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Nursing Care Plans: Nursing Diagnosis and Intervention, 5/e
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Knowledge Deficit - Patient Teaching; Health Education
Meg Gulanick, RN, PhD

NANDA: Absence or deficiency of cognitive information related to specific topic

Knowledge deficit is a lack of cognitive information or psychomotor skills required for health recovery, maintenance, or health promotion. Teaching may take place in a hospital, ambulatory care, or home setting. The learner may be the patient, a family member, a significant other, or a caregiver unrelated to the patient. Learning may involve any of the three domains: cognitive domain (intellectual activities, problem-solving, and others), affective domain (feelings, attitudes, beliefs), and psychomotor domain (physical skills or procedures). The nurse must decide with the learner what to teach, when to teach, and how to teach the mutually agreed on content. Adult learning principles guide the teaching-learning process. Information should be made available when the patient wants and needs it, at the pace the patient determines, using the teaching strategy the patient deems most effective. Many factors influence patient education, including age, cognitive level, developmental stage, physical limitations (visual, hearing, balance, hand coordination, strength), the primary disease process and other comorbidities, and sociocultural factors. Older patients need more time for teaching, and may have sensory-perceptual deficits and/or cognitive changes that may require a modification in teaching techniques. Certain ethnic and religious groups hold unique beliefs and health practices that must be considered when designing a teaching plan. These practices may vary from "home remedies" (such as special soups, poultices) and alternative therapies such as massage, biofeedback, energy healing, macrobiotics, or megavitamins in place of prescribed medications, or reliance on an elder in the family to coordinate the plan of care. Patients with low literacy skills will require educational programs that include more simplified treatment regimens, simplified teaching tools (cartoons, lower readability levels), a slower presentation pace, and techniques for cuing patients to initiate certain behaviors (pill schedule posted on refrigerator, timer for taking medications).

Although the acute hospital setting provides challenges for patient education because of the high acuity and emotional stress inherent in this environment, the home setting can be similarly challenging because of the high expectations for patients or caregivers to self-manage complex procedures such as IV therapy, dialysis, even ventilator care in the home. Caregivers are often overwhelmed by the responsibility delegated to them by the health care professionals. Many have their own health problems, and may be unable to perform all the behaviors assigned to them because of visual limitations, generalized weakness, or feelings of inadequacy or exhaustion.

This care plan describes adult learning principles that can be incorporated into a teaching plan for use in any health care setting.

Related Factors

Defining Characteristics

Expected Outcomes

Ongoing Assessment

Actions/Interventions/Rationale
Key:
(i) independent
(c) collaborative
(i) Determine who will be the learner: patient, family, significant other, or caregiver.
Many elderly or terminal patients may view themselves as dependent on their caregiver, and therefore not want to be part of the educational process.
(i) Assess motivation and willingness of patient and caregivers to learn.
Adults must see a need or purpose for learning. Some patients are ready to learn soon after they are diagnosed; others cope better by denying or delaying the need for instruction. Learning also requires energy, which patients may not be ready to use. Patients also have a right to refuse educational services.
(i) Assess ability to learn or perform desired health-related care.
Cognitive impairments need to be identified so an appropriate teaching plan can be designed. For example, the Mini-Mental Status Test can be used to identify memory problems that would interfere with learning. Physical limitations such as impaired hearing or vision, or poor hand coordination can likewise compromise learning and must be considered when designing the educational approach. Patients with decreased lens accommodation may require bolder, larger fonts or magnifying mirrors for written material.
(i) Identify priority of learning needs within the overall plan of care.
Adults learn material that is important to them.
(i) Question patient regarding previous experience and health teaching.
Adults bring many life experiences to each learning session. Adults learn best when teaching builds on previous knowledge or experience.
(i) Identify any existing misconceptions regarding material to be taught.
This provides an important starting point in education.
(i) Determine cultural influences on health teaching.
Providing a climate of acceptance allows patients to be themselves and to hold their own beliefs as appropriate.
(i) Determine patient's learning style, especially if patient has learned and retained new information in the past.
Some persons may prefer written over visual materials, or they may prefer group versus individual instruction. Matching the learner's preferred style with the educational method will facilitate success in mastery of knowledge.
(i) Determine patient or caregiver's self-efficacy to learn and apply new knowledge.
Self-efficacy refers to one's confidence in their ability to perform a behavior. A first step in teaching may be to foster increased self-efficacy in the learner's ability to learn the desired information or skills.

