K
Deficient Knowledge
NANDA-I
NOC (Nursing Outcomes Classification)
Knowledge: Disease Process, Energy Conservation, Health Behavior, Health Resources, Healthy Diet, Infection Management, Medication, Personal Safety, Prescribed Activity, Substance Use Control, Treatment Procedure(s), Treatment Regimen
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).
Multicultural:• Acknowledge racial/ethnic differences at the onset of care. EB: Awareness of one’s own prejudices and stereotypes is considered essential to the development of cultural competence in working with diverse populations (Seelman, Suurmond, & Stronks, 2009).
• Consider involving bilingual members of a community who are considered outside the traditional health care system who may assist in the teaching of community health issues. EB: Members of an ethnic or cultural group who are well networked may have greater influence when educating peers on needed lifestyle and health-related changes (Henderson, Kendall, & See, 2011).
• Assess the extent of understanding of language and cultural practices when teaching clients who may not understand English. EBN: Language and other unknown barriers inherent in cultural practices may result in health hazards and risks (Ardoin & Wilson, 2010).
• Assess for the influence of cultural beliefs, norms, and values on the client’s knowledge base. EBN: Illness beliefs guide health behavior (Seelman Suurmond, & Stronks, 2009).
• Assess for cultural/ethnic self-care practices. EBN: Folk and home remedies may interact with medications and treatment (Seelman, Suurmond, & Stronks, 2009).
• Use teaching methods that are culturally sensitive and support client customs, values, and lifestyle. EB: Provide information in a way that clients can understand (Seelman, Suurmond, & Stronks, 2009). Educational programs that focus on the cultural context and not disease symptoms alone have proven to be more effective than generic education programs (Bailey et al, 2009).
• Be aware of the potential influence of medical interpreters in information sharing and decision-making and of the possible difficulties for clients when using medical interpreters. EBN: Different categories of interpreters (e.g., trained, untrained, professional) may influence how information is shared and understood (Hadziabdic et al, 2010).
Home Care:• All of the previously mentioned interventions are applicable to the home setting.
• Assess the client/family learning needs, information needs, and current level of knowledge. EB: The education needs of caregivers change over time, and caregivers report a need to learn how to apply information as it relates specially to their home situation (MacIsaac, Harrison, & Godfrey, 2010).
• Encourage family and peer support. EB: A partner-guided protocol that included integrated education and training of clients and partners improved symptom management. There was also significant improvement in self-efficacy and caregiver strain (Keefe, Somers, & Martire, 2008).
• Encourage caregivers to practice skills prior to discharge. EB: When interviewed, caregivers identified this as important for the transition to home (MacIsaac, Harrison, & Godfrey, 2010).
• Consider the emerging field of telehealth and assistive technology as a method for supporting ongoing education for symptom, treatment, and self-care management. EBN: Telehealth is proving to prevent rehospitalizations and improve access, especially for populations with limited mobility or access to face-to-face health care services (Harrefors, Axelsson, & Savenstedt, 2010).
References
Ardoin, K.B., Wilson, K.B. Cultural diversity: what role does it play in patient safety? Nurs Womens Health. 2010;14(4):322–326.
Bailey, E.J., et al, Culture-specific programs for children and adults from minority groups who have asthma. Cochrane Database Syst Rev 2009;(1):CD006580.
Chilman-Blair, K. Communicating with children about illness. Pract Nurs. 2010;21(12):631–633.
Chow, S.K., et al. Community nursing services for postdischarge chronically ill patients. J Clin Nurs. 2008;17(7B):260–271.
Cumbler, E., Carter, J., Kutner, J. Failure at the transition of care: challenges in the discharge of the vulnerable elderly patient. J Hosp Med. 2008;3(4):349–352.
Davis, G.C., White, T.L. A goal attainment pain management program for older adults with arthritis. Pain Manag Nurs. 2008;9(4):171–179.
Dickinson, A., et al. Fall prevention in the community: what older people say they need. Br J Community. 2011;16(4):174–180.
Dunn, K., Board, R. Parents and technology in the inpatient pediatric setting: a beginning model for study. Pediatr Nurs. 2011;37(2):75–80.
Flood, M., Phillips, K. Creativity in older adults: a plethora of possibilities. Issues Ment Health Nurs. 2007;28(4):389–411.
Fredericks, S., et al. Effects of the characteristics of teaching on the outcomes of heart failure patient education interventions: a systematic review. Eur J Cardiovasc Nurs. 2010;9:30–37.
Friedman, A.J., et al. Effective teaching strategies and methods of delivery for patient education: a systematic review and practice guideline recommendations. J Cancer Educ. 2010;26:12–21.
