knowledge to that which they already know or have experienced. For example, if a client is diagnosed with hypertension, is overweight, and has symptoms of headaches and fatigue, he is more likely to understand the need to lose weight if he remembers having more energy when he weighed less. The nurse needs to validate the relevance of learning with the client throughout the learning process. NURS 3000 - Professional Nursing Psychosocial Needs  Feedback: Feedback is information regarding a client’s performance in reaching a desired goal. It must be meaningful to the learner. Feedback that accompanies the practice of psychomotor skills helps the client to learn those skills. Support of desired behavior through praise, positively worded corrections, and suggestions of alternative methods are ways of providing positive feedback. Negative feedback, such as ridicule, anger, or sarcasm, can lead clients to withdraw from learning. Such feedback, viewed as a type of punishment, may cause the client to avoid the teacher to avoid punishment.  Nonjudgmental Support: Individuals learn best when they believe they are accepted and will not be judged. The individual who expects to be judged as a “poor” or “good” client will not learn as well as the client who feels no such threat. Once learners have succeeded in accomplishing a task or understanding a concept, they gain self-confidence in their ability to learn. This reduces their anxiety about failure and can motivate greater learning. Successful learners have increased confidence with which to accept failure.  Simple to Complex: Learning is facilitated by material that is logically organized and proceeds from the simple to the complex. Such organization enables the learner to comprehend new information, assimilate it with previous learning, and form new understandings. Of course, simple and complex are relative terms, depending on the level at which the client is learning. What is simple for one client may be complex for another.  Repetition: Repetition of key concepts and facts facilitates retention of newly learned material. Practice of psychomotor skills, particularly with feedback from the nurse, improves the performance of those skills and facilitates their transfer to another setting.  Timing: Individuals retain information and psychomotor skills best when the time between learning and active use of the learning is short; the longer the time interval, the easier it is to forget the learning. For example, a client who is only shown literature and videotapes about administering insulin but is not permitted to administer his or her own insulin until discharge from the hospital is unlikely to remember what was learned. However, giving his or her own injections while in the hospital enhances the client’s learning.  Environment: An optimal learning environment facilitates learning by reducing distraction and providing physical and psychologic comfort. It has adequate lighting that is free from glare, a comfortable room temperature, and good ventilation. Most students know what it is like to try to learn in a hot, stuffy room; the consequent drowsiness interferes with concentration. Noise can also distract the student and interfere with listening and thinking. To facilitate learning in a hospital setting, nurses should choose a time when no visitors are present and interruptions are unlikely. NURS 3000 - Professional Nursing Psychosocial Needs  Emotions: Emotions such as fear, anger, and depression can impede learning. A high level of anxiety resulting in agitation and the inability to focus or concentrate can also inhibit learning. Clients or families who are experiencing extreme emotional states may not hear spoken words or may retain only part of the communication. Emotional responses such as fear and anxiety decrease with information that relieves uncertainty. Medications may be prescribed for extremely distraught clients or families to reduce their anxiety and put them in an emotional state in which understanding or learning can occur.  Physiologic Events: Physiologic events such as a critical illness, pain, or sensory deficits inhibit learning. Because the client cannot concentrate and apply energy to learning, the learning itself is impaired. The nurse should try to reduce the physiologic barriers to learning as much as possible before teaching. For example, providing analgesics and rest before teaching is often helpful.  Culture: Cultural barriers to learning include language and values. The client who does not understand the nurse’s language may learn little. Western medicine may conflict with a client’s cultural healing beliefs and practices. To be effective, nurses must be culturally sensitive and competent; otherwise, the client may be partially or totally noncompliant with recommended treatments. Another impediment to learning is differing values held by the client and the health team. For example, if a client comes from a culture that views being overweight or “plump” as positive, the nurse should present information in the client’s cultural context. Then the nurse and the client should together determine an acceptable weight and develop a plan for achieving that weight (Bastable, 2017; Miller & Stoeckel, 2016).  Psychomotor Ability: It is important for the nurse to be aware of a client’s psychomotor skills when planning teaching. Psychomotor skills can be affected by health. For example, an older client who has severe osteoarthritis of the hands may not be able to self-administer insulin. The following physical abilities are important for learning psychomotor skills: ◦ Muscle strength. For example, an older client who cannot rise from a chair because of insufficient leg and muscle strength cannot be expected to learn to lift herself out of a bathtub. ◦ Motor coordination. Gross motor coordination is required for movements such as walking, and fine motor coordination is needed when using utensils, such as a fork for eating. For example, a client who has advanced amyotrophic lateral sclerosis (ALS) involving the lower limbs will probably be unable to use a walker. ◦ Energy. Energy is required for most psychomotor skills, and learning these skills uses more energy. Older adults and clients who are ill often have limited energy resources; learning and carrying out these skills must be timed for when the client’s energy sources are at their peak. NURS 3000 - Professional Nursing Psychosocial Needs ◦ Sensory acuity. Sight is used for most learning (i.e., walking with crutches, changing a dressing, drawing a medication into a syringe). Clients who have a visual impairment often need the assistance of a support person to carry out such tasks. 9. Table 17.2 Guidelines for Evaluating Online Health Information How are these guidelines of use to the nurse in client teaching situations? These guidelines are an aid to provide a path for the nurse to overcome barriers or obstacles to learning. These barriers need to be taken care of first in order to prep the patient to be able to receive nursing education. 