Iranian Nurses' Views on Barriers and Facilitators in Patient Education: A Cross-Sectional Study

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.

Is a Bilingual Vocal Education Program Effective on Diabetes Patients' Self-Efficacy?

Objective:The present study was carried out to compare a bilingual (Balouchi & Persian) vocal patient education program and routine education on patient's self-efficacy in type 2 diabetes patients suffering from visual impairments. Material and methods:This semi-experimental study was conducted on patients with type 2 diabetes mellitus (T2DM) suffering from visual impairments. A total number of 90 participants were divided into two equal groups: 45 patients in the intervention group and 45 controls in the routine care group. A permuted block randomization (AB) using a random number generator by default was implemented to organize the two groups. One of the researchers collected the demographics and self-efficacy data through face to face interviews. The diabetes management self-efficacy scale (DMSES) was used for self-efficacy assessment. Patients in the intervention group received an MP3 Player including 90 minutes of vocal education. Results:There were no significant differences in participants' demographic characteristics between the two study groups. However, a remarkable rise was observed in the self-efficacy score (P<0.0001) as well as HA1C and FBS levels among patients in the intervention group after vocal education (P<0.001). Conclusions:The findings of the present research suggest nursing and public health policy makers to reconsider their traditional patient education programs, particularly for diabetes patients with visual impairments among indigenous people.

Teacher-as-actor: Investigating the barriers and facilitators of patient education among hospitalized patients in a cardiology clinical unit

Patient education enables people with cardiovascular disease to develop self-management behaviors. This study aimed to explore facilitators and barriers to teaching patients in a clinical cardiology unit with a single site qualitative investigation involving 21 registered nurses attending four focus groups. This study identified barriers related to patient factors including individual characteristics and responses to education, comorbidities, acuity, and evolving diagnosis, while for nurses the barriers were lack of knowledge and expertise. Barriers associated with the physical environment included nursing workload issues and lack of resources. Facilitators included patients being engaged in the process of education, prepared, and ready to be educated, while a conducive physical environment was also seen as a facilitator. This study exposed inhibiting and enabling variables associated with the exchange between patients and nurses by viewing the nurse and the patient as actors and audience in a theatrical model where communicating to teach patients is seen as a collaborative art. The nurse who understands the barriers and facilitators to teaching will more likely engage the patient in successful learning and development of self-care behaviors.

The components of diabetes educator's competence in diabetes self-management education in Iran: A qualitative study

BACKGROUND

Limited research has been conducted in the field of diabetes educator's competency. However, no comprehensive and integrated explanations of educator's competence requirements in treatment centers exist in Iran. The aim of this study is to explain the components of diabetes educator's competence in diabetes self-management education in Iran.

MATERIALS AND METHODS

This was a qualitative descriptive-exploratory study. The data were collected through semi-structured and in-depth interviews and using purposeful sampling method in Isfahan University of medical science from April to October 2018. Sampling continued until data saturation. Participants included 20 people who were selected by purposive and snowball sampling method. The interviews were analyzed using content analysis method of Graneheim, Lundman.

RESULTS

Data analysis resulted in the emergence of three main categories including (1) Patient and family centered education, (2) process-based education, and (3) continuous progress in profession and also seven subcategories (patient and family activation, empower), facilitating educational process, comprehensive education assessment, development, implementation and evaluation of educational plans, developing educators' educational knowledge and skills, development of creativity and innovation, promote inter-professional cooperation in education.

CONCLUSION

The evaluation of facilitation factors for participation and empowerment patient and family along with creativity and interprofessional collaboration for comprehensive evaluation of patients in designing, implementation of educational programs were mentioned as important competencies of diabetes educators, which can have a significant impact on patients' recovery, treatment, and the promotion of society's health.

The need for renovating patient education in kidney transplantation: A qualitative study

BACKGROUND

Many kidney transplant recipients lack the knowledge, abilities, and support they need for self-care. On the other hand, most kidney transplant centers do not have a well-planned and specific training program for them, and educational interventions for kidney transplant recipients have not been adequately effective. This study aimed to describe strategies for improving patient education in kidney transplantation.

MATERIALS AND METHODS

Data were collected through semi-structured individual and group interviews with 24 patients, family members, and health-care staff in one of the main kidney transplant centers in Tehran. Participants were selected purposefully, and qualitative content analysis was used to analyze the data.

RESULTS

The main finding emerged from the data was the shift from current patient education program to patient- and family-centered education (PFCE). The strategies to achieve this goal were categorized into four main categories including "continuous patient and family education" (pre- and posttransplant patient education), "facilitating the process" (using new technologies, teamwork education, and patient and family accessibility), "strengthening human resources" (empowerment health-care team, allocation of human resources, promoting staffs' motivation, and updating educational content and materials), and "monitoring and evaluation" (correcting patient education recording, supervising the patient education, and appropriate educational evaluation).

CONCLUSIONS

Transforming from the current patient education program to PFCE seems to be essential to increase the effectiveness of patient education in kidney transplant process. To this end, providing continuous patient and family education, facilitating the processes, strengthening human resources, and monitoring and evaluation in health-care organizations conducting the kidney transplantation is necessary.

