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Rethinking patient education
Abstract
The aim of this paper is to critically examine and challenge some of the assumptions which underpin the research and non-research based literature on patient education. Doubts are expressed concerning the transferability of theories of adult learning to patient education; and concern is expressed over the imbalance in the literature where emphasis is placed on the psychological benefits of teaching, rather than physical outcomes. In the light of the available evidence which suggests that nurses are not ‘good patient teachers’ the case is made to support the suggestion that patient education should become the responsibility of specialist nurses. In addition, computer-assisted learning (CAL) is proffered as the solution to a number of the problems facing patient educators. CAL is seen as a means of empowering the patient, rather than the nurse to take control, and this is viewed as a positive move in the direction of self-care. The paper concludes by suggesting that CAL might be used with good effect by patients with particular learning difficulties; for example the blind or partially sighted, and people who are illiterate or have a low reading ability.
We examined the effect of diabetes knowledge and attitudes on self-management and quality of life (QoL) of people with type 2 diabetes mellitus (T2DM). We employed a cross-sectional study design. A total of 137 female and 129 male participants with T2DM completed the diabetes knowledge scale (DKN), Diabetes Integration Scale-19 (ATT19), Summary of Diabetes Self-care Activities (SDSCA) scale, and Diabetes Quality of Life (DQoL) scale, measuring diabetes knowledge, attitudes, self-management, and QoL respectively. The SDSCA scale measures diet, exercise, blood glucose monitoring, and foot care. The DQoL scale measures satisfaction and impact of QoL. An initial path model that tested the inter-relationships of the study variables was first identified based on previous research. Then, the path model was tested using Mplus 7.3. In the final model, diabetes knowledge was a significant predictor of attitudes and self-management in terms of blood glucose monitoring and foot care. Attitudes was a significant predictor of impact of QoL. Self-management in terms of blood glucose monitoring was a significant predictor of impact of QoL and diet was a significant predictor of satisfaction and impact of QoL. Exercise and foot care aspects of Self-management were significant predictors of satisfaction and impact of QoL respectively. The final model showed a good fit to the data: RMSEA = .045 (90% CI: .009, .071; Clfit = .601), CFI = .950, SRMR = .058. The findings suggest a theoretical basis to direct the development of appropriate health programs and interventions for improving QoL in people with T2DM and warrant replication in diverse samples.
Patient education is an integral component of nursing care. Patient education has been associated with favorable patient outcomes but may be difficult if resources are unavailable, "teachable moments" are unrecognized, or if self-confidence of the nurses providing the education is low. Using the theoretical model developed by the authors and focusing on the delivery of patient/family education, we examined pediatric nurses' perceptions about patient/family education in the hospital setting. A 20-item questionnaire that explored factors affecting teaching behaviors of 54 pediatric nurses in an acute care hospital setting was completed. Results from this study suggest that pediatric nurses' confidence was disorder-specific. Nurses were confident providing education about common disorders (asthma, pneumonia, and bronchiolitis) and less confident providing education about less common disorders (oncology, cardiac). The barrier to providing education identified most often was lack of written materials. Findings from this study can be used to develop teaching resources for nurses and to plan educational programs specific to less common pediatric problems.
Purpose
The purpose of this paper is to review evidence related to the factors that influence people's understanding of health information and how miscommunication of health information can jeopardize people's health.
Design/methodology/approach
A literature review was conducted of English language articles, cited in major literature databases from the last 40 years, which describe factors related to comprehension of health information. A total of 93 articles were included.
Findings
The paper finds that health communication should take into consideration the role of the following factors on the processing and interpretation of health information: health literacy, format presentation of information, and human cognitive biases and affective/personal influences.
Practical implications
Health communication is a major component of health care. Every health care encounter involves exchange of information, which is intended to enhance people's knowledge in order to assist them to make an informed decision about their health care. However, the mere act of providing information does not guarantee comprehension. People's comprehension of information depends on several factors, including health literacy and numeracy skills, the format presentation of health information and human cognitive biases in the information processing and interpretation. Ineffective health communication can result in a wide range of direct and indirect health consequences including failure to understand and comply with treatment, poorer health status, increased risk of injuries, increased hospitalization, and decreased use of preventive services.
Originality/value
This paper provides health professionals and educators with an overview of important issues related to health communication and highlights strategies that facilitate effective communication to help people to make informed decisions about their health care.
Perceptions and expectations reflecting what constitutes a ‘good’ death that seem to exist in Western societies are explored and compared with those presented by five symptom control team nurses at their home visits to 54 terminally ill cancer patients These perceptions and expectations are termed ‘scripts’ for dying and are derived from the nurses', patients’ and relatives’ audio-recorded conversations over a 3-month period The elements of the ‘scripts’ used were identified as (a) control of physical symptoms, (b) acceptance of cancer and its prognosis, (c) preservation of hope and ‘will to live’, (d) mobility and ‘fighting back’, (e) enjoyment of life, (f) a peaceful death at home How these components are determined from the conversations are presented and the responses of the patients to the nurses’‘scripts’ are analysed The dilemmas created by putting the ‘scripts’ into action for nurses, patients and relatives are discussed
Despite the fact that terminally ill patients are approaching the end-stage of their lives, the need for information and continuing involvement in their own care remains paramount and does not necessarily diminish as their dependency increases. This paper supports the view that nurses working in the area of rural palliative care are in an optimum position to establish the kind of relationship with patients and informal carers that augments a sense of involvement, self determination, equity and trust. This is of particular significance to rural palliative care where service provision may be under-resourced and where domiciliary nurses are often the key provider for continuing care and support.
