Module 3 Comfort & Pain Management, Adult Development, Teaching & Counseling and Health & Wellness

Health

A state of complete physical, mental, and social well-being, and is not merely the absence of disease.

Wellness

An active state in which people must make intentional choices to live in ways that support their physical, emotional, and mental health.

Illness

A person's unique, subjective response to a disease (which is a pathological change in the body or mind), and it involves an abnormal process that changes one's level of functioning.

Disease

A pathological change in the body or mind.

Primary Level of Health Promotion

Directed toward promoting health and preventing the development of disease or injury.

Examples of Primary Health Promotion

Immunizations, safe sex practices, and health education.

Secondary Level of Health Promotion

Focuses on screening for early detection and treatment of conditions.

Examples of Secondary Health Promotion

Regular blood pressure screenings and yearly mammograms.

Tertiary Level of Health Promotion

Begins after an illness is diagnosed and treated, with the goal of reducing disability and rehabilitating patients to their maximum level of functioning.

Examples of Tertiary Health Promotion

Stroke rehabilitation or support groups.

Role of Nurses in Health Promotion

Nurses play a vital role in health promotion and illness prevention across three levels.

How is pain defined in a clinical nursing context?

Pain is highly subjective and is defined as whatever the experiencing person says it is.

What are the key components of a complete nursing pain assessment?

Initial report, onset, duration, location, quality/character, intensity, and aggravating or alleviating factors.

Name three common pain assessment scales used in nursing.

Numeric scale, Wong-Baker FACES scale, and FLACC scale.

List four factors that influence a person's pain experience.

Age, sex/gender, cultural beliefs, and coping skills.

How does pain affect a patient's daily functioning?

It can alter activities of daily living, work, recreation, appetite, and sleep, while contributing to emotional distress.

What are the primary characteristics of acute pain?

Rapid onset, variable intensity (mild to severe), protective response to tissue damage, and resolution once the cause is treated.

What are the primary characteristics of chronic pain?

Slower onset, maladaptive nature, persists or recurs for more than 3 months, and represents permanent change.

What is the clinical significance of chronic pain regarding nursing care?

It requires long-term nursing support to maintain the patient's quality of life.

Give an example of acute pain.

Appendicitis or surgical pain.

Give an example of chronic pain.

Fibromyalgia or arthritis.

What is the goal of a team-based approach to pain management?

To optimize patient comfort by integrating both pharmacologic and non-pharmacologic interventions.

Which medications are typically used for mild to moderate pain?

Acetaminophen and NSAIDs.

What class of medication is typically reserved for more severe pain?

Opioids.

What are adjuvant medications in pain management?

Medications like gabapentin or muscle relaxants used to assist in pain control.

Why should non-pharmacologic interventions be prioritized in pain management?

To minimize polypharmacy.

List three examples of non-pharmacologic pain management strategies.

Removing the cause, promoting rest, and utilizing distraction (e.g., music therapy).

How can guided imagery be used in pain management?

As a non-pharmacologic intervention to help manage pain and promote comfort.

What physical therapies can be applied to manage pain?

Cold or heat therapies.

What emotional states are commonly associated with chronic pain?

Depression, fear, and insomnia.

How is the location of pain categorized in an assessment?

Localized, generalized, or radiating.

Freud (Psychoanalytic)

Personality develops through stages focused on pleasure zones; unresolved conflicts cause fixations affecting adult behavior.

Piaget (Cognitive)

Outlines cognitive progression from sensory learning to abstract reasoning and hypothetical thinking.

Erikson (Psychosocial)

Proposes eight stages presenting developmental crises (e.g., Trust vs. Mistrust); successful resolution builds a healthy personality for the next stage.

Havighurst (Psychosocial)

Focuses on developmental tasks based on maturation and social expectations, where success leads to happiness.

Gould (Psychosocial)

Involves adults progressively letting go of childhood assumptions and false beliefs to gain autonomy.

Levinson (Psychosocial)

Describes alternating stable and transitional periods where individuals re-evaluate life choices to build new "life structures".

Kohlberg (Moral)

Moral reasoning develops from fear of punishment toward an understanding of universal ethical principles and justice.

Gilligan (Moral)

Emphasizes that women's moral development focuses primarily on care, relationships, and responsibility rather than justice.

Fowler (Faith/Spiritual)

Describes stages of how individuals make meaning and find spiritual purpose in life.

Young Adult (18-39) major concerns

Injuries, self-harm, substance use, and STIs.

Young Adult (18-39) interventions

Focus on safety assessments, identifying family history risks, and encouraging preventive care like yearly physicals.

Middle Adult (40-65) physiological changes

Gradual physiological changes begin, including hormonal shifts, vision/hearing changes, and decreased muscle mass.

Middle Adult (40-65) interventions

Managing chronic illnesses, performing routine screenings (cancer, bone density), and assessing for caregiver role strain.

Older Adult (65+) healthcare needs

Chronic illness management, risk of accidental injuries, and cognitive function monitoring (dementia, delirium, depression).

Polypharmacy

Taking many medications from multiple specialists.

Older Adult (65+) interventions

Promoting daily safe physical activity, reinforcing a balanced diet, avoiding substance abuse, and encouraging social interaction to combat isolation.

Sandwich generation

Middle adults often caring for both parents and children.

Older Adult (65+) risk assessment

The risk of polypharmacy and elder abuse must be assessed.

Physical growth status in Young Adults

Physical growth is complete.

Middle Adult chronic conditions

Chronic conditions (e.g., hypertension, diabetes) start to appear.

When does the patient education process begin?

It begins at admission and is an ongoing process throughout the patient's care.

What is the primary goal of patient education?

To achieve optimal health and patient independence.

Why is it important to explain the 'why' behind information to adult learners?

Adult learners need to understand the rationale so they can apply new information quickly.

What two internal factors must a nurse assess regarding a patient's learning before starting education?

The patient's readiness to learn and their motivation.

List three categories of factors that impact a patient's adherence to a therapeutic plan.

Age/developmental level, sensory barriers (vision, hearing, mobility), and social/financial factors (family structure, support systems, financial concerns).

How does culture and language impact the nursing assessment for patient education?

Nurses must assess these to ensure communication is effective and to identify any specific language needs or cultural barriers to adherence.

Define health literacy.

Health literacy is a patient's ability to obtain, understand, and act on health information.

What is the relationship between health literacy and health management?

Higher health literacy yields better health management outcomes.

What is a recommended strategy for nurses to improve health literacy when speaking with patients?

Avoid complex medical jargon and use developmentally appropriate, clear, and simple wording.

What is the 'Ask Me 3' method used for in patient education?

It is a screening tool used to assess patient understanding of their health situation.

What are the three questions included in the 'Ask Me 3' method?

What is my main problem? What do I need to do? Why is it important for me to do this?

Besides 'Ask Me 3', what is another screening tool mentioned for assessing patient understanding?

The Newest Vital Sign.

What should a nurse provide to patients with language barriers to promote safety and understanding?

Supportive educational materials provided in the patient's native language.

Evaluation of Learning

Evaluation is continuous to ensure the patient has grasped the necessary skills and concepts.

Direct Questioning

Asking the patient directly (e.g., "How will you implement this when you go home?").

Observation

Watching what the patient states or does to ensure it is congruent with what was taught (e.g., using a walker correctly).

Return Demonstration

Highly useful for physical skills (e.g., self-administering insulin), where the patient successfully demonstrates the action back to the nurse.

Purpose of Evaluation

To ensure the patient has grasped the necessary skills and concepts.