As anxiety increases, the patient’s ability to pay attention often decreases. Anxiety is uneasiness or worry resulting from anticipating a threat or danger. When faced with change or the need to act differently, a person feels anxious. Learning requires a change in behavior and thus produces anxiety. A mild level of anxiety motivates learning. However, a high level of anxiety prevents learning from occurring. It incapacitates a person, creating an inability to focus on anything other than relieving the anxiety. Manage the patient’s anxiety (see Chapter 37) before educating to improve the patient’s comprehension and understanding of the information given (Fredericks et al., 2008).

Motivation is a force that acts on or within a person (e.g., an idea, emotion, or a physical need) to cause the person to behave in a particular way (Redman, 2007). If a person does not want to learn, it is unlikely that learning will occur. Motivation sometimes results from a social, task mastery, or physical motive.

A social motive is a need for connection, social approval, or self-esteem. People normally seek out others with whom they can compare opinions, abilities, and emotions. For example, new parents often seek validation of ideas and parenting techniques from others whom they have identified as role models in their social environment or health care workers with whom they have established a relationship.

Task mastery motives are based on needs such as achievement and competence. For example, a high school senior who has diabetes begins to test blood glucose levels and make decisions about insulin dosages in preparation for leaving home and establishing independence. The ability to successfully manage diabetes provides the motivation to master the task or skill. After a person succeeds at a task, he or she is usually motivated to achieve more.

Often patient motives are physical. Some patients are motivated to return to a level of physical normalcy. For example, a patient with a below-the-knee amputation is motivated to learn how to walk with assistive devices. Knowledge that is necessary for survival, problem recognition, and critical decision making creates a stronger stimulus for learning than knowledge that merely promotes health (Bastable, 2006).

You assess a patient’s motivation to learn and what the patient needs to know to promote compliance with their prescribed therapy. Unfortunately not all people are interested in maintaining health. Many do not adopt new health behaviors or change unhealthy behaviors unless they perceive a disease as a threat, overcome barriers to changing health practices, and see the benefits of adopting a healthy behavior. For example, some patients with lung disease continue to smoke. No therapy has an effect unless a person believes that health is important.

Health education often involves changing attitudes and values that are not easy to change by simply teaching facts. Therefore it is important for you to use various interventions based on theory when developing patient education plans. Because of the complexity of the patient education process, different theories and models are available to guide patient education. Using a theory that matches the patient’s needs in practice will provide more effective patient education. Social learning theory provides one of the most useful approaches to patient education because it explains the characteristics of the learner and guides the educator in developing effective teaching interventions that result in enhanced learning and improved motivation (Bandura, 2001; Stonecypher, 2009).

According to social learning theory, people continuously attempt to control events that affect their lives. This allows them to attain desired outcomes and avoid undesired outcomes, resulting in improved motivation. Self-efficacy, a concept included in social learning theory, refers to a person’s perceived ability to successfully complete a task. When people believe that they are able to execute a particular behavior, they are more likely to perform the behavior consistently and correctly (Bandura, 1997).

Self-efficacy beliefs come from four sources: enactive mastery experiences, vicarious experiences, verbal persuasion, and physiological and affective states (Bandura, 1997). Understanding the four sources of self-efficacy allows you to develop interventions to help patients adopt healthy behaviors. For example, a nurse who is wishing to teach a child recently diagnosed with asthma how to correctly use an inhaler expresses personal belief in the child’s ability to use the inhaler (verbal persuasion). Then the nurse demonstrates how to use the inhaler (vicarious experience). Once the demonstration is complete, the child uses the inhaler (enactive mastery experience). As the child’s wheezing and anxiety decrease after the correct use of the inhaler, he or she experiences positive feedback, further enhancing his or her confidence to use it (physiological and affective states). Interventions such as these enhance perceived self-efficacy, which in turn improves the achievement of desired outcomes.

