A deficit in knowledge is commonly experienced by individuals coping with new medical diagnosis varied pharmacological and treatment regimens, unfamiliar and often complex problems, as well as by individuals entering stages or role relationships that demand new pattern of response.
Some patients may have access to information or know where to seek it, others may have providers who are not teaching them or who cannot be understood. This lack of an open information, flowing relationship with provider often causes the client to misinterpret information or forget it because of the disuse/ lack of reinforcement for correct use.
Because of the patients education is considered a skill reimbursed by Medicare & other commercial insurance carriers. It is important for the nurse to include knowledge deficit in the plan of care. The deficit in knowledge may relate to clients lack of information about their disease process, medication or resources
Patients needs to be aware of the activities that reduce the risk, signs and symptoms of complications, and what to do when the condition manifest.
Kozier, et al, 2007; Perry and Potter, 2002
Intervention and Rationale
I: Assess motivation and willingness of client.
R: Some clients are ready to learn soon after they are diagnosed
I: Assess ability to learn or perform desired health-related care.
R: Cognitive impairments need to be identified so an appropriate teaching plan can be designed.
I: Identify any existing misconceptions regarding materials to be taught.
R: This provides starting point in education.
I: Determine cultural influences on health teaching.
R: Providing a climate of acceptance allows clients to be themselves and to hold their own beliefs as appropriate.
I: Determine clients learning style especially if client had learned and retained new information in the past.
R: Some persons may prefer written over visual materials, or they may prefer group versus individual instruction. Matching the learners preferred style with the educational method facilitates success in mastery of knowledge.
I: Determine clients baseline of knowledge regarding the disease process.
R: Provides information regarding understanding of the patients knowledge.
I: Review pathophysiology of condition and signs/symptoms of possible complications, e.g., gangrene and further amputation.
R: Provides a knowledge base from which client can make
informed choices and understand/identify healthcare needs.
I: Instruct client/ family in disease process, progression, what to expect, and answer all questions honestly.
R: Promotes optimal learning environment when client show willingness to learn. Family members may assist with helping the client to make informed choices regarding the treatment. Anxiety or large volumes of instruction may impede comprehension and limit learning.
I: Encourage questions.
R: Learners often feel shy or embarrassed about asking questions and often wants permission to ask them.
I: Provide an atmosphere of respect, openness, trust, collaboration, quiet without interruption.
R: This is especially important when providing education to the clients with different values and beliefs about health and illness, and it allows more concentration to the topic being discussed.
I: Explain purpose of activity restrictions and need for balance between activity/rest.
R: Rest reduces oxygen and nutrient needs of compromised tissues and decreases risk of fragmentation of thrombosis. Balancing rest with activity prevents exhaustion and further impairment of cellular perfusion.
I: Establish appropriate exercise/activity program
R: Aids in developing collateral circulation, enhances venous return, and prevents recurrence.
I: Problem-solve solutions to predisposing factors that may be present, e.g., employment that requires prolonged standing/sitting, wearing restrictive clothing(girdles/garters),
R: Actively involves patient in identifying and initiating lifestyle/ behavior changes to promote health and prevent recurrence of condition/development of complications.
I: Recommend sitting with feet touching the floor, avoiding crossing of legs.
R: Prevents excess pressure on the popliteal space.
I: Stress importance of medical follow-up/laboratory testing.
R: Understanding that close supervision of anticoagulant therapy is necessary (therapeutic dosage range is narrow and complications may be deadly) promotes client participation.
I: Instruct in meticulous skin care of lower extremities, e.g.,
prevent/promptly treat breaks in skin and report development of lesions/ulcers or changes in skin color.
R: Chronic venous congestion/postphlebotic syndrome ma develop (especially in presence of severe vascular involvement and/or recurrent episodes), potentiating risk of stasis ulcers/infection.
I: Focus teaching sessions on a single concept or idea.
R: This allows the learner to concentrate more completely on material being discussed. Highly anxious and older clients have reduced short-term memory and benefit from mastery of one concept at a time.
I: Document progress of teaching and learning.
R: This allows additional teaching to be based on what the learner has completed, thus enhancing the learners self-efficacy and encouraging the most cost-effective teaching.
Gulanick, 2007; Doenges, et. al, 2006; Kruse, et. al. 2003