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KNOWLEDGE, ATTITUDE AND PRACTICE OF PATIENT TEACHING AMONG NURSES WORKING IN TERTIARY HEALTH INSTITUTIONS IN ENUGU

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ABSTRACT

This study was carried out to determine the knowledge, attitude and practice of patient teaching among nurses working in selected tertiary health institutions in Enugu. The objectives of the study were to determine the nurses’ knowledge of patient teaching, attitude towards patient teaching and practice of patient teaching. A cross-sectional descriptive survey design was used for the study in two tertiary health institutions in Enugu. Simple random sampling technique was used to select the two institutions of study. The target population for study was 978 nurses. A sample of 430 nurses was proportionately selected for the study. Self developed questionnaire with open and closed ended questions were used to assess knowledge and practice and four point modified likert scale was used to assess attitude. Cronbatch alpha statistics was used to establish the internal consistency which gave a reliability coefficient of 0.80. Descriptive and inferential statistics were used to analyze data. Results were presented in tables as percentages, means, and standard deviations. Chi-square, students’ t-test and ANOVA were used to test hypotheses at P<0.05 level of significance. Findings revealed that all of the respondents (425=100% have heard about patient teaching, 50.4% indicated correctly meaning of patient teaching, 94.6% had knowledge of content and context of patient teaching, 72.7% had knowledge strategies, 80.9% knew types of patient teaching, and 85.9% knew teaching methods adopted in patient teaching. The attitude of nurses towards patient teaching was positive in both health institutions (means of 3.00 SD= 0.37 (UNTH) (3.06, SD = 0.37 (NOHE) the nurses practice of patient teaching was moderate – 98.1% of nurses engage in patient teaching, 65.2% engage in patient teaching daily, 59.9% do not plan for patient teaching, 62.7% used the unplanned type of patient teaching, 87.1% evaluate patient teaching and only 42.7% dose always. 64.0% of nurses do not document patient teaching because they do not have special chart for documentation. There was significant differences (P<0.05) in the knowledge of patient teaching between nurses of the two institutions and in the practice of patient teaching among nurses with different years of work experience. There was no significant difference (P>0.05) in the attitude of nurses towards patient teaching, the types of patient teaching and the practice of patient teaching among nurses of the two institutions of study.

 

 CHAPTER ONE

INTRODUCTION

Background to the Study

The well known parable “if you give a man a fish, you feed him for a day, but if you teach him to fish you feed him for a life time”, is apt for the illustration of the importance of patient teaching or education. Patient teaching or education involves helping patients become better informed about their condition, medical procedure and choices they have regarding treatment (Martin, 2012). Patient teaching is as old as nursing profession. This can be seen from the achievements of Florence Nightingale, founder of modern nursing in improving the standards for the care of war casualties in the Crimean war. Also in the Nightingale’s vision of nursing which included public health promotion roles of nurses which was only partially addressed in the early days of nursing (Berman, Snyder, Kozier, & Erb, 2012). Though other health professionals like physicians, pharmacists, registered dietician etc participate in patient teaching, nurses as educators play a key role in improving health of the patients. This is because nurses are closer to the patients than any other health professionals. (Daniels, 2004 & Kelliher 2011)

Nurses assess the patient’s level of understanding about treatment methods and correct any knowledge deficits. The nurse is often a physician interpreter to the patient/client explaining in easily understood terms, clarifying and referring. Patient teaching supports behaviour change that leads to positive adaptation. Thus patient teaching involves decreasing the fear of change, reducing anxiety and anticipatory stress. Patient teaching is an essential function of every professional nurse in every practice setting – Schools, communities, worksites, healthcare delivery sites and homes. Never has the demand for quality patient teaching (education) been greater than now. The current trend toward shorter hospital stay and decreased time for healthcare professional patient interactions have increased the need for effective patient teaching. Also more of the chronically ill patients are at home in need of nursing assistance from their families, friends and volunteers. Such patients and their families and friends should possess a moderate degree of understanding of the illness and its management. Nurses who are skilled educators increased client health and well being and reduce the demand for professional services (Taylor, Lillis, Lemore, 2007).

Nurses assume the role of teacher when clients have identifiable learning needs. The teacher learner relationship is enhanced by the continuance of the helping relationship in which mutual respect and trust have been established. The nurse builds on this trust by sharing information the nurse and client have mutually identified as important. The nurse care giver as a skilled teacher can expect to effect the following outcomes:   High level wellness and related self-care practices, disease prevention and early detection, quick recovery from trauma illness with minimal to no complications,   enhanced ability to adjust to developmental life changes and acute, chronic and terminal illness, family acceptance of the life style changes necessitated by the illness or disability of a family member, patients satisfaction: (Taylor et. al, 2007).