ObjectiveThe purpose of this work was to design and evaluate an information leaflet for new patients attending a physiotherapy outpatient department. This formed part of a wider agenda of improving the patients’ experience and increasing adherence to the Chartered Society of Physiotherapy's core standards.DesignA needs analysis was undertaken with existing patients to determine the content of the new leaflet. This was then tested for readability, reviewed by physiotherapy staff and evaluated by patients via a questionnaire.SettingThe musculoskeletal outpatient physiotherapy department at Southampton General Hospital.ParticipantsPatients referred to the outpatient physiotherapy service, plus all clinical and support staff employed in the musculoskeletal outpatient team.Main outcome measuresNumerical Rating Scale and Gunning's Fog Index.ResultsThirty-seven of 50 patients completed the needs analysis (74%), generating 42 ideas for the leaflet content. The definitive leaflet addressed one core standard and 16 specific criteria, and had a readability of grade 8.3, which is below the recommended maximum limit of grade 9 for health education leaflets. Using an 11-point Numerical Rating Scale, where 0 = of no benefit and 10 = extremely helpful, the mean rating for the leaflet from 29 of 100 patients was 8.6.ConclusionsThis work has produced a patient information leaflet for physiotherapy outpatients, a copy of which is freely available (electronically) from the author. The leaflet forms part of an ongoing commitment to improving the patients’ experience.
The aim of this study was to estimate the effectiveness of patient education methods on quality of life and functional impairment of patients with schizophrenia.
A multicentre, randomized controlled trial was carried out in two psychiatric hospitals in Finland from March 2005 to October 2007. A total of 311 patients with a diagnosis of schizophrenia, schizotypal disorder or delusional disorder were randomly allocated to computer-based patient education (n = 100), conventional education with standard leaflets (n = 106) and standard treatment (n = 105). Participants were followed up 12 months later. Primary outcome was quality of life (Q-LES-Q-SF) and secondary outcome was functional disability (SDS). Analysis was performed by intention-to-treat. This study is registered, number ISRCTN74919979.
Patients' global quality of life improved and functional disability decreased significantly in all education groups over the follow-up time. There were no significant differences between groups in these outcomes.
In light of the findings there is no evidence to support a particular education method as the best way to improve patients' quality of life or improve functional ability. On the other hand, no intervention was found to be harmful. Thus computer-based patient education may be a suitable alternative for some patients. While information technology will be more widely used in societies, computer-based intervention may be beneficial for some patients with serious mental disorders.
If patients return early in the course of acute, uncomplicated back pain to their normal activities, their symptoms improve more quickly. Written detailed patient information can have a positive effect on knowledge and can increase physical activity. In this study the effect of a short evidence-based back pain leaflet on knowledge, function and patients' beliefs was investigated.
A randomised controlled trial was carried out in 12 primary care practices. Patients with acute, uncomplicated back pain received either the back-pain specific information (intervention) or a leaflet without content regarding back pain (control). Participants' data were inquired before consultation of the general practitioner, as well as 1 week and 3 months later. Outcome measures were SF-36, FABQ-D, FFbH-R, knowledge concerning back pain, frequency of use of the leaflet, usefulness of the information and change of behaviour.
The included patients totaled 174. The response rates were 74.7% (1 week) and 67% (3 months). Patients receiving the intervention leaflet showed better knowledge at 1 week and greater improvement in function scores at 3 months. There was no effect on patients' beliefs. Patients of the intervention group reported more activity in everyday life.
Short written information may have small, in total possibly positive effects on knowledge, support of activity and function in patients with acute, uncomplicated back pain.
This study examined whether academic preparation, years of experience, or job role influenced registered nurses' attitudes regarding patient education, the frequency of assuming teaching roles, and the degree of comfort in providing patient education. This quantitative study used a survey tool sent to 412 registered nurses in five rural community hospitals. There were 273 surveys returned (66.3%). Data were analyzed using descriptive statistics, factor analysis, and analysis of variance with post hoc testing. Role ambiguity emerged with a significant difference based on educational preparation. Job role showed a significant difference in competency and comfort with patient education. Years of experience yielded significant differences in the registered nurses' degree of comfort in teaching within two of the three factors.
J Contin Educ Nurs 2010;41(1):41–48.
The prevalence of smoking is very high among methadone users. As a method of delivering health education, computers can be utilized effectively. However computer-assisted education in methadone users has not been evaluated systematically.
This study was aimed at assessing feasibility and patient acceptance of an interactive educational module of a multi-component smoking cessation counseling computer program for former illicit drug users treated in an outpatient methadone clinic.
The computer-mediated education for hazards of smoking utilized in this study was driven by major constructs of adult learning theories. The program interface was tailored to individuals with minimal computer experience and was implemented on a touch screen tablet PC. The number of consecutive methadone-treated current smokers enrolled in the study was 35. After providing socio-demographic and smoking profiles, the patients were asked to use the educational program for 40 minutes. The impact of the computer-mediated education was assessed by administering a pre- and post-intervention Hazards of Smoking Knowledge Survey (HSKS). An attitudinal survey and semi-structured qualitative interview were used after the educational session to assess the opinions of participants about their educational experience.
The computer-mediated education resulted in significant increase of HSKS scores from 60.5 +/- 16.3 to 70.4 +/- 11.7 with t value 3.69 and P < .001. The majority of the patients (78.8%) felt the tablet PC was easy to use, and most of the patients (91.4%) rated the educational experience as good or excellent. After controlling for patient baseline characteristics, the effect of computer-mediated education remained statistically significant.
Computer-assisted education using tablet PCs was feasible, well-accepted, and an effective means of providing hazards of smoking education among methadone users.
