Implementation of a new patient education programme for renal transplant recipients

The Effect of Asthma Education Program on Disease Management in Children with Asthma: A Retrospective Analysis

Aims/Background As a common chronic respiratory disease, asthma may lead to airway inflammation and accelerated, progressive loss of lung function, if not well controlled, posing risks to patients' life and health. This study evaluates the impact of asthma education program on enhancing asthma control, quality of life, and pulmonary function in children, addressing gaps in existing management approaches. Methods In this retrospective study, 60 patients who had undergone routine nursing mode at Beijing Shijitan Hospital affiliated to Capital Medical University from May 2022 to May 2023 were enrolled for the reference group; after excluding 3 patients, this study finally included 57 patients. Separately, 55 patients who had attended the child-oriented asthma education program on the basis of routine nursing care at the same hospital from May 2023 to May 2024 were enrolled for the observation group; after excluding 2 patients, this study eventually included 53 patients. The Childhood Asthma Control Test (C-ACT) score, the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) score, pulmonary function index levels measured in terms of percentage of predicted forced vital capacity (FVC%), peak expiratory flow (PEF), forced vital capacity in one second/forced vital capacity (FEV1/FVC), and the disappearance time of clinical symptoms (dyspnea, chest tightness, cough, wheezing) were compared between the two groups. Results Before the management, there were no differences in the C-ACT and PAQLQ scores between the two groups (p > 0.05). After management, the C-ACT and PAQLQ scores of the observation group were significantly higher than those of the reference group (p < 0.001). There were no differences in FVC%, PEF, and FEV1/FVC between the two groups before management (p > 0.05). After management, the FVC%, PEF, and FEV1/FVC levels of the observation group were higher than those of the reference group (p < 0.001). The disappearance time of clinical symptoms such as dyspnea, chest tightness, cough and lung wheezing in the observation group was shorter than that in the reference group (p < 0.001). Conclusion The child-oriented asthma education program is beneficial to the disease management in children with asthma, improving asthma control, quality of life, lung function indexes, and shortening the time of symptom disappearance.

Effectiveness of a health communication intervention on health literacy in the first year following kidney transplantation - A randomized controlled study

OBJECTIVE

This study aimed to evaluate the effect of a new health communication intervention focusing on knowledge management skills on health literacy and medication adherence during the first year following kidney transplantation.

METHODS

We randomized 195 patients during 2020-2021, to either intervention- or control group. Questionnaires were completed at baseline and at 12 months post-transplantation with a 12-month response rate of 84%. Health literacy was measured by the multidimensional Health Literacy Questionnaire (HLQ) instrument. Medication adherence was measured by the self-reported questionnaire (BAASIS©).

RESULTS

Results showed that the intervention group had a significant increase in 2 HLQ domains compared to the control group capturing the "ability to appraise health information" Domain 5, (p-value = 0.002) and the "ability to navigate the healthcare system" Domain 7, (p-value <0.04). The effect sizes of SRM were 0.49 (Domain 5) and 0.33 (Domain 7). Medication adherence was comparable in the groups at any measure points.

CONCLUSIONS

This study contributes to important knowledge about how a health communication intervention focusing on knowledge translation using motivational interviewing techniques positively strengthens health literacy in kidney transplant recipients.

PRACTICAL IMPLICATIONS

Current patient education practice may benefit from focusing on knowledge translation in combination with motivational interview technique.

Quality of counselling assessed by patients after total knee arthroplasty: A cross-sectional study

Patient counselling is a key function in nursing. High-quality counselling promotes adherence to treatment and reduces complications. The purpose of the study was to describe the quality of counselling experienced by total knee arthroplasty patients following surgery. The study was a descriptive cross-sectional study. The data were collected from patients following total knee arthroplasty (N = 60) in 2016 with a modified Quality of Counselling Instrument, and analysed using statistical methods. Over half of the patients (58%) were women and the mean age was 68 years (range 49-84). Over a quarter of patients (28.9%) lived alone, and about two-thirds were overweight (42.1%), or obese (31.6%). After surgery, many patients (88%) experienced moderate pain. Half of patients (52.6%) received a good quality of counselling for the disease and its treatment, and counselling for recovery from treatment (81.6%) was good. Most patients (92.1%) received satisfactory counselling about physical activity. There was a correlation between the disease and its treatment counselling and quality of life (r = -0.553, p = 0.003) and pain (r = -0657, p = 0.000). Interaction during counselling was good (97.4%) and it was implemented in a patient-centred way (89.5%). High-quality counselling implemented in a patient-centred manner can play a part in reducing pain and increasing patients' quality of life.