10. What three areas of readiness to learn should the nurse assess prior to implementing any client teaching? Nurses can promote readiness to learn by providing physical and emotional support during the critical stage of recovery. As the client stabilizes physically and emotionally, the nurse can provide opportunities to learn. The nurse assesses for these readiness characteristics:  Physical readiness. Is the client able to focus on things other than physical status, or are pain, fatigue, and immobility using all the client’s time and energy? How much coordination and energy will be needed to complete the task?  Emotional readiness. Is the client emotionally ready to learn self-care activities? Clients who are extremely anxious, depressed, or grieving over their health status are not ready. An available and strong support system can positively influence emotional readiness.  Cognitive readiness. Can the client think clearly at this point? Are the effects of anesthesia and analgesia altering the client’s level of consciousness? What is the client’s knowledge base, cognitive ability, and preferred learning style? 11. How can the nurse increase the client’s motivation to learn? The nurse can increase a client’s motivation to learn by providing information of the consequences if nothing is done. Nurses can increase a client’s motivation in several ways:  By relating the learning to something the client values and helping the client see the relevance of the learning  By helping the client make the learning situation pleasant and nonthreatening  By encouraging self-direction and independence  By demonstrating a positive attitude about the client’s ability to learn  By offering continuing support and encouragement as the client attempts to learn (i.e., positive reinforcement) NURS 3000 - Professional Nursing Psychosocial Needs   By creating a learning situation in which the client is likely to succeed (Succeeding in small tasks motivates the client to continue learning.) By assisting the client to identify the benefits of changing behavior. 12. Clinical Alert p. 306 What behaviors/responses might the nurse see in a client who cannot read? Many clients are embarrassed about their reading level or will conceal that they cannot read. Instead, they may say things like “I forgot my glasses,” “The form is too long,” “I want my family to read it first,” or “There are too many medical and legal terms.” Most clients at the lowest reading levels, if asked, will report that they “read well.” 13. Write a specific and measurable client learning goal r/t a situation of a client learning how to administer their own insulin injections. Patient will demonstrate how to administer their own subcutaneous insulin injection as prescribed by health care provider after two days. Table 17.3 Strategy Explanation or description (e.g., lecture) Major Type of Learning Cognitive Characteristics Teacher controls content and pace. Learner is passive and therefore retains less information than when actively participating. Feedback is determined by the teacher. May be given to individual or group. Strategy One-on-one discussion Major Type of Learning Affective, cognitive Characteristics Encourages participation by learner. Permits reinforcement and repetition at the learner’s level. Permits introduction of sensitive subjects. Strategy Answering questions Major Type of Learning Cognitive Characteristics Teacher controls most of content and pace. NURS 3000 - Professional Nursing Psychosocial Needs Teacher must understand question and what it means to the learner. Learner may need to overcome cultural perception that asking questions is impolite and may embarrass the teacher. Can be used with individuals and groups. Teacher sometimes needs to confirm whether the question has been answered by asking the learner, for example, “Does that answer your question?” Strategy Demonstration Major Type of Learning Psychomotor Characteristics Often used with explanation. Can be used with individuals and small or large groups. Does not permit use of equipment by learner; learner is passive. Strategy Discovery Major Type of Learning Cognitive, affective Characteristics Teacher guides problem-solving situation. Learner is active participant; therefore, retention of information is high. Strategy Group discussions Major Type of Learning Affective, cognitive Characteristics Learner can obtain assistance from supportive group. Group members learn from one another. Teacher needs to keep the discussion focused and prevent monopolization by one or two learners. Strategy Practice Major Type of Learning Psychomotor Characteristics Allows repetition and immediate feedback. Permits hands-on experience. Strategy Printed and audiovisual materials NURS 3000 - Professional Nursing Psychosocial Needs Major Type of Learning Cognitive Characteristics Types include books, pamphlets, films, programmed instruction, and computer learning. Learners can proceed at their own speed. Nurse can act as resource, need not be present during learning. Potentially ineffective if reading level of the materials is too high. Teacher needs to select language of materials that meets learner needs if English is a second language. Strategy Role Playing Major Type of Learning Affective, cognitive Characteristics Permits expression of attitudes, values, and emotions. Can assist in development of communication skills. Involves active participation by learner. Teacher must create supportive, safe environment for learners to minimize anxiety. Strategy Modeling Major Type of Learning All types of learning Characteristics Nurse sets example by attitude, psychomotor skill Strategy Computer learning resources Major Type of Learning All types of learning Characteristics Learner is active. Learner controls pace. Provides immediate reinforcement and review. Use with individuals or groups. NURS 3000 - Professional Nursing Psychosocial Needs 14. Table 17.3 Selected Teaching Strategies: Familiarize yourself with these strategies. See above 15. Why is it important to document all situations of client teaching? Documenting Documentation of the teaching process is essential because it provides a legal record that the teaching took place and communicates the teaching to other health professionals. If teaching is not documented, then legally, it did not occur. It is also important to document the responses of the client and support people to teaching activities. What did the client or support person say or do to indicate that learning occurred? Has the client demonstrated mastery of a skill or the acquisition of knowledge? The nurse records this in the client’s chart as evidence of learning. A sample documentation of teaching follows: 6/8/2020 1130 Learning to use glucometer to check her own capillary blood glucose levels. Noted a slight hesitation with each