Are nurses good patient educators?

Nurses? perceptions, understanding and experiences of health promotion

AIM

This paper presents an account of nurses' perceptions and understanding of health promotion in an acute setting.

BACKGROUND

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.

METHOD

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.

RESULTS

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.

CONCLUSIONS

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.

RELEVANCE TO CLINICAL PRACTICE

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.

Accident and Emergency nurses' attitudes towards health promotion

AIM

This paper presents a study exploring Accident and Emergency nurses' attitudes towards health promotion.

BACKGROUND

Much has been written about nurses and health promotion. Research has focused mainly on community nurses, less on nurses working in acute hospital settings, and apparently not at all on those working in Accident and Emergency units.

METHODS

Q methodology, a technique for extracting subjective opinions, was used. Eleven nurses working in Accident and Emergency departments completed 33-item Q-sorts and wrote personal definitions of health promotion. Based on published literature in the field, the Q sample was structured with reference to nurses' attitudes as they related to health promotion. Factor analysis was performed on the data, and the resulting factors were interpreted. The data were collected in 2003.

RESULTS

Three alternative constructions emerged from the data, representing three alternate views about health promotion. The most widely held opinion (representing nine of the 11 nurses) was a positive view of health promotion and the nurses' role in health promotion in Accident and Emergency environments.

CONCLUSIONS

It is not possible to generalize the findings of this study due to the small number of participants. However, their knowledge of, and commitment to, health promotion is encouraging. Recommendations for practice are that there is continued and increased post-registration education in health promotion for nurses and continuing exploration of the hospital nurses' health promotion role. Further research is needed to explore nurses' perceptions of barriers to effective health promotion and nurses' health promotion activities in Accident and Emergency environments.

Fear and in-hospital social support for coronary artery bypass grafting patients on the day before surgery

The purpose of this study was to ascertain the amount of in-hospital social support received by coronary artery bypass grafting patients and the impact of this support on their feelings of fear and anxiety. As adapted from Kahn's theory, social support was understood as emotional, informational and tangible support. The bypass grafting fear scale was developed to measure the fear, and the hospital anxiety and depression scale and the state anxiety inventory were used to measure the anxiety. Data were collected pre-operatively with a questionnaire from in-patients (N=193) and analysed using logistic regression analysis and one-way ANOVA. The majority of patients received plenty of social support from nurses and a great deal of multiprofessional counselling. When the amount of social support was high, patients experienced lower levels of fear and anxiety. It is concluded that social support from nurses can effectively reduce pre-operative fear and anxiety, but that the amount of support should be high.

Developing the nurse's role in patient education: rehabilitation as a case example

Over the past decade considerable emphasis has been placed on the nurse's role in patient education. Despite this numerous studies have suggested that this aspect of nursing practice is under-developed. Using rehabilitation as a case example this paper explores the nursing contribution to patient education in five conditions: multiple sclerosis; arthritis; myocardial infarction; spinal injury and stroke. Although the literature identifies considerable potential for nurses to take a lead role in patient education this is rarely achieved in practice. Analyses of printed curricula from a range of courses indicate that nurses are not adequately prepared for patient education and that a reorientation of nurse education is required.

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.

The nature of health promotion in acute and community settings

Since the late 1980s, there has been a consistent call from nursing's advisory and legislative bodies to incorporate the discipline of health promotion into the nursing profession. On reflection, however, evidence indicates that despite these calls there has not been a universal uptake of health promotional activity into the profession. What is evident is that where health promotional activity does take place, it occurs more in the community than in the acute setting. This article sets out to explore the reasons for this. It suggests that certain current and future activities may help to further promote the universal adoption of health promotion within nursing practice.

Registered nurses' perceptions of teaching: constraints to the teaching moment

Nursing literature indicates that patient teaching is an integral role function of the nurse. While some authors suggest that patient teaching is an essential part of nursing care, others argue that nurses are not adequately prepared to assume the role of teacher. This study explores the context within which nurses engage in patient teaching, revealing tensions experienced on a day to day basis within the practice setting. The principles of teaching and learning are also explored, raising questions about the extent to which nurses utilize these principles to guide the teaching moment. It is asserted that nurses find it difficult to engage in activities which are pivotal to the provision of quality patient education. Whether this is because they have little awareness or understanding of the principles of education, or whether this is related to the milieu in which teaching takes place, is explored.

Providing appropriate information to patients and carers following a stroke

This paper reports on a study which sought to identify the information needs of patients and their informal carers at various stages post-stroke with the aim of developing a database from which individualized information packages could be provided. The study used in-depth qualitative interviews with a total of 31 interviewees (both patients and carers) to explore information needs at three different points post-stroke: during hospitalization; up to 1 month post-discharge; and 2-12 months post-discharge. The information needs identified related to: recovery, treatment and prognosis; practical caring tasks; social activities; and resources available in the community. The study indicated that the information needs of patients and carers following stroke are not currently met and a desire for individualized information was identified. It is concluded that it may not be possible to meet patients' and carers' desire for information about recovery and prognosis but that a customized database covering the other areas highlighted by this study would facilitate improved information provision. It is anticipated that the process of providing such packages would improve communication within the rehabilitation team.

Strategies to integrate patient and family education into patient care redesign

This article discusses five strategies to effectively integrate patient and family education into patient care redesign. The strategies include building the plan, building a shared mission and vision, building involvement, building collaboration through initiatives, and building accountability. Each strategy or "building block" is vital to the resulting structure of patient and family education. Effective results of the strategies are discussed as milestones. The process must be ongoing to ensure continuous improvement in quality patient care outcomes, consumer satisfaction and cost-effectiveness.

Nurses' attitudes toward patient and family education: implications for clinical nurse specialists

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.

Nursing and health education: victim blaming

Health education may contribute to creating victims. In this article, the concept of victim blaming, and how the victim role is created, is explored using transactional analysis. Specifically, the Drama Triangle is used as a tool for analysis rather than a model for practice.

A sociological approach to health promotion for nurses in an institutional setting

This paper sets out to examine health promotion practice in hospital settings from a sociological viewpoint. It starts by tracing the development of health promotion among hospital and community nurses. The influences that professional and institutional structures and agendas have in health promotion are explored and a model of operation is proposed. The main emphasis is that health promotion is not an activity relying solely on skills acquisition by the nurse, but one that requires recognition of where power and control are located. A model of working is proposed which takes account of the institutional and professional agendas and the need to balance these with the needs and rights of the patient.

The nurse as patient educator

This article aims to examine the andragogical theory of adult learning and the implication that knowledge of adult learning theory is a prerequisite for successful patient teaching.