Learning assessments — impossible to teach effectively without them

Educators must learn assessment skill to know how to teach the patient

During new employee orientation, Kathy Ordelt, RN-CPN, CRRN, patient and family education coordinator at Children’s Healthcare of Atlanta asks those present how they would determine what to do for a patient if she were to blindfold them, plug up their ears, take away the tools of their trade such as a stethoscope, and put thick leather gloves on their hands. They tell her that if they can’t see, hear, or touch the patients, they can’t care for them.

Ordelt responds, "All the tools of assessment are gone. You would not know where to start. The same thing holds true for learning."

She says health care providers cannot begin to educate patients and families until they determine what patients already know, how they like to learn, and if there are any factors that will interfere with the teaching or learning.

It is important to remember that learning is not simply memorizing information — it is comprehending what was taught and being able to apply the information, says Kimberly Crosby, RN, director of guest services at St. Louis Children’s Hospital.

"We do an assessment because we want people to comprehend and apply the information. The goal of teaching is to impact the outcome in some way. We want them to be able to make better decisions, acquire skills, know what to do in a particular situation, or just gain additional knowledge about a topic," she explains.

Learning assessments are done so the brief time available to educate the patient can be used in a way that will best help him or her, says Laura Seuferling, MPH, a health educator in patient & family education at the University of Washington Medical Center in Seattle.

"If I don’t do an assessment, I am blindly spewing out information [that] is wasting the patient’s time, and my time and I am not helping him or her," she explains.

The skill of assessing learning needs is one of those interpersonal communication skills essential for all health care providers. Some people are just better at interpersonal skills than others, but coaching and learning from experience can improve everyone’s skills, says Fran London, MS, RN, health education specialist, The Emily Center at Phoenix Children’s Hospital.

"Working with the health care team is one way to get better at assessment. Team members can learn from one another what works and what doesn’t," she says.

Role-playing also is a good way to teach educators how to do learning assessments, says Cheryl A. Goddard, RN, a clinical educator at St. Louis Children’s Hospital. In addition to helping those who educate patients gain assessment skills, it is important to make sure they know what teaching tools are available so they can use the ones that match a patient’s preferred learning style, she says.

Health care providers also need to know what tools are available to help overcome any barriers that might hinder the teaching. For example, there are 105 ethnic groups in Atlanta and, while educators cannot be culturally competent in all of them, they can know where to go to find the answers, says Ordelt. There are libraries at Children’s Healthcare of Atlanta that have cultural information, and the institution also has a multicultural coordinator who oversees interpretation, translation, and cultural competency.

Skills for assessing

"Mostly, health care providers need to learn to listen and pick up on learners’ cues of discomfort, resistance, misunderstanding, or confusion," says London. She teaches health care providers that whenever they feel frustrated or whenever they feel the learner isn’t listening or isn’t getting it — that’s a sign that more assessment is needed. Frustration means educators are not individualizing the teaching enough to meet the learner’s needs, explains London.

If there are barriers to education, the health care provider must figure out how to give the information to the patient or family in the correct way, says Ordelt. "Our responsibility is to find the right way to reach them so those barriers are minimized," she adds.

To determine how to best teach a patient, the learning assessment should evaluate what the patient would like to learn, how much the patient already knows, the patient’s readiness to learn, how the patient likes to learn, and the issues that have to be addressed to best teach the patient, such as language or cultural and religious barriers. "All the things that can cause us to stop and take note and think about how we can provide the information so that the learner will receive it," says Ordelt. The information can be gleaned by both observation and asking appropriate questions, she adds.

One of the first things to note is whether the patient is ready to learn, says Terry Barlow, RN, a patient educator in the learning center at Fairview-University Medical Center in Minneapolis. Barlow, who works with transplant patients, says she gauges readiness to learn by observing the patient as he or she enters the learning center. She notices whether the patient makes eye contact, asks questions, or is smiling.