Hadziabdic, R., et al. Problems and consequences in the use of professional interpreters: qualitative analysis of incidents from primary healthcare. Nurs Inquiry. 2010;18(3):253–261.
Hannula, L., Kaunonen, M., Tarkka, M.T. A systematic review of professional support interventions for breastfeeding. J Clin Nurs. 2008;17(9):1132–1143.
Harrefors, C., Axelsson, K., Savenstedt, S. Using assistive technology services at differing levels of care: healthy older couples’ perceptions. J Adv Nurs. 2010;66(7):1523–1532.
Henderson, S. The effectiveness of culturally appropriate interventions to manage or prevent chronic disease in culturally and linguistically diverse communities: a systematic literature review. Health Soc Care Community. 2011;19(3):225–249.
Hodern, A., et al. Consumer e-health: an overview of research evidence and implications for future policy. HIM J. 2011;40(2):6–14.
Hörnsten, A., et al. Improvements in HbA1c remain after 5 years—a follow-up of an educational intervention focusing on patients’ personal understandings of type 2 diabetes. Diabetes Res Clin Pract. 2008;81(1):50–55.
Keefe, F.J., Somers, T.J., Martire, L.M. Psychologic interventions and lifestyle modifications for arthritis pain management. Rheum Dis Clin North Am. 2008;34(2):352–368.
Korus, M., et al. Exploring the information needs of adolescents and their parents throughout the kidney transplant continuum. Prog Transplant. 2011;21(1):53–60.
MacIsaac, L., Harrison, M.B., Godfrey, C. Supportive care needs of caregivers of individuals following stroke: a synopsis of research. Can J Neurosci Nurs. 2010;32(1):39–46.
Olinzock, B.J. Enhancing the learning of patients with SCI: a patient education tool. Sci Nurs. 2008;25(2):10–20.
Pelicand, J., et al. Therapeutic education programme for diabetic children: recreational, creative methods, and use of puppets. Patient Educ Couns. 2006;60(2):152–163.
Price, P.E. Education, psychology and compliance. Diabetes Metab Res Rev. 2008;24(Suppl 1):S101–S105.
Ranmal, R., Prictor, M., Scott, J.T., Interventions for improving communication with children and adolescents about their cancer. Cochrane Database Syst Rev 2008;(4):CD002969.
Rigdon, A.S. The development of patient education for older adults receiving chemotherapy. Clin J Oncol Nurs. 2010;14(4):433–441.
Schaefer, C.T. Integrated review of health literacy interventions. Orthop Nurs. 2008;27(5):302–308.
Seelman, C., Suurmond, J., Stronks, K. Cultural competence: a conceptual framework for teaching and learning. Med Educ. 2009;43(3):229–237.
Suhonen, R., Valimaki, M., Leino-Kilpi, H. A review of outcomes of individualised nursing interventions on adult patients. J Clin Nurs. 2008;17(7):843–860.
Tierney, P., Hughes, C., Hamilton, S. Promoting health behaviour change in the cardiac patient. Br J Card Nurs. 2011;6(3):126–130.
Winders, D., Gordon, M.K., Burns, B.M. Educational interventions for childhood asthma: a review and integrative model for preschoolers from low-income families. Pediatr Nurs. 2011;37:31–38.
Wong, E.M., Chan, W.C., Chair, S. Effectiveness of an educational intervention on levels of pain, anxiety and self-efficacy for patients with musculoskeletal trauma. J Adv Nurs. 2010;66(5):1120–1131.
Zurakowski, T., Taylor, M., Bradway, C. Effective teaching strategies for the older adult with urologic concerns. Urol Nurs. 2006;6(5):355–360.
Readiness for enhanced Knowledge
NANDA-I
NIC (Nursing Interventions Classification)
Nursing Interventions and Rationales
Include clients as members of the health care team in mutual goal setting when providing education. EBN: Involving individuals in setting goals that are relevant and meaningful to them is an important component of supporting client participation (Davis & White, 2008).
• Support client priorities, preferences, and choice. EBN: Adult learning theories and models support the use of choice with self-directed, autonomous learners (Olinzock, 2008).
• Seek teachable moments to encourage health promotion. EB: Providers are encouraged to use teachable moments during client visits to offer information on health promotion and prevention behaviors such as healthy nutrition, exercise, and weight management (Demark-Wahnefried et al, 2008).
• Use motivational strategies to promote client participation and sustain learning. EBN: The use of motivational and disease management interventions has demonstrated promise for improved adherence and lifestyle change (Dusing, 2008).
