Chapter 3: Health Education and Health Promotion
When a person works to prevent relapse and to sustain the gains made from actions taken, he or she is in which stage of the Transtheoretical Model of Change? -Maintenance -Action -Termination -Contemplative
-Maintenance Explanation: A person is in the maintenance stage of the Transtheoretical Model of Change when there is work to prevent relapse and to sustain the gains made from the actions taken.
The entire planning phase of the teaching-learning process concludes with which of the following? -Documentation -Response to teaching -Enhancement of learning -Changes need in teaching plan
-Documentation Explanation: The entire planning phase of the teaching-learning process concludes with the documentation of the teaching plan. The evaluation phase focuses on the patient's response to teaching, what can be done to improve or enhance learning, and any changes needed in the teaching plan.
Which of the following is accurate regarding wellness? Select all that apply. -One tries to maximize one's own health. -It requires a conscious commitment. -It is the result of adopting lifestyle behaviors for the attainment of one's highest potential. -It is a specific health status with the absence of disease. -Is the same for every person.
-One tries to maximize one's own health. -It requires a conscious commitment. -It is the result of adopting lifestyle behaviors for the attainment of one's highest potential. Explanation: Wellness, as a reflection of health, involves a conscious and deliberate attempt to maximize one's health. Wellness requires planning and conscious commitment and is the result of adopting lifestyle behaviors for the purpose of attaining one's highest potential for well-being. Wellness is not the same for every person.
The nurse is developing a health-promotion program at a company in which many employees are women in their 20s and 30s. For this population, the nurse plans to include information about -Bone-density screening -Parenting issues -Mammography -Values training
-Parenting issues Explanation: Young adults in their reproductive years want information about parenting issues. Values training is geared more for adolescents. Information about bone-density screening and mammography are for older women.
The nurse is planning to teach a client who was recently diagnosed with migraine headaches. It is best to teach the client -During the headache recovery phase -In a quiet room -With her spouse and children present -Immediately following a headache experience
In a quiet room Explanation: Learning may be optimized by minimizing factors that interfere with the process. These factors include pain and fatigue, which are common during the headache recovery phase (which is immediately following a migraine). Also, the presence of visitors could interfere with learning. If family members are to participate in providing care, then learning sessions should be scheduled with family members present. A quiet room is appropriate to the learning situation.
The nurse is providing information to a client about the safe use of a newly prescribed medication. The first question the nurse should ask is -Is the client ready to learn? -What is the expected outcome? -What teaching aids do I need? -How do I evaluate client learning?
Is the client ready to learn? Explanation: The nurse follows the nursing process when teaching a client. Probably the most important and first factor to assess is the client's readiness to learn. The other options are also components of the nursing process. The question what is the expected outcome is the goal of the nursing process. The use of teaching aids is part of the implementation process. Evaluating learning is the evaluation component of the nursing process.
The nurse is caring for a 33-year-old male client. Which clinical screening should the client have, based on his age? -Hemoccult screening -Electrocardiogram -Lipid panel -Colonoscopy
lipid panel Explanation: A lipid panel should be performed at age 20, then mutually determined by both the client and clinician. A baseline hemoccult screening and colonoscopy should occur at age 50. An electrocardiogram should be performed at age 40.
Which statement by the client indicates the client's experiential readiness to learn? -"Do you have a video about my disease? I don't like to read." -"Can we take a minute to pray before learning about my treatment plan?" -"Now that I am more comfortable, I am ready to learn about pain management techniques." -"I understand that I have diabetes and will need to learn how to administer my daily insulin injections."
-"Do you have a video about my disease? I don't like to read." Explanation: Experiential readiness refers to past experiences that influence a client's ability to learn. Emotional readiness refers to the client's acceptance of an existing illness or the threat of an illness and its influence on the ability to learn. Physical readiness refers to the client's ability to cope with physical problems and focus attention on learning.
A current trend in health education that significantly influences nursing practice is: -Increased emphasis on patient involvement in their own care. -Improved distribution of health information materials. -Increased numbers of health care providers. -Increased emphasis on the diversity of patient needs.
-Increased emphasis on patient involvement in their own care. Explanation: Much of the core of health education today is focused on increasing patient involvement and accountability for their care and treatment plans. Health education programs are often designed as patient safety initiatives and are geared toward encouraging increased communication between patients and care providers.
A nursing student observes the home care nurse provide education to a client with congestive heart failure (CHF). The nurse teaches the client how to read food labels and calculate sodium content. The nursing student recognizes that the home care nurse is aware of which basic principle of patient education? -Patient instruction related to self-care activities promotes patient independence -Patients are required to learn about their therapeutic nutritional regimen -The home care nurse has a physician order to teach a 2-g sodium diet -The home care nurse is providing hospital discharge instructions
-Patient instruction related to self-care activities promotes patient independence Explanation: Teaching is a function of nursing to assist patients to alter lifestyle patterns that increase health risk. By teaching the client how to calculate sodium content of foods the nurse is facilitating independence in nutrition disease management. Patients have the right to decide whether or not to learn. Teaching is an independent function of nursing and does not require a physician's order. Teaching related to food labels in the patient home is an appropriate environment for this client. The nurse can use actual foods from the patient's kitchen.
