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Health education and the pedagogical role of the nurse: Nursing students learning in the clinical setting

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Abstract

Background: Health education has been regarded as an important aspect of nursing for years. To be able to provide health education, nursing students need to know about the content of health education programs and the pedagogical role of the nurse. Methods: For nursing students to acquire knowledge about the pedagogical role of the nurse, they carried out a learning assignment where they explored the pedagogical role of the nurse in the ward for one week of an eight-week clinical rotation. A study was then conducted to explore whether the learning assignment influenced the students’ awareness of the nurse’s pedagogical role. Twenty-three third-year bachelor of nursing students, 12 in 2007 and 11 in 2008, participated in focus group interviews. Results: The findings showed that the students became more aware of nurses’ pedagogical role after the one week of exploring patient education with ward nurses. The students increased awareness was founded on their experiences, which were that the nurses seldom planned the health education and information given. Further that the nursing staff did not utilize planned educational materials for their patient education and that they seldom documented health education. Despite these finding, the patients were generally informed during caring interactions. Conclusions: A learning assignment related to the nurses’ pedagogical role seemed to have increased the students’ critical awareness of the nurse’s pedagogical role and the legal demands related to the obligation of nurses to educate patients.
www.sciedu.ca/jnep Journal of Nursing Educa tion and Practice, 2014, Vol. 4, No. 3
ISSN 1925-4040 E-ISSN 1925-4059
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ORIGINAL RESEARCH
Health education and the pedagogical role of the
nurse: Nursing students learning in the clinical setting
Kirsten Margrethe Halse1, Marianne Fonn2, Bjørg Christiansen1
1. Department of Nursing, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Norway.
2. Oslo University Hospital, Oslo, Norway.
Correspondence: Kirsten Margrethe Halse. Address: Department of Nursing, Faculty of Health Sciences, Oslo and
Akershus University College of Applied Sciences. Norway. Email: Kirsten.Halse@hioa.no
Received: June 3, 2013 Accepted: August 25, 2013 Online Published: October 16, 2013
DOI: 10.5430/jnep.v4n3p30 URL: http://dx.doi.org/10.5430/jnep.v4n3p30
Abstract
Background: Health education has been regarded as an important aspect of nursing for years. To be able to provide health
education, nursing students need to know about the content of health education programs and the pedagogical role of the
nurse.
Methods: For nursing students to acquire knowledge about the pedagogical role of the nurse, they carried out a learning
assignment where they explored the pedagogical role of the nurse in the ward for one week of an eight-week clinical
rotation. A study was then conducted to explore whether the learning assignment influenced the students’ awareness of the
nurse’s pedagogical role. Twenty-three third-year bachelor of nursing students, 12 in 2007 and 11 in 2008, participated in
focus group interviews.
Results: The findings showed that the students became more aware of nurses’ pedagogical role after the one week of
exploring patient education with ward nurses. The students increased awareness was founded on their experiences, which
were that the nurses seldom planned the health education and information given. Further that the nursing staff did not
utilize planned educational materials for their patient education and that they seldom documented health education.
Despite these finding, the patients were generally informed during caring interactions.
Conclusions: A learning assignment related to the nurses’ pedagogical role seemed to have increased the students’ critical
awareness of the nurse’s pedagogical role and the legal demands related to the obligation of nurses to educate patients.
Key words
Students’ learning, Clinical study, Nurses’ pedagogical role, Health education
1 Introduction
Health education has been regarded as an important aspect of nursing for years [1, 2]. Patient education is as important now
as ever [2]. Health education is defined as “the communication of health-related information and development of the
attitudes, skills, and confidence necessary to enable people to take action to improve their health” [3]. In relation to the
education of patients, the term pedagogy is used as a comprehensive term for all teaching activities [1]. Strategies include
one to one advice, encouragement, giving explanations orally and written information, instructing or telling patients about
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health information, counseling and asking questions [3, 4]. To be able to provide health education to patients, the nursing
student needs to know the content of health education programs and the pedagogical role of the nurse.
Internationally, the importance of health education is illuminated through the vast amount of nursing research studies
conducted on the subject [1, 2, 5-13]. In Norway, the significance of health education is specified in the Norwegian Health
Personnel Act of 1999. It is therefore important to emphasize the pedagogical role of the nurse in nursing schools [14].
In the nursing curriculum of the baccalaureate degree program at “Pilestredet campus, Oslo and Akershus University
College of Applied Sciences”, the students learn about nurses’ pedagogical role in lectures and in the skills laboratory
through role-playing. During clinical studies, students further their learning about this role in situations in which patients
require health education. Despite these opportunities, our experience is that students have difficulties grasping this part of
nursing, possibly because providing health education is not always obvious in nursing practice. For students to truly
understand the pedagogical role of the nurse and the value of health education, it seems important to increase students’
awareness of this role.