step. Demonstrated correct technique. Stated that she is “feeling more comfortable” each time she does it but still “needs to stop and think about the process.” Will continue to monitor client’s progress. S. Brown, RN. The parts of the teaching process that should be documented in the client’s chart include the following: Diagnosed learning needs Learning outcomes Topics taught Client outcomes Need for additional teaching Resources provided. II. Wellness and Illness: Chapter 20: Health, Wellness, and Illness 1. What is your definition of health? Defined in terms of the presence or absence of disease. How can one person’s definition of health differ from another person’s definition and both be correct? Personal Definitions of Health Health is a highly individual perception. Consider the following examples of individuals who would probably say they are healthy even though they have physical impairments that some would consider an illness: A 15-year-old with diabetes takes injectable insulin each morning. He plays on the school soccer team and is editor of the high school newspaper. A 32-year-old is paralyzed from the waist down and needs a wheelchair for mobility. He is taking an accounting course at a nearby college and uses a specially designed automobile for transportation. NURS 3000 - Professional Nursing Psychosocial Needs A 72-year-old takes antihypertensive medications to treat high blood pressure. She is a member of the neighborhood golf club, makes handicrafts for a local charity, and travels 2 months each year. Many people describe health as the following: Being free from symptoms of disease and pain. Being able to be active and to do what they want or must. Being in good spirits most of the time. These characteristics indicate that health is not something that an individual achieves suddenly at a specific time. It is an ongoing process—a way of life—through which an individual develops and encourages every aspect of the body, mind, and feelings to interrelate harmoniously as much as possible (Figure 20.1). Cultural Differences: Different cultures have their own ways of understanding health and well-being. For some, health might primarily be seen in physical terms, such as the absence of disease or infirmity. For others, it might encompass a broader spectrum, including spiritual, emotional, and community wellness. These cultural beliefs shape how health is perceived and valued, leading to variations in definitions that are all considered correct within their cultural contexts. Personal Experiences: An individual's experience with chronic illness, disability, or recovery from a disease can influence their definition of health. Someone who lives with a chronic condition might define health as the ability to manage symptoms and maintain a good quality of life, whereas someone who has never experienced a significant illness may view health as simply being free from disease. Age and Life Stage: Perceptions of health can change with age and life stages. Younger people might define health in terms of physical fitness and being active, while older adults might consider health as the ability to be independent, maintain social connections, and have cognitive clarity. Socioeconomic Status: Access to resources such as nutritious food, clean water, safe housing, education, and healthcare can influence definitions of health. Those with fewer resources might focus on survival and the absence of acute illness, while those with more resources might emphasize wellness, prevention, and the optimization of physical and mental functioning. Professional vs. Lay Perspectives: Health professionals might define health in terms of measurable factors like blood pressure, cholesterol levels, and other biomarkers of disease risk. In contrast, laypeople might consider feeling good and being able to engage in daily activities as indicators of health. Holistic vs. Reductionist Views: Some people adopt a holistic view of health, considering emotional, social, and spiritual well-being just as important as physical health. Others might have a more reductionist view, focusing on specific aspects of physical health or the absence of physical symptoms. 2. How would you rate your health today? Is that better, worse, or unchanged from the beginning of the semester? NURS 3000 - Professional Nursing Psychosocial Needs Being free from symptoms of disease and pain. Being in good spirits most of the time. But, not able to be active and to do what they want or must. If changed, what do you think has affected your health? Nursing school 3. Define wellness: is a state of well-being. Basic aspects of wellness include self-responsibility; an ultimate goal; a dynamic, growing process; daily decision-making in the areas of nutrition, stress management, physical fitness, preventive healthcare, and emotional health; and most importantly, the whole being of the individual. 4. Describe the wellness-illness continuum. The wellness-illness continuum is a conceptual model that illustrates health as a dynamic process, recognizing that an individual's health status is not static but fluctuates over time along a spectrum between optimal wellness and severe illness or disability. This model is instrumental in understanding that health encompasses more than just the absence of disease and includes a wide range of physical, mental, emotional, and social well-being dimensions. Dynamic Nature of Health: The continuum highlights that an individual's health status can move back and forth between wellness and illness due to various factors, including genetics, environment, lifestyle choices, and social determinants of health. Holistic Perspective: It encompasses the whole person, integrating physical, mental, and social well-being. This approach acknowledges that these dimensions are interrelated, with changes in one aspect potentially affecting others. Spectrum of Health States: The continuum ranges from high-level wellness at one end to severe illness or premature death at the other. High-level wellness is characterized by a proactive approach to living, where an individual actively seeks ways to improve their health and wellbeing. In contrast, the opposite end of the spectrum involves chronic illness, disability, or conditions that significantly impair quality of life. Personal and Subjective Experience: Health is subjective and personal. Where an individual falls on the continuum can be influenced by their perceptions, experiences, and expectations regarding health and wellness. Application and Importance: Preventive Healthcare: The model encourages a preventive approach to healthcare, emphasizing the importance of lifestyle choices, regular check-ups, and early intervention to maintain or improve one's position on the wellness end of the continuum. Health Promotion: It supports health promotion activities aimed at enhancing well-being, preventing disease, and improving quality of life, regardless of whether an individual is currently experiencing illness. NURS 3000 - Professional Nursing Psychosocial Needs Personalized Care: The continuum model underscores the importance of personalized care, recognizing that each individual's health journey is unique and may require different strategies to promote wellness or manage illness. Education and Empowerment: By understanding health as a dynamic and multifaceted concept, individuals are better equipped to make informed decisions about their health care and lifestyle choices, empowering them to take an active role in managing their health. 