Week 4

ADHERENCE TO THE THERAPEUTIC REGIMEN

Adherence to a therapeutic regimen usually requires that the person make one or more lifestyle changes
to carry out specific activities that promote and maintain health. Examples of behaviors facilitating health
include taking prescribed medications, maintaining a healthy diet, increasing daily activities and exercise,
self-monitoring for signs and symptoms of illness, practicing specific hygienic measures, seeking periodic
health evaluations, and performing other therapeutic and preventive measures.

A wide range of variables appears to influence the degree of adherence:

1. Demographic variables, such as age, gender, race, socioeconomic status, and level of education
2. Illness variables, such as the severity of the illness and the relief of symptoms afforded by the
therapy
3. Therapeutic regimen variables, such as the complexity of the regimen and uncomfortable side
effects
4. Psychosocial variables, such as intelligence, availability of significant and supportive people
(especially family members), attitudes toward health professionals, acceptance or denial of
illness, and religious or cultural beliefs
5. Financial variables, especially the direct and indirect costs associated with a prescribed regimen

The problem of non-adherence to therapeutic regimens is a substantial one that must be remedied before
patients can achieve their maximum self-care capabilities and health potential.
Teaching programs directed toward stimulating patient motivation produce varying degrees of
adherence. The variables of choice, establishment of mutual goals, and the quality of the patient–provider
relationship directly influence the behavioral changes that can result from patient education.

AIMS OF TEACHING AND COUSELING

A. Maintaining and Promoting Health
Nurses can help patients to value health and develop specific health practices that promote
wellness. Health teaching is varied and ranges from teaching passive exercises to a patient with
left-sided paralysis to designing a safe exercise program for a young athlete.

B. Preventing Illness
Illness prevention, a major theme in health teaching and counselling, takes many forms. You can
counsel:
a. Women of childbearing age about health practices that promote optimal fetal development,
b. Teach parents how to make their home safe for a toddler,
c. Counsel individuals at high risk for heart disease, cancer, or communicable diseases.

C. Communicate health and health education needs, concerns, and resources

Not everyone understands the importance of health educators or the role they can play in
improving local, national, and global health. As a health educator, you have the responsibility to
support and promote the profession to others and to work with those in your profession to
maintain standards and achieve health education and promotion goals.

D. Restoring Health
1. Teaching and counselling focus on developing self-care practices that promote recovery.
 2. Preoperative and postoperative teaching
3. Sexual counselling for a patient recovering from a myocardial infarction
4. Lifestyle counselling for a patient with an ostomy

LEARNING
Learning is the process by which a person acquires or increases knowledge or changes behavior in a
measurable way as a result of the experience.
a. A learning need is a desire or a requirement to know something that is presently unknown to
the learner.
b. Learning needs include new knowledge or information but can also include a new or different
skill or physical ability, or a new behavior or a need to change an old behavior.

Learning is a change in human disposition or capability that persists and that cannot be solely accounted
for by growth. Learning is represented by a change in behavior.

LEARNING DOMAINS
Patients learn in three domains: cognitive, psychomotor, and affective. The ability of patients to
manage their daily life and resume their former roles depends on the degree to which cognitive,
psychomotor, and affective learning results in behavioral changes.
a. Cognitive learning involves the storing and recalling of new knowledge in the brain (e.g., the
patient describes how salt intake affects blood pressure). Cognitive learning includes :
1. Intellectual behaviors such as the acquisition of knowledge, comprehension, application,
synthesis
2. Evaluation
b. Psychomotor learning is a physical skill involving the integration of mental and muscular
activity
c. Affective learning includes changes in attitudes, values, and feelings (e.g., the patient
expresses renewed self-confidence after physical therapy).

LEARNING THEORIES
Three main theoretical constructs are behaviorism, cognitivism, and humanism.

A. BEHAVIORISM
Behaviorists closely observe responses and then manipulate the environment to bring about
the intended change. Thus, to modify a person’s attitude and response, a behaviorist would
either alter the stimulus condition in the environment or change what happens after a
response occurs.

Nurses applying behavioristic theory will:

1. Provide sufficient practice time including both immediate and repeat testing and return
demonstration.
2. Provide opportunities for learners to solve problems by trial and error.
3. Select teaching strategies that avoid distracting information and that evoke the desired
response.
4. Praise the learner for correct behavior and provide positive feedback at intervals
throughout the learning experience.
5. Provide role models of desired behavior.
B. COGNITIVISM
Cognitivism depicts learning as a complex cognitive activity. In other words, learning is
largely a mental or intellectual or thinking process.
1. The learner structures and processes information. Perceptions are selectively chosen by
the individual, and personal characteristics have an impact on how a cue is perceived.
2. Cognitivists also emphasize the importance of social, emotional, and physical contexts in
which learning occurs, such as the teacher–learner relationship and the environment.
3. Developmental readiness and individual readiness (expressed as motivation) are other
key factors associated with cognitive approaches.

Nurses applying cognitive theory will:

1. Provide a social, emotional, and physical environment conducive to learning.
2. Encourage a positive teacher–learner relationship.
3. Select multisensory teaching strategies because perception is influenced by the senses.
4. Recognize that personal characteristics have an impact on how cues are perceived and
develop appropriate teaching approaches to target different learning styles.
5. Assess a person’s developmental and individual readiness to learn and adapt teaching
strategies to the learner’s developmental level.
6. Select behavioral objectives and teaching strategies that encompass the cognitive,
affective, and psychomotor domains of learning.

C. HUMANISM
Humanistic learning theory focuses on both the cognitive and affective qualities of the
learner. According to humanistic theory, learning is believed to be self-motivated, self-
initiated, and self-evaluated.
1. Each individual is viewed as a unique composite of biologic, psychological, social,
cultural, and spiritual factors.
2. Learning focuses on self-development and achieving full potential; it is best when it is
relevant to the learner.
3. Autonomy and self-determination are important; the learner identifies the learning
needs and takes the initiative to meet these needs.
4. The learner is an active participant and takes responsibility for meeting individual
learning needs.
5. Using humanistic learning theory, the nurse focuses on the feelings and attitudes of
learners, on the importance of the individual in identifying learning needs and in taking
responsibility for them, and on the self-motivation of the learners to work toward self-
reliance and independence.

Nurses applying humanistic theory will:

a. Convey empathy in the nurse–client relationship.
b. Encourage the learner to establish goals and promote self-directed learning.
c. Encourage active learning by serving as a facilitator, mentor, or resource for the
learner.
d. Use active learning strategies to assist the client’s adoption of new behavior.
e. Expose the learner to new relevant information and ask appropriate questions to
encourage the learner to seek answers.