Which action would be incorporated in a teaching strategy for a hearing-impaired client? -Use of slow, directed, and deliberate speech -Use of large-print materials -Arrangement of materials in a clockwise pattern -Having the person perform a return demonstration
-Use of slow, directed, and deliberate speech Explanation: When teaching clients with a hearing impairment, the nurse should use slow, directed, and deliberate speech. Use of large-print materials and arrangement of materials in a clockwise position would be used for clients with a visual impairment. Demonstrating information and having the person perform a return demonstration would be appropriate for a person with a developmental disability.
Which of the following is a diagnosis related to health education? -Ineffective health maintenance -Ineffective airway clearance -Altered nutrition, less than body requirements -Self-esteem disturbance
-Ineffective health maintenance Explanation: Diagnoses related to health education may include ineffective health maintenance, health-seeking behaviors, deficient knowledge, and readiness for enhanced knowledge. The other diagnoses are not related to health education.
The nurse is teaching an elderly client about heart failure. What action will the nurse do to enhance learning? -provide the necessary information in one teaching session -sit in a chair a few feet away from the client -look at notes to ensure all information is covered -frequently repeat the provided information
-frequently repeat the provided information Explanation: Effective teaching strategies for older adults include frequent repetition of information. Giving small amounts of information in multiple sessions is more effective for learning than providing a lot of information in one teaching session. The nurse needs to look at the client rather than notes to assist the client with speech reading. The nurse should sit near the client so the client can hear the nurse.
The nurse is caring for a group of clients. The nurse begins by identifying the clients with which condition(s) as most in need of health education to aid in the identification and management of complications or exacerbations? Select all that apply. --osteoporosis -multiple sclerosis -seasonal allergies -spinal cord injury -coronary artery disease
-osteoporosis -multiple sclerosis -spinal cord injury -coronary artery disease Explanation: Individuals with chronic illnesses and disabilities are among those most in need of health education. As the lifespan of the population increases, the number of people with such illnesses also increases. Health information targeted at identifying and managing the exacerbations or issues commonly associated with having a chronic illness or disability is a major focus of health education. Because of this, the clients who would be a priority for health education include those with osteoporosis, multiple sclerosis, spinal cord injury, and coronary artery disease as these are all chronic health conditions. Seasonal allergies are time limited and less likely to cause a disability or an exacerbation.
The nurse is preparing to teach a client about a newly prescribed medication. The client lacks insurance. The medication costs approximately $100 per month. The client states, "I can't afford it." The nurse assesses a variable to successful education and health promotion for this client based on the Health Belief Model is -Demographic and disease factors -Barriers -Resources -Perceptual factors
-resources Explanation: The Health Belief Model is based on the premise that four variables influence health promotion behaviors. Resources address financial and social behaviors. Demographics and disease factors include client age, gender, education, employment, severity of illness or disability, and length of illness. Barriers are factors that lead to unavailability or difficulty in gaining access to a health promotion alternative. Perceptual factors are how a client views his health status, self-efficacy, and the perceived demands of the illness.
The nurse is caring for a client who is newly diagnosed with diabetes. Which statement indicates to the nurse that the client is ready to learn about the disease process and treatment? -"I watched my parent check blood sugar levels several times." -"This is not a bad disease like cancer, so I will eventually get over it." -"There must be some mistake because I cannot believe I have this disease." -"I see the television commercials for diabetes medication, so I know I will be all right."
-"I watched my parent check blood sugar levels several times." Explanation: One of the most significant factors influencing learning is a person's learning readiness or the optimum time for learning to occur, which usually corresponds to the learner's perceived need and desire to obtain specific knowledge. The client is demonstrating experiential readiness because of having observed a family member perform a skill that was used to manage the illness. The statement that the illness is not like cancer does not indicate readiness to learn about the health problem. Stating that there must be a mistake in the diagnosis is an indication of denial and does not indicate readiness to learn. The statement about seeing television commercials for diabetes medication could indicate that the client needs additional information, because the content of the commercial might not be the treatment prescribed for the client. The commercial may have caused the client to decide that additional learning is not required.
The nurse is caring for a client with a chronic illness. Which client statement(s) indicates to the nurse that the client is at risk for nonadherence to the prescribed treatment? Select all that apply. -"There are so many pills to take at different times." -"I really do not understand why I need all these pills." -"When I feel sick I think it is because of the medication." -"I do not get my check until the beginning of the month." -"I live with family and they help me around the house."
