Handout: Learning Readiness Assessment Document



Learning Readiness Assessment Guide: CKD

The following tool is intended to be used as a guide, in order to assist health care providers in establishing where the learner is “at”, as well as identify learning milestones that indicate mastery of key concepts in CKD care. Please feel free to adapt and amend as per your professional judgment.

Please note that the assumption behind this tool is that you have already checked in with the patient/family about their primary concerns for that visit, and have dealt with those concerns, prior to starting into the learning needs.

|Key Learnings | Indicators: Not yet Ready |Suggested Support |Indicators: Partially Meeting |Suggested Support |Indicators: Advanced, ready for |Suggested Support |

|(over the course of CKD| | | | |more | |

|care) | | | | | | |

|1. Understands the |-Has few or no questions about the |Supportive measures/counseling.|-Shows some interest in medical |-Have the person tell you what they |-Indicates they have done research|-Short, concentrated teaching |

|diagnosis of CKD, and |illness. | |and self treatment. |understand about CKD, and |on their own (internet, library, |sessions about specific topics (ie |

|ways to delay disease | |Explore the impact of the | |correct/encourage as indicated. |other consultations). |specifics about ways to delay |

|progression. |-When asked what he/she knows, indicates |diagnosis. |-Asks some questions that indicate| | |progression, symptoms to look for, |

| |little understanding. | |awareness, but with gaps in |-Provide short, concentrated bits of |-Asks pertinent, focused questions|what to expect). |

| | |Resist the urge to move on to |knowledge (ie talks accurately of |additional general information (ie how to |that indicate application of the | |

| |-Questions/comments indicate a lack of |further teaching until patient |diagnosis, but doesn’t understand |delay progression, how the medications |theory to their own situation and |-Engage in assessment of learning or |

| |understanding of the consequences of CKD |showing signs of interest (see |medication usage). |will help, what symptoms to report, etc). |symptoms. |a teach- back to check understanding.|

| |(ie talks of cure or “beating this”). |next column), while | | | | |

| | |appreciating that sometimes a |-Group Education would be a |-Engage in assessment or a teach-back to |-Indicates some level of planning |-Advanced group education classes, |

| |-Shows little interest in treatment |low eGFR may dictate the need |benefit, as co-learning with other|check understanding. |ahead (ie asks about |such as advanced diet classes, if |

| |decisions. |to push. |patients, and meeting others with | |self-monitoring, things that they |available, very useful at this stage.|

| | | |the same illness very useful at |-Provide some short written |might try). | |

| |-States s/he “feels fine” |The person may simply need some|this stage. |directions/diagrams/summary of discussion | |-Provide some short written |

| | |time to assimilate the | |to take home. | |directions, diagrams, websites, |

| |-expresses anger/denial about the |diagnosis. | | | |summary of discussion to take home. |

| |diagnosis | | |-Expect pts to shift back and forth | | |

| | | | |between understanding and forgetting. | | |

|Key Learnings | Indicators: Not yet Ready |Support |Indicators: Partially Meeting |Support |Indicators: Advanced, ready for |Support |

| | | | | |more | |

|2. Understands common |To be completed | | | | | |

|symptoms of CKD, how | | | | | | |

|they are managed, and | | | | | | |

|what symptoms to report| | | | | | |

|to staff. | | | | | | |

|3. Understands |To be completed | | | | | |

|rationale behind proper| | | | | | |

|use, and common side | | | | | | |

|effects, of medications| | | | | | |

|in CKD. | | | | | | |

|4. Understands |To be completed | | | | | |

|pertinent lab values, | | | | | | |

|and takes part in | | | | | | |

|monitoring own lab | | | | | | |

|values. | | | | | | |

|5. Participates in |To be completed | | | | | |

|Advance Care Planning | | | | | | |

|with family and HCPs. | | | | | | |

|Key Learnings | Indicators: Not yet Ready |Support |Indicators: Partially Meeting |Support |Indicators: Advanced, ready for |Support |

