# Situation: A 52-year-old delivery driver was diagnosed with type 2 diabetes mellitus 1 week ago. His glycated hemoglobin (HbA1c) is 8.4%, and he was started on metformin. He finished high school and reads well. He tells the nurse at the hospital's outpatient diabetes clinic, "My father had diabetes and lost a leg. I do not want that to happen to me." The nurse plans a series of teaching sessions for him. In planning the sessions, the nurse applies the adult learning principles of andragogy. According to these principles, which kind of content MOST motivates an adult learner such as this client?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630346  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 52-year-old delivery driver was diagnosed with type 2 diabetes mellitus 1 week ago. His glycated hemoglobin (HbA1c) is 8.4%, and he was started on metformin. He finished high school and reads well. He tells the nurse at the hospital's outpatient diabetes clinic, "My father had diabetes and lost a leg. I do not want that to happen to me." The nurse plans a series of teaching sessions for him.

In planning the sessions, the nurse applies the adult learning principles of andragogy. According to these principles, which kind of content MOST motivates an adult learner such as this client?

## 보기

1. Content that helps him solve a problem he faces now **✔ 정답**
2. Content arranged by subject, as in a school textbook
3. Grades or rewards given by the teacher for each lesson
4. Instructions delivered by an expert with little discussion

**정답: 1**

## 해설

Knowles's andragogy holds that adults are self-directed, bring experience, are motivated internally, and want learning that solves problems they face now. Teaching that is immediately useful for managing his new diabetes fits these principles best.

## 심화 해설

Why option 1 is correct
Knowles’s andragogy describes adult learners as oriented toward learning that is immediately applicable. The six principles include the learner’s self-concept, the role of experience, readiness to learn, orientation to learning, the learner’s need to know, and intrinsic motivation [1]. Among these, orientation to learning means that adults prefer problem-centered content over subject-centered content. A 52-year-old man who was diagnosed with type 2 diabetes only 1 week ago is facing concrete daily problems: what to eat, how to take metformin, how to recognize hypoglycemia, and how to protect his feet. Content that helps him solve a problem he faces now directly matches this principle. His statement about his father losing a leg also shows that he has already identified a personally meaningful concern, which increases his readiness to learn. Adult learners engage most when the learning task is tied to a real-life role or problem they must manage now, not to a future academic goal.

Why the other options are less effective
Option 2 arranges content by subject, as in a school textbook. This is a subject-centered, not problem-centered, approach. Andragogy explicitly contrasts adult orientation to learning with the subject-centered model more typical of pedagogy [1]. Option 3 relies on grades or rewards given by the teacher. Knowles’s final principle holds that adults are motivated more by intrinsic factors than by external rewards [3]. A patient who says he does not want to lose a leg is already internally motivated; adding grades would shift focus away from the personal meaning of diabetes management. Option 4 describes expert-led instruction with little discussion. This ignores the adult learner’s self-concept as a self-directed person and the value of drawing on his own life experience [1]. A delivery driver with years of work and family experience learns better when he can connect new information to what he already knows and when he participates actively.

Applying andragogy to diabetes education
In cardiovascular patient education, higher concordance with andragogy principles is associated with education that respects the patient’s experience and addresses his perceived needs . For this client, the nurse can begin the first session by asking what problem worries him most right now, such as foot care or meal planning during work shifts. The teaching plan then becomes problem-centered from the start. The nurse’s role shifts from delivering content to facilitating the client’s use of his own experience and current concerns as the starting point for learning.

| Andragogy principle | What it means for this client | Teaching example |
| --- | --- | --- |
| Orientation to learning | Prefers problem-centered, immediately useful content | Start with foot inspection and footwear during delivery shifts |
| Readiness to learn | Motivated by a new life role: person with diabetes | Teach what he must know before his next work week |
| Self-concept | Sees himself as capable and self-directing | Ask him to identify his own questions and set one goal |
| Role of experience | Brings decades of work and family experience | Link meal timing to his actual driving route and breaks |
| Need to know | Wants to understand why each behavior matters | Explain how high glucose damages nerves and vessels in the foot |
| Intrinsic motivation | Driven by fear of amputation and desire to stay healthy | Use his stated concern as the anchor for each session |

Watch out! Do not confuse andragogy with simply being friendly or using simple words. The key difference is problem-centered, experience-based, self-directed learning, not the difficulty level of the material. Key point! For a newly diagnosed adult, the most motivating content is whatever helps him manage the problem he is facing today, which is why option 1 is the best answer.References (research sources)

- [1]Andragogy in Practice: Applying a Theoretical Framework to Team Science Training in Biomedical Research.Research articleKnapke JM, Hildreth L, Molano JR, Schuckman SM, Blackard JT, Johnstone M (2024) · DOI: 10.3389/bjbs.2024.12651

- [3]Andragogy and medical education: are medical students internally motivated to learn?Research articleMisch DA (2002) · DOI: 10.1023/a:1015790318032

## 임상 시나리오

Applying Andragogy in Diabetes EducationProblem-centered teaching for newly diagnosed adults
Adults learn best when teaching is problem-centered and immediately applicable to their daily life. For a patient newly started on metformin with HbA1c 8.4%, prioritize content on diet choices, medication timing, hypoglycemia recognition, and foot care.

Use the patient's stated concern about his father's leg loss as a readiness cue. Link each teaching point to a concrete problem he faces now, not to future academic goals.

CautionAvoid subject-organized lectures, external rewards, or expert-only delivery. These approaches reduce engagement in adult learners.

## 핵심 개념

- **Andragogy** — The art and science of helping adults learn, based on principles of self-direction, experience, readiness, problem-centered orientation, and intrinsic motivation.
- **Problem-centered orientation** — Adult learners prefer learning content that helps them solve immediate, real-life problems rather than subject-organized content.
- **Intrinsic motivation** — Internal drives such as personal relevance and desire to solve problems, which are more powerful for adults than external rewards.
- **Readiness to learn** — Adults are most ready to learn when they perceive a need to know something that applies to their current life situation or role.
- **Self-directed learning** — Adults take responsibility for their own learning and prefer active participation over passive reception of expert instruction.

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