The major part of health education research is within the area of formal teaching [1]. Studies have reported a positive effect
of health education on patients. For example, a study of elderly patients’ knowledge about their medication showed that
their knowledge increased after receiving information from nurses before leaving the hospital [5]. In one study regarding
the reduction of cancer patients’ barriers to pain and fatigue, the results showed that patients who had received four
educational sessions on pain and fatigue assessment and management experienced significant improvements in pain and
fatigue immediately post intervention, and these improvements were sustained over time [6]. The results from another
study indicated that one single health conversation encounter had a significant impact on the participants, and so room
must be created for pedagogical encounters as part of a cardio-vascular heart disease prevention follow-up in primary
healthcare [7]. On the other hand, other studies have shown that some patients need more health education than they
received in hospital. One study indicated that after discharge after cardiac surgery, women patients needed more
information about why postoperative pain management is important beyond simple pain relief. This was the case even
though the women were advised by the hospital to take an analgesic, both regularly and as needed, upon returning home [8].
Kääriainen & Kyngä found that 13 % of the staff did not adapt the issues dealt with in patient education to the patient`s life
situation, and that less than half of the staff asked the patients to give feedback on the patient education [9].
Other studies focus on how the nurse’s pedagogical role is performed. In some studies, health education is divided into
formal and informal education [1]. Informal health education takes place continually as a natural part of nurse–patient
interaction, and patients are often taught during various activities [1]. In one study, the results indicated that the nurses`
daily patient education was largely invisible. This was interpreted as caused by a lack of awareness of patient education
among both managers and nurses [10]. Another study showed that the nursing staff had quite good knowledge concerning
matters involving patient education and good skills to maintain the patient education process, even though there was not
always enough time and resources for this [9]. Person & Friberg concluded that health conversation encounters require
preparedness and pedagogical awareness, as well as an ability to be attentive to the patients need for understanding and
level of motivation for lifestyle changes [7]. Health education is not always documented although documentation is part of
nurse` educational practices [11, 12].
Several studies have focused on nurses’ opinions of the pedagogical role [1, 4, 13, 15-17]. Some nurses see their role as a health
educator as a key function, but also that they are not always able to fulfill this role. For example, Lee & Lee found that
nearly half of the nurses felt they did not impart all the necessary preoperative information to patients. This was attributed
to time constraint and nursing workload, communication difficulties and limiting teaching resources. They also suggest
that there are somewhat unclear boundaries between nurses and other healthcare professionals regarding their
responsibilities in patient education [13]. A study of nurses working with elderly patients in a hospital setting showed that
most nurses feel confident in their ability to provide health education [18]. However, not all nurses feel this way. Bergh, et
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al. found that nurses are not always sure of whom to address and what to teach and/or inform [10]. Danielson & Berntsson
reported that RNs feel there is little agreement between the demands of nurses’ role as health educators and preparation
during their study [16]. By contrast, Lamiani & Furey found that nursing studies increased the nurses’ ability to act as health
educators [17]. Lee & Lee found that nurses who had participated in surgical or perioperative training courses had greater
satisfaction with preoperative teaching [13].
In summary, health education has a positive impact on a patient’s health situation, but for some patients the health
education they receive is not satisfactory. The pedagogical role is also equivocal, because health education has both formal
and informal aspects. Not all activities related to health education are performed satisfactorily, and not all nurses feel
competent in performing this function. It is therefore necessary to focus more on the role of health educator during nursing
education. We did this by planning a learning assignment during a clinical study period in which the focus was on students
learning about the pedagogical role of nurses. The students were assigned to explore how the nurse performed her
pedagogical role in the ward. The purpose was to increase the students’ knowledge of the pedagogical role of nurses and
thereby make them better prepared to provide health education in the future.
The learning assignment
The assignment required the students to focus on how the nurse’s pedagogical role was shaped in the ward during one
week of an eight-week clinical practice. The ward was populated with 12 students, who worked in groups of two. Two
groups of two students (group 1) asked RNs about how they managed their pedagogical role. Students in group 2 observed
how an RN applied her pedagogical role. Group 3 asked patients for their opinions about the information received. Group
4 gathered information about the laws and guidelines for health education, and group 5 scrutinized nursing care plans
related to this topic. At the end of each day, the students met for 1½ hours to discuss their experiences and findings, and at
the end of the week each group provided a written summary, which was forwarded to the head nurse. The student
facilitator and the university college lecturer functioned as tutors.
The content and organization of the learning assignment are presented in detail in Table 1.
Table 1. Content and Organization of the Learning Assignment
Group 1 Four students ask the nurses about how they manage their pedagogical role.
