motivation

NSG 200: Teaching, Adherence, Motivation, and Evaluation

Overview

• Instructor: Marian L. Obiegbu-Chima, MSN, RN, CDCES
• This course module focuses on the concepts of self-management, adherence, motivation, and evaluation in nursing practice and patient care.

Module Student Learning Outcomes

• Define the concept of self-management including adherence, motivation, and evaluation.
• Recall concepts of health promotion and patient education.
• Apply client information to adherence or motivational theories.
• Outline the connection between interrelated concepts.
• Apply the nursing process to prioritize nursing care across the lifespan related to concept exemplars.

Class Student Learning Outcomes

• Differentiate between compliance vs adherence.
• Explain how health beliefs, motivation, and readiness to change affect patient behaviors.
• Apply Maslow's Hierarchy of Needs, Health Belief Model, and Stages of Change to patient education.
• Use clinical judgment to determine the best nursing interventions to promote adherence.

Promoting Adherence

Reasons for Non-Adherence

• Factors to consider:
    - Patient-centered care is crucial for adherence.

Case Example

• Scenario:
    - A patient with newly diagnosed hypertension prescribed medication, dietary changes, and exercise.
    - At follow-up: Blood Pressure (BP) remains elevated, and the patient states, “I just haven’t started the medication yet.”
    - Potential reasons for this behavior include lack of understanding, motivation, or barriers to care.

Motivation

Types of Motivation

• Intrinsic Motivation:
    - Internal drive to engage in activities for personal satisfaction.
• Extrinsic Motivation:
    - Behavior driven by external factors, such as rewards or avoiding punishment.

Compliance vs Adherence

Maslow’s Hierarchy & Health Behaviors

• Considerations:
    - If a patient cannot afford basic needs (like food or housing), focus on how unlikely they are to prioritize:
      - Exercise?
      - Medication adherence?
      - Prevention?

Health Belief Model

• Influences on health behavior:
    - Perceived susceptibility: Beliefs about personal risk.
    - Perceived severity: Beliefs regarding how serious a condition is.
    - Perceived benefits: Belief that action will reduce risk or improve health.
    - Perceived barriers: Identification of obstacles preventing action.
    - Cues to action: Triggers prompting behavior change.
    - Self-efficacy: Confidence in one’s ability to succeed in change.

Stages of Change (Transtheoretical Model)

Stages and Patient Thoughts

• Precontemplation:
    - Patient thinks, “I don’t have a problem.”
• Contemplation:
    - Patient thinks, “Maybe I should change.”
• Preparation:
    - Patient thinks, “I’m planning to change.”
• Action:
    - Patient states, “I started the change.”
• Maintenance:
    - Patient expresses, “I’m sustaining the change.”

Guiding Patient Behavior Change

Key Concepts

• Maslow’s Hierarchy of Needs:
    - Addresses priorities at various levels, starting from physiological needs to self-actualization.
• Cues:
    - Assessment of individual needs and readiness for change.
• By matching the patient’s stage of change to specific interventions, nurses can effectively facilitate behavior change.

Clinical Judgment Model

Steps in Clinical Judgment

1. Recognize cues.
2. Analyze cues.
3. Prioritize hypotheses.
4. Generate solutions.
5. Evaluate outcomes.

NGN Case Clusters

Case Cluster 1: Hypertension & Medication Adherence

1. Recognize Cues:
     - A 54-year-old patient is diagnosed with hypertension, feels fine, and has not started medication.
2. Analyze Cues:
     - Identify possible influences on non-adherence, e.g., lack of perceived severity.
3. Prioritize Hypothesis:
     - Determine if knowledge deficit or ineffective health maintenance is the issue.
4. Generate Solutions:
     - Choose the most appropriate nursing intervention, such as explaining complications of untreated hypertension.
5. Evaluate Outcomes:
     - Look for indications of improved adherence, guiding clinical outcomes.

Case Cluster 2: Diabetes & Lifestyle Change

1. Recognize Cues:
     - A 47-year-old patient with newly diagnosed Type 2 diabetes expresses interest in exercising but feels uncertain.
2. Analyze Cues:
     - Identify patient's stage of change; likely in contemplation.
3. Prioritize Hypothesis:
     - Determine which need to address first (e.g., knowledge deficit versus anxiety).
4. Generate Solutions:
     - Encourage gradual activity goals to foster confidence.
5. Evaluate Outcomes:
     - Identify effective teaching by patient’s commitment to exercise.

NCLEX Case Scenarios

Examples

1. A 58-year-old patient with Type 2 diabetes is reluctant to exercise, indicating compliance issues related to perceived difficulty of sticking to a regimen.
2. Another patient with COPD acknowledges smoking cessation as challenging while in contemplation stage.

Key Takeaways

1. Patients change behavior when:
     - The problem is recognized as significant.
     - They believe change will be beneficial.
     - Barriers are acknowledged and addressed.
     - Patients are ready to change.

2. The role of the nurse includes:
     - Assessing beliefs.
     - Evaluating readiness for change.
     - Partnering with patients in their care.
     - Supporting self-management.

Concept Definitions

• Self-Management: The ability to maintain health autonomously.
• Adherence: Collaboration and engagement between patient and provider in care decisions.
• Motivation: The drive sustaining behavior towards health.
• Evaluation: The assessment of goal attainment.
• Health Promotion: Enabling individuals to control their health outcomes.
• Patient Education: Integrating health-related behaviors into patient care and choices.
• Effective education is linked to improved adherence.

Different Stages in the Nursing Process

1. Assessment:
     - Gather history, conduct physical exams, understand developmental stages, and identify health beliefs and barriers.

2. Planning:
     - Set SMART goals and outcomes, address barriers, and prepare appropriate educational materials.

3. Implementation:
     - Focus on basic needs as structured by Maslow before proceeding with high-priority education.

4. Evaluation:
     - Using teach-back methods and self-reporting to monitor adherence and assess barriers.