1.5 Learner Assessment
As previously discussed in this chapter, when providing health teaching and health promotion interventions, nurses use an individualized approach tailored to meet each client’s unique needs, preferences, and learning styles. An essential part of this process is assessing the client’s readiness to learn and identify barriers that may hinder learning.
Nurses begin by developing a nonjudgmental rapport with the client and assessing their emotional state, motivation, and any potential challenges that may impact their learning. Common barriers include pain, anxiety, grief, literacy issues, and financial concerns. These factors must be addressed before initiating health teaching to ensure effective learning.
For example:
- If the client is in pain, the nurse should provide pain management before beginning teaching. However, because opioids and anesthesia can impair cognitive functioning, teaching should be scheduled around the administration of these medications.
- If the client is anxious, the nurse should create a calm environment and use therapeutic communication to help the client express their feelings and cope with their concerns.
- If the client is experiencing grief due to a new life-threatening diagnosis such as cancer, the nurse may need to postpone teaching until the client reaches a stage of acceptance.
Barriers to learning and strategies for addressing them will be explored in more detail later in this chapter.
Readiness to Learn
A client’s readiness to learn refers to their ability and willingness to acquire knowledge and initiate behavior changes that lead to improved health outcomes. This readiness is influenced by the client’s emotional state, motivation, and previous learning experiences.
Nurses assess readiness to learn by performing the following actions before beginning a teaching session:
- Evaluating the client’s emotional and psychological state.
- Determining the client’s level of motivation and engagement in the learning process.
- Identifying any external factors that may support or hinder learning. An important aspect of assessing readiness is understanding where the client is in the behavior change process. The transtheoretical model (TTM), also known as change theory, helps nurses identify a client’s stage of change and tailor the health teaching accordingly.
Change Theory
An important piece of assessing a client’s readiness to learn is considering what stage of change the client is currently experiencing and tailoring the teaching and health promotion interventions to the stage. The transtheoretical model (TTM), commonly referred to as change theory, is a commonly applied framework used to help clients change behaviors and make healthier lifestyle choices, such as smoking and substance cessation, weight loss, enhanced physical activity, sunscreen use, and condom use. TTM includes these five stages of change[1]:
- Precontemplation
- Contemplation
- Preparation
- Action
- Maintenance
With successful teaching and support, clients can progress through these stages of change, but relapse to previous stages can occur at any time.
Additional information about Change Theory is discussed in the “Behavioral Change” section of the “Healthy Lifestyles” chapter.
Identifying Barriers to Learning
In addition to identifying a client’s readiness to learn and their current stage of change, other barriers can prevent learning. Barriers include a variety of issues that the nurse must address in the teaching-learning plan in order for health teaching to be successful.[2] View Table 1.5 for an overview of potential barriers to learning, implications, and nursing actions.
Table 1.5 Barriers to Learning, Implications, and Nursing Actions
| Barrier | Implication | Nursing Actions |
|---|---|---|
| Health Literacy | Limited health literacy affects understanding of medical terminology, instructions and health information. This can lead to misunderstandings and difficulty following treatment plans. | Use plain language, visual aids, and teach-back techniques by asking the client to explain or demonstrate the information presented. Simplify complex terms and provide written materials at an reading level no higher than the sixth grade level, as recommended by the National Institute of Health.[3] |
| Language and Communication | Language barriers between client and health care providers can impede effective communication and affect the accuracy of information exchange. | Utilize professional interpreters in-person or virtually, printed materials translated into their preferred language, and culturally-competent communication. Use active listening and patience. |
| Cultural Considerations | Cultural beliefs, practices, and values can impact a client’s willingness to accept and adopt the medical treatment plan. Culturally insensitive care can lead to misunderstandings and resistance. | Provide culturally sensitive care. Understand cultural norms, beliefs, and practices. Involve family members if needed. |
| Client Discomfort | Anxious, stressed, or clients experiencing pain may find it difficult to focus and retain information. | Address emotional states and pain before teaching. Create a calm and supportive environment. |
| Cognitive and Sensory Impairments | Cognitive and/or sensory impairments may lead to difficulty processing information or make it challenging to participate in health teaching situations. | Determine client’s ability to participate in a session. Use visual aids, repetition, and involve support persons as approved by the client. Tailor the learning environment to client needs. |
| Lack of Social Support | Clients lacking support from significant others, family members, or caregivers may struggle to implement lifestyle changes or adhere to treatment plans on their own. | Identify support networks. Provide encouragement. Work with clients to determine realistic and attainable goals. |
| Medical Jargon | Use of complex medical terminology and jargon can cause confusion and make it difficult to understand conditions and treatment options. | Explain terms in simple language. Provide glossaries. |
| Client Resistance | Resistance to education can be due to personal beliefs, skepticism about medical advice, or distrust of the health care system. | Build trust. Use active listening and address concerns empathetically. Provide evidence-based information. |
| Limited Follow-up | Without follow-up, clients may forget instructions or have unaddressed questions, leading to gaps in understanding and adherence. | Schedule follow-up sessions in person or with phone calls after hospital discharge or clinic visits. Provide written summaries of education. Encourage questions. |
| Perceived Irrelevance | When information is perceived as irrelevant to their situation, clients may dismiss or ignore it completely. | Relate content to real-life scenarios. Explain practical implications. |
| Low Motivation or Desire to Change | Clients who do not see immediate benefits from change or lack motivation to make changes may not actively engage in the learning process. | Use motivational interviewing to understand client’s personal goals. Motivational interviewing is described in the “Behavioral Change” section of the “Healthy Lifestyles” chapter. Explore barriers and benefits. Provide positive reinforcement. |
Nurses must proactively address these barriers by using clear communication, culturally sensitive approaches, and client-centered teaching methods based on the TTM change theory. Tailoring education to each client’s individual needs, preferences, and circumstances can help overcome these challenges and promote improved client outcomes.
Nurses must also be aware of potential personal and institutional barriers that can affect learning, such as the following:
- Time Constraints: Nurses often have limited time to spend with clients due to the acuity of client assignments. Insufficient time can lead to rushed explanations and missed opportunities for comprehensive education and evaluation of learning.
- Inadequate Teaching Resources: Limited availability of teaching resources, such as handouts, visual aids, or translated materials, can hinder effective learning.
- Uncomfortable Learning Environment: The room may be dark, the temperature may be uncomfortable, or the space may be inadequate for teaching. If the learning environment is uncomfortable for the learner, they may be more focused on their discomfort and less likely to pay attention or focus on what is being taught. If the learning environment is uncomfortable for the nurse, the nurse may hurry through the information in an effort to get out of the environment more quickly. The result is the nurse may not give adequate time for the client to absorb information or for verification that the client understands the information.
These personal and institutional barriers must also be addressed for effective learning to occur.
- Raihan, N., & Cogburn, M. (2023). Stages of change theory. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK556005/ ↵
- Beagley, L. (2011). Educating patients: Understanding barriers, learning styles, and teaching techniques. Journal of PeriAnesthesia Nursing, 26(5), 331–337. https://pubmed.ncbi.nlm.nih.gov/21939886/ ↵
- Stiller, C., Brandt, L., Adams, M., & Gura, N. (2024). Improving the readability of patient education materials in physical therapy. Cureus, 16(2), e54525. https://doi.org/10.7759/cureus.54525 ↵
Refers to a learner’s ability to acquire knowledge and initiate behavior change that leads to effective and successful outcomes.
A commonly used framework used to help clients change behaviors and make healthier lifestyle choices, such as smoking and substance cessation, weight loss, enhanced physical activity, sunscreen use, and condom use.