Group 2
Two students observe how a nurse performs the pedagogical role during a 7.5-hour shift and consider the
following questions.
a) What information, advice, and health education does the nurse give to patients and/or their relatives?
b) In what situations does the nurse inform, guide, or teach the patient and/or relatives?
c) How does the nurse inform, guide, and teach patient/or relatives?
Group 3 Two students ask patients their opinion of the information, guidance, and health education they have received.
Group 4
Two students:
a) Gather information about the relevant laws and guidelines at both the local hospital and national levels;
b) Try to discover what the students need to learn to manage this specific function.
Group 5
Two students:
a) Analyze patient files to find nursing documentation concerning health education;
b) Check routines, guidelines, and relevant literature referring to the nurse’s pedagogical role in the ward.
Ethical considerations concerning the learning assignment
The faculty granted permission to let students perform the learning assignment and the hospital granted permission to have
students ask and observe the staff. The Privacy and Data Protection Office, CEO Executive Staff at the hospital were
informed and made no objections regarding students asking patients. Since the RNs were not participants in the study, but
only took part in the learning assignment in as much as they were only asked and observed by students about how they
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managed their pedagogical role, it was not necessary for neither the staff nor the patients sign consent form. Both patients
and nurses were asked by students if they were willing to participate and only did so if they wanted to.
Evaluation of the learning assignment
A study was then conducted to explore whether the learning assignment influenced the students’ awareness of the nurses`
pedagogical role. To gain better insights into the results of the learning assignment, the teacher in cooperation with a
colleague from the Institute of Nursing led focus group interviews with the students. The following research question was
formulated: How did the learning assignment about the nurse’s pedagogical role influence the students’ learning and
perception of this role?
2 Method
2.1 Participants
Twenty-three third-year bachelor of nursing students, 12 in 2007 and 11 in 2008, performed the learning assignment. All
of them agreed to participate in the study.
2.2 Focus group interviews
The students were divided into two groups of five or six students, and four interviews were conducted. The interviews took
place one week after the assignments in 2007 and 2008. Focus group sessions are discussions that take advantage of group
dynamics for accessing rich information [19]. An interview guide was developed and comprised questions related to the
students’ experiences of how the pedagogical role was performed in the ward and what they learned by doing the
assignment. The moderator who attended the interviews had no prior knowledge of the students. The teacher attended as a
co-moderator. The interviews were conducted at the hospital, lasted for about 60 minutes, and were tape-recorded and
transcribed verbatim.
2.3 Data analyses
The chosen unit of analysis was the group and not its individual members because opinions and views were produced in a
group situation [19].
Kvale & Brinkmann’s guidelines for qualitative research, which involve a back-and-forth process between the parts and
the whole, guided the analysis. The analysis was based on Kvale & Brinkmann’s three levels of interpretation: self-
understanding, common sense, and theoretical perspective [20]. The data were read repeatedly and discussed by the authors
to gain a general picture before they were condensed into preliminary meaning units. These meaning units were sorted into
three categories across all four interviews: 1) students’ perception of the pedagogical role; 2) students’ perception of
formal and informal education; and 3) students’ perspectives of documenting health education. The findings are presented
based on these categories.
Previous research covers the theoretical perspective from which the findings are discussed. This analytical process implied
a transition from description and conceptualization to a more comprehensive understanding.
2.4 Ethical considerations
Students who participated in the focus group interviews received written information. They were informed that
participation was voluntary and that they had the right to withdraw at any time. In the presentation of data, no names or
other identifying characteristics are used. All students agreed and signed a written consent form. The Norwegian Social
Science Data Services was also informed and made no objections.
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3 Findings
3.1 Students’ perception of the pedagogical role
The general opinion among the students was that the assignment increased their awareness of the pedagogical role of the
nurse. This opinion was gained by viewing the topic from different angles and through discussions with fellow students:
I am more aware of it now than before. When I am in the patients’ room it is always in the back of my mind. I
think that this is the most important thing I have experienced in working with this. I am more concerned with this
role now and have seen how important it is.
The students believed that most of the nurses had difficulties distinguishing between the types of pedagogical methods
generally used in health education: to inform, guide, and teach. Quite a few of the students expressed that they found this
distinction challenging: “We learned something about the different definitions, but they still intertwine.”
The students had difficulty comparing the patients’ and nurses’ opinions of the health education given because the
patients’ and nurses’ understanding of the pedagogical concepts varied. The students observed that the nurses mainly
informed and guided the patient, and that there was less direct teaching of the patient.
The students observed a mix of experiences in the nurses’ ability to adjust to the patients’ level of comprehension. One
student remarked, “Some of the nurses were very good; they just said one sentence that said it all, but some use several
sentences.”
3.2 Students’ perspectives on formal and informal education
The students observed that the patients received a great deal of information from the RNs in nurse–patient interactions
throughout the day, but there seemed to be little formal patient teaching taking place either when the patients were
hospitalized or at discharge. The students perceived that more formal information was given during the medical rounds.
