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Assessment

Discuss about the Foundation of Nursing for Kidney Diseases.

In the current times, there have emerged various communicable and non-communicable diseases. Most of the non-communicable diseases such as cancer, kidney diseases, and diabetes among others are associated largely with the lifestyle of the affected individuals. In this era of modernization and globalization, people engage in less vigorous activities or exercise a factor that leads to weight gain and obesity in the majority of the people. The healthy weight of an individual can be classified depending on their body mass index (BMI). The normal ranges of BMI are between 17.5 and 24.9 kg/m2 (Rippe & Angelopoulos, 2012). Body mass indexes above these ranges indicate that a person is either overweight or obese. According to Haslam and Wittert (2014), obesity has increased significantly by more than 100% since 1980 globally. It is stipulated that by 2014, more than 1.9 billion adults were overweight worldwide. Among these, more than a third of them were obese. Obesity is associated with a number of diseases that majorly include cardiovascular disorders and type 2 diabetes. Moreover, obesity may lead to loss of self-esteem, self-confidence and general productivity of an individual due to reduced mobility and inactivity (Rippe & Angelopoulos, 2012). However, management through lifestyle modification can aide in the prevention of obesity and other related diseases. Lifestyle change can be achieved through health education provision to the affected individuals by health care providers. Notably, the effectiveness of the training offered depends on the client’s developmental stage (Murtagh, 2013). Therefore this writing focuses on how various developmental and learning theories can be utilized by health care providers to effectively manage lifestyle conditions such as obesity while considering the developmental stage of an individual, through assessment, diagnosis, planning, implementation and evaluation of a teaching plan.

According to Piaget’s cognitive developmental theory, Grace who has an age of 44 years is at the sixth stage, formal operational stage. In this stage she has abstract reasoning, a factor that has helped in her associating obesity with detrimental effects on her health (LeCroy & Anthony, 2015). Additionally, in this cognitive developmental stage, she can consider the possible outcomes of actions on her health, and therefore it contributes to the shaping of her health seeking behaviors. Health seeking behaviors have a significant impact on the health of an individual as it determines the time of seeking health services, duration and adherence to prescribed therapies. Moreover, at this stage, one can analyze a health risk or problem and solve it in a logical and systematic manner. Therefore, this helps a nurse to work collaboratively with the client in solving the primary problem and thus contributing to improved health. However, it is the responsibility of the nurse to assess the cognitive developmental stage of an individual not only based on age but also on other factors as some people never reach formal operational stage regardless of their advanced age (Romano, 2015).

Nursing Diagnosis

As mentioned, it is imperative for the nurse to assess the client based on their developmental stage to identify the specific needs. According to Erik Erikson’s psychosocial theory, Grace is at the stage of generativity versus stagnation in which people aged between 40 and 64 years exhibit the same needs that are supposed to be achieved for a person to successfully move to the next stage without stagnation (Newman & Newman, 2016). Stagnation is an indication of poor health that may affect emotional, social, mental and physical aspects of an individual. A sense of productivity, achievement, and satisfaction can only ensue in Grace’s case if she can successfully contribute positively to self, family, and community, a phenomenon that makes her life count. Thus the primary focus her health is in her family, work, relationships with others and society. Some conditions can prevent a person from meeting the central tasks of this middle adulthood. Obesity can deter Grace from moving through this stage successfully as it limits one’s movement from one place to another, reduces productivity and affects the social relationships due to reduced self-esteem (Zhang, Juan, Middlestadt, Susan & Cheng-Ye, 2011). Firstly, obesity as the primary concern of Grace may not enable her to express love to her school age children through guiding them to perform certain activities such as household chores and sports among others. Consequently, the children may not develop to be responsible adults as required from their developmental level that requires them to learn various skills and gain academic and social competencies like their peers (Sa?enz, 2015). Secondly, she is supposed to maintain health patterns to successfully move though her current stage of which she may stagnate if she develops chronic diseases whose etiology is obesity such as type 2 diabetes and hypertension. Thirdly, she may not develop a sense of unity with family, friends and other relatives as it may experience reduced mobility and therefore preventing her from attending social functions and interacting with others. In the same way, she may not effectively perform required activities to make a comfortable home and in her working environment, factors that can lead to lack of pride in self-accomplishments. She may also not use her leisure time in a creative manner due to the physical and emotional health limitations that are attributed to obesity and reduced self-esteem. Lastly, at this stage, she is expected to reverse roles with aging parents if any, but in Grace’s case it may be difficult to achieve this as she is equally faced with challenges that may deter her from achieving the roles she is supposed to perform. Thus she cannot establish balance between various life aspects as required in the genital stage of Sigmund Freud’s psychosexual development (Weber & Kelley, 2014). Notably, she has enough motivation for wellness as well as having enough time to practice lifestyle changes since she is working on part time basis. In the same way, she has access to a park that can be used for recreational activities including those that can assist in the adoption of healthy lifestyle such as exercises.