The importance of shared meaning-making for sustainable knowledge translation and health literacy

The aim of the present paper is to describe and discuss how recent theories about translation, bridging medical and humanistic understandings of knowledge translation, in the medical humanities can bring about a new understanding of health literacy in the context of patient education. We argue that knowledge translation must be understood as active engagement with contextual meaning, considering the understandings, interpretation, and expertise of both patient and health care provider (deconstruction of the distinction between biomedical and cultural knowledge). To illustrate our points, we will describe the case of Jim, a kidney transplant recipient who received standard patient education but lost the graft (the new kidney). If we apply Kristeva's view to this context, graft function is not merely biology but a complex biocultural fact. In this perspective, graft function is seen as a phenomenon that embraces translation between health as a biomedical phenomenon and healing as lived experience, and that opens for shared meaning-making processes between the patient and the health care provider. In Jim's case, this means that we need to rethink the approach to patient education in a way that encourages the patient's idiosyncratic way of thinking and experiencing, and to transform health information into a means for sustaining Jim's singular life - not biological life "in general." The patient education programme did not take into consideration the singularities of Jim's biographical temporality, with its changes in everyday life, priorities, attitudes, and values. Hence, we claim that health literacy should involve a simultaneous interrogation of the patients and the health professional's constructions of knowledge.

Two Sides of a Coin: Parental Disease-Specific Training as Seen by Health Care Practitioners and Parents in Pediatric Liver Transplantation

In the absence of widely accepted education standards for parents of children after liver transplantation (LTx), the content and structure of parental training are influenced by health care practitioners’ (HCP) individual knowledge and assessment of the relevance of its contents. This study examines the hypothesis that expectations towards training differ between HCPs and parents, and that the quality of parental training affects the job-satisfaction of HCPs. Attitudes towards disease-specific education were assessed by tailor-made questionnaires in HCPs (n = 20) and parents of children with chronic liver disease or after LTx (n = 113). These were supplemented by focused interviews in n = 7 HCPs and n = 16 parents. Parents were more satisfied with current counseling than HCP. Language barriers and low parental educational background were perceived as obstacles by 43% of HCPs. The quality of parental knowledge was felt to have a strong influence on HCPs job satisfaction. The expectations towards the content of disease-specific education largely overlap but are not synonymous. HCP and parents agreed with regards to the importance of medication knowledge. Parents rated the importance about the meaning of laboratory values and diagnostic procedures significantly higher (3.50 vs. 2.85, p < 0.001 and 3.42 vs. 2.80, p < 0.001) than HCPs. Parents and HCPs would prefer a structured framework with sufficient staff resources for disease-specific counseling.

Renal recipients' knowledge and self-efficacy during first year after implementing an evidence based educational intervention as routine care at the transplantation clinic

BACKGROUND

Following an implementation plan based on dynamic dialogue between researchers and clinicians, this study implemented an evidence-based patient education program (tested in an RCT) into routine care at a clinical transplant center. The aim of this study was to investigate renal recipients' knowledge and self-efficacy during first year the after the intervention was provided in an everyday life setting.

METHODS

The study has a longitudinal design. The sample consisted of 196 renal recipients. Measurement points were 5 days (baseline), 2 months (T1), 6 months (T2), and one-year post transplantation (T3). Outcome measures were post-transplant knowledge, self-efficacy, and self-perceived general health.

RESULTS

No statistically significant changes were found from baseline to T1, T2, and T3. Participants' levels of knowledge and self-efficacy were high prior to the education program and did not change throughout the first year post transplantation.

CONCLUSION

Renal recipients self-efficacy and insight in post-transplant aspects seem to be more robust when admitted to the hospital for transplantation compared to baseline observations in the RCT study. This may explain why the implemented educational intervention did not lead to the same positive increase in outcome measures as in the RCT. This study supports that replicating clinical interventions in real-life settings may provide different results compared to results from RCT's. In order to gain a complete picture of the impacts of an implemented intervention, it is vital also to evaluate results after implementing findings from RCT-studies into everyday practice.

