N260 Exam 1
What is the cognitive domain?
Intellectual activities such as thinking, remembering, reasoning, It involves judging, considering, believing, reflecting and recalling Uses the mind to exercise judgment, draw inferences, make conclusions and decisions Cognitive learning objectives are concrete and reflect this emphasis on reason. They are relatively easy to conceptualize, write, and measure
TTM - Precontemplation
Not intending to make changes within the next 6 months. Two categories of people in this stage. First are uninformed or less informed people who are unaware of the consequences of their behavior. Second are people who have experimented with change but have failed in the past so that they are no longer seeking to change. Usually this second category is resistant or unmotivated to change
2 Processes of Change from Contemplation to Preparation
Self-reevaluation - personal assessment of how behavior change will affect self-image. Use imagery, role models, values clarification Self-efficacy - self-confidence in the ability to change their behavior in the present
The MATCH Framework
1. Match Goals 2. Plan Interventions 3. Develop Program 4. Prepare Implementation 5. Evaluate
USPSTF Carotid Artery Stenosis
Against screening for asymptomatic carotid artery stenosis in the general adult population. Grade D
Applying TTM to Primary Prevention - Examples
Acceptance of contraceptives in men Changing sun protection behaviors Health couching for mindfulness meditation HIV, STD and pregnancy prevention in adolescents Increasing fruit and vegetable consumption Obesity reduction in primary care Physical activity promotion Prevention of dental caries Tobacco cessation counseling by dental hygienists
What are the principles of MI?
Express empathy Develop discrepancy Roll with resistance Support self-efficacy
TTM - Relapse
When one falls back from action or maintenance into a prior TTM stage
4 Embedded Concepts of Miller-Stoeckel Model
1 - Cultural Caring - Behaviors/attitudes by nurse respect and value diversity 2 - Communication - Information exchange is foundation for clients to receive health information 3 - Negotiation - Client is a partner with the nurse to achieve goals 4 - Collaboration - working together to achieve health education goals
4 Client Education Components of Miller and Stoeckel Model
1 - Nurse as Educator - nurse teaches health info 2 - Client as Learner - client consumes health info 3 - Nurse-Client Relationship - relationship focused on achieving health 4 - Client Education Outcomes - result of health education
Precede-Proceed - 8 Components
1. Social assessment/situational analysis phase 2. Epidemiological assessment 3. Educational and ecological assessment 4. Administrative and policy assessment and intervention alignment phase 5. Implementation phase 6. Process evaluation 7. Impact evaluation 8. Outcome evaluation
USPSTF screening for abdominal aortic aneurysm (AAA)?
1-time screening for AAA with ultrasonography in men aged 65 to 75 years who have ever smoked Grade B
PATCH Model Phases
1. Mobilize the community 2. Collect and organize data 3. Choose health priorities 4. Develop comprehensive intervention plan 5. Evaluate
5 stages of TTM and Cyclical Nature of Theory; Timeline?
1. Pre-contemplation 2. Contemplation 3. Preparation 4. Action 5. Maintenance Progression through these stages are cyclical and spiral. Patient may regress and skip stages Usually 6 months to 5 years
Benefits of Smoking Cessation
2 weeks-3 months - circulation improves, walking is easier, lung function increases up to 30% 1-9 months - lung cilia regain normal function, ability to clear lungs of mucus increases, coughing/fatigue/SOB increases 1 year - excess risk of CHD decreases to half that of a continuing smoker 5 years - risk of stroke reduced to that of people who have never smoked 10 years - lung cancer death rate drops to half that of a continuing smoker; risk of cancer in mouth/throat/esophagus/bladder/kidney/pancreas decrease 15+ years - risk of CHD is similar to that of people who have never smoked
Cardiovascular Screening - ABCDE
A - Assess risk and aspirin use B - Blood pressure should be below 130/80 C - assess Cholesterol levels and smoking history D - assess Diet and weight, and check diabetes diagnosis/risk E - Exercise of at least 150 min/week of moderate activity, or more than 75 min/week of vigorous physical activity
Grade Levels for US Preventive Services Task Force Guidelines
A - Recommended. High benefit. Offer/provide service B - Recommended. Moderate benefit. Offer/provide service C - Not recommended. Net benefit is small. Only provide as a last resort D - Not recommended. No net benefit. Discourage use of service I - Insufficient evidence. Benefits not determined. Make sure patient is well-informed before offering service
Nicotine Replacement Therapy (NRT)
A form of medicine that delivers small amounts of nicotine to the body to help a person quit using tobacco Eliminates the immediate, reinforcing effects of nicotine that is rapidly absorbed via tobacco smoke Allows patient to focus on behavioral and psychological aspects of tobacco cessation
What is Motivational Interviewing (MI)?