Smeltzer, Bare, Hinkle and Cheever (2011) stated that teaching as a function of nursing is included in all State nurse practice acts and in the standards of clinical nursing practice of the American Nurses Association. Patient teaching/client teaching is also mandated by several accrediting bodies, such as the Joint Commission on Accreditation of Health care organizations (JCAHO 2002). The American Hospital Associations patient’s bill of Rights calls for the clients understanding of health status and treatment approaches. Informed consent for treatment procedure can be given only by clients who are well informed (Daniels, 2004). The UKCC guidelines for professional practice offer a number of helpful points that can be applied to the teaching of patients and their family including: – The importance of giving clear information on which the patient/client can make informed choices.

  • The need to recognize patients/clients as equal partners.
  • The importance of using language that is familiar to them
  • The need to ensure that patients/clients understand the information they are given and so on (Quinn, 2010).

In Nigeria also, patient teaching is included in the curriculum for General Nursing and Midwifery by the Nursing and Midwifery Council of Nigeria (N&MCN) (N&MCN, 2006).The challenges in today’s health care environment necessitate the need for patient teaching in an organized way. Also demands from consumer for comprehensive information about their health issues throughout the life cycle accentuate teaching to occur in every patient-nurse encounter (Smeltzer et.al, 2011). Patients come to the hospital with diverse disease conditions which can be acute or chronic. When patients are provided with a solid knowledge base about their disease process and treatment, outcome is more favorable. For them to be taught, nurses are required to teach them. Nurses are exposed through training and if they do not have this knowledge, they will not be motivated to teach patients, and patients will not understand their problems and how to manage them (Ward 2012).

Nurses need to have right attitude towards patient teaching for the patients to learn. They should look for opportunities to teach the patients no matter how tight their schedule appears to be.

There is also need for nurses to practice patient teaching routinely, in order to impact on the patients positively and perfect their expertise in it. If they do not practice patient teaching, patients will not be satisfied with nursing care given to them.

However, this integral role of nursing profession-patient teaching has been compromised in the nurse’s attempt to deal with disease and its effects on patients. Patient teaching is a parameter for professionalism in Nursing and should be treated with equal importance as other nursing actions. The foregoing promoted the interest of the researcher for the present study. 

Statement of Problem

Patient teaching involves identification of patients learning needs/teaching opportunities, application of teaching strategies, evaluation and documentation. According to Burt, Mccraig & Simmons study (2008) findings showed that one in five Medicare clients was readmitted within 30days.  90% of the readmission was unplanned. Approximately 6.8 of clients discharged from hospitals in 2005-2006 visited emergency department within 7days of which 31% were readmitted. Findings from Driscoll, (2008) showed that clients and their family caregivers attributed these post discharge problems to their unmet informational needs. Also Koelling (2005) Weiss, (2007) associated quality of patient teaching provided by nurses with patient readmissions.

Furthermore finding from a study on problem encountered by breast feeding mothers in their practice of exclusive breastfeeding in tertiary hospitals in Enugu State by Okolie (2012) showed that lack of adequate education at antenatal clinics was (63%) and she advocated patient education through health education by nurses.

The UNTH hospital management and the nursing services department in collaboration with school of Nursing University of Nigeria Teaching Hospital Alumni Association based in USA(SONUNTHAAUSA) have equipped the nursing services department library in the continuing education unit with current textbooks, teaching aids such as models and softwares (demonstration techniques) etc. in 2011and 2013 respectively. This is aimed at improving the knowledge base of the nursing staff in order to carry out patient teaching efficiently. Despite these efforts made by the above mentioned bodies, the researcher observed that most nurses do not fully utilize these aids in assessment and in teaching patients. Also, patients discharged home were readmitted in no distant time. Majority of the patients do not have sufficient knowledge about their diseases and treatment regimen as evidenced by the twenty (20) patients, whose opinions were sampled in the outpatient unit of UNTH Enugu. This has created so many problems for the nurses and patients like long hospital stay and abscondments etc. The researcher wonders whether nurses know about patient teaching, what to teach and if they do, what do they teach and what do they do to achieve effective teaching outcome and how do they practice patient teaching? The above observation stirred the interest of the researcher to investigate issues relating to knowledge, attitude and practice of patient teaching among nurses in selected tertiary health institutions in Enugu State.   

Purpose of Study

The purpose of this study is to determine the knowledge, attitude and practice of patient teaching among nurses in selected tertiary health institutions in Enugu State. 