5. List and describe factors which influence health behaviors.  Internal variables:Internal variables include biological, psychologic, and cognitive dimensions. They are often described as nonmodifiable variables because, for the most part, they cannot be changed. However, when internal variables are linked to health problems, the nurse must be even more diligent about working with the client to influence external variables (e.g., exercise and diet) that may assist in health promotion and prevention of illness. Regular health exams and appropriate screening for early detection of health problems become even more important.  External variables:External variables affecting health include the physical environment, standards of living, family and cultural beliefs, and social support networks.  Environment:People are becoming increasingly aware of their environment and how it affects their health and level of wellness. Geographic location determines climate, and climate affects health. For instance, malaria and malaria-related conditions occur more frequently in tropical rather than temperate climates. Pollution of the water, air, and soil affects the health of cells. Some man-made substances in the environment, such as asbestos, are considered carcinogenic (i.e., they cause cancer). Tobacco is “hazardous to one’s health,” with rates of cancer higher among both smokers themselves and those who live or work near individuals who smoke in their environment.  Standards of Living:An individual’s standard of living (reflecting occupation, income, and education) is related to health, morbidity, and mortality. Hygiene, food habits, and the ability to seek healthcare advice and follow health regimens vary by income level.  Family/Cultural Beliefs:The family passes on patterns of daily living and lifestyles to offspring. For example, a man who was abused as a child may physically abuse his own children. Physical or emotional abuse may cause long-term health problems. Emotional health depends on a social environment that is free of excessive tension and does not isolate the individual from others. A climate of open communication, sharing, and love fosters the fulfillment of the individual’s optimal potential.  Social Support: Having a support network (family, friends, or a confidant) and job satisfaction can facilitate healthy behaviors. Support persons can help the individual confirm that illness exists. Individuals with inadequate support networks sometimes become increasingly ill before NURS 3000 - Professional Nursing Psychosocial Needs confirming the illness and seeking therapy. Support persons also provide the motivation for an ill individual to become well again. 6. What is health adherence? is the extent to which an individual’s behavior (e.g., taking medications, following diets, or making lifestyle changes) coincides with medical or health advice. Another term used synonymously with adherence is conformance. The degree of adherence may range from disregarding every aspect of the recommendations to following the total therapeutic plan. There are many reasons why some individuals adhere and others do not (Box 20.3). To enhance adherence, nurses need to ensure that the client is able to perform the activities, understands the necessary instructions, is a willing participant in establishing goals of therapy, and values the planned outcomes of behavior changes. Examples of questions to be included in the assessment of medication adherence are found in the Assessment Interview. Components of Health Adherence Medication Adherence: Involves taking medications as prescribed, including timing, dosage, and frequency. Non-adherence can lead to significant health complications, treatment failure, or the need for more aggressive treatments. Dietary Adherence: Following dietary recommendations, which can be crucial for managing conditions like diabetes, celiac disease, or high cholesterol. It often requires significant lifestyle adjustments and understanding of dietary impacts on health. Lifestyle Changes: Includes exercising, quitting smoking, reducing alcohol consumption, and other behavioral changes aimed at improving health or managing a condition. Factors Influencing Health Adherence Understanding of Treatment: Patients who have a clear understanding of their condition and the rationale behind their treatment plan are more likely to adhere to their prescribed regimens. Complexity of Regimen: Simpler routines (e.g., medications taken once daily) tend to have higher adherence rates than more complex regimens. Side Effects: The presence or fear of adverse side effects can significantly impact a patient's willingness to adhere to a treatment plan. Support Systems: Social support from family, friends, and healthcare providers can enhance adherence by providing reminders, assistance, and encouragement. Access to Care: Barriers such as financial constraints, lack of insurance, or geographic location can impede access to medications, dietary needs, and follow-up care, affecting adherence. Patient-Provider Relationship: Trust and open communication between patients and healthcare providers are crucial for addressing concerns and adjusting treatment plans to improve adherence. NURS 3000 - Professional Nursing Psychosocial Needs Measuring Health Adherence Health adherence can be challenging to measure accurately, as it often relies on self-reporting, which can be subject to bias. Other methods include pill counts, pharmacy refill records, and, more recently, digital health technologies like smart pill bottles or wearable devices, which can offer more precise adherence data. Importance of Health Adherence Improving health adherence is vital for optimizing treatment outcomes, enhancing quality of life, and reducing healthcare costs. Non-adherence can lead to disease progression, increased morbidity and mortality, and higher costs due to additional treatments and hospitalizations. Effective strategies to improve adherence include patient education, simplifying treatment regimens, using reminders, providing emotional and social support, and addressing barriers to access. 7. Define illness:is a highly personal state in which the individual’s physical, emotional, intellectual, social, developmental, or spiritual functioning is thought to be diminished. It is not synonymous with disease and may or may not be related to disease. An individual could have a disease and not feel ill. Similarly, an individual can feel ill, that is, feel uncomfortable, and yet have no discernible disease. 