NRS 429 Describe a health promotion model used to initiate behavioral changes

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.

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.” 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. 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.

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. 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.)

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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. 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.

References:

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: 10.1016/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). 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). 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).

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.

References

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.

References:

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 participatory health model is a great model that has gained popularity in recent times because it involves shared decision making between not just members of the healthcare team and the patient but also the families of the patient or client are involved in decision making in regards to health treatment and treatment options. This model incorporates the evidence based practices recommended by the medical practitioner but also takes into account familial preferences, values and goals towards making the decision (Levy et al., 2016). This health model is great because as the patient when you are diagnosed with a illness you initially might be in a state of shock and might not be ready to accept the diagnosis yet and thus as a result making healthcare decision becomes incredibly hard to do and essentially that becomes the barrier on the patients ability to learn so involving family with the participatory health model is essential to make sure the best treatment is being followed.

References

Levy, S. E., Frasso, R., Colantonio, S., Reed, H., Stein, G., Barg, F. K., & Fiks, A. G. (2016). Shared decision making and treatment decisions for young children with autism spectrum disorder. Academic Pediatrics, 16(6), 571-577.

An example of a health promotion model used to initiate behavioral change is the Pender Health Promotion Model. This model discusses the multifaceted nature of individuals as they interact within their environment in pursuit of health. It helps teach behavioral change by focusing on the three vital areas: “the person’s characteristics and experiences, behavior-specific cognition and affect, and behavioral outcomes” (Khoshnood et al., 2020). The model ascertains that distinct personal characteristics affect behavior. Therefore, modifying the variables that influence behavior through nursing interventions results in behavior change. The model underscores the need to adopt health-promoting behaviors to engender improved health (Whitney, 2018). This model enables one to understand that ill behavior leads to poor health outcomes; hence there is a need to redirect efforts toward teaching health-promoting behavior.

Some barriers that impede the patient’s ability to learn include socioeconomic barriers, low education levels, illiteracy, and cognitive skills. Socioeconomic barriers encompass a lack of access to the resources necessary to trigger learning and contradictory cultural or spiritual beliefs. In addition, low education levels and illiteracy stifle one’s ability to understand various concepts. A person also needs to be of optimal cognitive functioning to engage in learning. A compromise in one’s cognitive skills jeopardizes the grasping and retainment of information.

Patients’ readiness to learn or change is a crucial determinant of the learning outcomes. The patient must be receptive to the learning process to achieve the learning outcomes. Conversely, the learning process will be impeded if the patient is unwilling to learn or change (Whitney, 2018). Consequently, the behavior change will not be realized. Therefore, the nurse must adopt measures encouraging learning and change, such as considering the patient’s preferences and alleviating the possible impediments to the learning process.

Khoshnood, Z., Rayyani, M., & Tirgari, B. (2020). Theory analysis for Pender’s health promotion model (HPM) by Barnum’s criteria: a critical perspective. International journal of adolescent medicine and health, 32(4). https://doi.org/10.1515/ijamh-2017-0160

Whitney, S. (2018). Teaching and Learning Styles. In Health Promotion: Health & Wellness Across the Continuum. Grand Canyon University. Retrieved from https://lc.gcumedia.com/nrs430v/dynamics-in-nursing-art-and-science-of-professional-practice/v1.1/

Health promotion is an act or the process of engaging in a lifestyle that improves or makes for good health. The U.S. government uses the tool ‘Healthy People 2020’ as a foundation for wellness and prevention efforts and a model for measurement… their vision being to have a society in which all people live long, healthy lives (Whitney, 2018).

One of the health promotion models that help in initiating an individual’s health promotion behavioral changes is the Health Belief Model. The health belief model focusses on the individual’s belief and values as related to sickness and diseases. Their belief influences how much importance they will attach to things like wellness check, importance of good diet and exercise, following health education/health promotion practices as recommended by their healthcare providers.

While conducting health teaching using the health belief model, the nurse should first assess the need of the individual or the community. Health education will be based on the need or health risk behavior identified. According to (Montanero & Bryan, 2013) the five necessary components for individual change in the health behavior modeled in Rosenstock’s model (health belief model) are, the perceived susceptibility towards health threat; severity of the threat; benefits of action to reduce threat of illness; barriers to initiating preventative action, and ability to take preventative action or self-efficacy” (Whitney, 2018). Health education will target these perceptions.

Barriers affecting patients’ ability to learn were patients’ lack of interest in learning, nurses lack of knowledge. Language barrier and lack of education tools, for instance health education brochures does not come in all languages. Other barriers like race, immigration, cultural beliefs, socioeconomic class, education level, individual’s learning styles, all contribute to patient’s ability to learn.

Patient’s readiness to learn can be seen by their asking questions. Use the different learning styles to teach them. Give them brochures and refer them to some useful websites where they can learn more.

References:

Galloway, R.D., (2003). Health promotion: Causes, Beliefs and Measurements. Clin Med Res. 2003 Jul;1(3):249-58. doi: 10.3121/cmr.1.3.249. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1069052/

Whitney, S., (2018). Teaching and Learning Styles. In Health Promotion: Health & Wellness Across the Continuum. (Chapter 1). Grand Canyon University. https://lc.gcumedia.com/nrs429vn/health-promotion-health-and-wellness-across-the-continuum/v1.1/#/chapter/1

NRS 429 Describe a health promotion model used to initiate behavioral changes