Myocardial infarction patients (MI, or heart attack) are vulnerable patients that require special care. The purpose of this study was to develop a teaching guide to be used by nursing staff with MI patients in the hospital setting, and to investigate the impact of this Individualized Patient Teaching Guide (IPTG). This research met its specific purposes through a three phase structure: development of the teaching guide, implementation, and assessment of participant impact. In phase one, development of the teaching guide, two focus groups were conducted: one with previous MI patients and the other with nursing staff. The IPTG was developed using topics identified as important by these two groups. Twenty patients participated in the implementation phase. The intention was for these patients to have patient teaching guided by the options they chose on their IPTGs. Seventy per cent of the patients provided feedback concerning the impact of the guide. All of these patients (n=14) indicated that Risk Factors was very important or important for them to learn about while in the hospital, and 13 of them received instruction on Risk Factors from health care practitioners. Psychological concerns was the topic most neglected: only one of the patients that had identified this as important received instruction on this topic. While the majority of patients (n=10) indicated that the IPTG provided them with an opportunity to identify their learning needs, only four of the patients surveyed felt that their learning needs were completely met in the hospital setting. The other six patients indicated that the information provided to them was insufficient. It seems that some of the topics identified as important were addressed in the clinical setting. Furthermore, the tool did allow patients an opportunity to identify learning needs. However, given that the majority of patients indicated dissatisfaction with the amount of education they received in the hospital setting, it may be concluded that the IPTG did not accomplish the goal of improving the in-patient learning experience. Reasons for this are discussed. / Thesis (Master, Education) -- Queen's University, 2008-07-25 11:33:49.114

Background: Antibiotic treatment of humans was introduced in 1930. The drug improved the living conditions globally due to the fact that bacterial diseases now could be treated. The development of antibiotic resistant bacteria is undeniable and globalization increases the spread of the resistant bacteria. The main reason for the emergence of resistant bacteria are incorrect and excessive use of antibiotics. Aim: The aim of the study is to investigate registered nurses’ experiences when caring for patients that have been subscribed antibiotic treatment. Method: A qualitative study with a semi-structured interview design based on interviews with eight nurses from one private hospital in The Philippines. The interviews were transcribed and analyzed using a qualitative content analysis. Result: Three themes were identified in the study, “To increase compliance”, “Nurses’ knowledge of antibiotic treatment” and “The nurses’ reflections on antibiotic treatment”. The first theme describes how the nurses provide a safe and open-minded environment for the patients, how to support and encourage the patient during treatment and how to give comprehensible information to the patient. The second theme describes the nurses’ knowledge of the emergence of antibiotic resistance, reasons for antibiotic treatment, the manifestation of antibiotic resistance and also the effects of antibiotic resistance. The third theme describes the nurses’ reflections and thoughts concerning antibiotics as well as how they perceive the population’s knowledge of antibiotics. Discussion: All of the nurses highlighted the poverty in The Philippines as the main reason for poor compliance. A large part of the population cannot afford to consult a doctor which results in people treating themselves without the proper knowledge. A majority of the nurses therefore request health education provided from the government.  A private hospital also strives to please the patient which can result in doctors prescribing a lot of antibiotics to please their patients.

Acute decompensation of chronic heart failure is common and results in many patients being re-hospitalized every year (Jancin 2008). One of four voluntary core measures deployed by the Joint Commission for evaluation of quality of heart failure care in hospitals is heart failure discharge instructions, also called core measure HF1. Although the core measure is a widely disseminated standardized measure related to discharge education, there is little evidence about its impact on patient or readmission outcomes. The purpose of this study was to determine the relationship between the completion of heart failure discharge instructions as defined by the Joint Commission core measure HF1 in a single site, 500 bed tertiary hospital population in the Upper Midwest and the primary endpoint of subsequent readmission to the hospital 30, 90, 180 and 365 days following an index discharge for primary diagnosis of heart failure. Secondary endpoints included hospital readmission charges and total hospital readmission days per year. Patient characteristics, clinical characteristics, unit factors and index visit utilization variables were controlled. This study also described the relationship between nursing unit factors and completion of HF1. A retrospective, descriptive design, and analyses using primarily generalized linear models, were used to study the relationship of HF1 to utilization outcomes (readmission, hospital days and cost) and unit context (discharge unit and number of inter-unit transfers). Individual level retrospective demographic, clinical, administrative and performance improvement data were used (n = 1034). Results suggested a weak and non-significant association of completion of the core measure HF1 bundle and readmission within 30 days for all cause readmissions (p = .22; OR 1.32), and no association with HF to HF readmissions at 30 days. There was an inverse association 2 after 6 months for all cause readmission, and after 90 days for HF to HF readmission. There was a non-significant trend toward a relationship to total hospital days, but no relationship of HF1 to total annual charges. The study did find a significant relationship between type of discharge nursing unit and HF1 completion, and type of discharge unit and readmission. The discharge nursing unit was quite consistently and strongly related to all cause readmissions in binary (p = .029: OR 1.58) and counts analyses (p = .001; OR 1.52), but was not related to the subset of HF to HF readmissions. The study concludes that there is limited relationship between HF1 and 30 day all cause hospital readmission and total readmission days, but a stronger relationship between HF1 and discharge from a cardiology specialty unit. There was also a relationship between cardiology discharge unit and reduction in all cause readmissions.