A humanistic, client-centered, psychosocial, directive counseling approach that explores the feelings, beliefs, ideas and values about behaviors to uncover ambivalence
More inclusive definition of health
A means to achieve desirable goals in life while maintaining a multidimensional health equilibrium of physical, mental, social, political, economic and spiritual balance
Define Tertiary Prevention Give Examples
Actions taken after the onset of disease or an injury with a view to assist diseased or disabled people Palliative therapy, occupational therapy or physical therapy, family support
Define Secondary Prevention Give Examples
Actions that block the progression of an injury or disease at its incipient stage. Screenings, medical interventions to cure/arrest disease, preventing disease spread or complications, risk appraisal
Applying TTM to Secondary Prevention - Examples
Adherence to activity recommendation in chronic low back pain Adherent to HAART in AIDS Adherence to statins Adherence to medications to treat MS Cervical cancer screening Diabetes self management Hypercholesterolemia education classes Mammography participation STD screening Smoking cessation
Prevalence of Tobacco Use
Adult smoking prevalence - 14.1% of all adults in the US are current smokers -34.1 million Sex - Men (15.3%), Women (12.7%), LGB (19.2%) Age - 18-24 (8%), 25-44 (16.7%). 45-64 (17.0%), 65+ (8.2%) Race and Ethnicity - highest among non-Hispanic whites (15.5%), non-Hispanic blacks (14.9%) and American Indians/Native Americans (20.9%), Multiracial (19.7%) Income - higher below poverty level (21.4%) Education - highest among those w/o high school diploma (21.6%), GED (35.3%) and high school diploma (19.6%) People with Generalized Anxiety Disorder - 34.5%; 27% with moderate symptoms States - highest in Arkansas, West Virginia and Kentucky
What to do if the patient is not ready to quit?
Ask if the patient ever plans to quit? Ask how quitting will benefit you to quit later, as opposed to now? Ask what is the worst thing that could happen if you quit tomorrow?
The 5 A's of Quitting Smoking
Ask about tobacco use Advise tobacco users to quick Assess readiness to quit. If willing, go to ASSIST. Assist with a quit attempt Arrange for follow-up care
Propositions of Behaviorism
Behavior that is followed by reinforcement tends to strengthen the behavior. Behavior followed by punishment tends to be suppressed. Behavior followed by the removal of a negative stimulus tends to increase in strength. Behavior that tends to recur is in some way being reinforced or is reinforcing itself One behavior may serve to reinforce or strengthen another behavior Irregular and inconsistent reinforcement of a behavior strengthens the continuance of that behavior Immediate and consistent reinforcement of a behavior strengthens that behavior most rapidly Rewards that are specific to and desired by the learner are more powerful than general or routine rewards Rewards and punishments that are clearly connected to the behavior are more powerful than vague or inconsistent responses Behavior that receives no response and meets no biologic need tends to extinguish
What is behaviorism?
Behaviorism focuses on tangible, observable behaviors, such as learning to give an injection, changing dietary practices, and safely bathing an infant
Specific Types of Non-Nicotine-Replacement Therapy
Bupropion SR (non-Nicotine) - Zyban (Rx); Generic bupropion SR (Rx) Varenicline (non-Nicotine) - Chantix (Rx)
Major Health Risks of Smoking and Tobacco
CVD and metabolic disease Smoking-related cancers Pulmonary disease Heart disease from secondhand smoke Lung cancer from secondhand smoke Residential fires
Acute Health Effects of e-Cigarettes
Cardiovascular - Increased heart rate; Increased blood pressure Respiratory - Impaired pulmonary function; Decreased exercise capacity; Larynx and voice changes Carbon monoxide intoxication
Chronic Health Effects of e-Cigarettes
Cardiovascular - Ischemic heart disease; Coronary artery disease Respiratory - Impaired pulmonary function; Chronic obstructive lung disease; Larynx and voice changes Cancer - Lung; Esophageal; Gastric Low birth weight Oral and Periodontal disease Lower bone density, high fracture risk
4 Processes of Change to move from Precontemplation to Conemplation
Consciousness raising - raising awareness of causes, consequences and cures for a problem. Arrange for observation sessions, provide feedback, give talks Dramatic relief - enhances emotional arousal about one behavior, and how relief can be achieved from behavior change. Do role play, share personal testimony Environmental re-evaluation - exploring how behavior affects environment, and how behavior change will influence environment. . Use empathy training and values clarification Decisional balance - discuss the pros and cons of behavior change, emphasizing the pros.