Health care demands are rising rapidly as we move towards the year 2000 and effective health education is essential if increasing numbers of patients are to be nursed in the community and the effects of preventable illnesses are to be minimized. It is therefore extremely pertinent to discuss how well nurses are educating their patients at present and what strategies the profession may need to consider in order to meet educational needs of the future. It seems clear that nurses have a responsibility to provide the information that their patients require, although there remains some debate regarding whether they are the most appropriate member of the health care team to do so. Recent studies show that nurses can be effective educators. However, although many recognize the importance of this role, they still often lack the skills, knowledge, motivation and support required to organize and implement an adequate programme of patient education.
Computers have only recently begun to find a place in the everyday work of health care staff. The use of computer-assisted learning (CAL) in patient education is in its infancy. However, the medium appears to offer several advantages to patients. The successful integration of the medium into clinical practice requires the acceptance and support of staff members. Little research exists to date which examines staff responses to the introduction of CAL into their workplace. This small study (n = 14) aims to explore the reactions of staff to the introduction of an experimental CAL package for use in the education of renal patients on continuous ambulatory peritoneal dialysis (CAPD). The opinions of staff members to CAL are probed and their views ascertained regarding the usefulness of CAL to both staff and patients. Results suggest that, despite their initial reservations about CAL, staff were generally positive about the medium.
A randomized controlled trial was undertaken to test the effects of an education programme, which included an information booklet, on patients' knowledge and acceptance of their indwelling urethral catheters. A total of 45 patients participated, all of whom were either established or new catheter users. Data were collected at pretest, test and follow-up visits. The information booklet and researcher were found to significantly influence patients' knowledge and acceptance of their catheters. The findings are discussed with a number of conclusions drawn and recommendations for current practice.
Interviews were undertaken with 202 men admitted to five hospitals in northeast England following an uncomplicated first myocardial infarction. The likelihood of patients speaking to a nurse about recovery or seeing a physiotherapist, dietician or specialist rehabilitation nurse, varied considerably between hospitals.
Whilst virtually all patients received written information concerning some aspect of life‐style change or cardiac rehabilitation, the quality and range of information, particularly with regard to information about stress or anxiety, was frequently limited.
Instructions about seeing a general practitioner following discharge were often vague; formal rehabilitation programmes, where they existed, excluded some patients.
The study suggests that much patient education is dependent on the provision of written information alone, and that further evaluation of the effectiveness of self‐help material supported by nursing input is desirable.
This study had two purposes: (1) to examine nurses' attitudes toward patient and family education; and (2) to identify issues, barriers, and concerns related to patient and family education. A three-part survey was distributed to licensed nurses employed in a large healthcare system in Central Florida. Analysis of variance with posthoc multiple comparisons found differences in responses between different demographic groups. A model for meeting the patients' and families' education needs is proposed, using the various roles of the clinical nurse specialist to facilitate the process.
Patient teaching in general hospitals is becoming increasingly important both due to higher patient turnover and the principles of self-care. This study focuses on how hospital nurses describe ideals and realities in teaching adult patients in a general hospital, and how they describe the factors affecting their teaching function. The study has a qualitative approach. Fourteen registered nurses, working in a general hospital, are interviewed. The interviews are semistructured. The four stages adapted from Glaser & Strauss' grounded theory approach are used as a support in the elaboration and the analysis of the data. The study shows that the ideals about patient teaching are rather weakly articulated. The realities are, however, more distinctly described. Empirical findings reveal two different 'teaching processes' articulated by the informants. Both processes are novel and different from the traditional teaching process mentioned in the literature. Which processes the nurses are applying in the clinic seem to depend on the objective and content of the patient teaching. This evidence has so far not been reported in previous studies. Regarding the factors affecting their patient teaching, the nurses emphasize the following three; The nurses' qualifications, training in the teaching function and the organizational setting.
Motivation and ability are attributes of learning readiness for patient teaching. Achievement motivation theory includes the assumption that the tendency to succeed in regaining functional losses due to stroke is related to patients' perceptions of how difficult activities will be to accomplish. Ability is assessed using the Functional Independence Measure. A framework is applied to a patient situation demonstrating that the tendency to succeed is greater when striving to achieve goals with an uncertain level of difficulty than when goals are either easy or hard. Implications for nursing and research are described.
Can nurses learn to let go? Issues arising from an intervention designed to improve patients’ involvement in their own care
The aim of the paper was to explore the reasons behind a perplexing observation that an intervention designed to alter professional behaviour in general practice consultations in South Wales was poorly sustained despite initial enthusiasm among the nurses. Nurses’ baseline and continuing responses to the new approach with patients with non-insulin dependent diabetes are described, drawing on observations and interviews with the 18 practice nurses in the 15 experimental practices.
The nurses fell into two groups: those showing greater understanding of the principles underlying the approach and a more reflective attitude to their work; and those who adapted the simple technology provided to their usual consultation style. This variation was related to their perception of their role and their attitudes to diabetic care, especially the challenge posed by the ‘difficult patient’. They were noticeably less willing to allow the patient freedom to decide what to do once diabetic control was deteriorating according to biochemical measures. It is concluded that the failure of the nurses to sustain behaviour change over time stems from a basic dilemma, namely, what is the extent of my responsibility and how ought I to discharge it? There is scope for more research into professional perspectives on chronic care, the strategies they use to manage patients and to cope with their own feelings, and the implications of these strategies for patients.
A single-blind randomized controlled trial of a leaflet developed for people with acute low back pain was compared with the usual general practitioner management of back pain.
To test the effectiveness of a patient information leaflet on knowledge, attitude, behavior, and function.
Despite the commonality of back pain in general practice, little evidence on the effectiveness of simple interventions such as leaflets and advice on self-management has been reported. On the basis of a five-stage needs analysis, a simple leaflet was developed that considered the views of patients and health professionals.
