HE

• Compliance


  The extent to which the patient's behavior coincides with clinical advice
• Adherence


  The extent to which a person's behavior corresponds with agreed recommendations from a health care provider
• Nonadherence

  Occurs when the patient does not follow treatment recommendations that are mutually agreed upon. It can be intentional or unintentional.
• Factors on nonadherence


  • Socioeconomically related
  • Patient related - stress, forgetfulness, substance abuse, having multiple medical conditions
  • Condition related
  • Therapy related
  • Healthcare team or System related
• Locus of Control


  An individual's sense of responsibility for his or her own behavior and the extent to which motivation to act originates from internal (within the person) or external (influenced by others) factors
• Health Locus of Control


  Specifically relates Locus of Control to health behaviors and describes an individual's belief that health is dependent on internal and external factors
• Dimensions of Health Locus of Control

  • Internal - Power originates from within and is related to personal abilities
  • Chance external - Fate is a powerful outside influence
  • Others external - Others such as family, friends, and associates are powerful influences
  • Doctors external - Doctors have power to control outcomes
• Motivation


  An internal state that arouses, directs, and sustains human behavior
• Motivational Factors


  • Motivational Incentives
  • Personal Attributes
  • Environmental Influences
  • Relationship Systems
• Personal Attributes


  Learner's developmental stage, age, gender, emotional readiness, values and beliefs, sensory functioning, cognitive ability, educational level, actual or perceived state of health, and severity or chronicity
• Environmental Influences


  Physical and attitudinal climate
• Relationship Systems


  Significant other, family, community, and teacher-learner interaction
• Motivational Axioms


  • The state of optimal anxiety
  • Learner readiness
  • Realistic goal setting
  • Learner satisfaction/success
  • Uncertainty-reducing or uncertainty-maintaining dialogue
• State of Optimal Anxiety

  Learning occurs best when a state of moderate anxiety exists. In this optimal state for learning, the learner's ability to observe, focus attention, learn, and adapt is operative.
• Learner's Readiness


  Desire to move toward a goal and readiness to learn are factors that influence motivation. Desire cannot be imposed on the learner.

  
• Realistic Goals


  Goals that are within a person's grasp and possible to achieve will likely be something toward which an individual will work. Setting unrealistic goals that lead to loss of valuable time can set the stage for the learner to give up.
• Learner Satisfaction/Success


  The learner is motivated by success. Success is self-satisfying and feeds the learner's self-esteem.
• Uncertainty Reduction or Maintenance


  A common experience in the healthcare arena. "If I stop smoking, then my chances of getting lung cancer will be reduced."
• Assessment of Motivation


  A part of general health assessment and states that it includes such areas as level of knowledge, client skills, decision-making capacity of the individual, and screening of target populations for educational programs.
• Motivational Strategies


  • Cognitive Evaluation Theory
  • ARCS Model
  • Motivational Interview

  
• Cognitive Evaluation Theory


  It posits that knowing how to foster motivation is essential because educators cannot rely on intrinsic motivation to promote learning

  
• Concept Mapping


  A nursing educational strategy which enables the learner to integrate previous learning with newly acquired knowledge through diagrammatic "mapping"
• ARCS Model


  Focuses on creating and maintaining motivational strategies that can be used for designing instruction. A - Attention, R - Relevance, C - Confidence, S - Satisfaction
• Motivational Interview


  A client-centered, directive counseling method in which clients' intrinsic motivation to change is enhanced by exploring and resolving their ambivalence toward behavior change. Initially used in substance abuse treatment with adults.
• General Principles of Motivational Interview (READS)

  • Roll with resistance
  • Express empathy
  • Avoid argumentation
  • Develop discrepancy
  • Support self-efficacy
• OARS strategy for building motivation to change

  • Open-ended questioning
  • Affirmations of the positives
  • Reflective listening
  • Summaries of the interactions
• Models and Theories Related to Compliance, Adherence, and Motivation for Health Behaviors

  • Health Belief Model
  • Health Promotion Model
  • Self-Efficacy Theory
  • Protection Motivation Theory
  • Stages of Change Model / Transtheoretical Model of Behavioral Change
  • Theory of Reasoned Action and Theory of Planned Behavior
  • Therapeutic Alliance Model

  
• Health Belief Model


  To address compliance with therapeutic regimens. Guides the development interventions related to health.

  
• Health Promotion Model


  The purpose of the model is to assist nurses in understanding the major determinants of health behaviors as a basis for behavioral counseling to promote healthy lifestyle.
• Self-Efficacy Theory


  A social-cognitive perspective that is a predictive theory dealing with the belief that one is competent and capable of accomplishing a specific behavior. Includes performance accomplishments, vicarious experiences, verbal persuasion by others, and emotional arousal.
• Protection Motivation Theory


  Explains behavioral change in terms of threat and coping appraisal. Beneficial for understanding why individuals participate in behaviors that are unhealthy.
• Stages of Change Model / Transtheoretical Model of Behavioral Change

  • Precontemplation
  • Contemplation
  • Preparation
  • Action
  • Maintenance
  • Termination
• Theory of Reasoned Action and Theory of Planned Behavior

  Concerned with predicting and understanding any form of human behavior within a social context. Based on the premise that humans behave in a rational way that is consistent with their beliefs, influenced by emotion and mood.
• Therapeutic Alliance Model


  Addresses a shift in power from the provider to a learning partnership in which collaboration and negotiation with the consumer are key. Compares the components of compliance, adherence, and alliance.

  
• Concordance


  Consultation that allows mutual respect for the patient's and professional's beliefs, and allows negotiation to take place about the best course of action for the patient.
• Roles of the Nurse as an Educator

  • Facilitator to change - Promote Health
  • Contractor - Educational Contracting
  • Organizer - Manipulation of materials and change, Organization of the learning situation
  • Evaluator - Evaluation of outcome on education programs
• Evaluation


  A systematic process that judges the worth or value of teaching and learning
• Evidence-based practice (EBP)


  • The conscientious use of current best evidence in making decisions about patient care
  • The most relevant and best research, one's own clinical expertise, and patient preferences and values
  • It narrows the gap between research and nursing practice
• Randomized Controlled Trials (RCTs)


  • Strongest evidence upon which to base practice decisions
  • An experimental form of impact evaluation in which the population receiving the program or policy intervention is chosen at random from the same eligible population and a control group is also chosen at random from the same eligible population
• Types of evidence


  • External Evidence - evidence from research
  • Internal Evidence - data gathered from a diligently conducted quality improvement projects
  • Practice Based Evidence - internal evidence that can be used both to identify whether a problem exists and to determine whether an intervention based on external evidence effectively resolved that problem