Tobacco Quit Rates
Cigarette smokers die 14 years younger than non-smokers. For those who continue smoking, at least half die due to tobacco-related disease 2/3 smokers want to quit (68.0%). 55.4% of smokers tried to quit. Only 7.4% quit smoking. Only 57.2% had been advised to quit by a healthcare professional. Only 31.2% had used counseling and/or meds
Limits of TTM
Classifying people in stages has several problems. First, people can move through the stages of the model in minutes. Second, the validity of self-reported behavior with regard to stage is questionable. Third, a significant number of people cannot be assigned to recognized stages Classifying people in stages such as precontemplation means lumping different categories together, and people who have never thought of changing their behavior may be grouped with people who have relapsed after making successful behavior change. Most applications of the TTM in the area of substance abuse have focused on the construct of stages of change and very few have focused on other constructs such as processes, decisional balance, and self-efficacy Application of the TTM to substance abuse behaviors has yielded mixed results and that the model is descriptive rather than predictive. There is definitive need to make the model robust in its predictive potential
USPSTF Tobacco Smoking Cessation in Adults and Pregnant Women
Clinicians ask all adults about tobacco use, advise them to stop using tobacco, and provide behavioral interventions and US Food and Drug Administration (FDA)--approved pharmacotherapy for cessation to nonpregnant adults who use tobacco.. Grade A Clinicians ask all pregnant persons about tobacco use, advise them to stop using tobacco, and provide behavioral interventions for cessation to pregnant persons who use tobacco. Grade A
What is cognitivism?
Cognitivism focuses on the thought processes as humans learn; for example, seeing a relationship between food intake and blood glucose levels, using memory tricks to recall health instructions, and gaining insight into one's own behavior.
4 Processes of Change from Action to Maintenance
Contingency management - uses punishments/ rewards for taking steps in a particular direction. Use self-reinforcements, contracts, recognition for achievements Stimulus control - modify environment to increases cues for healthy behaviors and decrease cues for unhealthy behaviors Helping relationships - developing caring, open and trusting relationships to help person adhere to healthy behavior. Use rapport building, support groups Temptation - urge to engage in unhealthy behavior with a difficult situation. Opposite to self-efficacy. Three factors - emotional distress, positive social situations and cravings
Kolby's Experiential Learning Model: Learning Style
Converger, which combines AC and AE; • Applies practical application of ideas • Focuses on specific problems • Is relatively unemotional • Prefers dealing with things rather than people • Has a tendency to narrow interests • Specializes in physical sciences Diverger, which combines CE and RO; • Has good imaginative ability, generates ideas • Sees multiple perspectives • Is interested in people; emotional • Has broad cultural interests • Specializes in the arts and humanities Assimilator, which combines AC and RO; • Creates theoretical models • Reasons inductively, logically sound theories • Is interested in abstract concepts • Has less interest in people • Focuses less on practical use of theories • Specializes in basic sciences and math Accommodator, which combines CE and AE • Likes to do things (plans, experiments, new experiences); willing to take risks • Adapts well to specific immediate circumstances • Solves problems intuitively, trial and error • Relies on others for information rather than self • Likes people; sometimes impatient • Specializes in technical or practical fields, such as business
PEN3 - 3 Constructs and their Domains
Cultural Identity 1. Person 2. Extended family 3. Neighborhood Relationships and Expectations 1. Perceptions 2. Enablers 3. Nurturers Cultural Empowerment 1. Positive 2. Existential 3. Negative
USPSTF PAD and CVD Screening with Ankle-Brachial Index
Current evidence is insufficient to assess the balance of benefits and harms of screening for peripheral artery disease (PAD) and cardiovascular disease (CVD) risk with the ankle-brachial index (ABI) in asymptomatic adults Grade I
USPSTF aspirin recommendations to prevent CVD and colorectal cancer
Initiating low-dose aspirin use for the primary prevention of cardiovascular disease (CVD) and colorectal cancer (CRC) in adults aged 50 to 59 years who have a 10% or greater 10-year CVD risk, are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years. Grade B
How does plotting along the Stoeckel Wellness-Illness Continuum work?