For this study, 64 patients with acute back pain were assigned to the leaflet or control group. The participants were visited at home after 2 days, 2 weeks, then 3, 6, and 12 months, where they completed a range of self-report measures. Behavioral aspects were discretely recorded by a "blinded" researcher. Primary outcomes were knowledge, attitude, behavior, and function.
In all, 272 home visits were undertaken. The findings show that at 2 weeks, knowledge about sitting posture was greater in the leaflet group (P = 0.006), which transferred to a behavioral difference (sitting with lumbar lordosis support) when participants were unaware that they were being observed (P = 0.009). This difference remained significant at 3 months. Patients in the leaflet group also were better at maintaining a wide base of support when lifting a light object than the control subjects throughout all five assessments. There were no significant differences in the functional outcomes tested.
This trial demonstrates that written advice for patients can be a contributory factor in the initial general practitioner consultation because it may change aspects of knowledge and behavior. This has implications for the management of acute back pain, with potential health gain.
The present paper investigates what the term discharge planning actually means to nurses working in the acute care environment. A qualitative approach was used for this study. Twelve volunteer registered nurses (RNs) working in a large metropolitan Victorian public hospital were interviewed. All participants stated emphatically that they were involved in the discharge planning process although differing levels of involvement existed. "Organizing" and "planning" were key words used by participants to define the term discharge planning. All but one participant considered the nurse to be the coordinator of the discharge planning process. How participants communicated with other nursing staff regarding the discharge planning needs of individual patients depended on the policy of each individual ward. Communication was perceived to be a major factor that either enhanced or impeded the discharge planning process.
This article aimed to explore the factors relating to nurses themselves that influence the delivery of preoperative patient education in everyday surgical clinical contexts at one large general adult teaching hospital in Ireland.
As landmark studies of preoperative education undertaken in the UK in the 1970s identified the superiority of structured programmes of patient education over and above 'regular' preoperative care, there have been many intervention/outcome experimental studies carried out in this area. However, there has been little interpretative work conducted that explores the regular, or 'usual' preoperative education given to patients in everyday surgical units. Methods. A sample of 12 experienced surgical nurses was selected and each participant was interviewed in depth. Data were analysed using a qualitative strategy resembling grounded theory.
Findings indicate that preoperative education was variously interpreted by participants, and participants' accounts suggested that different understandings and practices by nurses resulted in patients receiving different levels of care. In addition, diverse levels of knowledge and experience of individual nurses resulted in unevenness in the type of preoperative education that patients received. A number of participants advocated a more formal method of preparation for nurses in the area of preoperative education. Finally, in some surgical areas, specialist nurses worked side-by-side with regular ward nurses and their input in preoperative education was largely seen by participants in a positive way, particularly in view of the structural constraints that ward nurses faced.
We conclude that nurse-related factors in preoperative education do not arise in a vaccum, but rather are related to the wider organizational practices and culture. The difficulties with preoperative education identified in data may be addressed through organizational investment in preoperative education.
This paper produces evidence for nurses and clinical nurse managers about how nurse-related factors impede preoperative education, and may provide a starting point for how to begin to address obstacles to better preoperative care.
This paper presents an account of nurses' perceptions and understanding of health promotion in an acute setting.
Health promotion is considered the remit of every nurse. To engage in health-promoting practice, however, nurses need to understand the term 'health promotion' clearly.
A single qualitative embedded case study was used. Purposive sampling of eight nurses was employed. Initially, theses nurses were observed in practice and, following this, a semi-structured one-to-one interview was conducted with each observed nurse. Qualitative data analysis guided by work of Miles and Huberman was employed.
The data revealed one main theme: health-promoting nursing practice and this consisted of six categories and five subcategories. The findings indicated that nurses struggled to describe their understanding of health promotion, their understanding was limited and the strategies described to conduct health promotion were narrow and focused on the individual. Their perceptions and descriptions of health promotion were more in keeping with the traditional health education approach. Overall health promotion was reported to occur infrequently, being added on if the nurse had time. Factors relating to education, organizational and management issues were identified as key barriers prohibiting health-promoting nursing practice.
Nurses must recognize that health promotion is a broad concept that does not exclusively focus on the individual or lifestyle factors. Nurses must be educated to recognize health-promoting opportunities in the acute setting, as well as how to plan for and conduct health promotion so that it becomes integral to practice. A review of the methods of organizing and delivering nursing care is also advocated.
Ward managers have an important role in supporting nurses, creating a culture for health promotion and sharing power in decision-making processes, so that nurses feel valued and empowered.
This article explores more efficacious strategies for holistic nurses to promote healthy behavior choices in their clients. It presents an overview of self-determination theory (SDT) and describes research evidence that supports the application of SDT to promoting healthy behavior change in clients. When nurses act in ways that support clients' innate needs for autonomy, competence, and relatedness, clients may be more successful at internalizing self-regulation and more inclined to adopt and maintain lifelong behavioral changes. Some examples of nursing interventions to motivate behavior change are outlined in this article.
To determine whether well trained lay people could deliver asthma self-management education with comparable outcomes to that achieved by primary care based practice nurses.
Randomised equivalence trial.
39 general practices in West London and North West England.
567 patients with asthma who were on regular maintenance therapy. 15 lay educators were recruited and trained to deliver asthma self-management education.
An initial consultation of up to 45 min offered either by a lay educator or a practice based primary care nurse, followed by a second shorter face to face consultation and telephone follow-up for 1 year.
Unscheduled need for healthcare. Secondary outcome measures: Patient satisfaction and need for courses of oral steroids.
