The unwillingness to change behavior to manage health needs adds to the complexity of the critical care teaching-learning encounter. Disbelief and denial may be present any time during the hospitalization. The education process follows the same framework as the nursing process: assessment, diagnosis, goals or outcomes, interventions, and evaluation.4 Although this chapter discusses these steps individually, in practice, they may occur simultaneously and repetitively. Financial Factors Gifts: When a loved one is ill, it is traditional to send flowers, balloons, or cards. Sleep cycle alterations caused by sleep deprivation or sensory overload related to continuous noise from machines or people affect the patient’s ability to concentrate and comprehend information. It seems as if this century’s population of adults cannot tolerate a lack of information.   Studies have documented that quality education shortens hospital length of stay, reduces readmission rates, and improves self-care management skills.4-6 Complications associated with the physiologic stress response may be prevented if the patient or family perceives the education encounter as positive. Orient teaching to meet patient. Learning needs during the initial contact or first hours of hospitalization can be predicted. • What information have you received from other members of the health care team today? Bedside practitioners are expected to provide culturally competent care to each individual in the critical care setting. Assignment of multiple caregivers may negatively affect the ability of the patient and family to form a trusting relationship with the nursing staff. Challenges of Patient and Family Education Disbelief Use patient support groups and visits by recovered patients with same problem. It begins on admission and continues until the patient is discharged. Congruency between nurse-identified needs and patient-identified needs brings about more positive learning experiences and encourages the learner to seek further information.   Young adults may struggle with the issue of how to incorporate intimacy into their lives without feeling isolated from the mainstream social scene. Medications: name, why the patient is receiving them, side effects to report to the nurse or health care team These types of situations present the nurse with special challenges in the education of patients and families. Sources of emotional stress include fear of death, uncertain prognosis, role change, self-image change, social isolation, disruption in daily routine, financial concerns, and unfamiliar critical care environment.3,20 These intense emotions can lead to a crisis situation and alter the ability of the patient and family to cope.25,26 During the critical illness, an individual’s ability to process or retain information and ability to participate in the treatment plan could be altered.2 If the disease process or physiologic stressors impair the patient’s ability to make decisions, the burden of decision making will transfer to the family. For example, how the individual answers questions such as “How comfortable are you in reading medicine labels?” or “How well do you understand your disease process?” may help the practitioner gain insight into the level of health literacy and plan appropriate educational interventions. Malcolm Knowles described these principles of adult learning in a model known as andragogy. • Postpones decision making These types of questions also assist the patient and family to tell their story of the illness and communicate their perceptions of the experience,5 allowing the adult learner to feel respected and involved in the treatment process. The learning process generally involves altering some part of current behavior to produce changes in lifestyle, incorporating the new or chronic illness into daily living. The patient’s and family’s ability to learn and readiness to learn are assessed. Learning needs can be defined as gaps between what the learner knows and what the learner needs to know, such as survival skills, coping skills, and ability to make a care decision. 2. 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