• Use a consultative, interactive teaching approach. EBN: A consultative role is especially recommended for self-directed and motivated learners (Olinzock, 2008).
• Consider using lifestyle and health promotion programs delivered in workplace or community sites outside traditional health care environments. Often tailored emails, team-based focus, and competitive reward programs can enhance the motivation to engage in lifestyle assessments and changes (Yap & Busch James, 2010).
• Use interactive and web-based technologies as appropriate to individualize health education interventions. Internet and web-based interventions that are interactive such as self-care assessment, decision-making, and peer support are useful in supporting lifestyle changes (Hodern et al, 2011; Kerr et al, 2008).
• Facilitate individualized proactive planning with clients before visits to their health care provider. EBN: Written materials provided to new visit clients has proven useful for clients (Friedman et al, 2010).
• Provide appropriate health care information and screening for clients with physical disabilities. CEB: Health promotion activities for clients with disabilities have been proven to contribute significantly to quality of life (Enni et al, 2006).
• Encourage peer group support as appropriate to enhance learning. EB: Peer support has proven instrumental in enhancing client knowledge, skills, and confidence over time (Harvey et al, 2008; Hoey et al, 2008).
• Use a combination of teaching methods. CEB: The use of intensive, multiple modalities in lifestyle modification programs such as structured sessions in conjunction with “hands on” and creative activities is associated with a positive effect on health knowledge and on lifestyle changes (Gallegos, Ovalle-Berumen, & Gomez-Meza, 2006).
• Involve children and especially adolescents in designing health promotion programs and teaching methods. EBN: Young people are more willing to engage in health promotion programs when the program is tailored to their specific needs rather than a standardized program. Some young people may prefer focus groups while others are more peer focused (Tall, 2011).
Consider settings outside traditional health care centers and interdisciplinary approaches for engaging children and adolescents in preventive health care. EB: School-based health centers offer a safe environment outside traditional health centers for adolescents to address their unique health concerns (Clayton et al, 2010).
• Provide a developmentally appropriate environment when addressing health education needs of adolescents. EB: Sustained involvement in peer educator and service learning programs where adolescents can reflect on health issues, inviting guest speakers, and using web resources has proven effective and has been linked to reductions in adolescent sexual risk behaviors, violence involvement, and school disconnection (Sieving et al, 2011).
References
Clayton, S., et al. Different setting, different care: integrating prevention and clinical care in school-based health centers. Am J Public Health. 2010;100(9):1592–1596.
Davis, G.C., White, T.L. A goal attainment pain management program for older adults with arthritis. Pain Manag Nurs. 2008;9(4):171–179.
Demark-Wahnefried, W., et al. Lifestyle interventions to reduce cancer risk and improve outcomes. Am Fam Physician. 2008;77(11):1573–1578.
Dusing, R. Overcoming barriers to effective blood pressure control in patients with hypertension. Curr Med Res Opin. 2008;22(8):1545–1553.
Ennis, M., et al. A randomized controlled trial of a health promotion education programme for people with multiple sclerosis. Clin Rehabil. 2006;20(9):783–792.
Friedman, A.J., et al. Effective teaching strategies and methods of delivery for patient education: a systematic review and practice guideline recommendations. J Cancer Educ. 2010;26(1):12–21.
Gallegos, E.C., Ovalle-Berumen, F., Gomez-Meza, M.V. Metabolic control of adults with type 2 diabetes mellitus through education and counseling. J Nurs Scholarsh. 2006;38(4):344–351.
Harvey, P.W., et al. Self-management support and training for patients with chronic and complex conditions improves health-related behaviour and health outcomes. Aust Health Rev. 2008;32(2):330–338.
Hodern, A., et al. Consumer e-health: an overview of research evidence and implications for future policy. HIM J. 2011;40(2):6–14.
Hoey, L.M., et al. Systematic review of peer-support programs for people with cancer. Patient Educ Couns. 2008;70(3):315–337.
Kerr, J., et al. Randomized control trial of a behavioral intervention for overweight women: impact on depressive symptoms. Depress Anxiety. 2008;25(7):555–558.
Olinzock, B.J. Enhancing learning for patients with SCI: a patient education tool. SCI Nurs. 2008;25(1):10–19.
Sieving, R.E., et al. A clinic-based, youth development approach to teen pregnancy prevention. Am J Health Behav. 2011;35(3):346–358.
Tall, H. Developing health services designed for young people. Br J Sch Nurs. 2011;6(4):193–198.
Yap, T. Busch James D: Tailored e-mails in the workplace: a focus group analysis. AAOHN J. 2010;58(10):425–432.