567 patients were randomised to care by a nurse (n = 287) or a lay educator (n = 280) and 146 and 171, respectively, attended the first face to face educational session. During the first two consultations, management changes were made in 35/146 patients seen by a practice nurse (24.0%) and in 56/171 patients (32.7%) seen by a lay educator. For 418/567 patients (73.7%), we have 1 year data on use of unscheduled healthcare. Under an intention to treat approach, 61/205 patients (29.8%) in the nurse led group required unscheduled care compared with 65/213 (30.5%) in the lay led group (90% CI for difference -8.1% to 6.6%; 95% CI for difference -9.5% to 8.0%). The 90% CI contained the predetermined equivalence region (-5% to +5%) giving an inconclusive result regarding the equivalence of the two approaches. Despite the fact that all patients had been prescribed regular maintenance therapy, 122/418 patients (29.2%) required courses of steroid tablets during the course of 1 year. Patient satisfaction following the initial face to face consultation was similar in both groups.
It is possible to recruit and train lay educators to deliver a discrete area of respiratory care, with comparable outcomes to those seen by nurses.
Little is known about what it is like to live in adolescence with a chronic inflammatory bowel disease. This article reports the findings of a small qualitative study that explored the experience of four New Zealand youth aged between 16 and 21 years, who had been recently diagnosed with Crohn disease. Semistructured interviews focused on discovering the youth' thoughts, feelings, and perceptions of living with this condition. Analysis of the transcribed data is presented thematically. The findings reveal stress as integral to living with Crohn disease. They illuminate the paradoxical relationship between fear and hope and provide insight into what helps and what hinders young people's ability to cope with the disease and its treatments. Collectively, these three themes describe the ways in which the lives of young adults are drastically and almost irreparably changed by Crohn disease. The findings contribute to the "promoting wellness" literature and will inform those who support the increasing number of young people living and coping with a chronic inflammatory bowel disease.
Three educational interventions for the control of essential hypertension in ambulatory patients were based on analyses of the educational needs of patients and providers. The educational program increased reported compliance with medication, improved the proportion of patients losing weight, and improved appointment keeping. Most important, there was a favorable effect on blood pressure (BP) control. The proportion of patients with BP under control in the group assigned to all three interventions increased by 28% (from 38% to 66%), while the proportion in the control group receiving standard medical therapy with no educational interventions remained unchanged at 42%.
Both the conceptualization and the measurement of satisfaction have been of major concern in medical care research. Some scholars used satisfaction as a determinant of utilization, others as a consequence of utilization. Measures of satisfaction are largely content oriented. Reliabilities are reported, but validity is usually assumed (face validity) or assessed through correlations with a criterion variable like "wish to change providers." Using multidimensional scaling techniques, this study identifies several components in the construct "satisfaction" and relates them to the utilization of services. A general satisfaction measure provides us with an assessment of physicians and the medical care delivered, a specific satisfaction measure assesses past experience with the regular source of the care. Both of these can be divided into a positive and negative subcluster. Regressions were computed predicting satisfaction from utilization, and utilization from satisfaction, each time controlling in a preceding step for sociodemographic factors. The relationships varied strongly by provider; as a rule, a larger proportion of the variance could be explained analyzing for one provider at a time than for all providers combined. Analyzing one provider at a time showed that satisfaction substantially increased the proportion of explained variance in utilization in hierarchical regression, but utilization did not increase the explained variance in satisfaction.
The domesticated Andean grain chenopod, Chenopodium quinoa, is sympatric with closely related wild types that are classified as two species. Large-fruited (1.5-1.8 mm diam.), broad-leaved plants are placed with C. quinoa, as either subsp. milleanum or var. melanospermum. Plants with smaller fruits (1.0-1.5 mm) and rhombic to tri-lobed leaves are treated as Andean varieties of C. hircinum, a species originally described from the eastern plains of South America. This alignment was evaluated by comparative analysis of electrophoretic and morphometric data taken from populations occurring throughout the range of C. hircinum (s.l.). Samples from the eastern Andean slopes and plains of Argentina (C. hircinum s. str.) form a coherent group that is positioned at one extreme in the pattern of leaf and fruit variation. These samples, characterized by small, obtuse-margined fruits and acute, lobed leaves, are linked to material from the high Andes through a series of intermediate Andean samples. Andean material shows a wide range of variation in fruit size and shape. Leaf shape is more conservative, although samples from Bolivia trend toward the acute, trilobed condition. In contrast to morphological relationships, allozyme variation is simple and well defined. Andean material is homogeneous (Ī > 0.98), with unique alleles widely dispersed, mainly in southern populations. Populations of C. hircinum (s. str.) are more variable (Ī = 0.951) and well differentiated from the highland group (\bar{I} = 0.825) by a relatively common set of unique alleles. Minimal electrophoretic differentiation among Andean samples indicates that the companion weed of C. quinoa is a single biological entity that may represent an Andean element of C. hircinum, although the pattern of fruit variation suggests linkage to C. quinoa.
Three educational interventions for the control of essential hypertension in ambulatory patients were based on analyses of the educational needs of patients and providers. The educational program increased reported compliance with medication, improved the proportion of patients losing weight, and improved appointment keeping. Most important, there was a favorable effect on blood pressure (BP) control. The proportion of patients with BP under control in the group assigned to all three interventions increased by 28% (from 38% to 66%), while the proportion in the control group receiving standard medical therapy with no educational interventions remained unchanged at 42%.
