Help nurses find model for teaching

Techniques can address stage of readiness to learn

To help oncology nurses determine what type of education model might work for them when teaching patients, Mary Szczepanik, MS, BSN, RN, manager of cancer education, support, and outreach for OhioHealth Cancer Services in Columbus, conducts a one-hour class that provides information on two models of teaching.

Szczepanik says there are different ways of teaching, and nurses should determine what works best for them whether they use one of these models or another they have read about.

The theories she covers in a class to help nurses educate patients in a hospital setting where there is little time to teach are the Adaptation to Illness Theory and the Situational Leadership or Education Theory.

"What I try to do is talk to the nurses and help them understand what is possible and practical in a hospital setting and how to determine not only what the patient has to learn before he goes home but the best way to teach it to him based on how ready he is to learn," Szczepanik says.

The Adaptation to Illness Theory has three stages. The first addresses a patient's readiness to learn when they do not yet have a definitive diagnosis. Szczepanik says in this stage patients are most interested in the present and are pretty tense and anxious.

Teaching would focus on the tests and treatments patients are actually having and some basic information on how they could get more information.

"At the first stage they are not going to remember very much or comprehend very much so you are really going over the basics and teaching about the tests and treatments," explains Szczepanik.

In the second stage the diagnosis has been confirmed and the patient has accepted his or her illness and agreed to a particular treatment or care. It may be they are in the late stages of cancer and go right into hospice but the model works no matter the circumstance, says Szczepanik.

The impairment to education at this stage is that the patient is in a state of forced dependence on both medical personnel and family members. Because of this their ability to retain information is limited.

"It is one of the main reasons we use print materials as backup, so they can go back and read the information again after we have taught it to them," says Szczepanik.

At this stage she tells nurses to do all they can to help the patient feel more independent. For example, the nurse could encourage the patient to bring family photos to place around his or her room so the environment is more familiar or the nurse might arrange a visit from the art therapist.

"Anything to help them feel normal will improve their ability to comprehend and retain information," explains Szczepanik.

The third stage is the convalescent period when the patient is at a higher level of health. This stage doesn't necessarily mean the patient is being cured; it could be a hospice patient who has his or her pain under control. Regardless, patients are more receptive to teaching at this stage. This last stage usually does not apply to teaching in a hospital setting, Szczepanik says.

When using the Adaptation to Illness Theory continuous assessment is important because the facts of the case with cancer patients often change. A person might be at the second stage of adaptation one day having agreed to a treatment and then is given new information the next day and is back to the first level, says Szczepanik.

Adapt teaching to learner's readiness

The Situational Education Theory helps the nurse adapt his or her teaching style to the learner's readiness.

"You do that by adjusting the amount of instruction you give, the amount of supervision you give, and the support you give in teaching a patient based on their level of readiness to learn," says Szczepanik.

To determine a patient's readiness to learn the nurse should get answers to three questions.

First determine if the patient has had recent education and experience specific to what needs to be taught. If so, the patient will know what equipment is needed to perform the task and what type of environment is needed to safely complete it at home. The second question is if the patient has set clear goals. The final question determines if the patient is able and willing to take responsibility.

To answer these three questions the nurse would have a conversation with the patient, read the chart, and talk with the nurse that cared for the patient on the last shift.

Szczepanik says if the patient is at the lowest level of readiness to learn the nurse will educate by giving very specific instructions and supervising very closely. At this point the nurse is doing the task, such as a dressing change, while the patient watches. This is called a telling style of education, according to the theory authors Paul Hersey and Ken Blanchard.

At the second level of readiness to learn, while the patient might know the type of equipment needed to perform a task, he or she is still dependent on the supervision and specific instructions of the nurse. At this level the nurse is explaining and clarifying the task the patient is completing.

"The authors of this theory call this a selling style. You are still protecting the learner from error because you are directly supervising him, but you give him more to do and you are explaining more," says Szczepanik.

The patient does more and the nurse explains in more detail the task at hand. Szczepanik encourages nurses to ask open-ended questions with this teaching style. For example, the nurse might ask what the patient would do if he or she dropped the piece of equipment on the floor.

Once patients have had experience and their confidence has increased they are more likely to move to the next level of readiness to learn, which would be the ability to do most of the task on their own. The teaching style at this level is called participating, says Szczepanik.

"You only move to the third level if you know the patient really knows how to do the task," says Szczepanik.

At this stage the nurse would verbally review the procedure with the patient and then provide lots of support, encouragement, and clarification if needed.

When the patient reaches the final level, he or she has the skills to complete the task with very little supervision or instruction.

"What I try to remind the nursing staff who attend these classes is that we rarely get patients to this level before we send them home," says Szczepanik.

At the beginning of the class Szczepanik asks the nurses to select a patient they cared for during their last shift and identify the patient's educational needs. For example, the patient might be going home on a complicated medicine regimen. Szczepanik then uses these specific patients as examples while teaching.

She has been teaching this class for about 10 years and although she currently focuses on oncology nurses, she says, the class is beneficial to nurses on any hospital unit.


For more information about teaching nurses how to adapt teaching style to a patient's readiness to learn using a teaching model, contact:

  • Mary Szczepanik, MS, BSN, RN, Manager, Cancer Education, Support and Outreach, OhioHealth Cancer Services, 3535 Olentangy River Road, Columbus, OH 43214. Phone: (614) 566-3280. E-mail: