Contexte : En France, les réseaux de santé se sont progressivement développés selon des organisations plus ou moins formContexte : En France, les réseaux de santé se sont progressivement développés selon des organisations plus ou moins formalisées. Constitués d’abord spontanément, ils se sont imposés massivement dans le paysage sanitaire français depuis leur reconnaissance institutionnelle (2002). Dès leur création, de nombreux réseaux ont proposé des activités d’éducation thérapeutique. La satisfaction croissante des participants ainsi que l’amélioration de leur état bioclinique caractéristiques pédagogiques qui définissent les réseaux. Objectif : Appréhender et comprendre les conditions pédagogiques dans lesquelles s’effectuent les apprentissages des patients en lien avec leur maladie, dans les réseaux de santé. Méthode : Etude exploratoire qualitative portant sur les discours produits par des patients et des soignants lors d’entretiens semi-dirigés. Les discours sont complétés par des observations de séances d’ETP. Une méthode d’analyse de contenu thématique a été utilisée pour exploiter les verbatim produits et les notes d’observation. Résultats : Sept réseaux de santé d’Ile-de-France ont été inclus. Vingt-six patients et dix-sept professionnels de santé ont été interrogés. Douze observations de séances ont été réalisées. Onze catégories liées à l’analyse permettent de caractériser l’apprentissage que les patients développent de manière spécifique et signifiante dans les réseaux de santé. Conclusions/perspectives : Cette étude ouvre de nouvelles perspectives quant à la réflexion sur l’organisation de l’ETP de « ville », tant dans sa planification que dans les formats proposés aux patients.alisées. Constitués d’abord spontanément, ils se sont imposés massivement dans le paysage sanitaire français depuis leur reconnaissance institutionnelle (2002). Dès leur création, de nombreux réseaux ont proposé des activités d’éducation thérapeutique. La satisfaction croissante des participants ainsi que l’amélioration de leur état bioclinique en lien avec les activités éducatives suivies, conduisent inévitablement à s’interroger sur les caractéristiques pédagogiques qui définissent les réseaux. Objectif : Appréhender et comprendre les conditions pédagogiques dans lesquelles s’effectuent les apprentissages des patients en lien avec leur maladie, dans les réseaux de santé. Méthode : Etude exploratoire qualitative portant sur les discours produits par des patients et des soignants lors d’entretiens semi-dirigés. Les discours sont complétés par des observations de séances d’ETP. Une méthode d’analyse de contenu thématique a été utilisée pour exploiter les verbatim produits et les notes d’observation. Résultats : Sept réseaux de santé d’Ile-de-France ont été inclus. Vingt-six patients et dix-sept professionnels de santé ont été interrogés. Douze observations de séances ont été réalisées. Onze catégories liées à l’analyse permettent de caractériser l’apprentissage que les patients développent de manière spécifique et signifiante dans les réseaux de santé. Conclusions/perspectives : Cette étude ouvre de nouvelles perspectives quant à la réflexion sur l’organisation de l’ETP de « ville », tant dans sa planification que dans les formats proposés aux patients. / Context: In France, healthcare networks have progressively grown as more or less formalised organizations.Spontaneously created at first, they have massively imposed themselves within the French public health landscape since their institutional recognition (2002). From the very beginning, many networks have offered activities of therapeutic education to the patients. Growing satisfaction among applicants as well as the improvement of their bio clinical parameters following the practice of educational activities inevitably questions the educational features of these networks. Objective: Grasping and understanding the pedagogical conditions in which patients learn how to live with their diseases in healthcare networks. Method: An exploratory qualitative study of patients’ and caregivers’ verbatim statements extracted from semistructured interviews. Verbatim transcripts are topped up by observations of TPE sessions. Verbatim transcripts and reports of observations are analysed through a specific thematic content method. Results: Seven healthcare networks in the Ile-de-France area have been included. Twenty-six patients and seventeen caregivers have been interviewed. Twelve observations of TPE sessions have been conducted. Eleven themes have been identified to describe the learning process that patients have specifically and meaningfully developed within healthcare networks. Conclusion and perspectives: This study is opening new prospects for the TPE organisation: a new reflexion on its achievement and management, and on the educational activities offered to patients concerned with ambulatory care.

Background: Heart failure causes great suffering and costs for the society each year. Structured care of patients with heart failure can improve treatment, reduce hospitalization and increase quality of life. Patients with heart failure who are compliant can maintain health and well-being to a greater extent but requires patient education. Aim: The aim of the study was to investigate whether patients with heart failure, at an HF outpatient clinic, have high compliance with recommended self-care actions. The study also investigate statistical differences between sex, education level and marital status amongst participants with high compliance. Method: A quantitative approach was used, where patients´ self-care ability was measured using the European Heart Failure Self-Care Behaviour Scale (EHFScBS). Sixtyfour patients were asked for participation and 46 approved (72%). Result: The result showed low compliance with self-care actions in general. The claims regarding medication and limited fluid-intake showed high compliance. Among the participants with high compliance, four statistical differences (p ≤0.05) were identified regarding gender, marital status and education level. The results are in part consistent with previous research, showing that, despite education strategies, it may be difficult for HF-patients to deal with their own self-care. Conclusion: Based on the fact that patients with HF show low compliance with self-care actions, knowledge about different factors affecting the self-care ability in order to provide optimal care for each individual patient is of importance. EHFScBS used in the study can also be used as a measuring instrument for heart failure in the HF-outpatient clinic. / Bakgrund: Hjärtsvikt orsakar stort lidande och kostar samhället stora belopp varje år. Ett strukturerat omhändertagande av patienter med hjärtsvikt kan förbättra behandling, minska antalet sjukhusinläggningar och ge ökad livskvalitet. Patienter med hjärtsvikt som är följsamma till egenvårdsråd kan i högre grad bibehålla hälsa och välbefinnande. För att uppnå detta krävs patientutbildning. Syfte: Syftet med studien var att undersöka om patienter med hjärtsvikt, vilka regelbundet följs upp på hjärtsviktsmottagning, har hög följsamhet till rekommenderade egenvårdsråd. Studien avsåg också att undersöka om det fanns några statistiska skillnader mellan kön, utbildningsnivå och civilstatus vad gäller hög följsamhet till egenvårdsråd. Metod: En kvantitativ ansats tillämpades där patienternas egenvårdförmåga mättes med Europeiska beteendeskalan för egenvård vid hjärtsvikt (EHFScBS). 64 patienter tillfrågades om deltagande och 46 av dessa valde att delta (72%). Resultat: Resultatet av studien visade låg följsamhet till egenvårdsråd överlag. Endast för påståendena med avseende på medicinering och begränsat vätskeintag påvisades hög följsamhet. Bland de deltagare som hade hög följsamhet påvisades fyra statistiska skillnader (p ≤ 0,05) med avseende på kön, civilstatus och utbildningsnivå. Resultaten överensstämmer till viss del med tidigare forskning som påvisat, att det trots utbildningsstrategier kan vara svårt för hjärtsviktspatienter att sköta sin egenvård. Slutsats: Utifrån att patienter med hjärtsvikt har låg följsamhet till egenvårdsråd är det viktigt att som vårdgivare ha kännedom om olika faktorer som påverkar egenvårdsförmågan för att kunna erbjuda varje enskild patient ett så optimalt omhändertagande som möjligt. Egenvårdsskalan (EHFScBS) som använts i studien kan med fördel användas som ett mätinstrument på hjärtsviktsmottagningar.

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The study explored whether certain factors might be used to distinguish between people with cancer who do or do not want detailed information about their disease progress, do or do not want to be informed if their disease is no longer considered curable, and who do or do not want an estimation of life expectancy if their disease is no longer considered curable. The factors included whether an individual has an internal versus external locus of control, uses an active coping strategy or a planning coping strategy, the level of spirituality, and age. Participants consisted of 51 people with cancer from a cancer center in the state of Washington. Results indicated that 98% wanted detailed information about their disease progress, 94% wanted to be informed if their disease was no longer considered curable, and 78% wanted an estimation of life expectancy if their disease was no longer considered curable. Due to the majority of the participants endorsing the need for prognostic information none of the factors (e.g. coping strategies, locus of control, spirituality) were able to predict the information needs of the patients with cancer. Clinical implications of this study suggest that physicians have an ongoing, open dialogue with their patients about their prognostic information needs. The dialogue might be especially important for patients undergoing active treatment for cancer, since it could affect treatment decisions.