8. Describe the differences between an acute illness and a chronic illness. Acute illness is typically characterized by symptoms of relatively short duration. The symptoms often appear abruptly and subside quickly and, depending on the cause, may or may not require intervention by healthcare professionals. Some acute illnesses are serious (e.g., appendicitis may require surgical intervention), but many acute illnesses, such as colds, subside without medical intervention or with the help of over-the-counter medications. Following an acute illness, most individuals return to their normal level of wellness. A chronic illness is one that lasts for an extended period, usually 6 months or longer, and often for the individual’s life. Chronic illnesses usually have a slow onset and often have periods of remission, when the symptoms disappear, and exacerbation, when the symptoms reappear. Acute Illness Characteristics: Sudden Onset: Acute illnesses typically begin suddenly and have a rapid onset of symptoms. Short Duration: They usually have a brief duration, often lasting from a few days to a few weeks. Self-limiting: Many acute conditions resolve on their own without the need for long-term treatment, though some may require immediate medical attention. Specific Cause: Acute illnesses are often caused by specific agents such as bacteria, viruses, or injuries. NURS 3000 - Professional Nursing Psychosocial Needs Severe Symptoms: Symptoms can be severe but are typically short-lived and resolve with treatment or over time. Examples: Common cold, influenza, acute appendicitis, and broken bones. Chronic Illness Characteristics: Gradual Onset: Chronic illnesses often develop gradually over time and may not have a single, identifiable onset. Long Duration: These conditions are long-lasting and are often life-long, with impacts that can vary in intensity over time. Continuous or Recurrent: Chronic illnesses may present continuous symptoms or periods of remission and flare-ups. Management, Not Cure: While some chronic diseases can be controlled or managed effectively with treatment, they generally cannot be cured. Impact on Quality of Life: Chronic conditions can significantly impact an individual's quality of life, including their physical, emotional, and social well-being. Examples: Diabetes, heart disease, arthritis, and chronic obstructive pulmonary disease (COPD). Key Differences Duration: The most apparent difference is the duration—acute illnesses are short-term, while chronic illnesses are long-term or lifelong. Onset: Acute illnesses have a sudden onset, whereas chronic illnesses develop gradually. Treatment Goals: The primary goal in treating acute illnesses is to cure the condition, while managing a chronic illness focuses on controlling symptoms, managing pain, and improving quality of life. Cause: Acute illnesses often have a specific and identifiable cause, such as an infectious agent or injury. In contrast, chronic illnesses may have multiple and complex causes, including lifestyle factors, genetics, and environmental exposures. Impact: While acute illnesses can significantly impact health in the short term, chronic illnesses have a prolonged impact on a person’s lifestyle, mental health, and physical well-being. 9. List and describe the five stages of illness; a. Stage 1: Symptom Experiences At this stage, the individual comes to believe something is wrong. Either someone significant mentions that the individual looks unwell, or the individual experiences some symptoms, such as pain, rash, cough, fever, or bleeding. Stage 1 has three aspects: ◦ The physical experience of symptoms NURS 3000 - Professional Nursing Psychosocial Needs ◦ The cognitive aspect (the interpretation of the symptoms in terms that have some meaning to the individual) ◦ The emotional response (e.g., fear or anxiety). During this stage, the unwell individual usually consults others about the symptoms or feelings, validating with support people that the symptoms are real. At this stage, the sick individual may try home remedies. If self-management is ineffective, the individual enters the next stage. b. Stage 2: Assumption of the Sick Role The individual now accepts the sick role and seeks confirmation from family and friends. Individuals often continue with self-treatment and delay contact with healthcare professionals as long as possible. During this stage, individuals may be excused from normal duties and role expectations (Figure 20.4). Emotional responses such as withdrawal, anxiety, fear, and depression are not uncommon depending on the severity of the illness, perceived degree of disability, and anticipated duration of the illness. When symptoms of illness persist or increase, the individual is motivated to seek professional help. c. Stage 3: Medical Care Contact Sick individuals seek the advice of a health professional either on their own initiative or at the urging of significant others. When individuals seek professional advice, they are really asking for three types of information: ◦ Validation of real illness ◦ Explanation of the symptoms in understandable terms ◦ Reassurance that they will be all right or a prediction of what the outcome will be. The health professional may determine that the client does not have an illness or that an illness is present and may even be life threatening. The client may accept or deny the diagnosis. If the diagnosis is accepted, the client usually follows the prescribed treatment plan. If the diagnosis is not accepted, the client may seek the advice of others who will provide a diagnosis that fits the client’s perceptions. d. Stage 4: Dependent Client Role After accepting the illness and seeking treatment, the client becomes dependent on the professional for help. Clients vary greatly in the degree of ease with which they can give up their independence, particularly in relation to life and death. Role obligations—such as those of wage earner, parent, student, sports team member, or choir member—complicate the decision to give up independence. Most clients accept their dependence on the primary care provider, although they retain varying degrees of control over their own lives. For example, some clients request precise information about their disease, their treatment, and the cost of treatment and may delay the decision to accept treatment until they have all this information. Others prefer that the primary care provider proceed with treatment and do not request additional information. NURS 3000 - Professional Nursing Psychosocial Needs e. Stage 5: Recovery or Rehabilitation During this stage, the client is expected to relinquish the dependent role and resume former roles and responsibilities. For clients with acute illness, the time as an ill client is generally short, and recovery is usually rapid. Thus, most find it relatively easy to return to their former lifestyles. Clients who have long-term illnesses and must adjust their lifestyles may find recovery more difficult. For clients with a permanent disability, this final stage may require therapy to learn how to make major adjustments in functioning. 