K
Deficient Knowledge
NOC (Nursing Outcomes Classification)
Client Outcomes
Client Will (Specify Time Frame)
• Explain disease state, recognize need for medications, and understand treatments
• Describe the rationale for therapy/treatment options
• Incorporate knowledge of health regimen into lifestyle
• State confidence in one’s ability to manage health situation and remain in control of life
• Demonstrate how to perform health-related procedure(s) satisfactorily
• Identify resources that can be used for more information or support after discharge
NIC (Nursing Interventions Classification)
Nursing Interventions and Rationales
• Consider the client’s ability and readiness to learn (e.g., mental acuity, ability to see or hear, existing pain, emotional readiness, motivation, and previous knowledge) when teaching clients. EBN: Learning readiness changes over time based on situational, physical, and emotional challenges. The nurse assumes the role of authority, guide, motivator, mentor, and consultant depending on the learning readiness of the client (Olinzock, 2008).
• Assess personal context and meaning of illness (e.g., perceived change in lifestyle, financial concerns, cultural patterns, and lack of acceptance by peers or coworkers). EB: Improved symptom management and client satisfaction were noted as a result of interventions that focused on the needs of the client and the meaning and perspective of his illness (Hörnsten et al, 2008).
• Offer anticipatory educational interventions that support self-regulation and self-management. EBN: Surgical clients who received anticipatory educational interventions focusing on self-care knowledge and the use of coping methods including stress-reduction and breathing exercises experienced increased self-efficacy and decreased anxiety (Wong, Chan, & Chair, 2010).
• Monitor how clients process information over time. EBN: Clients are unique in how they process information. Some clients will be more uncertain than others and may need more educational intervention over time (Suhonen, Valimaki, & Leino-Kilpi, 2008).
• Use individualized approaches that focus on client priorities and preferences. EBN: Individualized educational interventions have a positive effect on client outcomes (Suhonen, Valimaki, & Leino-Kilpi, 2008).
• Engage client as a partner in the educational decision process. EBN: A nursing approach that is collaborative and that uses encouragement and support to increase self-efficacy resulted in client satisfaction, empowerment, and confidence (Hannula, Kaunonen, & Tarkka, 2008).
• Consider using motivational and problem-solving teaching strategies to support self-efficacy, self-regulation, and self-management. EBN: Advice giving and providing information alone do not directly result in behavioral change. Encouraging clients to become involved and “self-generate” solutions to problems can enhance self-control and confidence (Tierney, Hughes, & Hamilton, 2011).
• Assess the client’s literacy skill when using written information. EBN: Health care professionals may overestimate reading and comprehension levels of their clients. Education for those with low literacy should be as unthreatening as possible (Schaefer, 2008).
• Provide visual aids to enhance learning. EB: Visual aids such as pictures and simple word captions have proven to be effective when used to highlight important information, especially when working with clients with low literacy (Friedman et al, 2010).
• Consider coordinated, multifaceted methods of disbursing information over multiple sessions. EBN: Using multiple sources of media and reinforcing information over multiple sessions have proven effective for heart failure clients (Fredericks et al, 2010).
• Use teaching methods that reinforce learning and allow adequate time for mastery of content. EB: Teaching strategies that focus on repetition, simplifying content, and stating rationale for the “why” of learning enhance adherence (Price, 2008). EB: Offering more than one educational session and longer face-to-face contact has been implicated in positive outcomes, especially for clients with low literacy (Schaefer, 2008).
• Help the client locate appropriate follow-up resources for continuing information and support. EBN: Advocating for client’s participation using a community-based case management program has demonstrated improved clinical and financial outcomes for clients with complex chronic conditions (Chow et al, 2008).
• Use computer- and web-based methods as appropriate. EBN: Computers and technology are proving effective educational tools. Work with consumers to evaluate the credibility of websites and technology applications. Keep in mind the accessibility of any particular technology preferences of clients and their readiness to use technology as a resource (Friedman et al, 2010).
