What are the Levels of Emphasis on Population Wellness? (5) 1. Tertiary Health Care 2. Secondary Health Care 3. Primary Health Care 4. Clinical Preventive Services 5. Population-Based Health Care Services What is the emphasis of the health care industry today? Shifting from managing illness to managing health of a community and environment (T/F) The Core Functions Project developed the Health Service Pyramid. (T/F) The pyramid shows population-based health care services provide the basis of preventive services Both are True Describe Population-Based Health Care Services A wellness perspective focusing on the health of populations and the communities in which they live, rather than just on finding a cure for an individuals disease. (T/F) Life Expectancy for Americans is steadily increasing over the past century True What does Clinical Preventive Care focus on? It focuses on reducing and controlling risk factors for disease through activities

Ex: Occupational Health Programs What does Primary Care focus on? It focuses on improved health outcomes for an entire population

Ex: Primary Care and Health Education, Proper Nutrition, Maternal/Child Health Care, Family Planning, Immunizations, Control of Diseases T/F Health promotion programs lower the overall costs of health care by reducing the incidence of disease, minimizing complications, and reducing the need to use more expensive health care resources True What are the 5 levels of care for which health providers offer services? 1. Disease Prevention 2. Health Promotion 3. Primary Health Care 4. Secondary Health Care 5. Tertiary Health Care What does Tertiary Health Care try to reduce? It tries to reduce the symptoms and the spreading of a disease after an illness has been diagnosed

EX: Surgical Intervention to remove harmful tissues, Antidepressants when depression has been diagnosed, Rehabilitation to store physical function What does Secondary Care do? It proactively detects the development of presence of a disease

EX: Routine Exams, Blood Test, Screening, Mammograms What does Primary Care do? It tries anything to prevent a disease from developing at the most basic individual level

EX: Brushing Teeth, Using Condoms, Hand-Washing, Vaccinations Restorative Care What is the function? What does it help patients regain? What does it focus on? Who is it reimbursed by? -It serves patients recovering from an acute or chronic illness/disability

-It helps patients regain maximum function and enhance quality of life

-Focuses on patient and family independence

-Reimbursed by government(Medicare or Medicaid), Private insurance, or Private Pay What does Extended Care Facilities Provide? They provide intermediate medical, nursing, or custodial care for patients recovering from acute illness or disabilities What does Intermediate Care/Skill Nursing Facilities provide? They provide care for patients until they can return to their community or residential care location What are some Examples of Continuing Care for people who are disabled, functionally dependent, or suffering a terminal disease? 1. Nursing Centers or facilities 2. Assisted living 3. Respite Care 4. Adult Day care centers 5. Hospice Issues in Health Care Delivery What are some examples? What are Pay for Performance Programs designed to do? What is The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)? -Nursing Shortage -Competency -Quality and Safety in Health Care -Pay for Performance -Patient Satisfaction

They are designed to promote quality, effective, and safe patient care by physicians and health care organizations

It is a standardized survey developed to measure patient perceptions of their hospital experience Quality and Performance Improvement What are some examples of Quality Improvement Program Models? What is the approach of QI (Quality Improvement)? What does QI data inform you about? What level do QI process begin? What does QI Programs focus on? In Performance Improvement (PI), what does analyze and evaluate? - Patient Self-Determination Act (PSDA), Six Sigma or Lean Rapid-Cycle Improvement or Rapid-Improvement Event (RIE)

-To continuously study and improve the processes of providing health care services to meet the needs of patients and others and inform health care policy

-It informs you about the processes work within an organization and offer info about how to make a EBP changes

-It focuses on processes or systems that contribute to patient, staff, or system outcomes

-It begins at the staff level, where problems are defined by the staff

-An organization analyzes and evaluates current performance and uses the results to develop focused improvement actions T/F Solutions necessary to improve the quality of health care depend largely on the active participation of nurses? Treu Health People 2030 What did Healthy People Initiative establish? What were the goals of Healthy People 2020? -Established ongoing Health Care Goals

-To increase life expectancy and quality of life, and to eliminate health disparities through improved delivery of health care services T/F There is a growing need to have organized health care services where the population lives, works, and learns?