10. Briefly describe the effect of illness on the client and on the family. Client: Impact on the Client Ill clients may experience behavioral and emotional changes, changes in self-concept and body image, and lifestyle changes. Behavioral and emotional changes associated with short-term illness are generally mild and short-lived. The client, for example, may become irritable and lack the energy or desire to interact in the usual fashion with family members or friends. More acute responses are likely with severe, life-threatening, chronic, or disabling illness. Anxiety, fear, anger, withdrawal, denial, a sense of hopelessness, and feelings of powerlessness are all common responses to severe or disabling illness. For example, a client experiencing a heart attack fears for his life and the financial burden it may place on his family. Another client informed about a diagnosis of a crippling neurologic disease may, over time, experience episodes of denial, anger, fear, and hopelessness. Family: Impact on the Family Illness affects not only the client who is ill but also the family or significant others. The kind of effect and its extent depend chiefly on three factors: (1) the member of the family who is ill, (2) the seriousness and length of the illness, and (3) the cultural and social customs the family follows. The changes that can occur in the family include the following: Role changes Task reassignments and increased demands on time Increased stress due to anxiety about the outcome of the illness for the client and conflict about unaccustomed responsibilities Financial problems Loneliness as a result of separation and pending loss Change in social customs. 11. See Figure 19.3 Maslow’s Needs; Chapter 19, p. 339; See p. 340 r/t characteristics of basic needs. Describe the five human need categories. How can this hierarchy be used to determine priorities when planning to address client problems? NURS 3000 - Professional Nursing Psychosocial Needs ◦ Physiologic needs. Needs such as air, food, water, shelter, rest, sleep, activity, and temperature maintenance are crucial for survival. ◦ Safety and security needs. The need for safety has both physical and psychologic aspects. The person needs to feel safe, both in the physical environment and in relationships. ◦ Love and belonging needs. The third level of needs includes giving and receiving affection, attaining a place in a group, and maintaining the feeling of belonging. ◦ Self-esteem needs. The individual needs both self-esteem (i.e., feelings of independence, competence, and self-respect) and esteem from others (i.e., recognition, respect, and appreciation). ◦ Self-actualization. When the need for self-esteem is satisfied, the individual strives for selfactualization, the innate need to develop one’s maximum potential and realize one’s abilities and qualities. 1. Identifying Physiological Needs: These are the basic, essential life needs: air, water, food, shelter, and sleep. Before addressing more complex issues, it's crucial to ensure that these fundamental needs are met. For example, a client experiencing homelessness (lack of shelter) or malnutrition (lack of food) requires immediate attention to these issues. Addressing physiological needs lays the groundwork for tackling more complex problems. 2. Ensuring Safety Needs: Once physiological needs are satisfied, the next priority is safety and security. This includes personal security, employment, resources, health, and property. For clients, this might involve securing safe housing, stable employment, or access to healthcare services. Ensuring that clients feel safe and secure is essential before moving on to more psychological or emotional needs. 3. Addressing Love and Belonging Needs: After physiological and safety needs are met, individuals seek to fulfill their need for love, affection, and belongingness. This involves relationships with friends, family, and romantic partners. In a client context, interventions might focus on enhancing social support systems, community integration, and building healthy relationships. Facilitating support groups or family therapy can be effective ways to address these needs. 4. Boosting Esteem Needs: Esteem needs relate to the individual’s need for respect, self-esteem, and self-confidence. These needs can be met by recognizing and validating the client's achievements and strengths. In practice, this could involve setting small, achievable goals for the client and celebrating those accomplishments, thereby building self-confidence and a sense of capability. NURS 3000 - Professional Nursing Psychosocial Needs 5. Facilitating Self-Actualization: At the pinnacle of Maslow’s hierarchy is self-actualization, which represents the realization of an individual’s potential, self-fulfillment, seeking personal growth, and peak experiences. Once other needs are addressed, supporting a client's self-actualization might involve encouraging them to pursue personal goals, interests, and talents. This is more about the client exploring what makes them feel fulfilled and content. Application in Client Prioritization: When planning to address client problems using Maslow’s hierarchy, it’s important to prioritize issues that threaten to undermine the lower-level needs before addressing higher-level needs. This doesn't mean neglecting aspects like self-esteem or personal growth if opportunities to support these arise. However, interventions and supports are often more effective when foundational needs are securely met, enabling the individual to focus on more complex aspects of personal development and well-being. III. Growth and Development: Chapter 23: Concepts of Growth and Development 1. Define and discuss the interrelationship between growth and development. Growth:is physical change and an increase in size. It can be measured quantitatively. Indicators of growth include height, weight, bone size, and dentition. The pattern of physiologic growth is similar for all individuals. However, growth rates vary during different stages of growth and development. The growth rate is rapid during the prenatal, neonatal, infancy, and adolescent stages and slows during childhood. Physical growth is minimal during adulthood. Development:is an increase in the complexity of function and skill progression. It is the capacity and skill of an individual to adapt to the environment. Development is the behavioral aspect of growth (e.g., an individual develops the ability to walk, talk, run, and think). Growth and development are independent, interrelated processes. For example, an infant’s muscles, bones, and nervous system must grow to a certain point before the infant is able to sit up, walk, or talk. Growth generally takes place during the first 20 years of life; development takes place during that time and also continues after that point. Principles of growth and development are shown in Box 23.1. 