Att överleva en hjärtinfarkt är en livsomvälvande händelse. Det leder ofta till ångest, stress och i vissa fall depression. Att få rätt information i de inledande stadierna efter behandlingen är avgörande. Dock är det så att på grund av snabba behandlingstider är patienternas utbildningstid före utskrivning ofta för kort. För att ge adekvat utbildning måste patientens självupplevda lärandebehov vara kända för utbildaren. Syftet med denna studie är att utforska de självupplevda inlärningsbehoven hos patienter som har genomgått behandling för en akut hjärtinfarkt under sin sjukhusvistelse. Metoden för denna studie är en litteraturstudie av kvantitativa studier där systematiska sökningar har utförts och relevanta studier har kvalitetsgranskats och analyserats. Resultaten är baserade på tio studier med olika inlärningsbehovsskalor. De högsta rankade inlärningsbehovskategorierna var "sårvård", "information om medicinering" samt "komplikationer och symtom” Den lägst rankade kategorin var "fysisk aktivitet". Betydande skillnader hittades i denna kategori i flera studier, vilket visade sig bland unga och yrkesverksamma patienter som rankade denna kategori högre.Generellt sett rankades alla inlärningsbehov högt, vilket gjorde skillnaden mellan de enskilda kategorierna mindre betydande. Skalorna var svåra att jämföra och mycket information om innehållet i kategorierna saknades. Slutsatsen är att sjuksköterskor ska fokusera på övergående praktiska och överlevnadsrelaterade utbildningsämnen i de inledande stadierna efter behandlingen, men att mer forskning, särskilt av, kvalitativ karaktär behövs. / Surviving a myocardial infarction is a lifechanging event. It often causes anxiety, stress and in some cases depression. Receiving the right information in the initial stages after treatment is crucial, but due to fast treatment times the time for patient education before discharge is often short. To provide the right education the patient’s self-perceived learning needs to be assessed. The aim of this study is to explore the self-perceived learning needs of patients, who have undergone treatment for an AMI, during their hospital stay. The method is a literature review of quantitative studies in which systematic searches were performed and relevant studies were assessed for quality and analyzed. The results are based on ten studies employing different learning needs assessment scales. The top ranked learning needs categories were ‘wound care’, ‘medication information’ and ‘complications and symptoms’. The lowest ranked category was ‘physical activity’, but significant differences were found I regards to this category in several studies, which showed that it was ranked higher amongst young and employed patients. Generally, all learning needs were ranked highly, which made the disparity between the individual categories less substantial. The different scales were difficult to compare and a lot of information regarding the contents of the categories were lacking. The conclusion is that nurses should focus on imminent practical and survival related education topics in the initial stages after treatment, but that more research is needed especially of a qualitative nature.

Bakgrund: Antalet patienter med kroniska sjukdomar ökar i världen, vilket ställer krav på sjuksköterskans stödjande roll i form av patientundervisning. Sjuksköterskan kan vägleda patienten till ett hälsosamt samt reflektivt förhållningssätt som ger utrymme för dennes lärande och egenvård. En del av egenvård är att hitta en vardag som bringar känsla av kontroll och hälsa. Syfte: Belysa sjuksköterskors erfarenheter av patientundervisning vid kroniska sjukdomar. Metod: En litteraturöversikt över vetenskapliga artiklar. Resultat: Resultatet visar att förståelse och att se patientens livsvärld upplevs som betydelsefullt. Stöd och vägledning möjliggör både en god hälsa samt egenvårdsförmåga. Faktorer som begränsar eller försvårar patientundervisningen kan vara bristande följsamhet, patientens ekonomiska situation, anhöriga samt tidsbrist i arbetet. Konklusion: Patientundervisning för att stärka patientens egenvårdsförmåga visar sig vara ett omfattande område. Sjuksköterskor belyser flera aspekter i patientundervisningen som bidrar till en god egenvårdsförmåga hos patienten. En personcentrerad vård skapar ett samarbete mellan sjuksköterska och patient där fokus ligger på gemensamma mål och förståelse för patientens livsvärld. Sjuksköterskan behöver i arbetet med patientundervisning vara medveten om eventuella barriärer som kan förekomma där ett lösningsorienterat och inlyssnande arbetssätt måste beaktas. / Background: The number of patients with chronic diseases is increasing worldwide, which increases the demand for the nurse's supportive role in the form of patient education. The nurse can guide the patient to a healthy and reflective approach that provides space for the patient's learning and self-management. A part of self-care is to find an everyday life that brings a sense of control and health. Aim: Explore nurse’s experience of patient education in case of chronic disease. Method: The study is a literature review of scientific articles. Findings: The results show that understanding and seeing the patient's world as important. Support and guidance enable good health and self-management ability. Factors that limit or complicate patient education can be lack of compliance, the patient's financial situation, relatives and lack of time at work. Conclusion: Patient education to strengthen the patient's self-management ability turns out to be an extensive area. Nurses highlight several aspects that help the patient's self-management. A person-centered care creates a collaboration between nurse and patient where the focus is on common goal and understanding of the patient's world. Nurse’s need to be aware of barriers, where a solution-oriented and listening approach must be considered.