Does changes in health care financing move patients more quickly to the community setting?

The focus on care is on health promotion, disease prevention and restorative care?

The focus on health promotion and disease prevention is essential for holistic practice of professional nursing? All True What do Public Health Nursing require and understanding of? (5) -Needs of population

-Factors that influence health promotion and health maintenance

-Trends and patterns influencing disease within a population

-Political processes used to affect public policy Community Health Nursing What is it? What is the focus? What is the goal? -Nursing practice in the community

-Focuses on health care of individuals, families, and groups within the community

-Goals are to preserve, protect, promote, and maintain health T/F Improved Delivery of Health Care occurs through: -Assessment of health care needs of individuals, families, and communities -Development and implementation of public health policies -Improved access to care True What does improved access to care ensure? It ensures that essential community-wide health services are available and accessible for the total community What does using public health principles allow nurses to understand? Allows them to better able to understand the types of environment in which patients live and the types of interventions necessary to help keep them healthy Social Determinants of Health What do they contribute Ex? What are the 5 determinants of health? Do they impact the overall health and wellness of that community? -They contribute to a person's current state of health

EX: Biological, socioeconomic, psychosocial, behavioral, or social in nature

-Biology/Genetics (Sex/Age), -Individual Behavior (Alcohol, injection drug use, unprotected sex, smoking) -Social Environment (Discrimination, income, gender), -Physical Environment (Where a person lives or crowding conditions) -Health Services (Access to quality health care and having health insurance)

Yes they do Disparities in Health Care Which groups are affected and are they affected negatively or positively? What is Health Disparities? Who experiences them? What is this a result from? -It negatively affects groups of people who have systematically experienced social or economic obstacles to health

-They are preventible differences in the burden of disease, injury, violence, or opportunities to achieve optimal health.

-They experienced by social disadvantaged populations

-This is resulted from poverty, environmental threats, inadequate access to health care, individual and behavioral factors, and educational inequalities T/F Vulnerable population includes individuals living in poverty, older adults, homeless, immigrants, individuals in abusive relationships, substance users, and people with severe mental illnesses True Competency in Community-Based Nursing

Nurses utilize a variety of skills and talents such as -Caregiver -Change Agent -Collaborator -Educator -Case Manager -Patient Advocate -Counselor -EPidemiologist As a caregiver, what do nurses do? Nurses use critical thinking to apply the nursing process to ensure appropriate, individualized nursing care for specific patients and their family As a Case Manager, what do nurses do? Nurses establish an appropriate plan of care based on assessment and coordinates needed resources and services for a patient's well-being across a continuum of care As a Change Agent, what do nurses do? Nurses identify and implement new and more effective approaches to problems As a patient advocate, what do nurses do? Nurses provide the info necessary for patients to make informed decisions in choosing and using services appropriately As a Collaborator, what do nurses do? Nurse works not only with patients and their families but also with other related health care disciplines As a counselor, what do nurses do? Nurses help patients identify and clarify health problems and choose appropriate courses of action to solve those problems As a Educator, what do nurses do? Nurses have the opportunity to work with single individuals and groups of patients.

Prenatal classes, infant care, child safety, and cancer screening are just some of the health education programs provided by nurses in the community practice setting As an Epidemiologist, what do nurses do? Nurses are involved in case findings, health teaching, and tracking incident rates of an illness. They protect the level of health of the community, develop sensitivity to changes in the health status of the community, and help identify the cause of these changes Community Assessment -What are the 3 components? What are the components of the community? -The 3 components are Systematic Data Collection on the Population, Monitoring Health Status of the Population, and Making Info Available About the Community's Health