(JAMA 241:1700-1703, 1979)
The present research was designed to identify psychosocial correlates of adherence among patients receiving hemodialysis at two outpatient clinics. The 116 participants were interviewed concerning their knowledge of treatment, health beliefs, treatment history, social support, personal characteristics, and adherence to the medication, diet and fluid-intake aspects of the regimen. In addition, medical record data were obtained on serum phosphorus and serum potassium levels, and on between-dialysis weight gains. The magnitude of relationships between predictors and adherence measures varied, depending on the method used to measure adherence. For the self-report measures, beliefs concerning the efficacy of the behavior and barriers to the behavior, along with reported family problems, proved to be consistent predictors. Other beliefs and characteristics did not contribute significantly. For the medical chart information, however, the predictive factors were less consistent. In general, situational factors seem to be the major contributors to patient adherence, and adherence itself is seen as a complex and multidimensional phenomenon.
In this paper it is argued that the time has now come for nurses to take on a more active health education role in response to continuing changes in society and trends in illness and morbidity.The implications of such shifts in priority and emphasis within the nurse's role are discussed in the context of the need for radical changes in the attitudes and perspectives of the profession in general and nurse education in particular.
Reports the development of a method of identifying the motivational qualities and educational value of microcomputer software from the student's viewpoint. Student assessments of 3 categories of educational software were compared with those of 2 samples of classroom activity covering similar mathematics topics. 20 male and 18 female 6th-grade Ss were asked to identify motivational and learning attributes of computer (CO) and classroom (CL) activities and to rate each aspect of the activities using a scale of 1 to 10 (low to high). A significant difference in mean ratings between the 2 types of learning activities was found for motivational, but not for educational aspects. Results show gender differences in the perception of motivational characteristics: Males identified aspects in both CL and CO settings related to achievement/challenge, and females noted aspects of animation in the CO condition and problem calculation in the CL condition. Ss' reports identified a broader range of motivational characteristics in CO than in CL activities. (23 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
It is estimated that 1 out of 5 American adults lacks the literacy skills needed to function effectively in todays society and as patients they present a challenge to health instruction. This book provides teaching strategies to aid in making self-help and self-management a reality for the patient with low literacy skills. The magnitude of the problem is explored and myths about illiteracy are exemplified. Two chapters deal with comprehension of written materials from theory to practical proven testing techniques including the cloze technique and the word-recognition test. Another chapter offers 2 formulas for testing the readability of written materials: the SMOG formula and the Fry index. Once a problem is identified a 4-step teaching strategy gives tips on teaching the low-literacy patient. For those pamphlets and booklets commonly given to patients suggestions for writing and rewriting to simplify the text are given along with examples of comprehension level. The use of audiotapes for teaching is explored in depth for those who learn better by listening. A chapter on the use of visuals stresses simplification to reduce the amount of text reading to emphasize instruction and to motivate and appropriate examples are given. Where written material audiotapes and visuals are drafted and produced according to the guidelines in the book the last chapter is devoted to pretesting to determine whether intended concepts are coming through. It defines the components of pretesting describes procedures discusses possible stages for production and provides examples of results. Although the book is aimed at providing teaching methods for the low-literate patient the suggestions also apply to the learning disabled.
This paper describes an experiment testing the effect of informing patients about barium X-rays on their emotional reactions before and during the procedure. A self-report scale of emotions was used to compare the level of anxiety reported by the informed patients with that of control subjects who did not receive this information.
The barium meal study showed no differences in anxiety scores between informed and control subjects, most of whom reported low levels of anxiety. The enema study, however, showed significant differences in these scores. Informed patients reported less anxiety during the X-ray than controls, who frequently reported high levels prior to and during X-ray.
The literature review has been carried out to examine the role of nurses as patient teachers. It attempts to determine why patient education is necessary and why it should be part ofthe nurse's role. Included is an account ofthe abilities required by the nurse in order to function in that role. It is generally agreed that it is part ofthe nurse's role to educate patients but this is often not carried out in reality. Where it is done it is mostly unplanned and haphazard in manner and the effectiveness uncertain. There are many reasons cited why this is the case and many of these reasons relate to the inadequate education and training of nurses for this role. Registered nurses are responsible for the nursing care of patients which should include their education. In order to be able to provide the necessary education nurses must have the opportunity to be taught to develop the appropriate skills during basic training. As a result, a study is now underway to attempt to determine the extent to which student nurses are being prepared for their role as patient educators during basic training.
Implicit images of human behaviour influence most research endeavours. Studies of patients' “compliance” with doctors' instructions have generally used an ideal image of the patient as a passive, obedient and unquestioning recipient of medical instructions. Divergence from this ideal—“defaulting”—is seen as irrational in the light of medical rationality. The blame for “default” is seen as lying with the patient. The research problem is then to find out what there is about the patient that makes him a defaulter. This is a view of the problem from the point of view of the medical profession. An alternative approach from the perspective of the patient is suggested. The focus is then on the social context in which illnesses are lived and treatments used. A more active view patients is entailed in which patients have expectations of the doctor, evaluate the doctor's actions, and are able to make their own treatment decisions. Rather than “defaulting” being found in certain types of individuals, almost anyone can be a “defaulter” at some time or another.
38 hypertensive Canadian steelworkers who were neither compliant with medications nor at goal diastolic blood-pressure six months after starting treatment were allocated either to a control group or to an experimental group who were taught how to measure their own blood-pressures, asked to chart their home blood-pressures and pill taking, and taught how to tailor pill taking to their daily habits and rituals; these men were also seen fortnightly by a highschool graduate with no formal health professional training who reinforced the experimental manoeuvres and rewarded improvements in compliance and blood-pressure. Six months later, average compliance had fallen by 1.5% in the control group but rose 21.3% in the experimental group. Blood-pressures fell in 17 of 20 experimental patients (to goal in 6) and in 10 of 18 control patients (to goal in 2).
This paper describes an experiment testing the effect of informing patients about barium X-rays on their emotional reactions before and during the procedure. A self-report scale of emotions was used to compare the level of anxiety reported by the informed patients with that of control subjects who did not receive this information. The barium meal study showed no differences in anxiety scores between informed and control subjects, most of whom reported low levels of anxiety. The enema study, however, showed significant differences in these scores. Informed patients reported less anxiety during the X-ray than controls, who frequently reported high levels prior to and during X-ray.