Intervening on health literacy by knowledge translation processes in kidney transplantation: A feasibility study

BACKGROUND

Patients awaiting kidney transplantation need to be prepared ahead of the upcoming transplantation by developing targeted pre- and post-transplant knowledge. On this background, we designed a new health literacy intervention, including a film and a counselling session, based on motivational interviewing for dialysis patients provided by dialysis nurses.

AIM

To explore patients' and nurses' experiences of the feasibility and acceptability of the intervention, focusing on the patient as a prepared knowledge actor.

DESIGN

An explorative qualitative study.

PARTICIPANTS AND METHODS

Data included in-depth interviews with nine patients and three nurses who participated in the intervention. The interviews were audiotaped and analysed following Kvale and Brinkmann's method for thematic data analysis.

FINDINGS

Three main themes were identified: a different kind of health intervention stimulating new insight; a challenging kind of health conversation and changed relationships and increased security.

CONCLUSIONS

Both the patients and the nurses had an overall positive attitude toward the intervention, providing a kind of dialogue to prepare dialysis patients going through kidney transplantation. The nurses found the MI methodology to be challenging. When introducing a comprehensive communication method like MI, potential training and supervision needs for the nurses must be addressed.

Implementing a tailored education programme: renal transplant recipients' experiences

BACKGROUND

Patient-centred education is a key element in the care of patients undergoing kidney transplantation. We implemented a tailored, evidence-based education programme for the post-transplant phase.

OBJECTIVE

The aim of the study was to explore renal transplant recipients' experiences of participating in a new, tailored, evidence-based education programme.

METHODS

An explorative qualitative design was chosen to elicit knowledge, insight and understanding of the renal transplant recipients' perspectives. Twelve renal transplant recipients participated in semi-structured interviews about eight weeks post-transplant. The interviews were audiotaped and analysed using thematic data analysis inspired by Kvale and Brinkmann's method for meaning condensation.

FINDINGS

Two main themes emerged: 'Situated tailoring to the person's everyday life knowledge', and 'Tailoring as a standard procedure regardless of the person'.

CONCLUSION

The findings of the present study indicate that the renal transplant recipients experienced the new education programme to be tailored to individual needs. Our study also revealed that the recipients experienced the health care personnel to take different considerations into account when educating. Viewing knowledge as continuously changing from controlled study contexts into clinical settings, we here demonstrate the need to evaluate new knowledge also after being implemented.

How does a new patient education programme for renal recipients become situated and adapted when implemented in the daily teaching practice in a university hospital? An ethnographic observation study

OBJECTIVE

To understand how a new patient education programme for renal recipients becomes situated and adapted when implemented in daily hospital teaching practice. The analysis focuses in particular on how principles of individual tailoring and patient involvement are adapted.

DESIGN

Ethnographic observation study. 19 teaching sessions were observed, resulting in 35 pages of data written observation notes.

SETTING

A Norwegian University hospital. The study included the transplantation (TX) post, the medical post and the outpatient clinic.

PARTICIPANTS

10 newly transplanted patients receiving the education programme, and 13 nurses trained in the new programme participated in the study.

RESULTS

We observed that the nurses attempted to implement the programme's core principles of individual tailoring and patient involvement as intended, but that patients found it difficult to formulate their knowledge needs and interest. Patients and nurses developed an approach to individual tailoring and patient involvement, which used knowledge about the patients' life and experiences as basis for translating generalised knowledge into knowledge that is individualised and meaningful for the patient. The individual tailoring was however also limited, as the nurses balanced between responsibilities for the programme's principles of individual adaption and patient involvement at the one hand, and responsibilities of safety and economy from a health systems perspective on the other hand.

CONCLUSION

Individual tailoring is observed to be a comprehensive practice which includes verbal, practical and emotional involvement with the patient's life world. This extends the notion and practice of individual tailoring as selecting among predefined, generalised knowledge based on an initial mapping of the patients' knowledge. While the adaptions to individual tailoring could have been seen as inaccurate implementation, in-depth analyses discloses that the extended approach to individual tailoring is in fact what retains the programme's core principles in the implementation context.