Introduction
The purpose of this assignment is to explore elements of patient’s learning needs using the case of Barbara Lund, a 36-year-old woman recovering from a recent surgical resection of a malignant thoracic spinal cord tumor.
Two methods of assessing the patient’s learning needs
Different methods of determining Lund’s learning needs are available. To know what Lund considers as her learning needs, it is imperative to engage her directly or indirectly.
Interview
The nurse educator shall use an interview to collect learning assessment data from Lund. The process shall be a face-to-face conversation to elicit responses. A nurse educator will ask Lund a series of questions regarding her current of knowledge about her medical condition. An interview is an inexpensive method of assessing the patient’s learning needs. It would ensure that a broader perspective of Lund’s tumor, anxiety, prognosis and potential functional abilities are determined. The conversation will be open-ended to probe the patient for deeper insights. The nurse educator shall be able to create a rapport with Lund and encourage her to be open about the interview. This technique will generate information required to assess Lund’s learning needs. Interview shall ensure that the nurse educator can clarify any questions that Lund does not understand while nonverbal cues would also provide additional information that the nurse educator needs to know.
Interview, however, can lead to bias because of the interest of the nurse educator. In addition, the self-reporting nature of this method exposes its respondent’s bias. The interview process is intended to be as objective as possible to overcome potential bias. The interview method also consumes time, open-ended data could be difficult to interpret while unfocused interview questions could lead to collection of irrelevant data to determine Lund’s learning needs.
A focus group discussion
An interdisciplinary team was involved in the care provision for Lund. Hence, a focus group discussion done with few stakeholders will be used to gain important information on the patient’s learning needs. The nurse educator will conduct an interview with few representatives of the interdisciplinary team that attended to Lund to determine her learning needs. The focus group members will provide their candid views and opinions about Lund’s learning needs.
A focus group discussion would ensure that the nurse educator obtains multiple perspectives from various members of the interdisciplinary team about Lund’s learning needs. It will show attitudes and beliefs of the patient from professional perspectives and may provide useful data for follow-ups. The method facilitates comments, explanations and use of experiences to assess the patient’s learning needs (McCawley, n.d).
A focus group is inexpensive and easy to conduct. It would lead to generation of new ideas to evaluate various perspectives for the patient. An interesting discussion that uses credible questions would result in highly valid data.
A focus group method, however, requires effective moderation skills and control for the group to avoid misuse. An interdisciplinary team may be highly variable and some members of the panel may not contribute toward Lund’s learning need assessment. Further, the group discussion may not yield the desired data because of its poor abilities to provide detailed information. In addition, it could be difficult to avoid bias based on members’ participation and data interpretation. Finally, a focus group discussion can consume much time relative to a face-to-face interview with the patient.
Criteria for prioritizing the patient’s learning needs
Lund has started to ask about her prognosis and potential functional abilities after the surgery. The patient also admitted that her surgeon tried to explain to her about the surgery but she could not understand because of her ‘naivety’ in anything medical.
Criteria for prioritizing Lund’s learning needs shall be based on gaps that are identified during learning need assessment. These criteria for prioritization will however focus on important elements of the patient care.
First, based on Lund’s naivety on medical issues, it is imperative to start with the basic elements of her cancer and surgery. From a general perspective, Lund will have to learn about cancer medications, treatment, complications and improving her quality of life after the discharge. In addition, the patient will also require information about activities of daily living, follow-ups, care and changes in her condition after the discharge. Such information will be useful for Lund and her family. Lund must understand that she must remain in bed for many days after surgery to ensure healing of the wound. She must observe different roles of an interdisciplinary team such as physical therapists, surgeons and rehabilitation specialists. Pain and anxiety management are also important for Lund and thus she must learn about them as priorities (Columbia University, 2015).
Specifically, the nurse educator must explain to Lund that the surgery was the most important intervention for her tumor condition (Ogden, 2015). As a result, many patients have recorded positive outcomes (Mayo Clinic, n.d). In addition, the nurse educator should point out that her condition is rare and could be difficult to manage (Eskandari & Schmidt, 2010). In some cases, the prognosis may be poor, particularly when the tumor is large or during subtotal surgical resection and in association with neurofibromatosis (Gnanalingham, Bhattacharjee, & O’Neill, 2004).
Finally, before the discharge, the nurse educator should prioritize rehabilitation care learning needs, guide Lund on activities, impacts of strenuous activities and physician’s recommendations.
