A knowledge deficit in relation to healthcare is a lack of information needed for a thorough understanding of a disease process and recommended treatments and the ability to make informed choices or carry out tasks in alignment with health maintenance.
A huge barrier to understanding health-related information is low health literacy. Patients with low health literacy are less likely to be able to manage complex diseases resulting in more frequent hospitalizations and increased mortality. Patients over age 65 have a lower health literacy than those of younger ages. Other risk factors for low health literacy include a limited education, low socioeconomic status, and non-native English speakers.
Teaching is one of the most important interventions a nurse provides to patients. Nurses can treat, administer, support, perform, assess, manage, and solve, but nurses are doing a disservice to patients when they simply “do” without a “why.” Teaching is the opportunity to arm patients with the information they need to make the best decisions for their health and well-being.
Causes of Knowledge Deficit (Related to)
- Lack of exposure
- Misunderstanding of information
- Unfamiliarity with subject (new diagnosis or treatment)
- Complexity of information
- Cognitive limitations
- Lack of interest/refusal to learn
- Poor health literacy
- Lack of access to learning resources
Signs and Symptoms (As evidenced by)
Subjective: (Patient reports)
- Verbalizes poor understanding
- Seeks additional information
- Denial of a need to learn
Objective: (Nurse assesses)
- Inaccurate demonstration or teach-back of instructions
- Inability to recall instructions
- Exhibiting aggression or irritability regarding teaching follow-up
- Poor adherence or worsening medical condition
- Avoiding eye contact or remaining silent during teaching
- Patient will identify risk factors of their disease process and how to prevent worsening of symptoms
- Patient will participate in the learning process
- Patient will demonstrate the proper execution of wound care/insulin administration/blood pressure monitoring/etc.
- Patient will identify barriers to their learning and how to overcome
Nursing Assessment for Knowledge Deficit
1. Assess readiness to learn.
The nurse must first assess if the patient is ready to learn by assessing their interest, emotional status, and mental capacity for learning. The nurse may need to wait until a more opportune time to teach.
2. Assess health literacy.
Health literacy affects a patient’s ability to comprehend and process health-related material. Poor health literacy means a patient may lack an understanding of their disease, medications, and when to seek care.
3. Consider cultural factors.
Some cultures value strong familial influence and defer to older or male relatives for health decisions. The nurse must display cultural competency when educating patients.
4. Note individual limitations.
Developmental level, educational level, age, and language must be taken into account before providing written or verbal instructions.
5. Assess how the patient learns best.
Patients may be visual, auditory, or hands-on learners. The nurse should provide teaching materials in the best format for the patient.
6. Assess current understanding of a subject.
When instructing about a health-related matter it may be beneficial to first decipher what a patient already knows so as not to alienate them.
7. Assess the patient’s ability to comprehend and apply knowledge.
The nurse should assess whether a patient is mentally and physically capable of comprehending and implementing instructions provided to them.
Nursing Interventions for Knowledge Deficit
1. Create a quiet learning environment.
Teaching should not be attempted in certain situations. If a patient is in pain, worried, upset, or tired then they are not in a state of mind to retain information. The nurse should wait until the patient can concentrate on what is presented to them without interruption.
2. Include the patient in their plan.
Telling a patient what they should or shouldn’t do will not necessarily guarantee adherence. Creating a plan that fits the client’s lifestyle will ensure the highest chance of adherence and motivation.
3. Use multiple learning modalities.
After establishing how the patient learns best, offer choices. Verbal instructions along with written materials, instructional videos, and illustrations are a few options.
4. Repetition is key.
When patients are dealing with stressful illnesses and procedures, they may not always recall or completely comprehend teaching. Repetition and reinforcement is a strategy that solidifies information.
5. Don’t overload.
Too much information at once can be confusing and overwhelming. Present small chunks of information over time.
6. Establish priorities.
A patient may be dealing with a new diagnosis, diet, medications, and post-surgical instructions all at once. This is a large amount of information and the nurse should consider what is most urgent as well as what the patient is capable of implementing at this time.
7. Include family as requested.
Some patients may depend on family members and spouses for support. Identify the support person or caregiver that will benefit the most from teaching.
8. Use translation services and interpreters.
Providing educational materials in a patient’s preferred language or using an interpreter will ensure the best comprehension.
9. Provide positive reinforcement.
When a patient displays adequate learning such as recalling the action of a medication or demonstrating how to use a device, the nurse should provide positive reinforcement and praise.
10. Provide additional resources.
To support continued learning, the nurse may offer additional resources such as websites, support groups, and community resources.
11. Encourage questions.
Patients should feel safe to ask questions without judgment or fear of embarrassment. Sitting down, maintaining eye contact, appearing calm and unrushed, and encouraging questions will give the patient confidence to engage.
References and Sources
- Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2008). Nurse’s Pocket Guide Diagnoses, Prioritized Interventions, and Rationales (11th ed.). F. A. Davis Company.
- Hickey, K. T., Masterson Creber, R. M., Reading, M., Sciacca, R. R., Riga, T. C., Frulla, A. P., & Casida, J. M. (2018). Low health literacy: Implications for managing cardiac patients in practice. The Nurse practitioner, 43(8), 49–55. https://doi.org/10.1097/01.NPR.0000541468.54290.49
- Health Literacy. (2020). Healthy People. https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/interventions-resources/health-literacy
- Georgetown University. (n.d.). Cultural Competence in Health Care: Is it important for people with chronic conditions? Health Policy Institute. https://hpi.georgetown.edu/cultural/