The students found it difficult to grasp how the responsibility for health education was divided between the doctors and
RNs.
Sometimes the doctors leave it to nurses to inform the patient about the diagnoses and medication—maybe
because of the lack of time?
Students did not observe that the RNs went back to the patients after the medical rounds to question whether the patient
had understood the information:
I have been attending the medical rounds where the doctor informed the patient about the diagnosis and date for
discharge from hospital, but I didn’t see the nurses going back to make sure the patient understood the
information or any written documentation in the patient file that information had been given or was understood.
The students noted that patients sometimes received information during interactions that was not related to the procedures
taking place. For example, a patient might be informed about discharge while being helped with personal hygiene. When
students asked the patient afterwards, the patient did not remember having been informed about discharge.
The students observed that the patients did not always perceive information given during practical situations as health
education. Generally, the students’ perception was that information from the nurses was given to patients to ease practical
situations: “Most of what I observed happened during practical situations; there was no plan or special strategy.”
The students observed that the information was mainly given orally and was not written. They said that they had had
trouble finding patient information brochures about procedures, examinations, and daily routines in the ward. The students
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also reflected on the use of brochures: “It is so easy to hand someone a brochure at discharge, but this still does not mean
the information is understood.”
When the students asked the nurses about what they considered to inhibit the delivery of adequate patient information, lack
of time was often mentioned. Some students reflected on the future and envisioned that, as newly educated nurses, it would
be difficult to find the time to prioritize health education.
3.3 Students’ perspectives on documentation of health education
The students had no problem finding national laws and guidelines concerning health education. Through interviews with
staff from the Centre for Learning and Mastering, the students became aware that the center had more guidelines for health
education than the ward: “I feel that we have become more aware of the guidelines.” They did, however, experience
difficulty in finding the hospital’s internal guidelines on how to deliver and document health education and were
concerned about the lack of documentation in the patient files: “You are supposed to document the patients’ basic needs
and progress; there ought to be a mark for patient education.” According to the students, there was no obvious place in the
documentation system for the nurses to document the delivery of health education. Insufficient documentation seemed to
trigger the students’ awareness of the importance of keeping a record: “It is always in the back of my head now: when
information is given it also needs to be documented. And we are obliged to inform the patients.” The students found that
information given to relatives was documented more often.
4 Discussion
The findings show that the students increased their awareness of the pedagogical role of nurses through the assignment,
even though they observed that the nurses seldom planned the given education and that patients were generally informed
during caring interactions. These findings are consistent with studies showing that health education is an integrated part of
nursing [1, 10]. The students found that the RNs and patients have a great deal of interaction throughout the day, and the
continual flow of information is both natural and valuable. However, one consequence is that the nurses’ pedagogical role
may be unclear for students. Formal health education is a vital component of direct patient care. The students became
aware of this even though they did not observe nurses carry out formal health education.
There is a need to focus on formal health education, but informal pedagogical activities during nursing interventions must
also be acknowledged. The students observed that the patients received a great deal of information throughout the day.
This way of teaching/informing patients frequently occurs [1, 10]. The informal situations should be acknowledged because
they can have pedagogical potential and can transform into education that is more formal if nurses are able to grasp the
need of the patient. To obtain a deeper understanding of health education, the challenge for both RNs and students is to
become more aware of this distinction and to recognize that informal and formal health education are each important in
their own way.
The students had trouble finding documentation of given health education in the patients’ files, which is also an issue
found in other studies [11, 12]. According to the Patients’ Rights Act, the information given should be documented in each
patient’s file [21]. The RNs documented facts about the patients in relation to many aspects of patient care, but
documentation of health education seemed scarce. According to the students, there was no obvious place to document the
delivery of health education in the documentation system. Another factor could be that the RNs perceived their
pedagogical role as an integrated part of their daily routines, as found in other studies [1, 10], and thought it would be
excessive to document everything. For students, it was not obvious how health education activities should be documented
when the RNs seldom documented even more formal nursing interventions. Less documentation of health education is
very troubling as the nurses and the hospital should legally be documenting all teaching. Observing that documentation of
health education seldom occurred made the students more aware of the demands of documentation of all aspects of patient
care.
