NSG 411 1st EditionExam # 2 Study Guide#1 HEALTH PROMOTION - Definition: behavior motivated by the desire to increase wellbeing and actualize human health potential. - How is it different from disease prevention? Disease management?o Disease prevention- behavior motivated by a desire to actively avoid illness, detect it early, or maintain functioning within the constraints of illness#2 STAGES OF CHANGE- What is change?o Any planned or unplanned alteration of the status quo in an organism, situation or process- The stages of Lewin’s theoryo Unfreezing – occurs when a developing need for change causes disequilibrium in the system. People have a sense of dissatisfaction and have a void they would like to fill. Involves initiating the change o Moving – occurs when people examine, accept, and try the innovation. Period when participants in a prenatal class are learning exercises or when elderly clients in a senior citizen center are discussing ways to try and make their apartments safe from accidents. People experience a series of attitude transformations, ranging from early questioning ofthe worth to full acceptance and commitment to accomplishing the changeo Refreezing – occurs when change is established and accepted and permanent part of the system. Rest of the system has to adapt to it. - Think of one example and work it through the stageso Unfreezing- family seeks help solving alcoholism problemso Moving- family learns ways to prevent alcoholism, stop drinking, etco Refreezing- family has stopped drinking#3 PLANNED CHANGE MODEL – how is this different from the nursing process??? Planned change is a purposeful, designed effort to effect improvement in a system with the assistance of a change agent.- Characteristics of planned change are key to its success:o The change is purposeful and intentionalo The change is by design, not by defaulto Planned change in community health aims at improvemento Planned change is accomplished through an influencing agent- Strategies: Describe each one and identify the population with which it is best used.o Empiric-rational: used to effect change based on the assumption that people arerational and when presented with empiric information, will adopt new practices. New information is offered to people. o Normative-reeducative: used to influence change that not only presents new information but also directly influences peoples attitudes and behaviors through persuasion. Assumes that peoples practices and attitudes are determined by sociocultural norms and that they need more than presentation of information tochange behavior. Strengthens client-understanding, self control and commitment. This type of client is found in teaching, counseling and therapy situationso Power-coercive: use coercion based on fear to effect change. Change agents mayderive power from the law, position, or person power. Situations that are life-threatening may require power-coercive strategies. These strategies may be usedwith people who cannot help themselves or in situations that threaten individuals safety or the public health - Requirements for making positive change with groups - be able to describe these and provide an exampleo Participation- persons affected by a proposed change should participate as much as possible. Participation ensures a greater likelihood that the change will be accepted and maintained. o Resistance- the change agent can expect people to resist change. People do not make a change until they are convinced of its worth. May also come from a conflict over goals and methods or a misunderstanding about what the change will mean and require. Nurse must prepare clients for the change, provide support and patience during change process and encourage response and expression of feelingso Interdependence –a change in one part of the system affects its other parts. Must anticipate and prepare for the impact of the proposed change on the clients involved, other persons, departments, organizations or even geographic areas.o Flexbility –unexpected events. The nurse needs to be able to adapt to unexpected events and make the most of them. A good change planner anticipates possible blocks or problems by preparing stragegies and alternative plans.o Self-understanding- essential for an effective change agent. Understand oneself and understand patient. Understanding the principles of planned change can assist the community health nurse in guiding individuals, families, and communities toward achieving the highest level of health.#4 DOMAINS OF LEARNING- Cognitive: Deals with knowledge and intellectual skills/abilitieso Levels: Describe and list several action verbs Knowledge – lowest level of learning involves recall. Remember things previously learned. - Ex: states that insulin, if taken, will control diabetes Comprehension – combines remembering with comprehension, combines remembering with understanding. Want client to grasp and understand meaningand to recognize importance of suggested health behaviors.- Ex: client will describe a well-balanced diet during pregnancy Application – learner cannot only understand material but apply it to new situations. Possibility of self-care when clients use their knowledge to improve their own health. - Ex: adjusts insulin dosage daily to maintain proper blood sugar level Analysis - learner breaks down material into parts, distinguishes between elements, and understands the relationships among the parts. Preliminary step toward problem-solving. Demonstrating how to isolate the parts in a situation and encourage the clients to consider the relationships among the parts and to draw conclusions from their thinking. - Look for words such as differentiate, contrast, debate, question and examine.- Ex: discusses relationships between insulin, diet, activity and diabetic control Synthesis- ability not only to break down and understand the elements of a situation but also to form elements into a new whole. integrates with other learning, generating new ideas.- Ex: couple who wants to potty train their child may learn the physiologic and psychological dimensions of toilet training, analyze their own situation and then develop strategies for training the child.  Evaluation- comparing to standards. Judging according to a standard. - Ex: compares degrees of diabetic control (outcomes) with desired control (objectives)- Ex: a client in a nutrition class