Therapeutic Interventions

Actions/Interventions/Rationale
Key:
(i) independent
(c) collaborative
(i) Provide physical comfort for the learner.
This allows patient to concentrate on what is being discussed or demonstrated. According to Maslow's theory, basic physiological needs must be addressed before patient education.
(i) Provide a quiet atmosphere without interruption.
This allows patient to concentrate more completely.
(i) Provide an atmosphere of respect, openness, trust, and collaboration.
This is especially important when providing education to patients with different values and beliefs about health and illness.
(i) Establish objectives and goals for learning at the beginning of the session.
This allows learner to know what will be discussed and expected during the session. Adults tend to focus on here-and-now, problem-centered education.
(i) Allow learner to identify what is most important to him or her.
This clarifies learner expectations and helps the nurse match the information to be presented to the individual's needs. Adult learning is problem-oriented. Determine priorities (i.e., what the patient needs to know now versus later). Patients may want to focus only on self-care techniques that facilitate discharge from the hospital or enhance survival at home (e.g., how to take medications, emergency side effects, suctioning a tracheal tube) and be less interested in specifics of the disease process.
(i) Explore attitudes and feelings about changes.
This assists the nurse in understanding how learner may respond to the information and possibly how successful the patient may be with the expected changes.
(i) Allow for and support self-directed, self-designed learning.
Adults learn when they feel they are personally involved in the learning process. Patients know what difficulties will be encountered in their own environments, and must be encouraged to approach learning activities from their priority needs.
(i) Assist the learner in integrating information into daily life.
This helps learner make adjustments in daily life that will result in the desired change in behavior (or learning).
(i) Allow adequate time for integration that is in direct conflict with existing values or beliefs.
Information that is in direct conflict with what is already held to be true forces a reevaluation of the old material and is thus integrated more slowly.
(i) Give clear, thorough explanations and demonstrations.
(i) Provide information using various mediums (e.g., explanations, discussions, demonstrations, pictures, written instructions, computer-assisted programs, and videotapes).
Different people take in information in different ways. Match the learning style with the educational approach.
(i) Ensure that required supplies or equipment are available so that the environment is conducive to learning.
This is especially important when teaching in the home setting.
(i) When presenting material, move from familiar, simple, and concrete information to less familiar, complex, or more abstract concepts.
This provides patient with the opportunity to understand new material in relation to familiar material.
(i) Focus teaching sessions on a single concept or idea.
This allows the learner to concentrate more completely on material being discussed. Highly anxious and elderly patients have reduced short-term memory and benefit from mastery of one concept at a time.
(i) Pace the instruction and keep sessions short.
To prevent fatigue. Learning requires energy.
(i) Encourage questions.
Learners often feel shy or embarrassed about asking questions and often want permission to ask them.
(i) Allow learner to practice new skills; provide immediate feedback on performance.
This allows patient to use new information immediately, thus enhancing retention. Immediate feedback allows learner to make corrections rather than practicing the skill incorrectly.
(i) Encourage repetition of information or new skill.
To assist in remembering.
(i) Provide positive, constructive reinforcement of learning.
A positive approach allows learner to feel good about learning accomplishments, gain confidence, and maintain self-esteem while correcting mistakes. Incorporate rewards into the learning process.
(i) Document progress of teaching and learning.
This allows additional teaching to be based on what the learner has completed, thus enhancing the learner's self-efficacy and encouraging most cost-effective teaching.

Education/Continuity of Care

Actions/Interventions/Rationale
Key:
(i) independent
(c) collaborative
(i) Provide instruction for specific topics.
(i) Explore community resources.
(c) Refer patient to support groups as needed.
To allow patient to interact with others who have similar problems or learning needs.
(i) Include significant others whenever possible.
To encourage ongoing support for patient.

NIC

Learning Facilitation; Teaching: Individual

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