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It is possible that the RNs were more aware of their pedagogical role, and performed more health education than the
students perceived. Even so, the assignment had an important impact on the students’ critical awareness in relation to the
nurse’s pedagogical role. Health education is an increasingly important part of the RN profession [2]. According to the
Norwegian Patient’s Rights Act of 1999, a patient has the right to receive the information needed to understand the illness
and treatment as well the risks and possible side effects [21]. It is therefore important that students master this role in a
comprehensive manner. Studies have noted that students receive inadequate training in the delivery of health educa-
tion [15, 16]. To promote health education and to improve students’ learning, it seems important to increase RNs’ skills and
awareness of their pedagogical role. Bergh, et al. state that nurses must become aware that patient education requires
visibility and development [10]. As emphasized by Ivarsson & Nilsson, the clinical setting is a significant arena for learning
about health education [15]. To further the pedagogical role in clinical settings, health care organizations and the managers
have a great responsibility for creating a pedagogical climate. Ensuring that guidelines and research on patient education
are more available in the ward, customizing the documentation system and promoting discussions about health education
are important actions. Bergh, et al. found that managers underestimate the importance of patient education in terms of time
allocated and the need for pedagogical competence. Furthermore, they state that managerial support must be recognized as
significant in creating better conditions for the performance of nurses’ daily patient education [10]. In our study, each group
of students provided a written summary at the end of the week, which was forwarded to the head nurse. In that way, the
manager became informed of the student’s experiences. Continued pedagogical education for RNs in the form of courses
also seems relevant. Ivarsson & Nilsson emphasized that nurses who have been working for some time need additional
knowledge of pedagogy [15]. According to Lee & Lee and Lamiani & Furey, continuing education increases nurses’ ability
to deliver health education [13, 17].
5 Conclusion
The findings of this study show that the learning assignment increased the students’ critical awareness about the nurse’s
pedagogical role and the legal demands related to this work. What contributed to this increased awareness, we assume,
were both the activities the students carried out and also the discussion between the students at the end of each day. Their
discussions were related to their experiences and the literature they had found about the pedagogical role of the nurse. This
kind of learning assignments can be applied easily to other subjects during clinical placements and may thus help students
recognize how professional expectations of the nurse’s role are exercised. Further research might investigate whether the
students who participated in this learning assignment felt more prepared and confident when delivering health education as
RNs compared to other students.
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... Although this may result from gaps in curricula or from inadequate clinical exposures, Allan et al. (2015) also refer to 'threshold concepts' that can only be mastered in practice. The patient education role is one threshold concept for NRNs that is under-reported in the literature (Halse et al., 2014). ...
... Kennard (2016) has also argued that although responsibility for patient education is mostly shouldered by nurses, they are the discipline most lacking in knowledge and awareness about health literacy. Student nurses have confirmed that patient education is poorly defined and rarely discussed in practice (Halse et al., 2014). As a threshold concept for NRNs, this raises concern. ...
Article
Background Nurses’ education of patients is important for building the knowledge and skills necessary for self-management. Little is known of newly registered nurses’ preparedness to deliver patient education, or of their experiences in clinical contexts where they may encounter barriers. Aims The aim of this study was to explore newly registered nurses’ patient education role in an acute hospital setting. Methods A purposive sample of seven newly registered nurses from an NHS teaching hospital in England were interviewed to explore their understanding and experiences of educating patients. An interpretive phenomenological approach was used to analyse responses. Results Three superordinate themes were identified: the professional self; the ward environment; and the nurse-patient relationship. Tensions existed between the ideals newly registered nurses brought to registered practice and the practice-based realities of patient education, which was often delivered informally with limited patient involvement in collaborative goal setting. Few newly registered nurses recalled more than superficial preparation in university for the role and some were encouraged by senior colleagues to downplay the importance of patient education. Conclusions The patient-education aspirations of newly registered nurses need to be nurtured. Educational institutions have an important role to play as do experienced nurses, making explicit the education they routinely deliver and supporting newly registered nurses to build their own pedagogic expertise.
... Vågan & Heggen (2014) fant at simulering og veiledning i praksisstudier ga sykepleierstudenter anledning til å rekonstekstualisere kunnskap. En studie viste at sykepleierstudenter sjelden erfarte at sykepleiere planla eller dokumenterte pedagogiske aktiviteter i relasjon til pasienter (Halse, Fonn & Christiansen, 2014). ...
... Vår studie viser at selv om studentene ser sammenhenger mellom helsepedagogiske tema og spesifikke situasjoner eller kontekster i praksisstudier, ønsker de et sterkere fokus, mer øvelse og tilbakemeldinger knyttet til helsepedagogisk kompetanseutvikling. Tidligere studier har også vist at det ikke er gitt at helsefagstudenter møter gode laeresituasjoner eller praksisveiledere med slik kompetanse, og som vektlegger det i yrkesutøvelsen (Hessevaagbakke, 2017;Youngson, 2016;Halse et al., 2014;Caladine, 2013). Ifølge Hvinden (2011) er det store forskjeller på hvor godt helsepedagogikk i regi av LMS-ene (laerings-og mestringssentre) er integrert i helseforetakenes helhetlige gjennomføring av pasient-og pårørendeopplaering. ...
