RESUMEN
Nurses' patient education is important for building patients' knowledge, understanding, and preparedness for self-management. The aim of this study was to explore the conditions for nurses' patient education work by focusing on managers' discourses about patient education provided by nurses. In 2012, data were derived from three focus group interviews with primary care managers. Critical discourse analysis was used to analyze the transcribed interviews. The discursive practice comprised a discourse order of economic, medical, organizational, and didactic discourses. The economic discourse was the predominant one to which the organization had to adjust. The medical discourse was self-evident and unquestioned. Managers reorganized patient education routines and structures, generally due to economic constraints. Nurses' pedagogical competence development was unclear, and practice-based experiences of patient education were considered very important, whereas theoretical pedagogical knowledge was considered less important. Managers' support for nurses' practical- and theoretical-based pedagogical competence development needs to be strengthened.
RESUMEN
This study aimed to explore the conditions for nurses' daily patient education work by focusing on managers' way of speaking about the patient education provided by nurses in hospital care. An explorative, qualitative design with a social constructionist perspective was used. Data were collected from three focus group interviews and analysed by means of critical discourse analysis. Discursive practice can be explained by the ideology of hegemony. Due to a heavy workload and lack of time, managers could 'see' neither their role as a supporter of the patient education provided by nurses, nor their role in the development of nurses' pedagogical competence. They used organisational, financial, medical and legal reasons for explaining their failure to support nurses' provision of patient education. The organisational discourse was an umbrella term for 'things' such as cost-effectiveness, which were prioritised over patient education. There is a need to remove managerial barriers to the professional development of nurses' patient education. Managers should be responsible for ensuring and overseeing that nurses have the prerequisites necessary for providing patient education as well as for enabling continuous reflective dialogue and opportunities for learning in practice.
Asunto(s)
Enfermeras Administradoras , Personal de Enfermería en Hospital/educación , Educación del Paciente como Asunto , Adulto , Grupos Focales , Humanos , Liderazgo , Persona de Mediana Edad , Investigación Cualitativa , Desarrollo de Personal/métodosRESUMEN
BACKGROUND: It is important to clarify nurses' perceptions of conditions for patient education in daily work as research findings are ambiguous. There is a gap between societal regulations on nurses' competence in accomplishment/achievement of patient education and research findings. AIM: The aim was to describe nurses' perceptions of conditions for patient education, focusing on aspects of competence. The aim was also to describe differences in conditions for nurses working in primary, municipal and hospital care. METHODS: The study is a cross-sectional survey and is part of a project about nurses' patient-education. A randomized selection of nurses (842) received a questionnaire comprising 47 items concerning factual experience and attitudes to patient education and 13 background items. Questionnaires were returned by 83% of participants. Descriptive statistics, non-parametric tests and content analysis for open-ended items were used. RESULTS: Nurses' perceptions of conditions for patient education differ between health-care settings. Primary care nurses are at an advantage in following research in patient education, perception of their own competence (prioritizing and knowing their mandate in patient teaching), pedagogical education and post graduate specializations. CONCLUSIONS: Nurses' patient education must be more visualized and appropriate conditions created at each workplace. In this change process, managers' support is considered vital.
Asunto(s)
Competencia Clínica , Relaciones Enfermero-Paciente , Personal de Enfermería/psicología , Educación del Paciente como Asunto/métodos , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
AIM: To describe nurses' perceptions of conditions for patient education, focusing on organisational, environmental and professional cooperation aspects, and to determine any differences between primary, municipal and hospital care. BACKGROUND: Although patient education is an important part of daily nursing practice, the conditions for this work are unclear and require clarification. METHOD: A stratified random sample of 701 (83%) nurses working in primary, municipal and hospital care completed a 60-item questionnaire. The study is part of a larger project. The study items relating to organisation, environment and professional cooperation were analysed using descriptive statistics, non-parametric tests and content analysis. RESULTS: Conditions for patient education differ. Nurses in primary care had better conditions and more managerial support, for example in the allocation of undisturbed time. CONCLUSIONS: Conditions related to organisation, environment and cooperation need to be developed further. In this process, managerial support is important, and nurses must ask for better conditions in order to carry through patient education. IMPLICATIONS FOR NURSING MANAGEMENT: Managerial support for the development of visible patient education routines (e.g. allocation of time, place and guidelines) is required. One recommendation is to designate a person to oversee educational work.
