Principles of Health Education WellStar Primary Care Nurse Practitioner Program Kennesaw State University NURS 7735 Adap

1. Principles of Health Education WellStar Primary Care Nurse Practitioner Program Kennesaw State University NURS 7735 Adapted from a lecture by Troy Spicer

2. Think in terms of risk, prevalence, morbidity Leading Causes of Disability and Death Are: Heart Disease Cancer Stroke Injuries COPD Suicide Chronic Liver Disease Homicide Acts of Abuse and Violence HIV Disease

3. Based on this information, for what health behaviors would you educate your patients? Smoking Cessation Eat Less Fat Exercise More Moderate ETOH Remove One’s Self from Abusive/Dangerous Situations Depression Wear Seat Belts Safe Sex

4. Steps of Successful Change I) Acknowledging that something is not right in our lives II) Deciding that we want to make a change III) Setting a goal IV) Deciding on and implementing a plan V) Assessing progress VI) Guarding against backsliding

5. Acknowledging that something is not right in our lives • Personal ownership of the problem is necessary • People who want to make the change out of personal, internalized reasons do better than those who seek change because “everyone is nagging me”

6. Deciding that we want to make a change • Most people need to feel that there is more to gain than to loose in the change, that the change is worth the pain

7. Setting goals • Goals must be realistic

8. Deciding on and implementing a plan • Plan should not only focus on what NOT TO do, but also, what TO do • Support through groups, peers, significant others is important

9. Assessing progress • Measure progress in terms of gradual changes

10. Guarding against backsliding • Establish a system of positive reinforcements • Establish follow up with patient • Let patients who backslide that it’s common to backslide and that does not doom them in the long run

11. Why Patients Tend to Resist Change I) Sometimes change involves giving up something pleasurable, such as eating high fat foods II) Sometimes change involves unpleasant action, such as exercise III) Sometimes change involves pain, such as elimination of ETOH IV) Sometimes change may jeopardize social relationships, such as some women who desire to loose weight encounter sabotage by their significant others V) Sometimes people get complacent in their health behaviors, such as the 65 year old man who says, “I’ve been smoking for the past 50 years, what have I got to gain at this age?”

12. Adapting Your Practice for Health Promotion I. Determine Your Goals and Set Priorities II. Decide on an Approach III. Get Colleagues On Board IV. Make Health Promotion Visible in the Office V. Use Resources that Support Your Efforts and Your Patient’s Efforts VI. Evaluate your Outcomes

13. Using this Methodology to Create a Health Promotion Program I. Determine Your Goals and Set Priorities Your practice decides that exercise promotion is a priority This decision is based on the observation of obesity and sedentary lifestyles within the practice. A chart review reveals high incidence of obesity within the practice. Obesity and sedentary lifestyle is judged to be a common and serious health risk. Goal is first to create health promotion plan Other goals can be set later

14. Using this Methodology to Create a Health Promotion Program II. Decide on an Approach Screen the patient EKG if indicated (eg, man over 40 with two or more cardiac risk factors) Set broad goals for patients such as adherence to exercise program Negotiate specific goals with patients regarding type, duration and frequency of physical activity such as walking

15. Using this Methodology to Create a Health Promotion Program III. Get Colleagues On Board Establish several team members to work on special projects

16. Using this Methodology to Create a Health Promotion Program IV. Make Health Promotion Visible in the Office Use posters, pictures and brochures Incorporate questionnaires into the sign-in process Give opportunity for patients to ask questions Try to incorporate health education in every visit, regardless of reason for visit

17. Using this Methodology to Create a Health Promotion Program V. Use Resources that Support Your Efforts and Your Patient’s Efforts Help patients set realistic and attainable goals Encourage and foster the patient’s inner motivation

18. Using this Methodology to Create a Health Promotion Program VI. Evaluate your outcomes Measure outcomes such as compliance, weight loss, and self report of exercise.

19. Successful Exploration of Behavioral Issues with the Patient The patient understands your rationale for bringing up the issue The patient feels that you are working with them on the issue The patient feels free to discuss the issue with you Don’t coerce change on first attempt. Revisit issue over time

20. Successful Exploration of Behavioral Issues with the Patient You are clear about the patient’s knowledge level and values Explore the patient’s past experience with behavioral changes Assist the patient to identify barriers to behavioral changes

21. Successful Exploration of Behavioral Issues with the Patient Help the patient establish a realistic, specific goal, one behavioral goal at a time Help the patient establish a plan Teach the patient about the importance of monitoring their progress Follow up Support and encourage those who relapse

22. Characteristics of Pediatric Learner Infants/Toddlers/Preschoolers Limited ability to accept health teaching Interventions Incorporate toddlers and preschoolers in health teaching

23. Characteristics of Pediatric Learner School age (5-11 years) Able to learn some health related tasks Able to understand avoidance of contagion Interventions Motor skills by age 8 or 9 years are developed enough to teach self injection Begin increasing supervised autonomy in decision making

24. Characteristics of Pediatric Learner Adolescent (12-18 years) Recognizes own responsibility and actions contributing to health and illness Understands multicausality of illness and cures Understands the psychological influence in illness Blend fact, fantasy and emotion in decision making Interventions Motor skills fully developed Expect a degree of parental alienation which infers with supervision

25. Characteristics of Adult Learner General characteristics Problem centered focus of learning Demand influence on the direction of teaching Draw on experiences Interventions Maintain relevance

26. Characteristics of Adult Learner Young Adults (19-40 years) Interventions Focus on: Sexuality Childrearing Family Planning Stress Management Home & work safety Fitness Specific Disease/Risk Factors

27. Characteristics of Adult Learner Middle Age Adults (41-65 years) Interventions Focus on: Change of Life Issues Vision/Hearing Declines Strength Declines Stress Body Image Changes Functional Changes Specific Disease/Risk Factors

28. Characteristics of Adult Learner Late Adulthood (>65 years) Interventions Focus on: Chronic Disease CV/Resp Reserve Decline Exercise Incontinence Depression Loss of Function Increased Dependence Decrease Balance Acute Illness Increased Learning Time for Info and Skills

29. Anticipatory Guidance A coordinated, systematic scheme of patient education focused on leading the patient to anticipate issues and to facilitate patient coping with successful strategies.

30. Last Thought Where does health teaching occur? Who is the intended audience? How do you know that your health teaching is effective?