... A 2013 study focusing on nursing students and health education found that some students observed that nurses delivered DT while patients were distracted performing self-care tasks and that later, patients did not recall being taught the discharge information. Students also noticed that nurses did not verify the patients' understanding of the DT instructions (Halse, Fonn, & Christiansen, 2013). ...
... It is essential for nursing students to incorporate health literacy into educational interventions for their patients early in their nursing practices (Zanchetta et al., 2013). Whatever method is best for the patient to aid in retention should be used, but DT should be offered in writing with instructions documented by the provider (Halse et al., 2013). Students, practicing nurses, and patients benefit when DT is integrated into the patient care process (Nosbusch et al., 2011). ...
Article
Aim: The aim of this article was to assess how and to what degree nursing students are prepared for patient discharge teaching (DT). Background: The process of discharging patients has become more complex. Despite the expectation that nursing students will be competent in providing effective DT upon graduation, the preparation of new graduates is a problem for hospitals. Method: A review of the literature was conducted. Review: The review showed that novice nurses enter the workforce unprepared to provide adequate DT due to limited communication and limited time during their education, which led to low confidence and limited knowledge. Conclusion: Methods to overcome current barriers in DT, including simulation practices, the teach-back method, dedicated education units, collaborative efforts, discharge checklists, and health literacy identification, are presented as recommendations for nursing education.
... Education is of great importance in the prevention of low back pain and recurrence (Demoulin et al., 2012). Health education is an important role for nurses in all settings and has a positive impact on the reduction of back pain (Halse et al., 2014). Simultaneous application of health education and conventional care lead to an improvement in quality of life while reducing pain and disability (Albaladejo et al., 2010). ...
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Aim: The aim of this study was to determine the effect of health education on prevention of low back pain for health caregivers and cleaning workers. Background: Low back pain is a common health problem in the workplace. Health education is important in the prevention and recurrence of low back pain. Methods: A quasi-experimental design with a pre-test and post-test control group was used. The population of the study consisted of health caregivers and cleaning workers working in a university hospital in Turkey. A total of 120 participants, 60 in the intervention group and 60 in the control group, were included in the study. Data were collected between October 2016 and April 2017. A questionnaire, the Oswestry Low Back Pain Scale and the Knowledge Evaluation Form were used to collect data. Health education was given to the intervention group. Results: Following the health education, the mean scores of the Oswestry Low Back Pain Scale in the intervention group were significantly lower than the control group and had a larger effect size. Conclusion: This study provides evidence for the effectiveness of health education in the prevention of low back pain in health caregivers and cleaning workers.
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Aim To explore nurses' knowledge, skills and personal attributes for competent health education practice and their association with potential influencing factors. Background Clinical nurses are expected to perform effective health education interventions, but they do not feel competent. The self-assessment of the health education competence and its conditional factors is paramount for professional development. Design A cross-sectional study. Methods A total of 458 clinical nurses from two health specialized centers in Spain participated in this study. Data were collected using the Nurse Health Education Competence Instrument and a second self-report questionnaire from January to February 2019. Descriptive statistics, t-test, analysis of variance, Pearson’s and Spearman’s correlation and multiple linear regression were used to analyse the data. The STROBE guideline was used Results The mean scores of the knowledge (70.10 ± 15.11), skills (92.14 ±15.18) and personal attributes scales (32.32 ± 5.89) were found to be low to moderate. The main influencing factors for the health education implementation were lack of education and training (71.4%), lack of time (67.5%) and high workload (67.3%). Nurses with higher educational level and perceived self-efficacy for competently providing health education, more extensive professional experience and previous training in health education rated higher in knowledge, skills and personal attributes. Age and years of experience were negatively correlated with knowledge scores, but positively with the rest of domains of the competence and self-efficacy. The regression models for the overall health education competence’s domains were significant (p<0.001) with R2 values ranging from 28.0% to 49.3%. Self-efficacy, previous health education training and working in intensive care units were found to be significant in all cognitive, psychomotor and attitudinal scales. Conclusion Clinical nurses reported on some skills and personal attributes for health education practice, but they seem to lack health education knowledge necessary for a competent practice. This study suggested that effective education and training and supportive organizational cultures are key to enhance nurses’ health education competence. Identifying nurses’ educational needs on the main domains of the competence and its intrinsic/extrinsic influential factors may assist in both planning and organizing tailored training strategies and in promoting appropriate environments to support a high-quality health education practice Tweetable abstract Nurses’ knowledge, skills and attitudes about health education competence are low to moderate. Training and organizational support are key.
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The highest prevalence of traumatic fractures that need to use of orthopedic intervention such as skin traction has increased. This study aimed to the effect of educational protocol on improving nurses' knowledge and practice regarding skin traction. A quasi-experimental research design was used on convenience sample composed of 26 nurses working at orthopedic unit at Minia University and Minia General Hospitals. A Structured interviewing questionnaire about skin traction nurses' knowledge questionnaire and nursing skin traction observational checklist were used. A significant improvement in nurses' knowledge and practice about nursing care and principles of skin traction in post test. Implementation of the educational protocol. Increased nurses education and training for skin traction and periodic evaluation measures for these nurses should be constructed.
