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Q: What methods do you recommend hospital staff use to assess for learning readiness? How must they be altered if the patient is from a different country? How do cultural differences affect a readiness to learn assessment?
A: The readiness to learn assessment is incorporated into the patient’s medical history and begins when the patient is admitted to the hospital, says Nell Kapeghian, MSN, RN, coordinator of patient education at Deborah Heart and Lung Center in Browns Mills, NJ.
At the time of admission, barriers to learning are noted. For example, if the patient is non-English speaking or deaf, he or she might have trouble communicating with a health care professional. Physical problems that would inhibit learning such as pain and psychosocial barriers such as anxiety also are noted and assessed at each teaching session. Frequently the admitting nurse will ask patients what they want to know and what they already know about their illness or treatment in an effort to determine whether they are motivated to learn.
"Sometimes patients don’t want to know anything; they just want to get through the surgery or procedure. Their coping mechanism interferes with their readiness to learn," says Kapeghian.
Begin with a basic description of the disease or treatment and then take cues on the patient’s readiness to learn by his or her questions or lack of questions, says Patricia Agre, EdD, RN, director of patient and family education at Memorial Sloan-Kettering Cancer Center in New York City.
"Ideally, the patients should be the ones to tell the health care professional what they are willing to learn and at what pace. Patients have the right not to learn anything," Agre says.
Yet there is one exception to this rule. The patient or his or her caregiver must learn self-care techniques that impact the patient’s safety, such as the care of catheters or drains and the administering of medications.
"When it comes to self-care, the patients do have to learn, and the nurses have to negotiate to see how that will happen, at what pace, and what kind of help the patient will need," says Agre.
When working with people from another culture, health care workers often have to alter the methods they use for negotiating teaching sessions or interpreting cues for readiness to learn. For example, patients from Asia or the Middle East would not readily ask the questions that so many health care providers interpret as a readiness to learn. "In most of what is considered the non-Western world, the health care provider is the authority figure. They do not educate the patient, and the patient is not particularly concerned about knowing the information," says Sondra Thiederman, PhD, president of Cross-Cultural Communication, a San Diego company that specializes in training health care professionals in cross-cultural issues.
Body language is not universal, so it is not a good method to determine readiness to learn with people from other cultures, says Thiederman. For example, arms crossed over the chest would not necessarily signal an unwillingness to learn the information. The patient might simply be uncomfortable because of the language barrier, she says.
Asking patients what they already know about their disease or treatment is not always useful either.
"The patient may be uncomfortable about what they do know because they have some beliefs that don’t necessarily fit with Western health care," says Thiederman.
Yet questions are a good assessment tool, no matter the culture. They just may have to be asked differently, depending on the patient’s cultural background. To help health care providers at Memorial Sloan-Kettering better assess a patient’s readiness to learn, Agre developed a loose leaf binder on different cultures and religions. Information covered includes whether people from this culture like to be addressed formally or informally, their medical beliefs and use of folk medicine, diet restrictions, beliefs about death and dying, their social structure, and decision-making hierarchy. If the nurse knows there are diet restrictions in the culture, he or she would be able to ask specific questions to negotiate a diet that is appropriate for the patient’s condition as well as the culture, and thus increase compliance.
People in most cultures are discreet, so it is important to word the questions right, says Thiederman.
"When we ask questions openly, they have a tendency to feel intruded on. If we explain why we are asking the question, that will help," she explains.
[Editor’s Note: For more information on cross- cultural issues or on staff training, contact: Sondra Thiederman, PhD, President, Cross-Cultural Communication, 4585 48th St., San Diego, CA 92115. Telephone: (800) 858-4478.]