Barriers and facilitators to patient education provided by nurses: A mixed-method systematic review

AIM

To investigate the factors that facilitate or hinder nurses in providing patient education.

DESIGN

A mixed-method systematic review.

DATA SOURCES

Six databases (Cochrane Library, PubMed, EMBASE, Web of Science, MEDLINE and ERIC) were systematically searched for relevant publications.

METHODS

The study was conducted following the JBI for mixed-method systematic reviews, and the reporting followed the PRISMA guideline. Two researchers independently performed literature screening, literature evaluation, data extraction and synthesis. PROSPERO registration number: CRD42023427451.

RESULTS

Twenty-six eligible articles were included, including 15 quantitative articles, 10 qualitative articles and 2 mixed-methods articles. The resultant synthesis of key findings led to the identification of these barriers and facilitators, categorised into five distinct levels: nurse-related factors, organisational factors, patient-related factors, the nurse-patient relationship and interdisciplinary collaboration.

CONCLUSIONS

The findings highlight the factors that facilitate or hinder nurses in providing patient education, suggesting that multifaceted interventions can enhance the practice of patient education in nursing and support the development of appropriate patient education guidelines or public policies.

RELEVANCE TO CLINICAL PRACTICE

This review delineates the facilitators and barriers influencing nurses' provision of patient education, offering an initial framework for nursing managers to craft interventions aimed at enhancing the quality of patient education provided by nurses, consequently elevating the overall quality of nursing.

nurses' knowledge, skills and personal attributes for providing competent health education practice, and its influencing factors: A cross-sectional study

AIM

To explore nurses' knowledge, skills and personal attributes for competent health education practice and their association with potential influencing factors.

BACKGROUND

Clinical nurses are expected to perform effective health education interventions, but they do not feel competent. The self-assessment of the health education competence and its conditional factors is paramount for professional development.

DESIGN

A cross-sectional study.

METHODS

A total of 458 clinical nurses from two health specialized centers in Spain participated in this study. Data were collected using the Nurse Health Education Competence Instrument and a second self-report questionnaire from January to February 2019. Descriptive statistics, t-test, analysis of variance, Pearson's and Spearman's correlation and multiple linear regression were used to analyse the data. The STROBE guideline was used RESULTS: The mean scores of the knowledge (70.10 ± 15.11), skills (92.14 ± 15.18) and personal attributes scales (32.32 ± 5.89) were found to be low to moderate. The main influencing factors for the health education implementation were lack of education and training (71.4%), lack of time (67.5%) and high workload (67.3%). Nurses with higher educational level and perceived self-efficacy for competently providing health education, more extensive professional experience and previous training in health education rated higher in knowledge, skills and personal attributes. Age and years of experience were negatively correlated with knowledge scores, but positively with the rest of domains of the competence and self-efficacy. The regression models for the overall health education competence's domains were significant (p < 0.001) with R2 values ranging from 28.0% to 49.3%. Self-efficacy, previous health education training and working in intensive care units were found to be significant in all cognitive, psychomotor and attitudinal scales.

CONCLUSION

Clinical nurses reported on some skills and personal attributes for health education practice, but they seem to lack health education knowledge necessary for a competent practice. This study suggested that effective education and training and supportive organizational cultures are key to enhance nurses' health education competence. Identifying nurses' educational needs on the main domains of the competence and its intrinsic/extrinsic influential factors may assist in both planning and organizing tailored training strategies and in promoting appropriate environments to support a high-quality health education practice TWEETABLE ABSTRACT: Nurses' knowledge, skills and attitudes about health education competence are low to moderate. Training and organizational support are key.

Nurses' knowledge, skills and personal attributes for competent health education practice: An instrument development and psychometric validation study

AIM

To develop and psychometrically test the Nurse Health Education Competence Instrument for assessing nurses' knowledge, skills and personal attributes concerning competent health education practice.

DESIGN

A psychometric instrument development and validation study.

METHODS

A four-step approach was used: Step 1) operational definition based on an up-to-date concept analysis and experts' judgement; step 2) item generation and content validation by expert panel and target population; step 3) item analysis based on acceptability, internal consistency and face validity; and step 4) psychometric evaluation based on construct validity, criterion validity, internal consistency and stability, conducted from January -February 2019 with 458 hospital-care nurses.

RESULTS

The operational framework and expert groups showed good content validity, resulting in the first version. From the initial 88-item pool, 58 items were retained after item analysis. Exploratory factor analysis revealed three scales concerning the cognitive (three-factor solution with 23 items), psychomotor (two-factor solution with 26 items) and affective-attitudinal (one-factor solution with nine items) competency domains, which respectively accounted for 58%, 53% and 54% of the variance. Known-group study demonstrated significant differences by years working in the service and training received in health education, providing evidence for the measure's sensitivity. The three scales correlated positively with the criterion variable. Overall Cronbach alphas for the cognitive, psychomotor and affective-attitudinal scales were 0.95, 0.95 and 0.90, respectively. Intraclass correlation coefficients were >0.70.

CONCLUSIONS

The newly developed Nurse Health Education Competence Instrument is an original and tested self-reporting psychometric tool, being the first to identify nurses' knowledge, skills and attributes necessary for planning and assessing health education practice competency.

IMPACT

The instrument permits measurable insights into nurses' perceptions regarding their health education competence and related educational needs. This study provides a valid and specific learning tool that is appropriate to use both in clinical practice and in nursing education programmes.

Nurses’ Patient Education Questionnaire – development and validation process

Conditions for nurses’ daily patient education work are unclear and require clarification. The aim was to develop and validate the Nurses’ Patient Education Questionnaire, a questionnaire that assesses nurses’ perceptions of appropriate conditions for patient education work: what nurses say they actually do and what they think about what they do. The questionnaire was developed from a literature review, resulting in the development of five domains. This was followed by ‘cognitive interviewing’ with 14 nurses and dialogue with 5 pedagogical experts. The five domains were identified as significant for assessing nurses’ beliefs and knowledge; education environment; health care organisation; interdisciplinary cooperation and collegial teamwork; and patient education activities. A content validity index was used for agreement of relevance and consensus of items by nurses ( n = 10). The total number of items in the final questionnaire is 60, consisting of demographic items, what nurses report they do and perceptions about patient education in daily work. The questionnaire can be used by managers and nurses to identify possibilities and barriers to patient education in different care contexts.