| | | | | |more | |

|6. Understands renal |-Unwilling to engage in discussions |Supportive/counseling |-Shows awareness of treatment |-Have the pt describe what they know |-Shows an awareness of the |-Offer specific modality |

|replacement or conservative |about renal replacement therapy in | |options, but reluctant to consider|about treatment options and |treatment options, asks pertinent |information, engage in planning|

|options for CKD. |clinic appts (ie tells you that they |Explore the barriers to discussion |choosing an option at this time. |correct/encourage as indicated. |questions applied to their own |for access creation, etc. |

| |won’t think about this until they |about treatment options (ie past | | |situation. | |

| |absolutely have to). |experiences with dialysis within the |-Has a general sense of options, |-Negotiate next steps with the pt, as| |-Dialysis unit tours and |

| | |family or acquaintances, fears, etc). |but demonstrates gaps in |to what would be helpful info to |-May have made a preliminary or |general overviews of PD |

| |-Unwilling to attend treatment | |knowledge, or misinformation, |provide. |permanent decision about which |techniques may be useful at |

| |options group classes. |Resist the urge to force someone to |about renal replacement or | |choice they wish to make. |this stage. |

| | |discuss treatment options or attend |conservative treatment. |-Focus treatment info on lifestyle | | |

| |-Indicates that this is not something|classes, but if the eGFR is low, do | |matters, as this is likely most |-Questions indicate application of|-Maximize opportunities for |

| |you need to go into at this time. |explain the consequences of NOT making | |relevant at this stage (ie not the |their understanding, shows some |pt/family to meet the dialysis |

| | |a timely decision | |time to describe how the treatment |evidence of planning ahead. |staff, or palliative staff (if |

| |-Changes the subject when this topic | | |works in great detail). | |applicable) especially if there|

| |is brought up. |-Peer support from someone who has | | | |will be a transfer of care to |

| | |experiences renal replacement? | |-Offer group education classes (if | |new staff (ie CKD to PD, HD). |

| |-Focus is elsewhere, ie. “what can I | | |not already done), followed up by a | | |

| |eat?” | | |one-on-one appt to discuss specific | |-Prepare pt/family regarding |

| | | | |needs. | |what to expect from the renal |

| | | | | | |replacement or conservative |

| | | | |-Offer peer support from other pts | |care teams. |

| | | | |with experience with the various | | |

| | | | |modalities. | | |

| | | | | | | |

| | | | |. | | |

|Key Learnings | Indicators: Not yet Ready |Support |Indicators: Partially Meeting |Support |Indicators: Advanced, ready for |Support |

| | | | | |more | |

|7. Recognizes own personal |-Leaves decision-making to |Self-managing health care may not be |-Has some involvement with health |-Offer lots of encouragement. Follow|-Is able to identify own learning |-Engage in consultative |

|response to treatment and |providers. |a value of this pt/family. |care decisions, can identify some |up with action plans as negotiated |needs, treatment preferences. |approaches, rather than |

|negotiates care and care | | |goals of care. |with pt/family. | |prescriptive styles (ie “What |

|decisions with health care |-Accepts directives from providers|Resist the urge to push | | |-Leads the discussion about |about…?”, or “Have you thought |

|providers. |without question. |self-management, but do invite pts to|-Identifies some preferences for |-Recognize achievements regularly. |specific care decisions. |about..? or “Would you |

| | |involve themselves in care if/when |various options. | | |consider…?). |

| |-Has little involvement in health |able. | |-Engage in increasingly consultative |-Shows confidence in own opinion, | |

| |care planning or health | |-Is working on some specific |approaches, rather than directive |consults with health care |-As skill mastery progresses, |

| |maintenance. |Explain the rationale behind, and |activities centred around a goal or |style (ie “What about…?”, or “Have |providers, weighs advice given |encourage pt to participate |

| | |benefits of, self-management, as a |action plan (ie exercise, wt loss, |you thought about..?) |against own values. |increasingly in planning. |