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Aims and objectivesTo explore the consistency between the perceptions and actual practice of preoperative patient teaching and also the factors affecting the provision of teaching from the perspective of nurses working in surgical wards. Background Preoperative teaching is beneficial to surgical patients in alleviating their anxiety and promoting their postoperative recovery. Despite the leading role in patient teaching by nurses, sparse studies have been addressed the consistency between nurses' perceptions and their actual practice of preoperative teaching in surgical wards. DesignA cross-sectional survey. Method Data were collected by using self-reported preoperative teaching questionnaires together with nurse demographic data sheets. Sampling setting was an acute public hospital and all nurses working in surgical wards (n=100) were approached in the study. ResultsA total of 86 nurses returned the questionnaires. Details of anaesthesia' was the most prominent preoperative teaching component rated by nurses although their major teaching was pertained to preoperative preparation'. In addition, oral explanation was reported as the most prevalent way of information delivery and internet was the least preferred method. Discrepancies between nurses' perceptions and actual practice were found in this study. Moreover, nurses' time availability, language barriers and tight operation schedules were perceived as top factors affecting the provision of preoperative teaching. Furthermore, nurses' satisfaction with such patient teaching was significantly associated with their professional training and their daily workload in the clinical setting. Conclusions Preoperative patient teaching was not fully achieved by nurses in this study, and the results highlighted the conflicting issues related to the implementation process that could be resolved by means of proper planning and management in clinical practice. Relevance to clinical practiceHealthcare organisations and nurse managers should periodically review the existing clinical resources so that sufficient preoperative teaching strategies can be provided. Nurses' perceptions and satisfaction towards preoperative teaching can be compared with those of the patients in further studies so that the insights for developing an effective preoperative teaching programme can be more comprehensive.
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To describe nurses' perceptions of conditions for patient education, focusing on organisational, environmental and professional cooperation aspects, and to determine any differences between primary, municipal and hospital care. Although patient education is an important part of daily nursing practice, the conditions for this work are unclear and require clarification. A stratified random sample of 701 (83%) nurses working in primary, municipal and hospital care completed a 60-item questionnaire. The study is part of a larger project. The study items relating to organisation, environment and professional cooperation were analysed using descriptive statistics, non-parametric tests and content analysis. Conditions for patient education differ. Nurses in primary care had better conditions and more managerial support, for example in the allocation of undisturbed time. Conditions related to organisation, environment and cooperation need to be developed further. In this process, managerial support is important, and nurses must ask for better conditions in order to carry through patient education. Managerial support for the development of visible patient education routines (e.g. allocation of time, place and guidelines) is required. One recommendation is to designate a person to oversee educational work.
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The aim of this review was to identify conditional factors for nurses' patient-education work and to identify foundational aspects of significance when designing studies on this patient-education work. A few reviews of nurses patient education work exist, published up to 30 years ago, spawning interest in performing a review of more recent studies. A search of CINAHL, MEDLINE and ERIC was made for articles dating from 1998 to 2011. Thirty-two articles were selected and an integrative review was performed. Conditional factors were identified and beliefs and knowledge, environment, organization, interdisciplinary cooperation, collegial teamwork and patient education activities. A model was developed to describe foundational aspects of significance when designing studies. The conditional factors are to be seen as either enabling or hindering the accomplishment of evidence-based patient education and the level of person centredness, patient safe care and ethics - something that has to be considered when designing studies. More detailed studies are required to clarify the nature of patient education work and to create realistic conditions that enable the role to be fulfilled in everyday work. Such knowledge is of significance for nursing management in developing supportive activities for nurses.
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Avşar G, Kaşikçi M. International Journal of Nursing Practice 2011; 17: 67–71 Evaluation of patient education provided by clinical nurses in Turkey The purpose of this study was to determine the practices of patient education provided by nurses in hospital clinics. The data were collected using a questionnaire form developed by the researcher in the light of relevant literature. The questionnaire form included questions to help determine descriptive characteristics of nurses and practices of patient education. Statistical analysis was performed using percentages. Most of the nurses (82.4%) did not define a certain place or time for patient education, almost all of the nurses (98.9%) did not record the education process, and patients' family/relatives were not included in the education (82.4%). The results of this study have shown that clinical nurses do not adequately implement the phases of patient education. During nursing education, nurses' knowledge and skills in patient education should be developed, and they should be made to fully internalize their educational role.