-Structure or locale, People, Social Systems T/F Once you acquire a picture of a patients life, you then design interventions to promote health and prevent disease within the community-based practice setting True T/F Nurses need to consider the total person and the environment in which the person lives to individualize nursing care and enhance meaningfulness of the patients future healths status? True What is WHO's Definition of Health A state of being that people define in relation to their own values, personality, and lifestyle Health Belief Model

What does it address? What does it help us understand? What are the 3 components? What do variables influence? What is the influence of health beliefs? Why is understanding variables important? -It addresses the relationship between a person's belief and behaviors

-It helps us understand factors influencing patients perception, belief, and behavior to plan care that will most effectively help patients maintain or restore health and prevent illness

1. Individuals perception of susceptibility to an illness
2. Individuals perception of the seriousness of the illness    3)Likelihood that a person will take preventive action

-Variables influence how a person thinks and act

-Health Beliefs can negatively or positively influence health behavior or health practices

-It is important to understand the effects of variables because it allows us to plan and deliver individualized nursing care Maslow's Hierarchy of Needs

What are the 5 levels? What is it used for? Since certain human needs are more basic than others, what does this result in? What does it a provide a basis for nurses? What is the focus of care? What do you need to nurses need to understand to provide the most effective care? (level 1) Physiological Needs, (level 2) Safety and Security, (level 3) Relationships, Love and Affection, (level 4) Self Esteem, (level 5) Self Actualization

-it is a model that nurses use to understand the interrelationships of basic human needs

-This results in certain needs to be met before others (such as fulfilling the physiological needs before the needs of love and belonging)

-It provides a basis for nurses to care for patients of all ages in all health setting

-The focus of care is on a patient's needs rather than on strict adherence to the hierarchy

-Nurses need to understand the relationships of different needs and the factors that determine the priorities of each patient Holistic View Of Health What does it attempt to do? What does it consider? Who is involved? In the model, what do nurses use?

T/F Nurses use holistic therapies either alone or in conjunction with conventional medicines -It attempts to create conditions that promote optimal health

-It considers emotional and spiritual well-being and other dimensions of an individual to be important aspects of physical wellness

-Patients are involved in their healing [process, thereby assuming some responsibility for health maintenance

-True External/Social/Psychosocial Factors

-What external variables influence a person's health belief and practice?

T/F: The patients perception of the seriousness of disease and their history of preventive care behaviors(or lack of them) can influence how patients think about health?

-What factors increase the risk of illness and influence the way that a person defines and reacts to illness?

-What are some psychosocial variables?

-What do social variables determine?

What do economic variables effect?

What do cultural backgrounds influence? -Family practices, socioeconomic factors, and cultural background

-True

-Social and Psychosocial Factors

-Stability of the person's marital or intimate relationship, lifestyle habits, and occupational environment

-They partly determine how patients obtain care, the treatment method, economic cost to the patient. and potential reimbursement to the patients care agency or patient

-Economic Variables often affect a patient's level of health by increasing the risk for disease and influencing how or at what point the patient enters the health care system

-Cultural background influences beliefs, values, and customs. it influences the approach to the health care systems, personal health practices, and the nurse-patient relationship. -It also influences an individuals beliefs about causes of illness and remedies or practices to restore health. What are variables that increase the vulnerability of an individual or a group to an illness or accident, risk factors include?

-What is a risk factor -What are examples of Genetic and Physiological Factors? -What does age affect? -What can a person physical environment increase? EX? -What are the effects of lifestyle practices? 1)Genetic/Physiological Factors 2)Age 3)Environment 4)Lifestyle

-A risk factor is any situation habit, or other variable such as social, environmental, physiological, psychological, developmental, intellectual, or spiritual that increases the vulnerability of an individual or group to an illness or incident

-Age affects a person's susceptibility to certain illnesses

-Physical environment can increase the likelihood that certain illnesses will occur EX: cleanliness, heat, cold, overcrowding, and air quality

-Life style affects and behaviors have positive or negative effects on health Health Promotion, Wellness, And Illness Prevention

