Learning styles are key to retention

Conversation, videos, pamphlets all play role

Question: "How do you determine a patient’s learning preference, and once you know this, how do you individualize teaching to fit that preference?"

Answer: "If you ask most people, What’s your learning style?’ they have no idea what you’re talking about," says Fran London, MS, RN, health education specialist at Phoenix Children’s Hospital. That’s why the education documentation record at the hospital includes the prompt: "The last time you wanted to learn something new, how did you go about it?" The answer tells the educator how best to teach the patient because people naturally engage the method that works best for them when trying to learn something.

The teaching can be individualized to fit the patient’s preference by using the method the patient prefers to use in other situations, whether that method is conversation, written materials, videos, or direct experience, explains London. However, regardless of the patient’s learning preference, it is best to use more than one teaching method to improve recall. When several senses are used to learn, the patient has more ways to bring the information back up to consciousness when needed, she says.

"Retention is higher with a combination of styles of learning, such as seeing, hearing, and reading," agrees BJ Hansen, BSN, patient education coordinator at Grant/Riverside Methodist Hospitals in Columbus, OH. At this health care system, nurses are encouraged to use as many teaching methods as they can with each patient.

The written text, although commonly used for a reference, is just one piece of the educational process, she says. The nurse usually incorporates verbal instruction with visual aids, as well as written content. Visual aids commonly used to meet the needs of visual learners include illustrations, videotapes, demonstration, and models. For most patient populations, there are resources for various types of learners.

However, resources for non-English speaking patients are sparse. "We have a long way to go to get written information as well as visual resources to this patient group to complement a nurse’s verbal instruction with the help of an interpreter," says Hansen.

Much of the learning assessment, including preference of teaching method, can be done during the admission process to save time, says Cezanne Garcia, MPH, CHES, manager of patient and family education services at the University of Washington Medical Center in Seattle. To prompt assessment upon admission to the hospital, a form was created that assessed patient education needs in all appropriate areas. It also prompted the use of open-ended questions when necessary to get the most complete information.

For example, in the section titled "Educational/ Cultural/Learning Preferences," the assessment form prompts the admitting nurse to ask the patient: "What is your main concern about your care that we should include in your teaching plan?" Then there are questions about how the patient prefers to learn, such as pictures, videotapes, or written materials.

Currently, the health care facility is in the process of implementing an on-line documentation system on all inpatient care units. The system will allow the health care professional to review information recorded on the nursing admission assessment, such as learning preferences, but it also will cue assessment of readiness to learn because pain issues, medication, or cognitive functioning all influence whether or not a given moment is teachable, says Garcia.

If the moment is teachable, the educator can access a variety of patient education resources on the hospital’s Intranet site to individualize the teaching to fit the patient’s learning preference. An inventory includes a list of all materials that can be printed and the location of commercial pamphlets, videotapes, audio cassettes, and closed-circuit television programming.

The nursing admission assessment is a good place to determine learning preferences, says Hansen. At Grant/Riverside Methodist Hospitals, information on patients’ learning preferences is included on the Patient Health History form, and all disciplines involved in the teaching are responsible for reviewing the health history. "In my general patient education policy, I address assessing for barriers to learning, how they learn best, educational level, as well as cultural and religious issues," says Hansen.

For more information on incorporating learning preferences into teaching, contact:

Cezanne Garcia, MPH, CHES, Manager, Patient and Family Education Services, University of Washington Medical Center, 1959 Pacific St. N.E., Box 356052, Seattle, WA 98195. Telephone: (206) 598-8424. Fax: (206) 598-7821. E-mail: ccgarcia@u.washington.edu.

BJ Hansen, BSN, Patient Education Coordinator, Grant Riverside Methodist Hospitals, 111 South Grant Ave., Columbus, OH 43215. Telephone: (614) 566-5613. Fax: (614) 566-8067. E-mail: BHANSEN@ohiohealth.com.

Fran London, MS, RN, Health Education Specialist, Phoenix Children’s Hospital, 909 East Brill St., Phoenix, AZ 85006. Telephone: (602) 239-2820. Fax: (602) 239-4670. E-mail: flondon@phxchildrens.com.