1.5 Learner Assessment
As previously discussed in this chapter, when providing health teaching and health promotion interventions, nurses use an individualized approach that is tailored to meet the unique needs, preferences, and learning styles of each client. This section will discuss how nurses assess a client’s readiness to learn and common barriers to learning that must be addressed in the teaching plan.
Readiness to Learn
Nurses begin by assessing the client’s readiness to learn. Readiness to learn refers to a learner’s ability to acquire knowledge and initiate behavior change that leads to effective and successful outcomes. A client’s readiness to learn, as well as their previous experiences related to learning, will affect the teaching process.
Nurses begin by developing a nonjudgmental rapport with the client and evaluating the client’s emotional state, readiness to learn, motivation to learn, and any barriers that may impede learning. Barriers that can affect learning include factors such as pain, anxiety, grief, literacy issues, and financial concerns and will be discussed in more detail later in this chapter. Nurses address these barriers with nursing interventions prior to initiating the health teaching. For example, if the client is experiencing pain, the nurse provides pain management before the teaching session. However, opioids and anesthesia can cloud thinking and nurses should schedule teaching around administration of these medications. If the learner is anxious, the nurse provides a calm environment and uses therapeutic communication techniques to encourage the client to express their feelings. If the client is experiencing a feeling of loss and going through stages of grief related to a new life-altering diagnosis such as cancer, the nurse may elect to postpone the teaching session until the client is experiencing feelings of acceptance.
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 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. See Figure 5 for a depiction of the TTM model. 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]:
| Barrier | Implication | What can the nurse do? |
|---|---|---|
| Health Literacy | Limited health literacy affects understanding of medical terminology, instructions and health information. This leads to misunderstandings and difficulty following treatment plans. | Use plain language, visual aids, and teach-back techniques. Simplify complex terms and provide written materials at an appropriate reading level. |
| 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, translated printed materials, 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 in 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. 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. 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. 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.
- 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, March 6). 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/ ↵
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.