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No matter the health care setting, good learning assessment techniques are essential because there’s no time for a lengthy, involved assessment, says Kathleen Fitzgerald, MS, RN, CDE, a patient educator at Saint Joseph’s Hospital Health Center in Syracuse, NY.
In addition, a good assessment will uncover whether the patient is motivated to learn, the barriers to learning, and what the patient needs to know, helping to keep teaching sessions on target. In the long run, this saves time, explains Yvonne Brookes, RN, patient education liaison at Baptist Health Systems of South Florida in Miami.
One of the first questions Brookes asks a patient who has been admitted to the hospital is: "What brought you here?" It not only helps develop rapport between patients and their teachers, but it can reveal their attitude about the situation and provide clues to whether they are motivated to learn. They may have been admitted because they were noncompliant, yet their answer reveals they take no responsibility for what has happened to them, or seem disinterested or angry, all of which indicates lack of motivation.
There are some key questions that can be asked to determine how motivated the patient is to learn, says Brookes. These include:
"If they answer these questions, you know they will be motivated. They are like triggers to see how involved the patient is going to be," says Brookes.
When patients start asking the instructor questions during the assessment process, they are ready to learn, says Teresa Towne, RN, MSN, an inpatient educator at Bayhealth Medical Center in Dover, DE. Body language also is an indicator. If they are fidgety or look away a lot, it probably isn’t the best time to teach, she says.
In the outpatient setting, patients usually are referred to educators by their physician to learn a particular skill or technique for managing a chronic illness or for disease prevention. At that time, it is important to be up front with the patients and ask if they are willing to learn, says Fitzgerald.
When patients say they are receptive to learning, she verbally verifies what they are agreeing to learn, such as giving insulin. Fitzgerald then observes their actions to see if they follow through. Often, it’s a matter of helping them reduce barriers to learning, she says.
When people say they are willing to learn, yet seem to avoid the teaching or practicing the skill, Fitzgerald will ask them to tell her what is getting in the way to determine what they perceive as barriers. In the case of learning to use insulin, the process may be frightening to them. "Once I know that they are willing but scared, we can make a plan," she says.
Uncovering the barriers to learning is extremely important. Fitzgerald finds Prochaska’s Stages of Change Theory very helpful when determining a patient’s readiness to make a life change. The theory contends that there are stages of readiness that include pre-contemplation, contemplation, preparation, and action, and that change is a process that happens over time.
If a person is at the pre-contemplation stage and not even thinking about change, the educator might make the best use of time by helping the patient examine why he or she won’t make a behavior change. In that way, the patient may move to the next stage when he or she begins to think about change. For example, if a smoker is not ready to quit, an educator can help him or her explore the reasons he or she isn’t ready to stop.
"If the person is contemplating change, I can help them examine the pros and cons and remove some of those barriers so that the pros outweigh the cons. Often that helps us move forward much faster, says Fitzgerald.
When patients are receptive to learning and barriers have been taken into account, the patient’s learning needs can be met. Brookes cautions educators not to ask a lot of specific questions to identify barriers because they will surface during the general assessment. For example, if a patient has a family member interpret the conversation or has difficulty communicating in English there is a language barrier.
"Briefly look at the patient’s story and determine what he or she needs to learn," says Brookes. It often helps to have family members provide a few details about a patient’s typical behavior, responses, and daily living patterns.
It’s important to keep in mind the goals of patient and family education, which is for the patient to be able to make informed decisions, develop basic self-care skills, recognize problems, and have their questions answered. "We aren’t there to give a lecture, we want to meet the main goals of patient and family education whether in an inpatient or outpatient setting," says Brookes.
Part of the learning assessment at Bayhealth Medical Center includes asking the patients what they already know about their condition, then determining what it is they need to learn during their hospitalization. It also includes finding out the method of teaching best suited to the patient, says Towne. This can be done by naming several teaching methods, such as one-on-one instruction, audiovisual, written instruction, or group classes.
"If someone is an audiovisual learner, we have a research library where staff can check out videos, and we also have closed-circuit TV where videos can be viewed throughout the day," says Towne.
To determine the best method for teaching patients, have them think back to a time when they had to learn something and consider how they went about learning it, advises Brookes. In that way, patients can pinpoint the best method for teaching.
When patients have a lot to learn and a lot of lifestyle changes to make, it often helps to break the teaching down into manageable pieces while keeping the main goal in mind, says Fitzgerald. Also, it’s important to provide equipment, a class, or support that will help make the changes easier.
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