Plan

Grace’s health needs require preventive measures because they are primarily, ‘risk for diagnoses.' Based on the assessment data, she has some learning needs. Firstly, she has a risk for overweight related to unhealthy lifestyle practices. Secondly, she has a risk for chronic low self-esteem related to being overweight as evidenced by her verbalization on losing self-esteem and concern about weight. Thirdly, she has a risk for Disturbed body image related to obesity as evidenced by concern about weight gain. Fourthly, she has a risk for ineffective role performance and social interactions related to reduced mobility and lack of attending social functions due to excessive weight gain and low self-esteem. Fifthly, she has a risk for impaired parenting related to activity intolerance as evidenced by progressive weight gain. Lastly and most importantly she has a nursing diagnosis of readiness for enhanced self-health management.

By the end of the health education, the client will be able to demonstrate her understanding of the various ways in which she can enhance and sustain her self-esteem by providing a brief summary of the learning session. Secondly, the client should demonstrate progress and improved health over a period of one month by losing weight of at least one kilogram through modification of lifestyle.

As stipulated by Ausubel and Bloom’s learning theories, “learning should start from the known to the unknown and from simple to complex.” He noted that new information fits into existing knowledge like key fits into a lock (Aliakbari, Parvin, Heidari & Haghani, 2015). Therefore, during the implementation of client teaching and learning, the plan should be considerate of the existing knowledge of the client on the subject matter. Another significant approach that can be used is according to Skinner’s theory which suggests that learning can be shaped in the desired direction if the behavior is rewarded positively, continuously and immediately. This can be done through motivation, encouragement, praise and being supportive emotionally and psychologically by sharing success stories. A conducive environment that encourages active participation, that accepts the difference in desire, allows people to make mistakes and learn from them should be provided. The client should feel respected and accepted to facilitate self-discovery and evaluation as well as cooperation. The most appropriate instruction methods to be utilized are verbal explanations which are equivalent to lecture as well as demonstrations (Friedman, Cosby, Boyko, Hatton-Bauer & Turnbull, 2011). These are economical and easy to use methods that can be utilized at any given time. Since the interventions entail lifestyle changes that include exercise and nutritional modifications, they can effectively serve the purpose. The client can understand the subject matter better by explanation and observation during demonstration hence allowing the provision of a wide range of knowledge in a limited time. Moreover, it can be used to pace the learner’s way of learning and make adjustments as necessary. However, before the teaching session, a lesson plan should be prepared collaboratively to set the goals, identify available interventions such as cognitive behavioral therapy (CBT), teaching and learning aids and ways to evaluate the learning (Friedman, Cosby, Boyko, Hatton-Bauer & Turnbull, 2011).

Implementation

Learning outcomes of the learner/client can be determined through evaluation in some ways. According to Friedman et al. (2011), the effectiveness of teaching process can be noted through questioning during and after the learning session. Similarly, return demonstration can be used instantly to evaluate understanding of the client on the subject matter. The learner can also be asked to provide a summary of the whole learning session by providing the key points learned. This way the nurse can help the learner to understand herself, assist in the retention and transfer of knowledge, provide motivation and judge the learner’s achievements. Furthermore, the effectiveness of teaching can be determined and provide feedback.

In conclusion, learning can be achieved through health education provided based on the developmental and age of an individual. Developmental theories as well as learning theories can be used to adequately assess, diagnose, plan for, implement, and evaluate a teaching and learning education. Teaching approaches methods can also be selected while considering the needs of the client and their level of cognitive, psychosexual and psychosocial development. Therefore, it is imperative that all nurses have knowledge of these essential theorise in an effort to uphold evidence-based practice (EBP).

References

Aliakbari, F., Parvin, N., Heidari, M., & Haghani, F. (January 01, 2015). Learning theories application in nursing education. Journal of Education and Health Promotion, 4, 2-27.

Friedman, A. J., Cosby, R., Boyko, S., Hatton-Bauer, J., & Turnbull, G. (January 01, 2011). Effective Teaching Strategies and Methods of Delivery for Patient Education: A Systematic Review and Practice Guideline Recommendations. Journal of Cancer Education, 26, 1, 12-21.

 Haslam, D., & Wittert, G. (2014). Fast facts: Obesity. Oxford, England: Health Press

LeCroy, C. W., & Anthony, E. K. (2015). Case studies in a child, adolescent, and family treatment. Hoboken, New Jersey: John Wiley & Sons

Murtagh, J. (2013). Murtagh's patient education. North Ryde, New South Wales: McGraw-Hill

Newman, B. M., & Newman, P. R. (2016). Theories of human development. New York, Psychology Press, Taylor & Francis Group

Rippe, J. M., & Angelopoulos, T. J. (2012). Obesity: Prevention and treatment. Boca Raton: CRC Press.

Romano, J. L. (2015). Prevention Psychology: Enhancing Personal and Social Well-Being. Washington, D.C: American Psychological Association.

Sa?enz, H. M. (2015). Psychopathology in women: Incorporating gender perspective into descriptive psychopathology. Cham : Springer

Weber, J., & Kelley, J. (2014). Health assessment in nursing. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins

Zhang, Juan, Middlestadt, Susan E, & Ji, Cheng-Ye. (2011). Psychosocial factors underlying physical activity. (BioMed Central Ltd.) BioMed Central Ltd.

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