Background: Exclusively breastfeeding a child during the first six months of life reduces the risk of mortality by 14 times. 42 % of mothers in Indonesia breastfed their infant exclusively in 2012. It is the registered nurses´ responsibility to provide information about consequences of their decision to the patient. Aim: The aim of this study was to investigate how registered nurses describe how they provide patient education about breastfeeding to newly delivered mothers and how registered nurses experience their role as a patient educator. Method: It was an empirical, qualitative study based on a focus group interview with four registered nurses and two midwives. The interview was based on a semi-structural interview design. The focus group interview was transcribed and analyzed using a qualitative content analysis. Result: Three major themes were found in this study, “strategically using different techniques while educating”, ”patient and family centered care” and “the registered nurse as a significant source of knowledge”. The first theme describes how the registered nurses used different techniques to encourage the mothers to breastfeed. The second theme describes the importance to include the entire family in the education and to adjust the education depending on the patient. The third theme describes how the registered nurses saw themselves as significant sources of knowledge and that it was their responsibility to provide evidence-based knowledge. Discussion: All registered nurses and midwives described the importance of evaluating the education. Families had a great influence over the patient in the Indonesian culture, hence, it was crucial to involve them in the education. The registered nurses felt that they were in the right position to give crucial information and education about breastfeeding.

Congestive heart failure (CHF) is a progressive medical condition affecting more than 7 million people in the United States (US) with 700,000 new cases reported annually. More than half of those treated for CHF are readmitted at least once a year. The problem addressed by this quality improvement initiative was lack of adherence to low sodium diet (LSD) among CHF patients, knowledge and skill deficit, and excessive 30-day CHF readmissions. The health belief model and the self-care deficit theory guide nurses in acquiring the skills needed to teach LSD. Twelve months of data were selected from 93 CHF readmissions from a target population of 499 CHF admissions. Measures of central tendency were used to extract meaningful summaries between variables for patterns related to 30-day readmissions and to plan educational interventions to improve patient outcomes. The educational intervention focused on educating nurses to teach adult patients with CHF to adopt a LSD. Discharge teaching materials developed were standardized, customizable, evidence-based, and included opportunities for evaluation of patient understanding and reteaching as necessary. Analysis of variance was conducted to evaluate the difference between days to readmission and compliance with the patient education process, and no significant difference (p < .05) was found (F(3,89) = .314, p = .815). The implications of this project for social change include preparing nurses to teach patients to adopt a LSD, empowering CHF patients to improve health outcomes, and improving the financial outcomes related to CHF.

Heart failure is a complex heart disease that incapacitates more than 5 million people, is associated with increasing healthcare cost, and remains the leading cause of admission in the United States. As the United States faces increasing financial burden related to readmission of heart failure patients within 30 days of discharge, many healthcare institutions are evaluating interventions to determine the most effective opportunities to improve systems, including nursing practice. The purpose of this doctoral project was to improve readmission rates within 30 days of discharge from an acute care facility through the development and implementation of a standardized, evidence-based, patient-centered discharge education toolkit using the Teach-Back method. Orem's self-care theory and the situation-specific theory of heart failure self-care were utilized as a theoretical framework to inform this doctoral project. The sources of evidence were obtained from the Get With The Guidelines-Heart Failure database and through a review of nursing and health-related databases. Descriptive statistics were used to compare the pre- and posteducation session readmission rates. The rate of readmissions occurring within thirty days of discharge pre- and post-educational session retrieved from the GWTG-Heart Failure database were 9.4% and 0.0% respectively. These results showed that this discharge toolkit reduced heart failure 30-days readmission rates. The limitations and strengths of this project will be used to guide further research on heart failure readmission and self-care management. This DNP project will promote positive social change for clinicians, who can use this discharge toolkit to improve self-management in adults with heart failure and thus decrease the costs related to readmission.

The purpose of patient education is to provide patients and their families with the tools needed to care for themselves after discharge from the hospital, but shortened hospital stays, limited health literacy, language, and age can impede the patient's comprehension of the information provided. Researchers have found that the lack of effective patient education is related to 30-day hospital readmissions. The Power of 3 educational tool, designed by Sanchez and Cooknell, addressed the factors that impeded effective patient teaching by using the adult learning theory and low health literacy concepts. The Power of 3 was implemented as a quality improvement project in the Total Joint Center in October 2014. The purpose of this project was to assess the effect of an adult learning-based educational tool on the readmission rates for venous thrombus embolism and infection and on the effect on mobility in total joint surgery patients. This goal was accomplished by performing a retrospective chart review on 90 randomized patients, 45 before and 45 after implementation. The Power of 3 demonstrated a statistically significant change in the length of time a patient remained out of bed on the day of surgery after implementing the educational tool (0.75 hours vs. 1.514 hours, p = 0.0182, CI 95%). In addition, the number of patients that nursing staff documented who were out of bed was also statistically significant on the day of surgery (12 patients vs. 24, p = 0.0461, CI 95%). This educational tool can facilitate patient teaching by addressing language and educational barriers between patients and health care workers.