A theoretical model is described whose particular emphasis is directed towards operationalizing the statements: ‘effective teaching bridges the gap between information and practice’ or ‘teaching is more than telling’. It concentrates on nurse behaviours (facilitation) designed to actively engage the patient in learning, whereby he accepts his diagnosis or situation, projects the effects of prescribed therapy on his future life, and commits his intentions to practice.
It utilizes principles of learning derived from the perceptual (phenomenological) approach and indicates the nurses' responsibilities. The model identifies four critical elements in the engagement process–the patient's values, his perception of the disease threat, his perceived utility of the prescription, and the facilitating behaviours of the nurse. The strategy is adapted from a combination of the Health Belief Model and the Personal Choice Model .
In an effort to compare different methods of instructing patients, 99 women 18-25 years of age were given computer, spoken, weitten, or no instructions for the collection of a clean voided urine specimen. The group who received computer instructions was the most uniform in its performance (P less than 0.002, F-test) and reported the fewest procedural problems (P less than 0.02, Fisher test). In addition, this group had fewer contaminating bacteria than the group who received written instructions (P less than 0.03 , Mann-Whitney test). The group who received no instructions had more bacteria (P less than 0.0001, Mann-Whitney test) than any of the other groups. The effectiveness of the computer instruction was probably related to numerous attributes, including the individualized quality of the dialogue, self-pacing, self-testing, and privacy.
Both the conceptualization and the measurement of satisfaction have been of major concern in medical care research. Some scholars used satisfaction as a determinant of utilization, others as a consequence of utilization. Measures of satisfaction are largely content oriented. Reliabilities are reported, but validity is usually assumed (face validity) or assessed through correlations with a criterion variable like "wish to change providers." Using multidimensional scaling techniques, this study identifies several components in the construct "satisfaction" and relates them to the utilization of services. A general satisfaction measure provides us with an assessment of physicians and the medical care delivered, a specific satisfaction measure assesses past experience with the regular source of the care. Both of these can be divided into a positive and negative subcluster. Regressions were computed predicting satisfaction from utilization, and utilization from satisfaction, each time controlling in a preceding step for sociodemographic factors. The relationships varied strongly by provider; as a rule, a larger proportion of the variance could be explained analyzing for one provider at a time than for all providers combined. Analyzing one provider at a time showed that satisfaction substantially increased the proportion of explained variance in utilization in hierarchical regression, but utilization did not increase the explained variance in satisfaction.
This study investigated the relationship between the individual difference variable, locus of control, and a patient's response to diabetes. Since internal persons have been found to be active information seekers as compared to external persons, it was predicted that internal diabetics would know more about their disease and would, therefore, demonstrate more control over it. As predicted, internal diabetics did have more diabetic information, although this superiority over externals diminished as the length of the disease increased. Contrary to prediction, internal diabetics seemed to incur more problems with disease than externals as the disease progressed. This finding was interpreted as presenting a limiting case to the usual thinking about the superiority of an internal's response to problem situations.
Over the past two decades, hundreds of articles, editorials, and commentaries have been published describing the considerable disruptive effects on quality of care of individuals noncompliance with health and medical advice. While much research has been directed at determining factors responsible for poor compliance, past studies have tended to focus upon easily measured characteristics of the patients, regimen, or illness which, unfortunately, are usually neither predictive nor alterable. This paper systematically reviews the literature on patient acceptance of recommended health behaviors, attempting to find social-psychological and related variables which have proven to be consistent predictors of compliance. The review suggests that certain health beliefs (especailly personal estimates of vulnerability to, and seriousness of, the disease, and faith in the efficacy of care), health-related motivations, perceptions of psychological and other costs of the recommended action, various aspects of the doctor-patient relationship, and social influence are the most productive dimensions for present intervention and further exploration. Building upon an earlier formulation, an hypothesized model is presented which combines these elements for explaining and predicting compliance behavior. Further research should, with standardized questionnaires and analysis techniques, employ prospective, experimental designs for a variety of population groups, settings, and regimens, to evaluate the ability of practical attempts to modify the model variables and thus enhance compliance.
Helping patients with hypertension achieve effective coping outcomes entails the implementation of multiple, autonomous nursing interventions specifically related to teaching and support. By teaching specific cognitive and behavioral strategies, the nurse assists the patient in developing effective means of incorporating the treatment regimen into a more healthful lifestyle. The supportive nursing actions help the patient make the necessary changes by providing the environment in which change may occur. As a result, the patient may reappraise the diagnosis of hypertension and its therapeutic regimen as less threatening and may consequently assume a more active role in its management.
A program of 8 lessons on various aspects of osteoarthritis (OA), its treatment, and patient self-care was prepared on an Apple IIc computer. The courses were then field-tested and evaluated by 72 older (age range 52-88) OA patients in community centers for senior citizens. Statistical analysis of the findings showed significant increases in knowledge and significant self-reported, beneficial behavior changes, including increased exercise, use of heat, and rest. Our findings demonstrate that older persons can use the computer to learn to cope with OA when a thoughtfully planned program is made available in a community setting.
Careless or confused use of terms such as information giving, teaching and counselling may lead to inadequate understanding and practice. In view of the progress made in this area, designed to help patients cope with illness and treatment, this paper aims to clarify and identify similarities and differences between these activities and discuss their relevance for those in most need of these types of care. Having recognised the complexity and persistence of such needs, patients, their relatives and nurses should perhaps decide their respective roles and work towards improving the quality of and opportunities for such interventions.
