A knowledge deficit in health related knowledge is a lack of information needed for a thorough understanding of a disease process, health behaviors or the recommended treatments. Adequate health knowledge also includes the ability to make informed choices about health and carrying out tasks in alignment with health maintenance.
A common 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 health problems. 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.
In this article:
- Causes (Related to)
- Signs and Symptoms (As evidenced by)
- Expected Outcomes
- Nursing Assessment
- Nursing Interventions
- Nursing Care Plans
- References
Causes (Related to)
The following are common causes of a knowledge deficit:
- 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)
The following are common signs and symptoms of a knowledge deficit. They are categorized into subjective and objective data based on patient reports and assessment by the nurse.
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 to recommended treatment or worsening medical condition
- Avoiding eye contact or remaining silent during teaching
Expected Outcomes
The following are common nursing care planning goals and expected outcomes for a knowledge deficit:
- 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 self-care skills such as wound care/insulin administration/blood pressure monitoring/etc.
- Patient will identify barriers to their learning and recognize potential solutions to these barriers where possible.
Nursing Assessment
The first step of nursing care is the nursing assessment, during which the nurse will gather physical, psychosocial, emotional, and diagnostic data. In the following section, we will cover subjective and objective data related to a 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.
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 the instructions provided to them.
Nursing Interventions
Nursing interventions and care are essential for the patients recovery. In the following section, you will learn more about possible nursing interventions for a patient with a 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, they may not be 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 when possible.
2. Include the patient in their plan.
Telling a patient what they should or shouldn’t do will not necessarily guarantee adherence. The nurse can co-create a plan for self-care with the patient. 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. However, the nurse should check with the patient before involving family members.
8. Use translation services and interpreters.
Providing educational materials in a patient’s preferred language or using an interpreter will ensure the best comprehension. Avoid using family members, friends or other healthcare providers. With important health information, a professional interpreter should be used.
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. It should also be emphasized that there is no such thing as a “bad” question.
Nursing Care Plans
Nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for a knowledge deficit.
Care Plan #1
Diagnostic statement:
Knowledge deficit related to information misinterpretation as evidenced by inaccurate follow-through of instructions.
Expected outcomes:
- Patient will verbalize understanding of the disease process and treatment.
- Patient will demonstrate the necessary lifestyle changes and participate in the treatment regimen.
Assessment:
1. Consider health literacy and the motivation and readiness to learn.
Patients and families must realize the necessity or purpose of health education. Readiness varies per person and is also influenced by many personal and external factors. Learning requires energy and concentration to understand. Education without readiness to learn may not be helpful and might induce stress.
2. Assess knowledge needs.
Knowledge needs will provide a baseline for educational sessions. It is important that the nurse understands what the patient already knows.
3. Identify existing misconceptions regarding the topic.
Misconceptions may lead to ineffective health-related behaviors. Correcting current misconceptions will help the patient appreciate more to apply accurate and scientific health practices or replace traditional ineffective approaches.
Interventions:
1. Provide an atmosphere of respect and openness.
Respect is essential during health education, especially with patients with different health beliefs and cultural values.
2. Involve the patient in developing the teaching plan.
Setting goals with the patient and involving them with the teaching plan would provide them with inclusivity and greater autonomy to decide for their health.
3. Allow adequate time to comprehend information that conflicts with existing values or beliefs.
Information directly conflicting with values and traditions believed to be accurate and superior necessitates reevaluation. Patients may need more time to process new information and accept that the old material may not be helpful anymore.
4. Encourage the patient to ask questions.
Questions facilitate open communication between the patient and nurse. They also allow verification if the information was understood, correct misconceptions, and if further education must be employed. One technique that can also be employed is the “teach back” technique where the nurse asks the patient to “teach back” what they just learned.
Care Plan #2
Diagnostic statement:
Knowledge deficit related to a lack of exposure to information as evidenced by verbalization of a lack of understanding.
Expected outcomes:
- Patient will explain the disease state, recognize the need for medications, and understand the treatments.
- Patient will incorporate knowledge of health regimen into lifestyle.
Assessment:
1. Assess barriers that contribute to the lack of exposure to information.
Targeting these barriers (e.g., time to learn, access to and availability of information, language used) will help facilitate increased exposure to information.
2. Determine the patient’s learning style.
People learn differently. Knowing the right learning style will aid in how the nurse should relay information to the patient.
3. Ascertain priority learning needs.
The nurse should prevent information overload. Learning requires energy and concentration. It could be tedious for patients who are still recovering from hospitalization. Information overload can lead to stress and poor health-seeking behaviors.
Interventions:
1. Allow for self-directed learning.
Patients learn well when they feel involved in the learning process. They get to expose themselves to the available information at their own pace. They also get to address learning difficulties encountered alone along the process.
2. Give clear, thorough explanations and demonstrations.
Accurate yet simple information about their condition and the rationale behind the management will help the patient realize their responsibility for their health.
3. Provide information using various media (e.g., pictures, written instructions through brochures and pamphlets, computer-assisted programs, explanations, discussions, and pictures).
Lack of exposure to information may mean no access to various media. Knowing which media is available for continuous exposure to information will help maximize learning. Some patients may struggle to read written material but will learn easily from a video.
4. Utilize the teach-back technique by letting the patient explain the information the nurse gave in their own words.
The teach-back approach evaluates how well the nurse explained the topic, and the patient understands the teaching.
References
- Ackley, B.J., Ladwig, G.B.,& Makic, M.B.F. (2017). Nursing diagnosis handbook: An evidence-based guide to planning care (11th ed.). Elsevier.
- Carpenito, L.J. (2013). Nursing diagnosis: Application to clinical practice (14th ed.). Lippincott Williams & Wilkins.
- 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.
- Gulanick, M. & Myers, J.L. (2014). Nursing care plans Diagnoses, interventions, and outcomes (8th ed.). Elsevier.
- 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/
- Wang, T., & Voss, J. G. (2022). Information Overload in Patient Education: A Wilsonian Concept Analysis. Nursing Science Quarterly. https://doi.org/10.1177/08943184221092451