Factors are displayed along a continuum showing incremental increases or decreases in health functioning. Each factor is plotted on the continuum moving from the center (score of 5 is neutral) toward the right (highest score of 10 indicates highest level of wellness) or left (lowest score of 0 indicates lowest level of wellness) and shows changes in the state of health. High-level functioning or wellness involves increased ability to perform the activities of daily living. Low-level functioning is brought on by illness or disability, resulting in the decreased ability to perform activities of daily living.
How to use Principles of Learning to enhance Patient Education
Focusing intensifies learning Repetition enhances learning Learner control increases learning Active participation is necessary for learning Learning styles vary Organization promotes learning Association is necessary to learning Imitation is a method of learning Motivation strengthens learning Spacing new material facilitates learning Recency influences retention Primary affects retention
Leading causes of death ages 15-24
From highest to lowest Unintentional injuries (MV accidentals, homicide with a firearm, unintentional poisoning), suicide, homicide
Leading causes of death ages 25-34
From highest to lowest Unintentional injury (unintentional poisoning and MV accidents), suicide, homicide
Applying TTM to Behavior Change - Examples
Gender differences in intimate partner violence Impact of poor sleep quality on health behaviors Modeling to remedy alcohol abuse amongst patients with mental illness Patients' participation in medical decision making Predicting physician behavior to recommend colonoscopy Processes of change scale for alcohol misuse Profiling youth who do not use drugs Staging of adults experiencing hearing difficulties
Global vs. Local Thinkers Internal vs. External Thinkers
Global thinkers consider large and abstract issues Local thinkers consider more details Internal thinkers are introverted, task-oriented and work alone External thinkers as extroverted, outgoing, people-oriented and collaborative
Cardiovascular Screening - Population Prevalence, Racial/Ethnic Groups At Risk
Half of all adults in the US (more than 100 million people) have HTN. Only a quarter have their HTN under control African Americans have the highest risk of incidence for heart disease American Indians/Alaskan Natives die from heart disease much earlier than expected Non-Hispanic Blacks and Mexican-American women have higher rates of obesity, a risk factor for CVD
Health-Directed vs. Health-Related Behaviors
Health Directed - behaviors a patient consciously pursues for health improvement/protection. Immunization, physical exams, low-fat diet, condoms Health Related - behaviors performed for reasons other than health but have health effects. Losing weight for physical appearance can also improve heart health
Assumptions of Behaviorism
Humans and animals learn in similar ways. Studying stimuli and response objectifies the learning processes. Internal processes, such as thoughts, motives, and emotions, are unimportant in understanding learning because they are not observable. Later behaviorists stated that motivation and the strength of the stimulus-response associations were important. Learning involves changing behavior. Organisms are born as blank slates with learning occurring after birth. Learning is largely the result of environmental events that condition behavior. The most useful theories explain behavior with as few learning principles as possible
Algorithm for Treating Tobacco Use
If the patient has NEVER used tobacco, no action required If the patient used tobacco in the past but does not now, prevent relapse If the patient uses tobacco and is not ready to quit, enhance motivation to quit If the patient uses tobacco and is ready to quit, provide appropriate tobacco-dependence interventions
TTM Historical Origins
In the late 1970s, James Prochaska from the University of Rhode Island undertook to review the various theories of psychotherapy. In this process he laid the foundations for the transtheoretical model He teamed with Carlo DiClemente, who did his doctoral work at the University of Rhode Island and is now a professor of psychology at the University of Maryland, to develop and refine the TTM The TTM is unique in that it specifies a time dimension in behavior change. It proposes that people move through various stages while making a behavior change and that the whole process can take anywhere from 6 months to 5 years. Due to its emphasis on stages, the model is also known as the stages of change (SOC) model
Witkin and Goodenough's Cognitive Style of Learning Field Independence