2. Box 23.1 Principles of Growth and Development. List and describe below. Growth and development are continuous, orderly, sequential processes influenced by maturational, environmental, and genetic factors. All humans follow the same pattern of growth and development. The sequence of each stage is predictable, although the time of onset, the length of the stage, and the effects of each stage vary with the individual. NURS 3000 - Professional Nursing Psychosocial Needs Learning can either help or hinder the maturational process, depending on what is learned. Each developmental stage has its own characteristics. For example, Piaget suggested that in the sensorimotor stage (birth to 2 years), children learn to coordinate simple motor tasks. Growth and development occur in a cephalocaudal direction, that is, starting at the head and moving to the trunk, the legs, and the feet (Figure 23.1). This pattern is particularly obvious at birth, when the head of the infant is disproportionately large. Growth and development also occur in a proximodistal direction, that is, from the center of the body outward (see Figure 23.1). For example, infants can roll over before they can grasp an object with the thumb and second finger. Development proceeds from simple to complex, or from single acts to integrated acts. To accomplish the integrated act of drinking and swallowing from a cup, for example, the child must first learn a series of single acts: eye–hand coordination, grasping, hand– mouth coordination, controlled tipping of the cup, and then mouth, lip, and tongue movements to drink and swallow. Development becomes increasingly differentiated. Differentiated development begins with a generalized response and progresses to a skilled, specific response. For example, an infant’s initial response to a stimulus involves the total body; a 5-year-old child can respond more specifically with laughter or fear. Certain stages of growth and development are more critical than others. It is known, for example, that the first 10 to 12 weeks after conception are critical. The incidence of congenital anomalies as a result of exposure to certain viruses, chemicals, or drugs is greater during this stage than others. The pace of growth and development is uneven. It is known that growth is greater during infancy than during childhood. Asynchronous development is demonstrated by the rapid growth of the head during infancy and the extremities at puberty. NURS 3000 - Professional Nursing Psychosocial Needs 3. Factors Influencing Growth and Development.  Genetics:The genetic inheritance of an individual is established at conception. It remains unchanged throughout life and determines such characteristics as gender, physical characteristics (e.g., eye color, potential height), and to some extent, temperament. Genetics plays a vital role in a client’s growth and development. It is important that nurses understand the role genetics plays in the development of illness and disease. The client’s genetic makeup influences weight, height, eye color, hair color, and skin pigmentation (Pierce, 2016). The client’s genetic makeup influences the delivery of medical and nursing care. For example, the development of new chemotherapy agents is based on the genetic makeup of the tumor. The drugs developed in this process are referred to as targeted therapies. Targeted therapies use information from the tumor’s DNA profile (Frandsen & Pennington, 2018).  Temperament:Temperament (i.e., the way individuals respond to their external and internal environment) sets the stage for the interactive dynamics of growth and development. Temperament may persist throughout the lifespan, although caution must be taken not to irrevocably label or categorize infants and children. NURS 3000 - Professional Nursing Psychosocial Needs  Family:The purpose of a family is to provide support and safety for the child. The family is the major constant in a child’s life. Families are involved in their children’s physical and psychologic well-being and development. Children are socialized through family dynamics. The parents set expected behaviors and model appropriate behavior.  Nutrition:Adequate nutrition is an essential component of growth and development. For example, poorly nourished children are more likely to have infections than are wellnourished children. In addition, poorly nourished children may not attain their full height potential.  Environment:A few environmental factors that can influence growth and development include the living conditions of the child (e.g., homelessness), socioeconomic status (e.g., impoverished versus financially stable), climate, and community (e.g., provides developmental support versus exposes the child to hazards).  Health:Illness, injury, or congenital conditions (e.g., congenital cardiac conditions) can affect growth and development. Being hospitalized is stressful for a child and can affect the coping mechanisms of the child and family. Prolonged or chronic illness may affect normal developmental processes.  Culture:Cultural customs can influence a child’s growth and development. Nutritional practices may influence the rate of growth for infants. Childrearing practices may influence development. 4. Review Erikson’s and Havighurst’s theories to explain the stages of human growth and development. Box 23.2 - Havighurst’s Age Periods and Developmental Tasks p. 416. Review the individual tasks in the stage most appropriate to you. Discuss your current status with each of the tasks listed. Erikson’s Psychosocial Development Theory Erikson’s theory posits that individuals go through eight distinct stages of psychosocial development from infancy to late adulthood. Each stage is characterized by a specific conflict that the individual must resolve to develop a healthy personality and acquire basic virtues. Successful resolution of each conflict results in strengths that contribute to well-being, while failure can result in difficulties and a weaker sense of self. 1. Trust vs. Mistrust (Infancy): Learning to trust caregivers and the environment. 2. Autonomy vs. Shame and Doubt (Early Childhood): Developing a sense of personal control and independence. 3. Initiative vs. Guilt (Preschool Age): Beginning to assert control and power over the environment. NURS 3000 - Professional Nursing Psychosocial Needs 4. Industry vs. Inferiority (School Age): Developing a sense of pride in accomplishments. 5. Identity vs. Role Confusion (Adolescence): Forming a strong sense of self and personal identity. 