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Women report more postoperative pain and problems performing domestic activities than men in the first month of recovery after cardiac surgery. The purpose of this article is to describe how women rate and describe pain interference with daily life after early discharge from cardiac surgery. A qualitative study was conducted in 2004-2005 with ten women recruited from a large Norwegian university hospital before discharge from their first elective cardiac surgery. Various aspects of the women's postoperative experiences were collected with qualitative interviews in the women's homes 8-14 days after discharge: a self-developed pain diary measuring pain intensity, types and amount of pain medication taken every day after returning home from hospital; and the Brief Pain Inventory-Short Form immediately before the interview. Qualitative content analysis was used to identify recurring themes from the interviews. Data from the questionnaires provided more nuances to the experiences of pain, pain management, and interference of postoperative pain. Postoperative pain interfered most with sleep, general activity, and the ability to perform housework during the first 2 weeks after discharge. Despite being advised at the hospital to take pain medication regularly, few women consumed the maximum amount of analgesics. Early hospital discharge after open cardiac surgery implies increased patient participation in pain management. Women undergoing this surgery need more information in hospital on why postoperative pain management beyond simple pain relief is important.
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The purpose of the study was to describe the quality of patient education evaluated by health personnel. The sample consisted of 916 nurses and physicians working in one hospital in Finland. The data were gathered with a questionnaire developed specifically for this study. The questionnaire measured patient education quality as two dimensions: patient education resources and implementation. The data were analysed using basic and multivariate methods. The overall resources of patient education were quite good. The problems were related to the possibilities for patient education, such as the lack of time, the unsuitability of conditions and the shortage of equipment. In addition, 54% had inadequate knowledge of patients' posttreatment condition and 29% of the impact the illness had on patients' everyday lives. Furthermore, 47% were less skilled in supporting self-care. On the other hand, health personnel's attitudes towards patient education were positive. They were able to use verbal and individual patient education very well, whilst other methods of patient education were used less well and more infrequently. The patient education was implemented largely as patient-centred and interactive. However, the patient was not always taken into account in the planning and evaluation of patient education. Several background variables of the health personnel had a statistically significant connection to patient education resources and implementation. These findings indicate that patient education is largely well implemented, although the resources need to be developed somewhat further.
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Pain and fatigue are recognized as critical symptoms that impact the quality of life of cancer patients. The barriers to pain and fatigue relief have been classified into three categories: patient, professional, and system barriers. The overall objective of this trial as to test the effects of the "Passport to Comfort" intervention on reducing barriers to pain and fatigue management for ambulatory care cancer patients. This quasi-experimental, comparative study uses a Phase 1 control group of usual care followed sequentially by a Phase 2 intervention group in which educational and system-change efforts were directed toward improved pain and fatigue management. A sample of 187 cancer patients with breast, lung, colon, or prostate cancers, and a pain and/or fatigue rating of 4 or more (moderate to severe), were recruited. Patients in the intervention group received four educational sessions on pain/fatigue assessment and management, whereas patients in the control group received usual care. Pain and fatigue barriers and patient knowledge were measured at baseline, one month, and three months post-accrual. Patients in the intervention group experienced significant improvements in pain and fatigue measures immediately postintervention, and these improvements were sustained over time. The "Passport to Comfort" intervention was effective in reducing patient barriers to pain and fatigue management as well as in increasing patient knowledge regarding pain and fatigue. This intervention demonstrates innovation by translating the evidence-based guidelines for pain and fatigue as developed by the National Comprehensive Cancer Network into practice.
Article
The purpose of this study was to describe lived experiences of a health conversation from the perspective of participants who, in the course of a health check, had been informed that they were at increased risk of cardiovascular heart disease. The modern lifestyle has created an increased occurrence of cardiovascular heart disease. Counselling about lifestyle changes to prevent disease is an important duty of nurses in primary healthcare when encountering patients with risk factors such as diabetes, hypertension and hypercholesterolemia. It is well known that accomplishing lifestyle changes is complicated. Research has shown the importance of assuming the patient perspective in pedagogical encounters and that nurses involved in patient teaching need more knowledge about the learning person. Written narratives about the health conversation followed by interviews with open-ended questions. Nine informants from the Skaraborg Project participated. A phenomenological analysis was chosen to describe the participants' experiences and to visualise the meaning of the new knowledge obtained in the encounter. Three themes were identified; 'The unavoidable message', 'Reflection on the content of the conversation' and 'The pedagogical encounter'. Sub-themes show the variations of meaning owing to the participants' previous life experiences. The nurse must be aware of differences in perceptions concerning the health conversation and possible consequences for the life situation. The health conversation encounter requires preparedness and a pedagogical awareness as well as an ability to recognise the person's need for understanding and level of motivation to make lifestyle changes. Relevance to clinical practice. Time and space must be created for health conversations and follow-up of cardiovascular heart disease to achieve a preventive pedagogical encounter in primary healthcare.