The expanding role of the nurse in educating patients and consumers necessitates media that can be adapted to a variety of learners, topics, and settings. Quality patient education in the health care field must meet accreditation and legal mandates, satisfy demands of consumers for information, and promote cost effectiveness. The microcomputer, with its unique capacity for individualized instruction, portability, and adaptability, is a potential medium for addressing these issues.
Seventy-two hypertensive patients visiting an emergency department (ED) were randomized to one of four study groups to test the effect on compliance of a health belief model (HBM) intervention: a control group, a group receiving an HBM clinical intervention in the ED, a group receiving an HBM telephone call two days after the ED visit, and a combination clinical plus telephone intervention. Patients receiving any HBM intervention were 50% more likely to make, and 47% more likely to keep, a follow-up referral appointment than control group patients.
The aim of this paper is to shed some light on the way trained nurses responded to the challenge of teaching patients to manage life on Continuous Ambulatory Peritoneal Dialysis (CAPD). This topic is of interest since nursing skills and knowledge are central to the successful management of patients on CAPD. More importantly, the treatment has the potential to keep patients alive who would not previously have been treated. Hence the assumption underpinning this work is that the opinions which nurses hold regarding this form of treatment may in due course influence its future. The data on which this paper is based were collected by means of participant observation over a period of nine months on one male and one female medical ward. Supplementary data were collected during this time at the out-patient clinic and at multidisciplinary CAPD meetings. The findings reported here are impressionistic and hypothesis-generating, but nevertheless they do provide sound insights into the way nurses reacted to patients on this new form of treatment. The type of patient selected for treatment and the ward workload were found to be the most influential factors in the way nurses regarded CAPD patients. It seemed that patients were viewed as 'members' of a collectivity rather than as individuals. Hence the job of the nurse was to rationalize competing demands on her time. Our data suggest that nurses viewed CAPD patients as generating 'extra work' and these patients were more likely to be viewed unfavourably.(ABSTRACT TRUNCATED AT 250 WORDS)
In order to evaluate the effectiveness of a structured respiratory teaching programme, clients with chronic obstructive pulmonary disease who were hospitalized in a 13-month period both prior to and following the implementation of the programme were compared on several parameters to assess changes in their ability to manage their disabilities. The study demonstrated that clients who participated in the teaching sessions had fewer hospital admissions, shorter lengths of hospital stay, and longer stays in the community. A sub-group of clients who were or had been in at-risk occupations was identified as representing the 'revolving door' client with shorter hospital and community stays. The teaching programme is described as well as specific elements that can be used for a shorter teaching experience to respond to time constraints when necessary.
The purpose of this study was to describe the amount of congruence in the perceptions of 38 matched nurse-patient dyads concerning the nurse's role in patient education. The perceptions of nurses and patients from two hospital settings were measured with two complementary sets of questions, developed for this study; t-tests were used to compare the mean responses of nurses and patients within and between the two settings to each set of complementary questions. The results indicated that incongruencies existed between nurses' and patients' perceptions of the nurse's role in patient education. Patients identified a general teaching function for nurses. When asked who they preferred to have teach them the specific information related to their condition, patients most frequently chose a physician. Nurses most frequently chose a nurse as the current and most desired patient teacher. Nurses incorrectly assumed that the desires of their patients for patient education were similar to their own. The results suggest that nurses need to develop a clear definition of their role in patient education, to validate patients' desires for teaching, and to examine organizational factors influencing their performance of the patient teaching role.
The coping demands of diabetes may be insurmountable to the unprepared and unwary. The psychosocial, self-management, and knowledge/skill demands of diabetes can affect every aspect of a person's life. Planning ways to cope with this unique circumstance may help a diabetic person adjust to a complex and difficult lifelong problem. Viewing the client, family and friends, nurse, physician, dietitian, and relevant other team members as a full corporate partnership, with individual and shared responsibility, also lays the groundwork for realistic problem-solving and coping by all concerned.
The present study compared a computerized health education format to face-to-face and written methods. The effects of delivery method on the retention of health information and on participant evaluation of the condition were assessed. College student participants (N = 200) were randomly assigned to one of four conditions (computerized, face-to-face, written, or control) such that each condition contained 25 males and 25 females. The experimental groups reviewed a lengthy text on sexually transmitted diseases (STD) whereas the control group received no information. Participants were then assessed for self-report anxiety, appraisement of the experience, and recall of the text. Results showed participants in the computer and written conditions freely recalled at an equivalent rate which was superior to the face-to-face format. No differences emerged between high and low computer experience subgroups of the computer condition. The face-to-face and computer conditions were assessed in positive terms with the written format being assessed more negatively. Although, detailed analysis revealed there was the potential for more negative perception of the computer method in association with increased anxiety. Results are discussed in terms of their demonstrating support for a computerized approach to health education.
A descriptive survey was conducted at an urban university medical center to ascertain the opinions of patients undergoing vascular surgery to a booklet used for preoperative teaching. In the postoperative period 21 patients reported their perceived value of the booklet in modifying their feelings about the surgical event, helping them to feel in control of postoperative pain, preparing them to participate in postoperative activities, and providing them with overall preoperative preparation. Patients also identified needs that the booklet did not meet and suggested modifications that might better meet patients' preoperative learning needs. Ninety percent of responding patients described the booklet as helpful in meeting their preoperative learning needs, and 95% said they would recommend the booklet to a friend. Patients who had discussed the booklet with a health-team member consistently described the value of the booklet more favorably than did patients who had not discussed the booklet before surgery. Nurses were identified as the health-team members who most often discussed the content of the booklet with the patient. The findings suggest that patients with no education beyond grammar school might have difficulty appreciating the value of the preoperative teaching booklet.