Individuals who are relatively field independent are more autonomous and have a strong sense of self and differentiation from others. By having an internal frame of reference, they grasp the whole situation and its component parts. They are self-reliant, intrinsically motivated, and have their own learning goals. They are less sensitive to the environment and less inclined to conform to groups In a learning situation, field-independent learners prefer to structure their own learning and study strategies. They are analytic, interested in abstract and theoretical concepts, and question opinions, ideas, and hypotheses. In learning situations they are able impose their own structure. They are less affected by criticism and make more I statements
CHEM - Comprehensive Health Education Model
Involve people Set goals Define problems Design plans Conduct activities Evaluate results
PATCH Framework - Planned Approach to Community Health Model
Key elements Community members participate in the program; Data drives program development; Participants develop thorough health promotion strategy; Evaluation emphasizes feedback and program improvement; Community capacity is increased
Tobacco Cessation and Behavior Change Issues
Many smokers do not understand the need to change behavior. Smokers think they can just "make themselves quit." Few smokers adequately PREPARE and PLAN for their quit attempt. Fewer than 5% of people who quit without assistance are successful in quitting for more than a year Behavioral counseling helps patients learn to cope with these difficult situations without having a cigarette: In person counseling (individual, group); Telephone counseling (helplines); Internet counseling
Sternberg's Executive Styles of Learning - 3 Individuals and how they prefer to learn
Legislative individuals are creative and prefer to decide for themselves what they will do and how they will do it. They like problems that are not already structured and prefer to create the framework themselves. They prefer to solve problems, apply rules to problems, apply lessons based on other people's work, and enforce rules. They tend to be nonconforming individuals. Executive individuals like problems that have some structure so they can address problems within that structural framework. They like guidelines and prefer to follow directions. These individuals are usually successful as students and employees because they do as they are told and like being evaluated on that basis. Judicial individuals like to oversee, analyze, and evaluate existing rules, procedures, and ideas. They like to critique, give opinions, and judge people and their work. These individuals prefer positions in which they can evaluate the effectiveness of programs, tasks, and human endeavors.
Gardner's Theory of Multiple Intelligences - 7 Types and How to Teach Them
Linguistic - reading, writing, talking. Use handouts, pamphlets, journals, discussions Logical-mathematical - reasoning, computing, problem solving. Use case studies and active participation Musical - listening to music. Use background music, use songs to aid memorization Visual-spatial - forming mental images. Use picture drawing, mind mapping, visualizations Bodily-kinesthetic - sharing with others. Use equipment handling and skills development Interpersonal - sharing with others. Use groups to do group activities Intrapersonal - working alone. Use programmed instructional software, computer-assisted learning and individual projects
Specific Types of Nicotine-Replacement Therapy
Nicotine polacrilex gum - Nicorette (OTC); Generic nicotine gum (OTC) Nicotine lozenge - Commit (OTC); Generic nicotine lozenge (OTC) Nicotine transdermal patch - Nicoderm CQ (OTC); Generic nicotine patches (OTC, Rx) Nicotine nasal spray - Nicotrol NS (Rx) Nicotine inhaler - Nicotrol (Rx)
Cardiovascular Screening - Modifiable and Non-Modifiable Risk Factors
Non-modifiable risk factors - genetics, age, family history Modifiable risk factors - lack of physical activity, cholesterol, blood pressure, smoking, obesity, diet, blood sugar
Safety Issues with e-Cigarettes
Not regulated, no health warnings Not approved by the FDA Unproven for cessation Safety issues - Explosions, Unknown chemicals and levels of nicotine, Some known toxic chemicals
Assumptions of Social Cognitive Theory
People learn through a process of modeling and observing others' behavior. People learn vicariously from others' successes and failures. Learning may or may not result in an observable change of behavior. Cognition is important in learning such as awareness, attention, expectations, and retention. People can actively exert control over their actions and environments
Propositions of Cognitivism
Perception refers to the act of becoming aware of something using any of the senses. To perceive means to take notice of, observe, detect, become aware of in one's mind, achieve understanding of, or apprehend. Perception refers to the portion of the world that is grasped mentally through sight, hearing, touch, taste, and smell
TTM - Action
Person has made meaningful change in the past 6 months. Behaviors are actions, and the new actions can be observed clearly in this stage. The person is making conscious efforts to perform the new actions
TTM - Maintenance
Person has maintained change for a period (at least 6 months or more, to up to 5 years)
What is the affective domain?