Patients are sent to the learning center by referral by their physician or the nurses on their unit. "If a patient does not want to be there I ask to reschedule the appointment — otherwise I am wasting my time and the patient’s," says Barlow.

Although Seuferling now works with clinicians, at one time she worked at a wellness center where she taught patients about diet and exercise. During this time she observed that, if patients were not ready to change their behavior, teaching them how to reduce saturated fat in their diet or providing an exercise program would not motivate them to alter their lifestyle.

To assess readiness to learn, Seuferling asked them why they came to the center. If they said their physician, dietitian, or spouse wanted them to come, that would be a sign that they might not be ready to learn.

Or she might ask them what they had already done to start an exercise program or change their diet. For example, Seuferling would ask, "Have you thought about what days of the week you will exercise and what time of day?" or "Do you have exercise shoes or clothes?" If they answered that they were very busy, that could indicate they were not ready to learn, she says.

The questioning Seuferling used was based upon the stages of change theory authored by James Prochaska, PhD, and Carol DiClemente, PhD. According to this theory, people may be in one of five changes that impact whether their behavior will change:

1. Pre-contemplative — no intention of taking action within the next six months
2. Contemplative — intends to take action within the next six months
3. Preparation — intends to take action within the next 30 days and has taken steps in this direction
4. Action — has changed overt behavior for fewer than six months
5. Maintenance — has changed overt behavior for more than six months

If patients are not ready to learn, it is important to try to motivate them to learn and get them to a stage of readiness. This might be accomplished by asking them why they think their physician sent them and then by going over why the changes are necessary. It might be helpful to give them a preliminary task such as keeping a food diary to track the saturated fat in their diet. In this way — instead of cutting out saturated fat — they could find substitutes. By meeting the patient halfway, they might be motivated to learn, says Seuferling.

To know where to begin teaching it is important to learn how much a patient already knows. "If patients have skills in an area, such as diabetes, we can build upon them. And if they have no previous experience, there is a different starting point," says Goddard.

Sometimes questionnaires can be used to gather information on how much a patient already knows. At St. Louis Children’s Hospital, there is a quiz available for families with a history of diabetes. The quiz can be used to determine how much the family already knows about managing diabetes.

Questionnaires also can be used to determine what patients want to know. However, most of the learning assessment gives insight into the learner so that educators can sense how to frame the information, how much detail the learner needs, and how best to teach it. "This is done best in conversation, observing the learner’s responses and listening to what is said," says London.

Sources

For more information about conducting learning assessments, contact:

  • Terry Barlow, RN, Patient Educator, Learning Center, Fairview-University Medical Center, 420 Delaware St. S.E., Minneapolis, MN 55455. E-mail: tbarlow1@fairview.org.
  • Kimberly Crosby, RN, Director of Guest Services, St. Louis Children’s Hospital, One Children’s Place, St. Louis, MO 63110. Telephone: (314) 454-2767. E-mail: kac1293@bjc.org. Web site: www.stlouischildrens.org.
  • Cheryl A. Goddard, RN, Clinical Educator, St. Louis Children’s Hospital, One Children’s Place, St. Louis, MO 63110. Telephone: (314) 454-4135. E-mail: cag2170@bjc.org.
  • Fran London, MS, RN, Health Education Specialist, The Emily Center, Phoenix Children’s Hospital, 1919 E. Thomas Road, Phoenix, AZ 85016-7710. Telephone: (602) 546-1408. E-mail: flondon@phoenixchildrens.com.
  • Kathy Ordelt, RN-CPN, CRRN, Patient & Family Education Coordinator, Children’s Healthcare of Atlanta, 1600 Tullie Circle, Atlanta, GA 30329. Telephone: (404) 785-7839. Fax: (404) 785-7017. E-mail: Kathy.ordelt@choa.org.
  • Laura Seuferling, MPH, Health Educator, Patient & Family Education, University of Washington Medical Center. 1959 N.E. Pacific St., Box 358126, Seattle, WA 98195. Telephone: (206) 598-3473. E-mail: seufer@u.washington.edu.