Major clues for the patient’s readiness to learn and the PEEK model
First, Lund has demonstrated readiness to learn by asking her team members about her prognosis and potential functional abilities. Second, the patient also notes that her surgeon tried to explain the surgery to her but she could not understand because of her medical naivety. Finally, Lund is quite anxious about the cancer diagnosis and about how she will be able to continue caring for her son. These elements show that the patient is ready to learn.
However, during the acute stage of her cancer, Lund was relied on an interdisciplinary team and her husband for support. Lund’s dependency was vital because of emotional, physical and medical needs caused by the surgery and anxiety over the death of her father. As a result, Lund has spent her energies on coping with psychosocial and physiological needs of the condition. Hence, her major focus has been on living and in this regard, demonstrating learning readiness in critical condition could be rare. Lund had limited energy to learn during her acute stage. In addition, pain and fatigue could have affected her readiness to learn. At this time, any learning needs and prioritization for Lund should focus on diagnostic evaluation and treatments because they are short-term and reflect the current situation of Lund. Once this condition is over, however, readiness to learn becomes obvious for nurse educators. Therefore, as Lund recovers and her independence emerges, she can now learn about post-acute period of her tumor. For Lund, an improved physical recovery, the need to understand her surgery, prognosis, potential functional abilities and the desire to care for her son and achieve a normal status, have acted as incentives for learning readiness about her surgery and current condition. Lund could have a short hospital stay and therefore it is necessary to observe learning readiness for management and prevention of complications for surgery after the discharge.
Although Lund displays elements of readiness to learn, there are potential obstacles that could interfere with her readiness to learn. Two elements of PEEK (Perceptions, Expectations, Emotions and Knowledge) model are used to describe possible readiness to learning obstacles.
First, Lund notes that she is not knowledgeable in the medical field. This situation can greatly influence her readiness to learn about her tumor, treatment, management and complications.
Second, Lund needs to manage her emotions about the surgery and other family relations. For instance, Lund was worried prior to the surgery. Presently, she worries about caring for her son. Anxiety about her prognosis, possible functional abilities and care for her son could affect Lund’s readiness to learn. Data collected from knowledge and emotional evaluation could be used to offer the required baseline information for improving learning readiness for Lund.
The VARK model and learning preference
Determining a preferred learning style for Lund would entail evaluating how the patient can learn best, the most suitable time to learn best and her abilities to learn best what she needs to learn. It could be relatively simple to determine whether Lund can learn better through written/verbal, visual/graphic, auditory/oral, kinesthetic/tactile concrete or active/reflective. However, the nurse educator must evaluate Lund’s educational and literacy levels to establish her possible learning preferences. In some instances, the patient or family members might not be interested in learning. For instance, Lund’s tumor is a rare condition and therefore the patient and family members may not be able to know what to ask an interdisciplinary team or do not yet understand that they will require information to manage the condition. Moreover, given the rarity of the tumor, the family of Lund may have never interacted with patients with the similar condition and therefore may have no knowledge on what to ask or expect from physicians and treatment. On the other hand, it is vital for the nurse educator and her team to understand the challenges that Lund may face with medical surgery learning, tumor management and post-discharge care. Hence, the nurse educator and her team must understand Lund’s knowledge about her current condition.
Based on the VARK model, Lund’s instructional approach shall be based on verbal/written preference. Lund’s level of knowledge on surgery and medical issues is described as ‘naivety’. Therefore, she can learn best and comfortably by reading. That is, Lund will read the written information and then internalize it in a long-term memory. Lund may also write down what she has learned as a way of expressing it.
Conclusion
It is imperative for nurses to assess their patients’ learning needs, learning preferences and prioritize learning needs. Data collected from patients are useful for managing their conditions. Assessment is necessary for prioritization and diversification of learning approaches to address knowledge issues that patients may have while in the hospital and after discharge.
References
Columbia University. (2015). Spinal Cord Tumor Resection. Web.
Eskandari, R., & Schmidt, M. H. (2010). Intramedullary spinal melanocytoma. Rare Tumors, 2(2), e24.
Gnanalingham, K., Bhattacharjee, S., & O’Neill, K. (2004). Intraosseous malignant peripheral nerve sheath tumor (MPNST) of the thoracic spine: a rare cause of spinal cord compression. Spine, 29(18), E402-5.
Mayo Clinic. (n.d). Surgery for malignant and primary spinal column tumors. Web.
McCawley, P. F. (n.d). Methods for Conducting an Educational Needs Assessment.
Ogden, A. T. (2015). Intramedullary Spinal Cord Tumors. Web.