Self-efficacy is a concept included in many health promotion theories because it often is a strong predictor of healthy behaviors and because many interventions improve self-efficacy, resulting in improved lifestyle choices (Bandura, 1997). Because of its use in theories and research studies, many evidence-based teaching interventions include a focus on self-efficacy. When nurses implement interventions to enhance self-efficacy, their patients frequently experience positive outcomes. For example, researchers associated interventions that include self-efficacy with effective management of heart failure (While and Kiek, 2009; Yehle and Plake, 2010), participation in physical activity (Ashford et al., 2010), self-management of arthritis (Nunez et al., 2009), and improved management of asthma in children (Coffman et al., 2009).

A temporary or permanent loss of health is often difficult for patients to accept. They need to grieve, and the process of grieving gives them time to adapt psychologically to the emotional and physical implications of illness. The stages of grieving (see Chapter 36) include a series of responses that patients experience during a loss such as illness. They experience these stages at different rates and sequences, depending on their self-concept before illness, the severity of the illness, and the changes in lifestyle that the illness creates. Effective, supportive care guides the patient through the grieving process.

Readiness to learn is related to the stage of grieving (Table 25-1). Patients cannot learn when they are unwilling or unable to accept the reality of illness. However, properly timed teaching facilitates adjustment to illness or disability. Identify the patient’s stage of grieving on the basis of his or her behaviors. When the patient enters the stage of acceptance, the stage compatible with learning, introduce a teaching plan. Continuous assessment of the patient’s behaviors determines the stages of grieving. Teaching continues as long as the patient remains in a stage conducive to learning.

Learning occurs when the patient is actively involved in the educational session (Edelman and Mandle, 2010). A patient’s involvement in learning implies an eagerness to acquire knowledge or skills. It also improves the opportunity for the patient to make decisions during teaching sessions. For example, when teaching car seat safety during a parenting class, hold a teaching session in the parking lot where the participants park their cars. Encourage active participation by providing the learners with several different car seats for them to place in their cars. At the completion of this session, the parents are able to determine which type of car seat fits in their cars and which is the easiest to use. This provides participants with the information needed to purchase the appropriate car seat.

The capability for learning and the type of behaviors that children are able to learn depend on the child’s maturation. Without proper physiological, motor, language, and social development, many types of learning cannot take place. However, learning occurs in children of all ages. Intellectual growth moves from the concrete to the abstract as the child matures. Therefore information presented to children needs to be understandable, and the expected outcomes must be realistic, based on the child’s developmental stage (Box 25-3). Use teaching aids that are developmentally appropriate (Fig. 25-1). Learning occurs when behavior changes as a result of experience or growth (Hockenberry and Wilson, 2011).

Teaching adults differs from teaching children. Adults are able to critically reflect on their current situation and sometimes need help to see their problems and change their perspectives (Redman, 2007). Because adults become independent and self-directed as they mature, they are often able to identify their own learning needs (Billings and Halstead, 2009). Learning needs come from problems or tasks that result from real-life situations. Although adults tend to be self-directed learners, they often become dependent in new learning situations. The amount of information provided and the amount of time that is spent with the adult patient vary, depending on the patient’s personal situation and readiness to learn. An adult’s readiness to learn is often associated with his or her developmental stage and other events that are occurring in his or her life. Resolve any needs or issues that the patient perceives as extremely important so learning can occur.

Adults have a wide variety of personal and life experiences on which to draw. Therefore enhance adult learning by encouraging them to use these experiences to solve problems (Eshleman, 2008). Furthermore, make education patient-centered by developing educational topics and goals in collaboration with the adult patient. Adult patients are ultimately responsible for changing their own behavior. Assessing what the adult patient currently knows, teaching what the patient wants to know, and setting mutual goals improve the outcomes of patient education (Bastable, 2008).

The ability to learn often depends on the patient’s level of physical development and overall physical health. To learn psychomotor skills, a patient needs to possess a certain level of strength, coordination, and sensory acuity. For example, it is useless to teach a patient to transfer from a bed to a wheelchair if he or she has insufficient upper body strength. An older patient with poor eyesight or the inability to grasp objects tightly cannot learn to apply an elastic bandage. Therefore do not overestimate the patient’s physical development or status. The following physical characteristics are necessary to learn psychomotor skills:

Stay updated, free articles. Join our Telegram channel

Join