Knowledge Deficit

Knowledge Deficit

(_)Actual (_) Potential

Related To:
[Check those that apply]
(_) New diagnosis:_____________________________
(_) Language differences:________________________
(_) Hospitalization
(_) Diagnostic test:_____________________________
(_) Surgical procedure:__________________________
(_) Medications:_______________________________
(_) Pregnancy
(_) Other:_____________________________
____________________________________
____________________________________

 

As evidenced by:
[Check those that apply]
Major:
(
Must be present)
(_) Verbalizes a deficiency in knowledge or skill. (_) Requests information.
(_) Expresses and inaccurate perception of health status.
(_) Does not correctly perform a desired or prescribed health behavior.
Minor:
(
May be present)
(_) Lack of integration of treatment plans into daily activities.
(_) Exhibits or expresses psychological alteration, (anxiety, depression) resulting from misinformation or lack of information.

 

Date &
Sign.
Plan and Outcome
[Check those that apply]
Target
Date:
Nursing Interventions
[Check those that apply]
Date
Achieved:
  The patient will:

(_) Describe disease process, causes, factors contributing to symptoms.

(_) Describe procedure(s) for disease or symptom control.

(_) Identify needed alterations in lifestyle.

(_) Other:

  (_) Assess patient's readiness to learn by assessing emotional respose to illness:
  • Acceptance
  • Anger
  • Anxiety
  • Denial
  • Depression
  • Other:

(_) Allow person to work through and express intense emotions prior to teaching.

(_) Examine patient's health beliefs:
________________________
________________________

(_) Assess patient's desire to learn.

(_) Assess preferred learning mode:

  • Auditory
  • Group
  • One to one
  • Visual
  • Other:

(_) Assess literacy level.

(_) Provide health teaching and referrals: ___________________
________________________
________________________
________________________

(_) Plan and share necessity of learning outcomes with patient - s/o.

(_) Evaluate patient - s/o behaviors as evidence that learning outcomes have been achieved:
________________________
________________________
________________________

(_) Other:________________
________________________
________________________
________________________

 

 

__________________________
Patient/Significant other signature

 

__________________________
RN signature