-"There are so many pills to take at different times." -"I really do not understand why I need all these pills." -"When I feel sick I think it is because of the medication." -"I do not get my check until the beginning of the month." Explanation: Many clients do not adhere to the prescribed treatment plans because the regimens are complex or are of long duration. There is no one causative factor for nonadherence; however, variables have been identified which include the complexity of the treatment, such as having to take many medications at different times. Another reason for nonadherence would be not understanding why medications are needed. Uncomfortable side effects, which can be interpreted as causing illness, are another reason for nonadherence. The cost for the treatment is another reason for nonadherence. Living with a supportive family will support adherence to the prescribed medical regimen.
A client has been reporting regularly to the health care unit for blood pressure monitoring. The health care provider diagnoses the client with essential hypertension after analyzing the readings over two or more sessions. What options will the nurse use to inform the client about next steps for blood pressure care? Select all that apply. -Advise the client to begin an exercise regimen based on the approval of the health care provider. -Remind the client to return back to the health care provider once a year for follow-up. -Ask the client to follow a diet that is low in saturated fats and sodium and high in fiber. -Advise the client to purchase a self-monitoring cuff or use an automatic cuff at a local pharmacy. -Educate the client about the correct position to measure blood pressure, as the position may affect readings.
-Advise the client to begin an exercise regimen based on the approval of the health care provider. -Ask the client to follow a diet that is low in saturated fats and sodium and high in fiber. -Advise the client to purchase a self-monitoring cuff or use an automatic cuff at a local pharmacy. -Educate the client about the correct position to measure blood pressure, as the position may affect readings. Explanation: Nurses play a vital role in the management of clients with hypertension. The nurse is an educator and provides the essential tools for the client to manage hypertension to prevent complications. First and foremost, information must be provided to the patient about the importance of lifestyle changes, such as smoking cessation, exercise, diet, stress reduction, and alcohol moderation. Information about the importance and technique of blood pressure monitoring is important but takes place after the nurse informs the patient about lifestyle changes. The client will need more frequent follow-up than once a year.
Select the nursing action that is least likely to motivate a person to learn. -Constructive encouragement when a person has been unsuccessful in the learning process -Emphasis on negative outcomes as a method to prevent learning incorrect practices -The creation of an atmosphere in which the patient is encouraged to express anxiety -The establishment of learning goals based on individual needs
-Emphasis on negative outcomes as a method to prevent learning incorrect practices Explanation: Successful learning is associated with positive encouragement and feedback, a comfortable learning environment, and realistic learning outcomes that an individual can understand and embrace.
Which step of the nursing process determines whether the client understands the health teaching that is provided? -Evaluation -Assessment -Planning -Implementation
-Evaluation Explanation: Evaluation includes observing the client, asking questions, and then comparing the client's behavioral responses with the expected outcomes. Assessment includes determining the client's readiness regarding learning. Planning includes identification of teaching strategies and writing the teaching plan. Implementation is the step during which the teaching plan is put into action.
Which health promotion model does the nurse identify is the reason some people choose actions to foster health and others refuse to participate? -Health Belief Model -Resource Model of Preventive Health -Achieving Health for All Model -Social Learning Theory Model
-Health Belief Model Explanation: The Health Belief Model was designed to foster understanding of why some healthy people choose actions to prevent illness while others do not. Another model, the Resource Model of Preventive Health Behavior, addresses the ways in which people use resources to promote health (Pender et al., 2011). It is based on social learning theory and emphasizes the importance of motivational factors in acquiring and sustaining health promotion behaviors. The Canadian health promotion initiative, Achieving Health for All, builds on the work of Lalonde (1977), in which four determinants of health—human biology, environment, lifestyle, and the health care delivery system—were identified. Determinants of health were defined as factors and conditions that have an influence on the health of individuals and communities.
Which of the following is an example of adherence to treatment? Select all that apply. -Maintaining a healthy diet -Self-monitoring for signs and symptoms of illness -Taking prescribed medications -Increasing daily activities -Inability to comply with follow-up appointments
-Maintaining a healthy diet -Self-monitoring for signs and symptoms of illness -Taking prescribed medications -Increasing daily activities Explanation: Examples of behaviors facilitating health include taking prescribed medications, maintaining a healthy diet, increasing daily activities and exercise, self-monitoring for signs and symptoms of illness, practicing specific hygiene measures, seeking recommended health evaluations and screening, and performing other therapeutic and preventative measures. Inability to comply with follow-up appointments is not an example of adherence to treatment.