Personal issues: attitudes, beliefs, behaviors, and emotions There is a relationship between emotional intelligence and general intelligence in academic achievement Learning objectives in the affective domain focus on influencing attitudes, motivating learners, developing respect, and clarifying values
Ideal Theory Traits
Predictive power Has changes on affect (conation), thought (cognition) and action (volition) Testability and verifiability Generalizability Basis and ability to be explained
Precede-Proceed Model - Acronym
Predisposing, Reinforcing & Enabling Constructs in Educational/Ecological Diagnosis and Evaluation Policy, Regulatory & Organizational Constructs in Educational and Environmental Development
Define Primary Prevention Give Examples
Preventive actions that are taken prior to the onset of disease or an injury with a view to remove the possibility of their ever occurring Immunizations, counseling, health education, exercise, personal hygiene
USPSTF Tobacco Use in Children and Adolescents
Primary care clinicians provide interventions, including education or brief counseling, to prevent initiation of tobacco use among school-aged children and adolescents. Grade B
Which providers use the Prevention Task Force Tool?
Primary care providers - family medicine physicians and NPs focused on preventive care and medicine Academics and researchers QI professionals and makers ot tools affecting primary care practice Health care policymakers and system leaders Employers and other healthcare purchasers Members of the public
What is the psychomotor domain?
Psychomotor learning requires that individuals acquire information and store it in memory. During the initial practice of a procedure, skills are shaped and learned until they become automatic This type of learning is the most concrete, and it is the easiest to teach, observe, and measure. Clients form a mental image of how a skill is performed and then translate that image into external behavior. Practice is encouraged until the client and the nurse is satisfied with the client's skills
Propositions of Social Cognitive Theory
Reciprocal determinism - Bidirectional interaction between cognitive and personal factors (P), environmental events (E), and behavior (B)
The 5 Phases of Intervention Planning in the TTM
Recruitment phase - measures are taken to persuade a large number of people to join the program. In this phase professionals must proactively reach out to the target population. 40% of the target population are in the precontemplation stage, 40% in the contemplation stage, and 20% in the preparation stage. Retention phase - efforts must be taken to retain people who join the program. This can be done by matching the processes of change with the stage of change a person is in today. Progress phase - efforts must be taken to help people progress during and after the intervention. Process phase -- efforts must be made to help participants move from one stage to another, and processes of change must be applied. The pros for changing must be underscored in precontemplation. The cons must be decreased during contemplation to progress to action. Processes of change must be matched with the stage. Outcomes phase - the end results are measured.
5 R's to Motivate Patients to Quit
Relevance - Encourage patient to indicate why smoking is personally relevant Risks - Ask patient to ID potential negative consequences of tobacco use Rewards - ask patient to ID potential benefits of stopping tobacco use Roadblocks - ask patient to ID barriers or impediments to quitting Repetition - motivational intervention should be repeated every time an unmotivated patient visits the clinic setting
USPSTF Blood Pressure
Screening for high blood pressure in adults aged 18 years or older Obtaining measurements outside of the clinical setting for diagnostic confirmation before starting treatment Grade A
3 Processes of Change from Preparation to Action
Self-liberation - making the commitment to change and act on change. Making public commitments or resolutions, or choosing from different options Counterconditioning - Learning a new behavior to replace an unhealthy one. Use desensitization, assertion, cognitive counters Social liberation - increase social opportunities or alternatives. Use advocacy, empowerment-buildin
Assumptions of Cognitivism
Some human learning is unique and differs from how animals learn. Learning is a mental activity and may not result in overt behavioral changes. People exert some control over their learning and actively participate in learning. Knowledge is organized and connected to the person's knowledge, beliefs, attitudes, and emotions. Unobservable mental processes can often be reasonably inferred by observable behavior.
Kolby's Experiential Learning Model: Learning Cycle
The learning cycle—that is, how experience translates into concepts that guide the choice of new experiences. Entry into the cycle begins with concrete experience (CE) followed by reflection and observation (RO). The third stage is abstract conceptualization (AC), which becomes the basis for ideas and theories that guide future behavior. In the fourth stage, active experimentation (AE), the individual tests the implications of new concepts and theories in different and more complex situations. By experimenting and applying new learning, individuals again engage in CEs, and so the cycle continues. As the knowledge base expands, the learning experiences become increasingly complex. Based on heredity, past experiences, and the demands of the present environment, individuals develop a unique, preferred style of learning.
