The teaching-learning process is a planned interaction promoting behavioral change that is not a result of maturation or coincidence. Teaching is an active process in which an individual shares information with others to provide them with information to make behavioral change. Learning is the process of assimilating information with a resultant change in behavior that can be measured. Each nurse has a philosophy of learning, based on individual beliefs that are the foundation for behavior.

Client education relies on a variety of learning theories by Pavlov, Skinner, Thorndike, Dewey, and others. Knowles’s assumptions about adult learners are applicable to client education. These assumptions are as follows: (1) An individual develops in an orderly manner from dependence to independence, (2) Learning readiness is affected by developmental stage and sociocultural factors, (3) An individual’s previous learning experiences are foundations for further learning, and (4) Immediate application of knowledge and skills reinforces learning.

The principles of learning include (1) Material should be meaningful to clients, easily understood, and related to previously learned information (relevance), (2) Clients should want to learn and perceive the value of information (motivation), (3) Clients should be able and willing to learn (readiness), (4) Clients should be developmentally able to learn and have the required cognitive and psychomotor abilities to learn (maturation), (5) Feedback to clients should be positive and immediate (reinforcement), (6) Active involvement promotes learning (participation), (7) Learning material should incorporate previously learned information and be presented in sequence from simple to complex (organization), and (8) Retention of material is reinforced by practice, repetition, and presentation in a variety of ways (repetition). Common barriers to learning are environmental, sociocultural, psychological, and physiological. Client learning is affected by learning plateaus, or peaks in effectiveness of teaching and depth of learning.

The domains of learning are the cognitive (intellectual), affective (emotional and attitudinal), and psychomotor domains. Teaching strategies should be based on an assessment of the best domain(s) to use for a particular subject. The most common teaching strategies are discussion, demonstration, role playing, visual aids, programmed instruction, and computer-assisted instruction. According to the American Nurses Association’s Social Policy Statement (1995), nurses are legally responsible for client teaching. The Joint Commission for Accreditation of Health Care Organizations and the American Hospital Association’s Patient’s Bill of Rights (1980) also mandates client teaching in health care settings.

Learning needs and abilities change throughout the life span. When teaching young children, nurses work with the child’s caregiver to provide teaching. Children learn by playing. Older children enjoy art and hands-on work with equipment. Adolescents are influenced by peers, so group teaching is effective with them. They also respond better to nurses who are good role models for health and nurses who keep their need for independence in mind. Older adults have visual and hearing impairments. They often need written instructions and explanations.

The teaching-learning process is similar to the nursing process. The nurse begins with an assessment of the learning styles, learning needs, abilities and strengths, readiness, previous experience, and present knowledge of the client. A lack of knowledge leads to a nursing diagnosis of Deficient Knowledge. Lack of knowledge may also be an etiology of other nursing diagnoses, such as Risk for Infection or Self-Care Deficit.

Planning and outcome identification involves what to teach, how to teach, who will teach, when teaching will occur, and where teaching will occur. Note that teaching can occur when the need arises (informal teaching) or when scheduled (formal teaching). Specific learning goals should be established, including measurable behavioral change anticipated, time frame, methods, and intervals for evaluation. When teaching the nurse should also consider possible developmental delays, the effects of chronic illness on learning, low literacy skills, and sensory impairments. When teaching home health care clients, the nurse should consider the environment in which the client lives, the client’s ability to access funds for treatment, and the client’s personal support system and community resources.

Implementation of the teaching plan requires the nurse to be knowledgeable about the topic and to have the interpersonal skills to get the message across. Evaluation involves determining what the client has learned and assessing the nurse’s teaching effectiveness. Effective teaching leads to a change in client behavior that promotes health.