| | |philosophy of the program. This is |diabetic monitoring, etc.). | | | |

| | |particularly useful in a group | |-Recognize that building confidence | |-Recognize the pt’s expertise when|

| | |education class, so that all hear the| |is the major focus for this stage. | |negotiating treatment decisions. |

| | |same message. | | | | |

| | | | | | |-Demonstrate trust in the pt’s |

| | |Regularly check-in with pt to see if | | | |ability to make good judgments. |

| | |they have goals they wish to address.| | | | |

Learning Readiness Assessment Guide: Dialysis

The following tool is intended to be used as a guide, in order to assist health care providers in establishing where the learner is “at”, as well as identify learning milestones that indicate mastery of key concepts in ESRD care. Please feel free to adapt and amend as per your professional judgment.

Please note that the assumption behind this tool is that you have already checked with the patient/family about their primary concerns for that visit, and have dealt with those concerns, prior to starting into the learning needs.

|Key Learnings (over the course of | Indicators: Not yet Ready |Suggested Support |Indicators: Partially Meeting |Suggested Support |Indicators: Advanced, ready for more |Suggested Support |

|dialysis care) | | | | | | |

|1. Understands how to care for |-When asked about his/her |Resist urge to push information; |-Indicates some understanding about |Have the pt describe what they |-Is able to accurately describe |Quiz the pt with possible |

|dialysis access. |understanding about access care, |explore barriers to learning |access care, with misinformation and |know about treatment options and |appropriate access care. |scenarios where the pt is |

| |indicates little knowledge. |(illness, grief, avoidance). |gaps in knowledge. |correct/encourage as indicated. | |required to use judgment |

| | | | | |-Asks questions that indicate |about access care (ie when |

| |-Changes subject when information |Suggest a return visit to discuss |-Indicates interest in learning more,|Offer short, focused information |planning ahead (ie identifies |showering, swimming, |

| |offered. |again at an agreed upon time. |can apply learning to own situation. |about access care, followed by |symptoms and correct responses to |protection during sports, |

| | | | |short, easy to read instructions |possible future access problems). |etc.) to evaluate |

| |-Has few or no questions about the | |-Learning may be rote (ie without |to take home. | |understanding. |

| |access or access care. | |understanding rationale). | | | |

|Key Learnings (over the course of | Indicators: Not yet Ready |Support |Indicators: Partially Meeting |Support |Indicators: Advanced, ready for more |Support Required |

|dialysis care) | | | | | | |

|2. Understands common complications |- | | | | | |

|of dialysis, and what symptoms to | | | | | | |

|report to staff. | | | | | | |

|Key Learnings (over the course of | Indicators: Not yet Ready |Support |Indicators: Partially Meeting |Support |Indicators: Advanced, ready for more |Support Required |

|dialysis care) | | | | | | |

|3. Understands pertinent lab values,| | | | | | |

|and takes part in monitoring own lab| | | | | | |

|values. | | | | | | |

|Key Learnings (over the course of | Indicators: Not yet Ready |Support |Indicators: Partially Meeting |Support |Indicators: Advanced, ready for more |Support Required |

|dialysis care) | | | | | | |

|4. Understands rationale behind, | | | | | | |

|proper use, and common side effects | | | | | | |

|of medications in dialysis. | | | | | | |

|Key Learnings (over the course of | Indicators: Not yet Ready |Support |Indicators: Partially Meeting |Support |Indicators: Advanced, ready for more|Support Required |

|dialysis care) | | | | | | |

|5. Participates in Advance Care | | | | | | |

|Planning with family and HCPs | | | | | | |

|Key Learnings (over the course of| Indicators: Not yet Ready |Support |Indicators: Partially Meeting |Support |Indicators: Advanced, ready for |Support Required |

|dialysis care) | | | | |more | |

|6. Understands the dietary |-Has few or no questions about diet |Resist the urge to push |-Has some understanding of change in |Provide short, focused information |-Looks beyond the material |Encouragement! |