USPSTF Lipid Screening in Children and Adolescents
The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for lipid disorders in children and adolescents 20 years or younger. Grade I
USPSTF CVD Screening with EKG
The USPSTF recommends against screening with resting or exercise electrocardiography (ECG) to prevent cardiovascular disease (CVD) events in asymptomatic adults at low risk of CVD events. Grade D/I
USPSTF Statin Use for Primary Prevent CVD in Adults
The USPSTF recommends that adults without a history of cardiovascular disease (CVD) (ie, symptomatic coronary artery disease or ischemic stroke) use a low- to moderate-dose statin for the prevention of CVD events and mortality when all of the following criteria are met: 1) they are aged 40 to 75 years; 2) they have 1 or more CVD risk factors (ie, dyslipidemia, diabetes, hypertension, or smoking); and 3) they have a calculated 10-year risk of a cardiovascular event of 10% or greater. Identification of dyslipidemia and calculation of 10-year CVD event risk requires universal lipids screening in adults aged 40 to 75 years. See the "Clinical Considerations" section for more information on lipids screening and the assessment of cardiovascular risk Grade B
How is plotting along the Stoeckel Wellness-Illness Continuum useful to the Nurse?
The continuum is useful when working with clients to get a holistic picture of their functioning. Clients can place themselves on each factor's continuum to identify their strengths and weaknesses. Plotting the continuum for each factor helps the Nurse as Educator determine clients' health perceptions and needs. By using the Stoeckel Wellness-Illness Functional Continuum as an assessment tool when working with clients, you gain a more accurate picture of how the client perceives his or her state of health. The continuum can also be used to compare a client's previous level of health with the present level, but because of its subjective nature, it cannot be used to compare one client with another.
Applying Behaviorism, Cognitivism and Social Cognitive Theory to Patient Education; How to Improve Desirable Behaviors?
The nurse's job as an educator, from an information processing point of view, is to provide the client with new information. It is important to divide learning into steps that are compatible with the client's health, intelligence, and previous learning experiences. The nurse assists the client in acknowledging current beliefs that enhance or inhibit learning. The new information is then translated into a message that the client can process. This involves capturing the client's attention through teaching strategies and teaching materials
Social Cognitive Theory
The view of psychologists who emphasize behavior, environment, and cognition as the key factors in development.
Value of Theories
Theory is a way to explain some observed phenomenon. Expressed as abstract thoughts or general subject principles, theories help make sense of the world and research findings Theories provide the theoretical framework to view the process of learning the progress of learners, and nurses' role as educators
Witkin and Goodenough's Cognitive Style of Learning Field Dependence
These individuals rely on an external frame of reference rather than imposing their own. They see the whole situation and its context rather than focusing on the smaller aspects. They are sensitive to their surroundings and open to external sources of information. They show more social behaviors, which contribute to effective interpersonal relationships. In a learning situation, field-dependent learners prefer the spectator role and are influenced by authority figures. They like structure, guidance, and clearly defined learning goals provided by the educator. They are motivated by extrinsic rewards rather than intrinsic ones. They enjoy interaction with other learners and prefer to cooperate and collaborate. They are sensitive to criticism; when they talk, they refer more to others and less to themselves. They are holistic in their approach to problem solving but are often unable to see the smaller components of larger problems, thereby making them less efficient.
Extended Use of Pharmacotherapy for Tobacco Cessation
Use does not present known health risks Minority of smokers who successfully quit use ad libitum NRT agents long-term NRT not FDA-approved for long-term maintenance Some evidence that extended use of some medications results in greater long-term smoking abstinence
Basic premise of Stoeckel Wellness-Illness Functional Continuum
Wellness and illness involve a variety of factors: social, physiologic, environmental, emotional, activities of daily living, and health access. The factors in the model can either enhance or distract from the client's health. Disease and illness are a failure of an individual's adaptive mechanisms to adequately counteract changes in functional and structural disturbances
TTM - Contemplation
When one is considering change in the foreseeable future but not immediately, usually defined as between 1 and 6 months. These people have considered the benefits (or pros) and costs (or cons) of changing their behavior
TTM - Preparation
When one is planning for change in the immediate future, usually defined as in the next month. The people in this stage have taken some significant steps, such as going to a recovery group, buying some exercise equipment, consulting a counselor, buying self-help materials, and so on
TTM - Termination
When the person has completely quit the habit, has no temptation to relapse, and is fully self-efficacious to continue with the change