Factors influencing the patient education performance of hemodialysis unit nurses

OBJECTIVE

This study aimed to identify the perceptions, barriers, and facilitators of patient education and factors influencing the performance of patient education among hemodialysis unit nurses.

METHODS

This study used a descriptive correlational design in which a total of 262 nurses from 27 hemodialysis facilities in six provinces in the Republic of Korea participated. Self-administered questionnaires were used to identify the perceptions, barriers, facilitators, and performance of patient education. Data were analyzed using a t-test, one-way ANOVA, Pearson's correlation, and stepwise multiple regression.

RESULTS

Factors influencing patient education performance were nurses' total clinical experience, perceptions, working experience in a hemodialysis unit, facilitators, number of nurses in the hemodialysis unit, and barriers. These variables accounted for 37.2 % of the variance in the final model.

CONCLUSION

Nurses' performance in patient education was significantly influenced by perceptions, facilitators, and barriers. Nurses' total clinical experience, working experience in a hemodialysis unit, and number of nurses in the unit also influenced patient education performance.

PRACTICE IMPLICATIONS

A nurse training program should be developed to reinforce nurses' patient education competency.

A valid and reliable tool in assessing patient education: the Patient Education Implementation Scale

AIM

This study aimed to develop a valid and reliable tool for assessing the frequency of nurses' implementation of patient education in line with the stages of determining needs, assessment and planning, implementation, and evaluation and documentation.

BACKGROUND

Patient education is important in terms of the patient's completion of a reliable and effective treatment process. Patient education is one of the main responsibilities of a nurse. No valid and reliable study that assessed nurses' patient education process implementation was found in the literature.

METHODS

This instrument development study was conducted with 583 nurses working at university, private, and research and training hospitals located in the province of Istanbul in Turkey. The items of the Patient Education Implementation Scale were developed in line with the literature and expert opinions. The analyses involved descriptive statistics and psychometric analyses. The level of statistical significance was accepted as P < .05.

RESULTS

The content validity index was calculated as 0.96 for the 42-item Patient Education Implementation Scale, which explained 63.37% of the total variance. The scale items whose factor loads were 0.45 or higher were divided into four factors as (a) determining education needs, (b) assessment and planning, (c) implementation, and (d) evaluation and documentation. The Cronbach's alpha coefficients were 0.78-0.95 for the subdimensions and 0.97 for the general scale.

CONCLUSION

It was determined that the Patient Education Implementation Scale is a valid and reliable tool.

Sources of Health care providers' Self-efficacy to deliver Health Education: a qualitative study

BACKGROUND

The self-efficacy of educators plays a crucial role in their professional competence and subsequent provision of care. The present study aims to explain the main sources contributing to the development of self-efficacy beliefs among healthcare providers in delivering health education.

METHODS

This qualitative study was conducted from 2015 to 2016 in various settings of Isfahan such as hospitals, doctor's offices, and healthcare centers. Twenty three health educators with an average of 10-year work experience in healthcare participated in the study. Data were collected using semi-structured in-depth individual interviews and were analyzed through conventional content analysis. Prolonged engagement with the participants, maximum variation in the participants' characteristics, sampling, and member check were among the factors enriching the research.

RESULTS

The six main categories extracted during data analysis included: 1) Quantity and quality of their experience; 2) Encountering unexpected events; 3) Client trust; 4) Self-concept; 5) Professional knowledge and skill; 6) Vicarious experiences.

CONCLUSIONS

The study results show two new findings, including "encountering unexpected events" and "client trust", affecting professional self-efficacy beliefs among healthcare providers in the delivery of health education. The other main findings were extremely similar to Bandura's theory. These results can be used as a basis in planning and implementing health development educational models for human resources.

Interprofessional Teamwork Education: Moving Toward the Patient-Centered Approach

HOW TO OBTAIN CONTACT HOURS BY READING THIS ISSUE Instructions: 1.3 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded after you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. In order to obtain contact hours you must: 1. Read the article, "Interprofessional Teamwork Education: Moving Toward the Patient-Centered Approach," found on pages 449-460, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website to register for contact hour credit. You will be asked to provide your name, contact information, and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until September 30, 2019. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. OBJECTIVES Explain the recommended framework in teaching and implementing interprofessional competencies. Identify suggested core competencies to implement interprofessional collaborative practice. DISCLOSURE STATEMENT Neither the planners nor the author have any conflicts of interest to disclose.

BACKGROUND

The aim of this study is to develop and contextualize a competency framework for interprofessional teamwork in Iran.

METHOD

The study was conducted in three phases. First, the competencies of interprofessional teamwork were extracted from the literature. In the second phase, the content validity of the initial framework was assessed by the experts through the Delphi rounds. Content validity ratio (CVR) and item-level content validity index (I-CVI) were used for quantitative analysis. Finally, in the third phase, the importance and utility of interprofessional teamwork competencies were assessed by the experts.

RESULTS

Initial framework was constructed with 28 competencies. Quantitative analysis by CVR indicated a score of less than .49 for three items. These items were excluded from the framework. The I-CVI for all items in the framework was higher than .78. The final framework was developed and validated with 16 competencies.

DISCUSSION

The developed framework is recommended for teaching and assessment of interprofessional teamwork competencies. J Contin Educ Nurs. 2016;47(10):449-460.