-What do nurses incorporate rather than simply treating illness? -What do health promotion activities help? -What does wellness education teach patients? -What does illness prevention actives protect? -What do active activities and passive activities do? -What is the goal of total health programs? -What are they based on? -What does passive strategies of health promotion do? -What do active strategies of health promotion do? -Nurses incorporate health promotion activities, wellness education, and illness prevention activities rather than simply treating disease

-They help maintain or enhance health

-It teaches patients how to care for themselves

-It protects against health threats, and thus maintain an optimal level of health

-Active strategies motivate the individuals to adopt health program Individuals learn passive strategies from others without their own participation

-The goal of total health programs is to improve a patient's level of well-being in all dimensions, not just physical health

-They are based on the belief that many factors can affect a person's level of health

-Passive strategies of health promotion, individuals gain from the activities of others without acting themselves EX: The fluoridation of municipal drinking water and the fortification of homogenized milk with Vitamin D

-Active strategies of health promotion, individuals adopt specific health programs Risk Factor Modification and Changing Health Behaviors

What are the 5 stages and what do they include? 1) Pre-contemplation: No intention to change

2)Contemplation: Considering a change within the next 6 months

3)Preparation: Making small change

4)Action: Actively engaging in strategies to change behavior

5:Maintenance Stage: Maintaining a changed behavior Patient Teaching: Lifestyle Changes

-What are the objectives? -What are the teaching strategies? -What is the evaluation? -Objective: Patients will reduce health risk related to poor lifestyle habits through behavior change

-Teaching Strategies: Provide active listening, ask about perceived barriers, assist the patient in establishing goals, and reinforcing the process of change

-Evaluation: Have the patient track adherence, and provide positive reinforcement Illness

-What is it? -What is aAcute illness? -What is a Chronic illness? -What are the 4 modifiable health behaviors related to many chronic illnesses? -What is an illness career? -What are variables that influence illness and illness behavior ? Illness is a state in which a person's physical, emotional, intellectual, social, development, pr spiritual functioning is diminished or impaired

-An acute illness is usually reversible, has a short duration, and is often severe. It may affect functioning in any dimension Symptoms: Appear abruptly, intense, and often subside after a relatively short period

-Chronic Illness: Persist, usually longer than 6 months, irreversible, and affects functioning in one or more systems

-4 Modifiable Factors: Physical Inactivity, Poor Nutrition, Tobacco Use, Excessive Alcohol Consumption

-Illness Career: is a flexible and changes in response to changes in health, interaction with health professions, psychological changes related to grief, and stress related to the illness

Internal Variables: Perception of illness and nature of illness. It influences patient behavior

External Variables: Visibility of symptoms, social groups, cultural background, economics, and accessibility to health care Impact of Illness on the Patient and Family

-What are the 5 things it impacts? -What is the impact of Body Image? -When is Self-Concept important? -What is the impact on Family Roles? -What is the Impact on Family Dynamics? 1. Behavioral and emotional changes 2. Impact on body image -Some illnesses can result in changes in physical appearances. -Patients and families reactions differ and usually depend on the type of changes (loss of limb or organ), their adaptive capacity, the rate at which changes take place, and the support services available

3. Impact on self-concept    -It is important in relationships with other family members    EX: A patient whose self-concept changes because of illness may no longer meet family expectations, leading to tension or conflict, which can result in a family members change their interactions with the patient
4. Impact on family roles    -When an illness occurs, parents and children try to adapt to the major changes that result. Role reversal is common
5. Impact on family dynamics    -Family dynamics are the processes by which the family functions, makes decisions.    Caring For Yourself    -What are nurses susceptible to developing?    -How does Compassion Fatigue and Burn Out Develop?    -What does it affect?    -what are some personal strategies? -Nurses are susceptible to developing compassion fatigue and the subsequent problems of secondary traumatic stress and burnout

-Compassion fatigue develops as a result of the relationships that nurses develop with their patients and family -Burn Out: Stems from conflicts or nurse job dissatisfaction with the working setting

-Both Compassion Fatigue and Burn Out affect the nurses health, often leading to a decline in health, changes in sleep and eating patterns, emotion exhaustion, irritability, restlessness, impaired ability to focus and engage with patients, feelings of hopelessness, inability to take please from activities, and anxiety.