• Use outreach and community educational intervention as appropriate. EBN: Advocating for client’s participation using a community-based case management program has demonstrated improved clinical and financial outcomes for clients with complex chronic conditions (Chow et al, 2008).
Pediatric:• Use family-centered approaches when teaching children and adolescents. EBN: Relationship building and negotiation of roles among parents and staff is considered essential as part of the educational experience, especially for families learning to manage complex medical technology and treatment (Dunn & Board, 2011).
• Use communication strategies to enhance learning that are uniquely tailored for children and/or adolescents. EBN: It is important when teaching to use language that is consistent with the developmental level of the child and that focuses on sources of information that children are familiar with, including visual sources, media, and social networking groups (Chilman-Blair, 2010).
• Use educational strategies that are appropriate to the developmental needs of the child or adolescent. EB: Select strategies that are developmentally appropriate when providing information to children and adolescents and that take into consideration the uniqueness of the young person’s physical condition, cognitive ability, perceived needs, and preferences (Ranmal, Prictor, & Scott, 2008).
• Consider using recreational playthings for younger children such as puppets in combination with structured sessions as a therapeutic education intervention for young children. CEB: Young children respond well to use of playthings in teaching sessions as it gives them a sense of control while group discussions allows them to discuss their real fears about disease management (Pelicand et al, 2006).
• Provide anticipatory guidance as necessary for procedures and about the course of illness for both parents and preschool children. EB: Anticipatory guidance and parent education support children’s coping and self-regulatory management especially with low-income families experiencing chronic conditions such as asthma (Winders, Gordon, & Burns, 2011).
• Educational strategies that are participatory are recommended for adolescents. EBN: Adolescents report wanting more information about procedures and disease processes and prefer having choices in how they receive information over time (Korus et al, 2011).
• Consider the benefits of computer and web learning as a teaching methodology. EB: Adolescents and children may benefit from the use of interactive e-learning and other technological sources of information. The credibility of information sites should be monitored (Dunn & Board, 2011).
Geriatric:• Involve older clients in setting their own goals and participating in the decision-making process. EBN: Allowing senior clients to set goals that are meaningful to them and are realistic has demonstrated positive clinical outcomes (Davis & White, 2008).
• Ensure that the client uses necessary reading aids (e.g., eyeglasses, magnifying lenses, large-print text) or hearing aids if necessary. CEB: Visual and hearing deficits require amplification or clarification of sensory input (Zurakowski, Taylor, & Bradway, 2006).
• Consider using self-paced learning and methods of reinforcing learning. EBN: As adult learners, older clients may prefer to focus on what is important to them first. Some may prefer having printed materials, videotapes, and brochures to review at a later time of their preference (Rigdon, 2011).
• Repeat and reinforce information during several brief sessions. EBN: At times, the energy levels of clients may be diminished. Brief sessions focus attention on essential information. Older clients benefit from repeated follow-up sessions (Rigdon, 2010).
• Discuss healthy lifestyle changes that promote safety, health promotion, and health maintenance for older clients. EB: Older people often lack knowledge about safety issues such as fall prevention and medication management in the home and community (Dickinson et al, 2011).
• Offer opportunities for practice of psychomotor skills. EBN: Older adults indicate a preference for hands-on learning. They learn with hands on and through rehearsal when taught psychomotor skills (Rigdon, 2011).
Refer elderly clients for postdischarge follow-up as they transition from hospital to home in regard to their treatment and medication regimens. EB: Extended follow-up and social support may prevent relapses and readmissions in older, vulnerable clients (Cumbler, Carter, & Cutner, 2008).
• Consider using technology, including interactive computer programs and other creative interventions, to disperse health education to older adults. EB: E-health programs may be helpful in dispersing information and providing social support, especially for older adults (Hodern et al, 2011).
• Consider the use of creative interventions, such as art, poetry, and writing, to help an older adult learn. CEB: Recent research indicates that creative interventions help to stimulate cognitive abilities in older adults (Flood & Phillips, 2007).
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