Assessing learning needs

Your first step in the process of patient teaching is assessing the patient’s learning needs, learning style, and readiness to learn. Assessment includes finding out what patients already know, what they want and need to learn, what they are capable of learning, and what would be the best way to teach them.

Begin the process by interviewing the patient. First, find out more about the patient as an individual and what his life is like. Questions you might ask include:

  • Tell me what an average day is like for you
  • How has your average day changed since you’ve been sick?
  • What do you like to do in your spare time?
  • Tell me about your family
  • Tell me about your work

Second, start assessing the patient’s learning needs. Questions you might ask include:

  • What are you most concerned about?
  • What are your goals for learning how to take care of yourself?
  • What do you feel you need to know to achieve your goals?
  • What specific problems are you having?
  • What do you know about your condition?
  • What are you most interested in learning about?
  • How will you manage your care at home?

Third, find out what the patient’s learning style is so you can match teaching strategies as closely as possible to the patient’s preferred learning style. Questions you might ask to determine the patient’s learning style are:

  • What time of day do you learn best?
  • Do you like to read/what types of books or magazines do you enjoy reading?
  • Would you prefer to read something first, or would you rather have me explain information to you?
  • Do you learn something better if you read it, hear it, or do it hands on yourself?
    Forth, gather information about the patient’s readiness to learn. Questions you might ask include:
    • How do you feel about making the changes we’ve discussed?
    • What changes would you like to work on now?
    • Are there any problems that would prevent you from learning right now?

Forth, gather information about the patient’s readiness to learn. Questions you might ask include:

  • How do you feel about making the changes we’ve discussed?
  • What changes would you like to work on now?
  • Are there any problems that would prevent you from learning right now?

After you’ve talked with the patient, interview the family. Conversations with the patient’s family can fill in missing information, change your understanding of what you’ve heard from the patient, or affect your view of what the patient’s home situation might be. Do family members ask to be present during teaching, and when teaching occurs, do they actively participate? Do they seem supportive of the patient’s need to change health behaviors and to learn new tasks and skills?

You can also consider using checklists and questionnaires to obtain information about learning needs, learning style, and learning readiness. Written materials also help you determine the patient’s literacy level and ability to understand written information. Confer with other health care team members. Each health care team member has valuable information about the patient and his or her learning needs and abilities. Collaborating with others who care for the patient can give you-and them-a better picture, allowing all of you to design more effective teaching strategies.

Determining learning needs, preferred learning style, and learning readiness are all requirements included in the Joint Commission on Accreditation of Health Care Organizations (JCAHO) standards for patient and family education. This part of the process begins when an individual, either the patient or the nurse, identifies a need for the patient to learn a new skill or to know more information. If the patient identifies the need-”What exactly will this operation involve?” or “Or how will I handle this when I go home?” he or she is already demonstrating motivation to learn. If you, rather than the patient, identify the need, your job will be not only to deliver the information in such a way that the patient is able to understand it, but also to demonstrate to the patient why the information is important.

In some instances, there are differences between the patient’s and the health professional’s view of the need to know. The health professional may perceive the need for information when the patient does not. For example, a pharmacist tries to give the patient information when filling a prescription. The patient’s response is: “Oh, I don’t need to know that-I trust my doctor. Whatever he ordered is fine. There’s no reason I should know all the details.” In this example, the best approach may be for the pharmacist to start with why the information is important and explain that the physician depends on the patient to know the information.

Determining learning style involves assessing how patients learn best, when they learn best, and how able they are to learn what they need to know. Finding out whether the patient learns best by hearing, reading, or hands-on learning is relatively straightforward. However, factors such as the patient’s educational and literacy levels also need to be considered. Sometimes patients and families may seem uninterested in learning because they don’t know what to ask or don’t yet realize that they will need information. For example, family members of a patient with a stroke may have never known anyone else with a stroke and thus may have no idea of what to plan for or what to ask. In some instances, nurses and other health professionals may take it for granted that patients have a better understanding of their condition and treatment than they actually do.

During the acute phase of an illness, patients are dependent on health care professionals. Dependency may be a realistic and necessary condition because of physical and psychosocial demands caused by the illness. Available energy is invested in coping with the physiological and psychosocial demands of the illness and the person’s focus may be on survival. Readiness to learn, therefore, is limited. Not only is energy diminished, but other distractors such as pain and fatigue are usually present. Learning needs at this time usually focus on diagnostic tests and treatments. These needs are considered short-term learning-the material being learned relates to the present situation and once the situation is over, it is usually no longer necessary to retain it. As the person recovers and independence increases, he or she progresses to the post-acute or resolution stage of illness. For most patients, an improving physical condition and the desire to return to normalcy acts as an incentive to learn how to recognize, prevent, and manage complications. Due to short hospital stays, much of the patient’s learning readiness for management and prevention of further problems will take place in an out-patient or a home setting.

Developing learning objectives