-Some person strategies are to focus on health-promoting behaviors and healthy lifestyle choices. T/F •The Joint Commission (TJC), the National Quality Forum (NQF), and the National Commission on Quality Assurance (NCQA) are a few of the influential organizations that have responded to these complexities by implementing new standards focused on cultural competency, health literacy, and patient- and family-centered care. These standards recognize that valuing each patient's unique needs improves the overall safety and quality of care and helps to eliminate health disparities. True Culture

-What is culture associated with?EX? -What is intersectionality? -What is oppression? ex? -What does understanding the dynamics of oppression allow us to operate on? -What does understanding culture require us to adopt? Culture: Is associated with norms, values, and traditions passed down through generations. It also has been perceived to be the same as ethnicity, race, nationality, and language

Intersectionality: More dynamic perspective that recognizes that we all belong simultaneously to multiple social groups within changing social and political context

Oppression: Is a formal and informal system of advantages and disadvantages tied to our membership in social groups Ex: Those at work , at school, and in families

-Understanding the dynamics of oppression that operate on various levels while simultaneously affecting us and the patients helps you engage in the process of becoming more culturally competent.

-Understanding culture requires us to adopt an intersectional perspective which allows us to consider the multitude of difference experiences of the patients so that you can provide effective, evidence-based, culturally competent care Transcultural Nursing

-What is it? -What is the goal? -What does effective nursing care integrate? -What do you provide during culturally congruent care? -What do you not assume in culturally congruent care? Transcultural Nursing: A comparative study of cultures to understand their similarities (culture that is universal) and the differences among them (culture that is specific to particular groups).

-The goal is to provide culturally congruent care, or care that fits a person's life pattern, values, and system of meaning

-Effective nursing care integrates the cultural values and beliefs in individuals, families, and communities with the perspective of a multidisciplinary team of health care providers

-You bridge cultural gaps to provide meaningful and supportive care for all patients

-Do not assume that all members of a cultural group will feel the same way about a given situation. -How do you provide patient-centered culturally competent care? -What are the goals of cultural assessment? -What does using cultural assessment model allow use to focus on? -What type of questions do we use? -What are the 5 questions in most explanatory models? -Why does cultural assessment take more time? -You must know how to collect relevant cultural data about the patient's presenting health problem(s) and how to then use it

-The goals are to obtain accurate info from a patient that allows you to formulate a mutually acceptable and culturally relevant plan of care for each health problems of a patient

-It allows us to focus on the info that is most relevant to the patients problems

-Use open-ended, focused, and contrasted questions

1)Etiology 2) Time and Mode of Onset of Symptoms 3) Pathophysiology 4) Course of Illness 5) Treatment for an illness episode

-Cultural assessments is intrusive and takes more time to conduct because it requires building trusting relationship between participants Difference Between Illness and Disease Illness: The way that individuals and families react to disease

Disease: Malfunctioning biological or psychological processes. Cultural Competency

-What is it defined as? -What does developing cultural competency allow? -What does it cultural competent organization integrate? -What did the Office of Minority Health (OMH) develop? -Cultural Competency: The enabling of health care providers to deliver services that are respectful of and responsive to the health beliefs, practices, and cultural and linguistic needs of diverse patients

-it allows systems, agencies, and groups of professionals to function effectively to understand the needs of groups accessing health info and health care and thus help eliminate health care disparities and health disparities

-They integrate these principles and capabilities into all aspects of the organization and systematically involves consumers, key stokeholds, and communities