This qualitative research study examined the patient education experience from the point of view of health care professionals, namely doctors of chiropractic in the Greater Toronto Area practicing for up to ten years. Health care professionals’ views and beliefs of this important aspect of health care have not been well studied. Patient education is defined as, “the process by which patients learn or acquire knowledge about his/her health status or condition and may involve learning in the cognitive, affective, and/or psychomotor domains.” The study explored eight participants’ views on the nature of patient education in their early and current practices by examining their feelings, beliefs, and use of patient education, its role in their practices, as well as the perceptions of their roles as patient educators. Two semi-structured interviews were conducted with each of the participants. The transcribed interviews underwent detailed qualitative analysis to determine response trends and consensus. The key findings revealed that the participants felt that, while they were well prepared in their undergraduate curricula to diagnose and treat patients, they were not as well prepared to be effective patient educators when they entered practice. Early in their careers, they did not understand or appreciate patient education’s importance and value as a component of their practice. Over time, their beliefs and understanding of patient education changed and participants reported that with experience, they began to value patient education to a greater extent. Changing values reflected changing behaviours. For example, participants increased their time and efforts related to patient education with increased clinical experience. A variety of teaching aids were used with wall charts/posters, three dimensional anatomical models, printed materials and images from textbooks being among the most common. Most of the teaching described by the participants would be characterized as transmission with a one-way flow of information from the doctor to the patient. To a great extent, patient education involved speaking with individual patients. Participants reported encountering, throughout their careers, intrinsic and extrinsic barriers that interfered with the effectiveness of their patient education. The findings suggest that curricular planners for health care professional programs, and specifically for chiropractors, might consider developing content aimed at improving students’ patient education knowledge and skills.

This qualitative research study examined the patient education experience from the point of view of health care professionals, namely doctors of chiropractic in the Greater Toronto Area practicing for up to ten years. Health care professionals’ views and beliefs of this important aspect of health care have not been well studied. Patient education is defined as, “the process by which patients learn or acquire knowledge about his/her health status or condition and may involve learning in the cognitive, affective, and/or psychomotor domains.” The study explored eight participants’ views on the nature of patient education in their early and current practices by examining their feelings, beliefs, and use of patient education, its role in their practices, as well as the perceptions of their roles as patient educators. Two semi-structured interviews were conducted with each of the participants. The transcribed interviews underwent detailed qualitative analysis to determine response trends and consensus. The key findings revealed that the participants felt that, while they were well prepared in their undergraduate curricula to diagnose and treat patients, they were not as well prepared to be effective patient educators when they entered practice. Early in their careers, they did not understand or appreciate patient education’s importance and value as a component of their practice. Over time, their beliefs and understanding of patient education changed and participants reported that with experience, they began to value patient education to a greater extent. Changing values reflected changing behaviours. For example, participants increased their time and efforts related to patient education with increased clinical experience. A variety of teaching aids were used with wall charts/posters, three dimensional anatomical models, printed materials and images from textbooks being among the most common. Most of the teaching described by the participants would be characterized as transmission with a one-way flow of information from the doctor to the patient. To a great extent, patient education involved speaking with individual patients. Participants reported encountering, throughout their careers, intrinsic and extrinsic barriers that interfered with the effectiveness of their patient education. The findings suggest that curricular planners for health care professional programs, and specifically for chiropractors, might consider developing content aimed at improving students’ patient education knowledge and skills.

A medical center specializing in ear, nose, and throat (ENT) services noted an increase in the number of postoperative ENT complications compared to the national average. The purpose of this mixed-methods project study was to examine ENT patients' preoperative patient education (PPE) needs regarding postoperative care. Grounded in Knowles's model of learning, core adult learning principles were applied as guidelines in facilitating patients' PPE learning. Data were collected from 58 ENT patients who were selected using a convenience sampling method and who responded to a PPE survey using a 5-point Likert scale and open-ended questions. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed using content analysis for emergent themes. The quantitative findings included patients' perceived needs for preoperative and postoperative information regarding ENT care and surgery complications. The qualitative findings included patients' perceptions of PPE in ENT and recommendations for how to use PPE before and after surgery. Implications for positive social change include an awareness of patients' perceptions of PPE needs in ENT by hospital administrators, doctors, and nurses. A better understanding of PPE by patients could result in lower levels of postoperative complications in ENT.