|changes required with renal |or nutrition. |information; explore barriers to |nutritional needs, with gaps and |sessions, and lots of written materials to|provided by the clinic (ie | |

|replacement, and how this may | |learning (especially if new to |misinformation. |refer to at home. |internet, recipe books, etc.) |Find out from pt/family |

|differ from CKD. |-When asked about level of |dialysis-may be going through | | | |what, if any, additional |

| |understanding, indicates little or no|grief, anxiety, feeling ill) |-Shows interest in discussing, but |Expect pt to shift between understanding |-Shows confidence in ability to |support they’d prefer. |

| |interest in hearing about diet | |often forgets or needs lots of |and forgetfulness. |choose wisely, initiates a | |

| |changes. |Arrange to come back at an agreed |reinforcement. | |consultation when a change in | |

| | |upon time. | |Promote group classes on healthy eating |status occurs. | |

| |-Indicates that he/she is not | |-Collects lists of foods, actively |(if available). | | |

| |following any diet regimen. |Leave some written materials |looks for recipes, shows attempts to | | | |

| | |(brief and general). |incorporate changes in diet. |Provide information about what they CAN | | |

| |-Expresses confusion/forgetfulness | | |eat, with less emphasis on what they can’t| | |

| |about receiving information in past |Families can be very helpful in |-Phones or contacts dietitians |eat (ie frame the information positively).| | |

| |about diet and renal disease |learning this material, if the pt.|frequently to verify choices. | | | |

| |(“nobody told me…”). |cannot. | |Support confidence-building by getting | | |

| | | |-May lack confidence in own ability |pt/family to explain THEIR rationale for a| | |

| | | |to choose healthy foods, seeks |choice, rather than just verifying | | |

| | | |approval. |appropriateness. (ie if you can get THEM | | |

| | | | |to explain why it’s a good choice-or | | |

| | | | |not-they will have learned more). | | |

|Key Learnings (over the course| Indicators: Not yet Ready |Support |Indicators: Partially |Support |Indicators: Advanced, ready for more |Support |

|of dialysis care) | | |Meeting | | | |

|7. Recognizes own personal |-Leaves decision-making to |Self-managing health care may not be a |-Has some involvement with |Offer lots of encouragement. Follow up with|-Is able to identify own learning |Engage in consultative |

|response to treatment and |providers. |value of this pt/family. |health care decisions, can |action plans as negotiated with pt/family. |needs, treatment preferences. |approaches, rather than |

|negotiates care decisions with| | |identify some goals of care. | | |prescriptive styles (ie “What |

|health care providers. |-Accepts directives from |Resist the urge to push self-management| |Recognize achievements regularly. |-Leads the discussion about specific |about…?”, or “Have you thought|

| |providers without question. |on these pts, but do invite them to |-Can identify preferences for| |care decisions. |about..? or “Would you |

| | |involve themselves in care if/when |various options. |As skill mastery progresses, engage in | |consider…?). |

| |-Has little involvement in |able. | |consultative, rather than prescriptive |-Shows confidence in own opinion, | |

| |health care planning or | |-Is able to work on some |approaches (ie “What about…?”, or “Have you|consults with health care providers, |Recognize the pt’s expertise |

| |health maintenance. |Explain the rationale behind, and |specific activities centred |thought about..?) |weighs advice given against own |when negotiating treatment |

| | |benefits of, self-management, as a |around a goal or action plan.| |values, etc. |decisions. |

| | |philosophy of the program. This is | | | | |

| | |particularly useful in a group | | | |Demonstrate trust in the pt’s |

| | |education class, so that all hear the | | | |ability to make good judgments.|

| | |same message. | | | | |

| | | | | | | |

| | |Regularly check-in with pt to see if | | | | |

| | |they have goals they wish to address. | | | | |

| | | | | | | |

| | | | | | | |

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