6. Intimacy vs. Isolation (Young Adulthood): Establishing intimate relationships while maintaining a sense of self. 7. Generativity vs. Stagnation (Middle Adulthood): Contributing to society and helping to guide future generations. 8. Ego Integrity vs. Despair (Late Adulthood): Reflecting on life accomplishments and accepting one’s life. Havighurst’s Developmental Task Theory Robert Havighurst emphasized that learning is a lifelong process, and he identified specific developmental tasks that individuals need to achieve at various stages of life, from infancy through older age. These tasks arise from a combination of physical maturation, personal values, and societal pressures. Successfully achieving these tasks leads to happiness and success with later tasks, while failure results in unhappiness in the individual, disapproval by society, and difficulty with later tasks. 1. Infancy and Early Childhood: Tasks include learning to walk, talk, control bodily functions, and form simple concepts of social and physical reality. 2. Middle Childhood: Tasks involve developing physical skills, healthy self-concepts, friendships, and reading, writing, and calculating. 3. Adolescence: Tasks include achieving new and more mature relations with age-mates of both sexes, achieving a masculine or feminine social role, and developing a sense of identity. 4. Early Adulthood: Tasks involve selecting a mate, learning to live with a marriage partner, starting a family, and managing a home. 5. Middle Age: Tasks include assisting teenage children to become responsible adults, achieving adult social and civic responsibility, and reaching and maintaining satisfactory performance in one's occupational career. 6. Later Maturity: Tasks involve adjusting to decreasing physical strength and health, adjusting to retirement and reduced income, and adjusting to death of a spouse. Review the concept map on p. 418, specifically focus on Erikson’s stages. Also see pp. 414-415. Review Erikson’s Psychosocial Development 1. Trust vs. Mistrust (Birth to 18 months): This stage focuses on the infant's basic needs being met by the parents. The outcome of this stage is based on how well these needs are met and leads to feelings of trust or mistrust towards the world. NURS 3000 - Professional Nursing Psychosocial Needs 2. Autonomy vs. Shame and Doubt (18 months to 3 years): In this stage, toddlers start to assert their independence. If caregivers encourage this self-sufficiency, the toddler will learn to be autonomous; if not, they may develop feelings of shame and doubt. 3. Initiative vs. Guilt (3 to 5 years): Children begin to assert power and control over their world through directing play and other social interactions. Successful management of this stage leads to a sense of purpose, while failure results in a sense of guilt. 4. Industry vs. Inferiority (6 years to puberty): Here, children need to cope with new social and academic demands. Success leads to a sense of competence, while failure results in feelings of inferiority. 5. Identity vs. Role Confusion (Adolescence): In adolescence, the development of a personal identity and a sense of self becomes important. Success leads to an ability to stay true to oneself, while failure leads to role confusion and a weak sense of self. 6. Intimacy vs. Isolation (Young adulthood): Young adults need to form intimate, loving relationships with other people. Success leads to strong relationships, while failure results in loneliness and isolation. 7. Generativity vs. Stagnation (Middle adulthood): During this stage, individuals need to create or nurture things that will outlast them, often by having children or creating a positive change that benefits other people. Success leads to feelings of usefulness and accomplishment, while failure results in shallow involvement in the world. 8. Ego Integrity vs. Despair (Late adulthood): In this final stage, individuals reflect on their lives and accomplishments. Those who are successful during this phase will feel a sense of integrity and wisdom, while those who are not may experience despair and regret. How might the nurse apply these principles to the care of an elderly client? 1. Promote Reflection and Storytelling Encourage elderly clients to share their life stories, achievements, and even regrets. This process not only validates their experiences but also helps them make sense of their lives, fostering ego integrity. Nurses can facilitate this through open-ended questions or structured life review interventions. 2. Supportive Listening Offering a non-judgmental, empathetic listening ear can be profoundly therapeutic. It can help elderly clients process their feelings, achieve a sense of closure, or reevaluate their life experiences in a more positive light. 3. Encourage Social Connections Helping elderly clients maintain or establish social connections supports their need for intimacy, combating feelings of isolation. This can be through facilitating visits with family and friends, or encouraging participation in group activities suitable for their health status. NURS 3000 - Professional Nursing Psychosocial Needs 4. Identify and Address Regrets Understanding an elderly client's regrets can guide interventions to address unresolved issues. For instance, if a client regrets not reconciling with a family member, the nurse might facilitate communication or a meeting, if appropriate. 5. Promote Independence and Autonomy Allowing clients to make choices about their daily lives respects their autonomy, a theme that resonates through several of Erikson's stages. This could range from deciding on meal choices to selecting which activities to participate in. 6. Validation and Affirmation Regularly affirming the client’s feelings, decisions, and experiences can boost their self-esteem and sense of worth, which is crucial for achieving ego integrity. Highlighting the impact of their life choices and acknowledging their worth can be deeply affirming. 7. Therapeutic Activities Engaging clients in activities that allow them to impart wisdom, share skills, or express themselves can be very fulfilling. This could include storytelling groups, teaching a skill to younger generations, or participating in art or music therapy. 8. Spiritual Care For many elderly individuals, spirituality or religion is a significant aspect of their identity and can be a source of comfort and strength. Nurses can support clients in practicing their faith, exploring spiritual questions, or connecting with spiritual leaders. 9. End-of-Life Care In the context of end-of-life care, helping clients to review their lives and find peace with their impending death is crucial. This involves sensitive communication, pain and symptom management, and supporting the individual's spiritual and emotional needs. In applying Erikson's theory, nurses can provide holistic care that acknowledges the psychological and emotional needs of elderly clients, thereby enhancing their quality of life and sense of well-being in their final years.