Asunto(s)
Actitud del Personal de Salud , Personal de Enfermería/psicología , Educación del Paciente como Asunto/organización & administración , Adulto , Anciano , Conducta Cooperativa , Femenino , Humanos , Masculino , Persona de Mediana Edad , Investigación Metodológica en Enfermería , Personal de Enfermería en Hospital/organización & administración , Cultura Organizacional , Enfermería de Atención Primaria , Servicios Urbanos de Salud/organización & administración , Adulto JovenRESUMEN
AIM: The aim of this review was to identify conditional factors for nurses' patient-education work and to identify foundational aspects of significance when designing studies on this patient-education work. BACKGROUND: A few reviews of nurses patient education work exist, published up to 30 years ago, spawning interest in performing a review of more recent studies. EVALUATION: A search of CINAHL, MEDLINE and ERIC was made for articles dating from 1998 to 2011. Thirty-two articles were selected and an integrative review was performed. KEY ISSUES: Conditional factors were identified and beliefs and knowledge, environment, organization, interdisciplinary cooperation, collegial teamwork and patient education activities. A model was developed to describe foundational aspects of significance when designing studies. CONCLUSIONS: The conditional factors are to be seen as either enabling or hindering the accomplishment of evidence-based patient education and the level of person centredness, patient safe care and ethics - something that has to be considered when designing studies. IMPLICATIONS FOR NURSING MANAGEMENT: More detailed studies are required to clarify the nature of patient education work and to create realistic conditions that enable the role to be fulfilled in everyday work. Such knowledge is of significance for nursing management in developing supportive activities for nurses.
Asunto(s)
Relaciones Enfermero-Paciente , Educación del Paciente como Asunto , Humanos , Modelos de Enfermería , Investigación en Evaluación de EnfermeríaRESUMEN
AIMS: To describe the use of pedagogically related keywords and the content of notes connected to these keywords, as they appear in nursing records in a coronary artery bypass graft (CABG) surgery rehabilitation unit. BACKGROUND: Nursing documentation is an important component of clinical practice and is regulated by law in Sweden. Studies have been carried out in order to evaluate the educational and rehabilitative needs of patients following CABG surgery but, as yet, no study has contained an in-depth evaluation of how nurses document pedagogical activities in the records of these patients. METHODS: The records of 265 patients admitted to a rehabilitation unit following CABG surgery were analysed. The records were structured in accordance with the VIPS model. Using this model, pedagogically related keywords: communication, cognition/development and information/education were selected. The analysis of the data consisted of three parts: the frequency with which pedagogically related keywords are used, the content and the structure of the notes. RESULTS: Apart from the term 'communication', pedagogically related keywords were seldom used. Communication appeared in all records describing limitations, although no explicit reference was made to pedagogical activities. The notes related to cognition/development were grouped into the following themes: nurses' actions, assessment of knowledge and provision of information, advice and instructions as well as patients' wishes and experiences. The themes related to information were the provision of information and advice in addition to relevant nursing actions. The structure of the documentation was simple. CONCLUSIONS: The documentation of pedagogical activities in nursing records was infrequent and inadequate. RELEVANCE TO CLINICAL PRACTICE: The patients' need for knowledge and the nurses' teaching must be documented in the patient records so as to clearly reflect the frequency and quality of pedagogical activities.
Asunto(s)
Puente de Arteria Coronaria , Documentación , Registros de Enfermería , Educación del Paciente como Asunto/organización & administración , Adulto , Anciano , Anciano de 80 o más Años , Comunicación , Puente de Arteria Coronaria/enfermería , Puente de Arteria Coronaria/rehabilitación , Documentación/métodos , Documentación/estadística & datos numéricos , Necesidades y Demandas de Servicios de Salud , Humanos , Tiempo de Internación/estadística & datos numéricos , Persona de Mediana Edad , Modelos de Enfermería , Rol de la Enfermera , Auditoría de Enfermería , Investigación en Evaluación de Enfermería , Investigación Metodológica en Enfermería , Proceso de Enfermería , Registros de Enfermería/estadística & datos numéricos , Personal de Enfermería en Hospital/organización & administración , Personal de Enfermería en Hospital/psicología , Planificación de Atención al Paciente , Cuidados Posoperatorios/métodos , Cuidados Posoperatorios/enfermería , Investigación Cualitativa , Semántica , SueciaRESUMEN
AIM: The aim of this study was to identify terms and expressions indicating patients' need for knowledge and understanding, as well as nurses' teaching interventions, as documented in nursing records. BACKGROUND: Previous international studies have shown that nursing documentation is often deficient in terms of recording patient teaching. METHODS: Patient records (N = 35) were collected in a general medical ward in a hospital in Sweden. The data contain 206 days of nursing documentation. The records were analysed with regard to content and structure. Terms and expressions indicating patients' need for knowledge and understanding and terms and expressions indicating nurses' teaching activities were analysed. RESULTS: The results showed that patients' need for knowledge is implicitly indicated by conceptions and experiences as well as questions. Furthermore, nurses' implicit teaching interventions consist of information, motivating conversations, explanations, instructions and setting expectations. However, the content and structure of the pedagogical activities in the patient records are fragmented and vague. RELEVANCE TO CLINICAL PRACTICE: Efforts must be directed towards elaborating upon the above-mentioned terms and expressions as indications of patients' need for knowledge and nurses' teaching interventions. Moreover, these terms and expressions must be recognized and acknowledged.