The practice of nursing care is multifaceted in its scope and delivery. Which of the following activities describe the role of nursing? Select all that apply. -Promoting health -Altering a medical plan of care -Preventing illness -Health education and maintenance -Changing prescribed treatment protocols
-Promoting health -Preventing illness -Health education and maintenance Explanation: Nursing responsibilities are expanding continuously with increasing numbers of advanced practice nurses and changing state nurse practice acts. However, nurses cannot alter a medical plan of care or change health care provider prescribed treatment protocols.
The nurse is performing discharge teaching for an elderly client with mild visual impairment. The nurse provides written instructions with large print and highlighted parts. The nurse also sits near the client, faces the client, and speaks in a lower-pitched voice. When the client arrives home, the client has difficulty following instructions. What error in teaching did the nurse commit? -Providing written instructions that are highlighted -Speaking in a lower-pitched voice -Using instructions with large print -Sitting near and facing the client
-Providing written instructions that are highlighted Explanation: The client is experiencing mild visual impairment, which may include difficulty with color discrimination. Highlighting material may not be effective for the client. The other actions by the nurse (providing written instructions in large print, sitting near the client, facing the client, and speaking in a lower-pitched voice) are appropriate interventions that would enhance learning.
The nurse is preparing a learning contract for a client to adhere to a prescribed activity schedule. Which content will the nurse include in the contract to motivate the client? -List of exercises to complete -Series of short, measurable goals -Time needed to complete the exercises -Actions to take if unable to perform an exercise
-Series of short, measurable goals Explanation: Using a learning contract or agreement can be a motivational tool for learning. Such a contract is based on assessment of client needs, health care data, and specific goals that are measurable. In a typical learning contract, a series of measurable goals is established, beginning with small, easily attainable objectives and progressing to more advanced goals. A list of exercises to complete, time to complete the exercises, and actions to take if an exercise cannot be performed would be content to include in the teaching plan and would not serve to motivate the client.
Health education is an important part of nursing practice. When challenged with the many needs of patients, families, and communities, the nurse should always remember that the most important nursing responsibility is to: -Establish clear mutual goals for teaching. -Stimulate the person's desire to learn. -Identify the most important concept/practice to learn. -Provide a comfortable environment for learning.
-Stimulate the person's desire to learn. Explanation: An individual must be motivated to learn, otherwise it makes no difference what is taught, at what time, or where. Without learner receptivity, health teaching cannot be effective.
A nurse knows that the use of a learning contract increases motivation and increases the likelihood of patient compliance with the treatment regimen. Which client goal best exemplifies a well-designed learning contract? -The client who wishes to stop smoking agrees to cut back on one cigarette a day for the first week of treatment and then decrease smoking by two cigarettes the following week of treatment. -The client seeking alcohol treatment agrees to stop drinking all forms of alcohol immediately and plans to chew a stick of gum when they experience the urge to have a drink. -The client who wishes to lose weight immediately reduces caloric intake to 1000 calories a day and agrees to keep to this diet plan until a 9-kg weight loss has been achieved. -The client who wants to begin an exercise program agrees to participate in a 10-km run 6 months after starting the new exercise regimen.
-The client who wishes to stop smoking agrees to cut back on one cigarette a day for the first week of treatment and then decrease smoking by two cigarettes the following week of treatment. Explanation: A well-designed learning contract is realistic and positive. In a typical learning contract, a series of measurable goals is established, beginning with small, easily attainable objectives and progressing to more advanced goals. By reducing a specific number of cigarettes each week, the client is more likely to meet the smaller attainable goals and remain motivated to stop smoking. Learning contracts need to be specific and incremental; therefore smaller measurable goals related to the reduction of alcohol intake would be more realistic. For the client who wants to lose weight, a better statement would be to lose 1 kg the first week and gradually increase weight loss over time. The client wishing to begin an exercise program would benefit from and be more likely to remain motivated by smaller goals of walking for 20 minutes three times per week for the first week and gradually increasing exercise intensity, duration, and frequency.
A nurse is planning a health education program for a group of high school students regarding the dangers of texting and driving. Which action by the nurse illustrates the understanding of health education as a primary nursing responsibility? -The nurse gathers evidenced-based information related to texting and driving and coordinates the education with the school. -The nurse obtains the name of the school's medical director and obtains a health care provider's order to conduct the education program. -After consulting the literature and preparing the educational program, the nurse contacts the school's medical director for approval of the planned educational program. -The nurse prepares a permission slip for all students to have signed by their parents, allowing the student to participate in the educational program.
-The nurse gathers evidenced-based information related to texting and driving and coordinates the education with the school. Explanation: Health education is an independent function of nursing practice and is included in all state nurse practice acts. Teaching, as a function of nursing, is included in all state nurse practice acts. As an independent nursing function a health care provider order or approval is not required. Health education is a primary responsibility of the nursing profession. Health education by the nurse focuses on promoting, maintaining, and restoring health; preventing illness; and assisting people to adapt to the residual effects of illness. Prior parental consent is not required for education related to health/safety promotion.