Objectives of the Study: The specific objectives of the present study were to:

  1. Determine nurse’s knowledge of patient teaching.
  2. Determine nurses attitude towards patient teaching
  3. Assess whether nurses practice patient teaching.
  4. Identify strategies and types of patient teaching adopted by nurses..
  5. Determine challenges nurses encounter in patient teaching.  

Research Questions

  1. Do nurses have the knowledge of patient teaching?
  2. What is the attitude of Nurses towards patient teaching?
  3. Do nurses practice patient teaching?
  4. Which strategies and types of patient teaching do nurses adopt?
  5. What challenges do nurses encounter in patient teaching?

Research Hypotheses

H01: There will be no significant difference in the knowledge of patient teaching between nurses of the two institutions.

H02: There will be no significant difference in the attitude of nurses of different health institutions towards patient teaching.

H03: There will be no significant difference in types of patient teaching adopted between nurses of the two institutions.

H04: There will be no significant difference in the practice of patient teaching among nurses in different institutions of study.

H05: There will be no significant difference in the practice of patient teaching among nurses with different years of work experience.

H06: There will be no significant difference in the practice of patient teaching among nurses with different levels of educational qualification.

H07: There will be no significant difference in the practice of patient teaching between male and female nurses.

Significance of the Study

Findings from this study if published will achieve the following:

  1. It will show areas of gaps in knowledge, attitude and practice of patient teaching among nurses and this will help nursing educators to know areas to emphasize on during training of nurses. If this is properly done, nurses will have sufficient knowledge about patient teaching and be motivated to teach.
  2. When nurses have sufficient knowledge about patient teaching and teach patients, statement of problem will be eliminated and patients will know about their disease conditions and treatment regimen and take good care of themselves and be useful to themselves, relations, communities and the nation.
  3. Nursing services department of institutions of study will utilize the findings of this study to organize continuing education programme for their nurses.
  4. Nursing and midwifery council of Nigeria may be stimulated by the findings of this study by reviewing the various nursing schools curricular in order to enrich them in the area of patient teaching.
  5. It will provide empirical evidence for patient teaching as there is dearth of nursing literature of this area in Nigeria.
  6. It will serve as a reference point for other researchers that would want to work in this area.

 Scope of Study

This study was conducted among nurses in tertiary health institutions in Enugu State. The study is limited to the knowledge of meaning, approaches, content, strategies and types/teaching of methods of patient teaching. Also study investigated nurse’s attitude to patient teaching, strategies and methods of patient teaching adopted by nurses in their practice, and if there is difference in knowledge and practice of patient teaching among nurses in the different institutions under study.

Operational definition of Terms

  1. Knowledge of patient teaching: In this study implies nurses ability to indicate correctly meaning of patient teaching, approaches, strategies, types and methods of patient teaching. The nurses should have from 50% and above responses in the indices of knowledge to be adjudged knowledgeable of patient teaching.

Categories of knowledge:

90 – 100% = Excellent knowledge

70 – 89% = Good knowledge

50 – 60% = Moderate knowledge

49 and below = poor knowledge.

  1. Attitude toward patient teaching: In this study implies nurses’ willingness to see patient teaching as their responsibility, eager to teach patients, steps she takes to establish a trusting relationship with the patient that will pave the way for patient teaching. For example; introducing him/her self to the patient, assessment of the patient on admission using nursing process format to identify learning needs of the patient, reading patients folders, engaging in extensive reading of different disease conditions of the patients to increase ones knowledge.
  2. Practice of patient teaching: Implies nurses adoption or use of any of the strategies of patient teaching and types of patient teaching as listed in the questionnaire namely: planned and unplanned, use of the different teaching methods e.g. discussion, demonstration, printed materials, audio-visual aids, and tools for teaching children e.g. story books, health fair, dolls, puppet play etc in patient teaching and evaluation and documentation of patient teaching.

Categories of practice of patient teaching:

90 – 100% = Excellent practice
70 – 89% = Good practice
50 – 60% = moderate practice
49 and below = poor practice
  1. Patient teaching/client teaching/patient education: Implies planned (structured) and unplanned (unstructured) health instructions/teaching given to patients by trained nurses which makes positive impact or leads to positive changes in health behaviour.
  2. Content of patient teaching: Implies the teaching process and everything, patient requires to know about his/her health and well being for example; health promotion, prevention of illness, restoration of health, and rehabilitation.
  3. Context of patient teaching: Implies the environment nurses used for patient teaching

e.g. ward rounds, bedside, clinics etc.

  1. Patient/client: interchangeably used in this study as recipients of nursing care, sick or well.
  1. Challenges encountered by nurses in patient teaching: implies those difficulties that prevent nurses from teaching patients e.g. lack of time, shortage of staff, lack of knowledge and skill and lack of teaching aids etc.

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