Knowledge Deficit - Patient Teaching; Health Education
Meg Gulanick, RN, PhD
NANDA: Absence or deficiency of cognitive information related to
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.
- New condition, procedure, treatment
- Complexity of treatment
- Cognitive/physical limitation
- Misinterpretation of information
- Decreased motivation to learn
- Emotional state affecting learning (anxiety, denial, or
- Unfamiliarity with information resources
- Questioning members of health care team
- Verbalizing inaccurate information
- Inaccurate follow-through of instruction
- Denial of need to learn
- Incorrect task performance
- Expressing frustration or confusion when performing task
- Lack of recall
- Patient demonstrates motivation to learn.
- Patient identifies perceived learning needs.
- Patient verbalizes understanding of desired content, and/or
performs desired skill.
- (i) independent
- (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
- (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
- (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
- (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
- (i) Identify any existing misconceptions
regarding material to be taught.
- This provides an important starting point in
- (i) Determine cultural influences on health
- 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
- 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
- (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
- (i) independent
- (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
- This allows patient to concentrate more
- (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,
- (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
- 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,
- 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
- (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
- (i) When presenting material, move from
familiar, simple, and concrete information to less familiar, complex, or more
- 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
- 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
- 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
- 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
- (i) independent
- (i) Provide instruction for specific
- (i) Explore community resources.
- (c) Refer patient to support groups as
- To allow patient to interact with others who have similar
problems or learning needs.
- (i) Include significant others whenever
- To encourage ongoing support for patient.
Learning Facilitation; Teaching: Individual
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