ABSTRACT Background: Patellofemoral pain syndrome (PFPS) is commonly seen in athletes and common symptoms are for example pain and stiffness, and difficulty in climbing stairs. Physiotherapy exercise interventions aim to increase the range of motion, strength, knee stability, balance, and functional ability. Shaping knowledge with patient education is a behaviour change technique that has proven important in musculoskeletal pain. How patient education can contribute to positive outcomes for physiotherapy exercise interventions in PFPS is unknown. Aim: To describe the effects of physiotherapy exercise interventions including patient education for adult and adolescent athletes with patellofemoral pain syndrome. Method: In a systematic literature review, only randomized controlled trials, on patients with a primary diagnosis of PFPS, published in English, were included. The data search was conducted by PICO in Pubmed and CINAHL. The methodological quality of the included studies was assessed by using the SBU checklist. Results: Six randomized controlled studies were included. According to the quality assessment the included studies had moderate to high quality and the outcome measures of the included studies were reliable and valid for measuring pain intensity, health-related quality of life, physical function, isometric muscle strength, and fear of movement. The results showed that physiotherapy interventions including patient education led to improved symptoms, functional ability, and health-related quality of life (HRQoL) for patients with patellofemoral pain syndrome in adult and adolescent athletes. Conclusion: Physiotherapy exercise interventions including patient education appear to increase physical function, muscle strength, and health-related quality of life and decrease pain and fear of movement for adult and adolescent athletes with patellofemoral pain syndrome. The conclusions are tentative as the review of the study quality for the included studies implied that four studies had a moderate risk of bias.

Bakgrund: Artros är en av de vanligaste muskuloskeletala sjukdomarna i västvärlden. Artrosskolan är en behandlingsmetod uppdelad i teori och praktik, som skall erbjudas alla patienter med artros. Detta för att ge patienten kunskap om sin sjukdom, smärthanteringsstrategier samt träning. Artrosskolan utvärderas i frågeformulär som registreras i Bättre omhändertagande av patienter med artros (BOA)som är ett kvalitetsregister för bättre omhändertagande av artrospatienter. Syfte: Att undersöka knä-och höftartrospatienters erfarenheter av artrosskolan, i form av upplevd kvalitet, lärdomar och upplevda effekt på besvären. Metod: En kvalitativ intervjustudie genomfördes i fokusgrupper med sammanlagt 14 deltagare. En semistrukturerad intervjuguide användes och data analyserades genom innehållsanalys med induktiv ansats. Resultat: Analysen ledde fram tillfyrakategorier med 3-5tillhörande subkategorier. Kategorierna var Artrosskolans utformning och innehåll, Information som kunde fördjupats, Tillämpning av ny kunskap och Upplevda fysiska och psykiska effekter av artrosskolan. Konklusion: Deltagarna nämner flera positiva upplevelser, lärdomar och effekter efter genomgången artrosskola. De anser att kvaliteten är god på den artrosskola de genomgått. Även områden där patienterna önskar mer information har synliggjorts.

Recall of hearing aid orientation (HAO) information by new hearing aid users was assessed in this pilot study. Twenty-eight older adults completed a 25-item recall test of hearing aid knowledge that contained questions targeting information presented during a typical HAO. The mean recall score immediately following the HAO was 80%. The mean recall score at the hearing aid follow-up 4 weeks later was 77%, indicating that most of the information was retained. Recall scores were not significantly different based on time of testing. Although a substantial amount of hearing aid use and care information was reported at the hearing aid follow-up, some important information was forgotten by several participants. These preliminary results suggest the need for greater focus on certain important hearing aid use and care information during the HAO.

Diabetes is a condition that can lead to foot ulcers that often progress to amputation of a limb. Providing patients with education about foot care is crucial because it can help to prevent or minimize the incidence of foot ulcer development and amputation of a limb. Foot care education as a strategy not only empowers patients with proper foot care knowledge and skill to support and motivate self-care but can also enhance the partnership between the provider and patient. The purpose of this quality improvement project was the implementation of a sustainable evidence-based foot care program for adult patients with diabetes as a routine organizational protocol for quality improvement in diabetic care in a primary care clinic. The question for this project was: How does the implementation of an evidence-based diabetic foot care protocol impact the health outcomes of diabetic patients in a primary care clinic? Orem’s self-care deficit nursing theory and the logic model for evidence-based practice were used to guide this DNP project. The research method for the quality improvement project was a review of the literature. The participants were staff and adults with diabetes at the primary care clinic. The results of the chart review showed that 80% of the charts included documented foot assessments and patient education, which was an improvement when compared to 40% pre-implementation of the foot care program. The program has improved the foot health knowledge and skills of clinicians and people with diabetes and has also helped to reduce the burden of healthcare costs related to the lower incidence of hospitalization for the treatment of wounds and amputation associated with complications of diabetes.