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