Improving transplant discharge education using a structured teaching approach

Nurses' attitudes and behaviors on patient medication education

BACKGROUND

Medication education is vital for positive patient outcomes. However, there is limited information about optimal medication education by nurses during hospitalization and care transitions.

OBJECTIVE

Examine nurses' attitudes and behaviors regarding the provision of patient medication education. The secondary objectives were to determine if nurses' medication education attitudes explain their behaviors, describe nurses' confidence in patient medication knowledge and abilities, and identify challenges to and improvements for medication education.

METHODS

A cross sectional survey was administered to nurses servicing internal medicine, cardiology, or medical-surgical patients.

RESULTS

Twenty-four nurses completed the survey. Greater than 90% of nurses believed it is important to provide information on new medications and medical conditions, utilize resources, assess patient understanding and adherence, and use open ended question. Only 58% believed it is important to provide information on refill medications. Greater than 80% of nurses consistently provided information on new medications, assessed patient understanding, and utilized resources, but one-third or less used open-ended questions or provided information on refill medications. Most nurses spend 5-9 minutes per patient on medication education and their attitudes matched the following medication education behaviors: assessing adherence (0.57; p<0.01), providing information on new medications (0.52; p<0.05), using open-ended questions (0.51; p<0.01), and providing information on refill medications (0.39; p<0.05). Nurses had higher confidence that patients can understand and follow medication instructions, and identify names and purpose of their medications. Nurses had lower confidence that patients know what to expect from their medication or how to manage potential side effects. Communication, including language barriers and difficulty determining the patient's understanding of the information, was the most common challenge for nurses and they suggested utilization of translator services and patient-friendly drug information resources as a way to improve.

CONCLUSION

Nurses have positive attitudes toward patient medication education. However, their attitudes do not fully explain their behaviors and many nurses are spending limited time with patients on medication education. Enhancements to medication education could include resources on communication and collaboration with pharmacists.

Lifestyle and Self-Management by Those Who Live It: Patients Engaging Patients in a Chronic Disease Model

BACKGROUND

Patients pursuing organ transplantation have complex medical needs, undergo comprehensive evaluation for possible listing, and require extensive education. However, transplant patients and their supports frequently report the need for more lifestyle and self-management strategies for living with organ transplantation.

OBJECTIVES

First, to explore feasibility of a successful, patient-run transplant lifestyle educational group (Transplant Living Community), designed to complement medical care and integrated into the clinical setting; and second, to report the major themes of patients' and supports' qualitative and quantitative feedback regarding the group.

METHODS

Informal programmatic review and patient satisfaction surveys.

RESULTS

A total of 1862 patient satisfaction surveys were disseminated and 823 were returned (response rate, 44.2%). Patients and their supports reported positive feedback regarding the group, including appreciation that the volunteer was a transplant recipient and gratitude for the lifestyle information. Five areas were associated with the success of Transplant Living Community: 1) a "champion" dedicated to the program and its successful integration into a multidisciplinary team; 2) a health care environment receptive to integration of a patient-led group with ongoing community development; 3) a high level of visibility to physicians and staff, patients, and supports; 4) a clearly presented and manageable lifestyle plan ("Play Your ACES"(a) [Attitude, Compliance, Exercise, and Support]), and 5) a strong volunteer structure with thoughtful training with the ultimate objective of volunteers taking ownership of the program.

CONCLUSION

It is feasible to integrate a sustainable patient-led lifestyle and self-management educational group into a busy tertiary care clinic for patients with complex chronic illnesses.

Information needs of family caregivers regarding liver transplant candidates

Objective To assess the information needs of family caregivers of candidates on the waiting list for a liver transplant. Methods It is a cross-sectional study conducted in a transplant center in São Paulo State in the period between April and October of 2012. For the assessment of information needed, an instrument submitted to face and content value was used. The caregivers put 10 subjects in order according to their importance and the amount of interest they had in learning about each, prior to the transplant their family member would be subjected to. Sociodemographic characteristics were also recorded. For data analysis, descriptive statistics were used. Results 42 families participated in the study. The information need about liver disease complications, complications after transplantation and care needed after surgery had higher averages. Conclusions Knowing the information needs of caregivers is important to plan teaching-learning strategies aimed at improving assistance to patients and families in transplant programs.

Ventral hernia and patient experience of an elastic girdle

BACKGROUND

Abdominal girdles are used to prevent hernia and to facilitate the in-growth of mesh following ventral hernia surgery or instead of surgery. Scientific evidence supporting the use of girdle, including patient experience, is lacking. The aim was to investigate patient experience of wearing an elastic girdle in terms of support and tolerability.

METHODS

A trans-sectional study with quantitative onset was performed. Telephone interviews following a strict protocol were performed 2 years after girdle prescription. Of the 89 eligible patients, 67 completed the interview. The questionnaire constituted 13 questions.

RESULTS

Of the 52 women and 15 men, two thirds had ventral hernia surgery. Patients over 70 years more often used girdle as a substitute for surgery. Most patients (64%) were satisfied with the girdle and 94% used it as prescribed. Five out of 53 who used girdles preoperatively stated no improvement in their inconvenience. Almost all patients (97%) had some problem with the girdle.

CONCLUSION

In this first study on patient experience, nearly all patients used it as prescribed and subjective benefit was achieved even though side effects were present in most cases. Individual fitting and improved information about when and how to use the girdle is important for patient comfort and optimal function. This study attended patient experience of negative side effects from wearing a girdle. Improvement may be reached concerning comfort from the patients' perspective. The importance of both written and oral information has been revealed.