-They developed the Culturally and Linguistically Appropriate Standards (CLAS) -It is intended to advance health equity, improve quality, and help eliminate health care disparities by establishing a blueprint to help people and health care organizations implement culturally and linguistically apporpriate services What are skills are included that are still applicable for helping health care providers work effectively with patients from any culture? 1. Respecting a patient's health beliefs as valid and understanding the effect of the patient's beliefs on health care delivery

2. Shifting a model of understanding a patient's experience from a disease happening in his or her organ systems to that of an illness occurring in the context of culture (biopsychosocial context)
3. Ability to elicit a patient's explanation of an illness and its causes (patient's explanatory model)
4. Ability to explain to a patient in understandable terms the health care provider's perspective on the illness and its perceived causes
5. Being able to negotiate a mutually agreeable, safe, and effective treatment plan    What do cultural competency also allow us to focus on? -All marginalized groups and not just immigrants    -Prejudice, stereotyping and social determinants of health    -The health system, communities, and institutions    Campinha-Bacote Model

What are the 5 things it includes? 1)Cultural awareness: An in-depth self-examination of one's own background, recognizing biases, prejudices, and assumptions about other people

2)Cultural knowledge: Sufficient comparative knowledge of diverse groups, including the values, health beliefs, care practices, world view, and bicultural ecology commonly found within each group

3)Cultural skills: Ability to assess social, cultural, and biophysical factors that influence patient treatment and care

4)Cultural encounters: Cross-cultural interactions that provide opportunities to learn about other cultures and develop effective intercultural communication

5)Cultural desire: The motivation and commitment to caring that moves an individual to learn from others, accept the role as a learner, be open to and accepting of cultural differences, and build on cultural similarities. Cultural Competence Vs Patient Centered Care

-What is the difference? Patient-centeredness: provides individualized care and restores an emphasis on personal relationships

Cultural competence: aims to increase health equity and reduce disparities by concentrating on people of color and other disadvantaged populations Cultural Knowledge

T/F We should avoid stereotypes or unwarranted generalizations about any particular group that prevents an accurate assessment of an individual's unique characteristics and world view.

-What should we do instead? -Why is the iceberg analogy helpful? -What do we need to conduct to understand the patients world-view including religious values, ethnohistory, and caring beliefs and practices? -True

-Instead approach each person individually, and ask questions to gain a better understanding of the person's perspective and needs.

-It helps you to visualize the visible and invisible aspects of your world view and recognize that the same applies to your patients

-We need to conduct comprehensive cultural assessments Core Measures

-What did the Joint Commission and Centers for Medicare and Medicaid Service develop to improve health outcomes? -What are core measures intended to do? -What do nurses and other health care providers need to be familiar with? -They developed a set of evidence-based, scientifically researched standards of of care call Core Measures.

-They are intended to reduce health disparities

-They need to be familiar with how policies and institutional forces enable or inhibit their ability to provide culturally competent, patient-centered, high-quality, safe care to all patients. Standards for Patient Education

-What do all state Nurse Practice Acts Recognize? -What does the Join Commission Standards mandate nurses and health care team do? -How do we ensure educational efforts are patient centered? -It recognizes that patient teaching falls within the scope of nursing practice

-They mandate nurses and health care team assess the patient's learning needs and provide education

-By taking into considerations your patient's own education and experience; their desire to actively participate in the education process; and their psychosocial, spiritual, and cultural values Purpose of Health Education

What are 3 examples? 1) Improves health behaviors of clients 2)higher level of wellness 3) Prevention of illness and dsiability Learning

-What is teaching? -When is it most effective? -Teaching is a form of what type of communication? Teaching: An interactive process that promotes learning

-Teaching is most effective when it responds to the learner's needs

-it is a type of interpersonal communication, with the teacher and the learner actively involved in a process that increases the learn's knowledge and skills Role of the Nurse

-What did the Patient Care Partnership of the American Hospital Association indicate that patients have the right to make? T/F The info given to patients must be accurate, complete, and relevant.

T/F TJC's Speak Up Initiatives helps patients understand their right when receiving care -Informed decisions regarding their care -True -True TJC's Speak Up Tips •Speak up if you have questions or concerns. •Pay attention to the care you get. •Educate yourself about your illness. •Ask a trusted family member or friend to be your advocate. •Know which medicines you take and why. •Use a health care organization that has been carefully evaluated. •Participate in all decisions about your treatment. Bloom's Domain of Learning -What are the 3 components? 1) Psychomotor 2) Cognitive 3) Affective What does Psychomotor include? 1= Complex 7=Simple -What is the simplest behavior? -What is the most complex behavior? 1) Origination: using existing psychomotor skills & abilities to perform highly complex motor act that involves creating new movement patterns

2. Adaptation: The ability to change a motor response when unexpected problems occur
3. Complex Overt Response: Smoothly & accurately performing a motor skill that requires a complex movement pattern
4. Mechanism: A higher level of behavior by which a person gains confidence and skill in performing a behavior that is more complex or involves several more steps than a guided response
5. Guided Response: The performance of an act under the guidance of an instructor involving imitation of a demonstrated act

6)Perception: Being aware of objections or qualities through the use of sense organs EX: Mental, Physical, Emotional What does Cognitive include? What is the simplest and most complex? 1= Complex 6=Simple 1) Evaluation: A judgement of the worth of a body of info for a given purpose

2. Synthesis: The ability to apply knowledge and skills to produce a new whole
3. Analysis: Breaking down info into organized parts

4)Application: Using abstract, newly learned ideas in a concrete situation

5. Comprehension: The ability to understand the meaning of learned material
6. Knowledge: Learning new facts, and being able to recall them    What does Affective include?    Which is the simplest and most complex? 1= Complex 5=Simple 1) Characterizing: Acting and responding with a consistent value system

2)Organizing: Developing a value system by identifying and organizing values and resolving conflicts

3. Valuing: Attach worth to an object or behavior demonstrated by the learner's behavior

4)Responding: Active participation through listening and reacting verbally and nonverbally

5. Receiving: Willing to attend to another person's words    Basic Learning Principles

What are the 5 Basic Learning Principles? 1) Motivation: Is the client socially motivated to learn? What is the motivation to master the learning task? Is the client's desire to return to his or her normal ADLs?

2)Ability to Learn: Erikson's Cognitive Development Concrete Stage, Abstract Stage, Physical Abilities

3)Teaching Learning Environment: Lighting in the teaching area, Good ventilation, Appropriate furniture, Comfortable temperature, Quiet, Private, Others present as per client's desires

4. Attentional Set: Physical discomfort, Anxiety, Environmental distractions, Fatigue, Or none of these are present
5. Active Participation: Eagerness to acquire knowledge or skill. Include the client in the Decision-making process about his or her teaching plan.    Social Learning Theory-Bandura's

-What is self-efficacy? -What is the 4 components in the development of self-efficacy? A concept that refers to a person's perceived ability to successfully compete a task.

1)Enactive Mastery: Performance Outcome

2)Vicarious Experience: Self-Modeling

3. Verbal Percussion: Verbal Engagement
4. Physiological Arousal: Emotional State    What are the stages of Psychosocial Adaption to Illness? Denial    Anger    Bargaining    Resolution    Acceptance    What are the following physical characteristics that are necessary to learn psychomotor skills? Size (patient's height and weight should match the task to be performed or the equipment being used)

Strength (ability of the patient to follow a strenuous exercise program)

Coordination (dexterity needed for complicated motor skills such as using utensils or changing a bandage)

Sensory acuity (visual, auditory, tactile, gustatory, and olfactory; sensory resources needed to receive and respond to messages taught)

Erikson Cognitive Development of Concrete & Abstract Stage What were the benefits of the Patient Protection and Affordable Care Act? Access to health care for all

Reducing costs

Improving quality

Provisions include

Insurance industry reforms

Increased funding for public programs

Improved coverage for children