Knowledge, Attitude and Practice of Patient Teaching Among Nurses Working in Tertiary Health Institutions in Enugu
CHAPTER ONE
Objectives of the Study:
The specific objectives of the present study were to:
- Determine nurse’s knowledge of patient teaching.
- Determine nurses attitude towards patient teaching
- Assess whether nurses practice patient teaching.
- Identify strategies and types of patient teaching adopted by nurses..
- Determine challenges nurses encounter in patient teaching.
CHAPTER TWO
LITERATURE REVIEW
This chapter discussed related literature to the study. Literature was reviewed using textbooks, journals and internet extracts under the following headings:
Conceptual review of literature
Review of related theory
Empirical Review
Summary of the literature Review
Concept of Patient Teaching/Education
Rankin, Stallings and London (2005) defined patient teaching (patient education) as the process by which health professionals and others impart information to the patients that will alter their health behaviours or improve their health status. Martin (2012) opined that patient teaching involves helping patients become better informed about their conditions, medical procedures, and choices they have regarding treatment. Quinn (2010) opined that patient teaching involves information giving asking and answering questions, explaining and demonstrating.
Faulkner (1996) cited in Quinn (2010) asserted that patient teaching covers the teaching of the patient to understand his disease which may affect his future or have contributed to his present state.
Walsh (2005) viewed patient teaching as an interactive process whereby learning which may be used to influence behaviour, takes place. Freire (1985) in Walsh (2005) pointed out that real patient education entails emancipation that is librating people to make their own decisions on their own terms. He however, noted that nurses and other professionals have hesitated to allow patients the control that they need to make their own choices and decisions. At times this reluctance has stemmed from our maternalistic/paternalistic view of patients. Hospitals and other health care agencies have also created organizational barriers that prevent the patient from having the freedom to make decisions about health. Every patient has the right to seek information and participate in the educational plan. Simply providing information about health matters is a waste of time. This is because the purpose of education is to encourage patients to use knowledge to modify behaviour and perform activities that will result in improved health.
From the above definitions one can deduce that patient teaching is an interactive process whereby health professionals impart information on health matters with the aim of changing their health behaviours and thus improve their health status. The above definition implies that the role of the nurse is to plan learning experiences with the patient as a component of total care, so that patients share responsibility for health. When the nurse does this, patients are able to make rational decisions with respect to health, participates in self-care and adjust to the realities of life.
Importance of Patient Teaching
Patient teaching is very important in the health care setting.
Smeltzer, Bare, Hinkle Cheever, (2010) identified the following importance of patient teaching:
- Patient teaching provides adequate knowledge and training in self-care skills and thus helps clients to make informed decisions about health.
- It helps clients with chronic illness to participate actively in and assume responsibility for much of their own care.
- It helps those patients with chronic illness to adapt to their illness, prevent complications, carry out prescribed therapy and solve problems when confronted with new situations.
- It can also help in preventing crisis situations and reduce the potential for re-hospitalization resulting from inadequate information about self-care.
- Patient teaching helps clients to achieve their maximum health potential.
- It helps in reducing health care costs by preventing illness, avoiding expensive medical treatments, decreasing lengths of hospital stays and facilitating earlier discharge.
- Patient teaching is a tool for increasing patient satisfaction and for developing a positive image of the institution.
- Patient teaching is also a cost-avoidance strategy for those who believe that positive staff patient relationships avert malpractice suits.
- Patient teaching improves nurses’ job satisfaction because you know you impacted someone’s life quality.
CHAPTER THREE
RESEARCH METHODS
This chapter presents the research design, area of study, population of the study, sample and sampling technique, instrument for data collection, validity of instrument, reliability of the instrument, ethical consideration, and procedure for data collection, method of data collection and method of data analysis.
Design
A cross sectional descriptive survey design was used for this study. The descriptive survey approach design is based on on-going event. This design was successfully used by Osuala, Anarado, Nwazuruoke, Okpala and Okafor (2013) in a study of knowledge, attitude and barriers to nursing entrepreneurship among nurses in South East of Nigeria. The descriptive design is considered most appropriate for this study because the purpose of the study is to observe, describe and document the characteristics of phenomena of study in their natural setting at the time of study.
Area of study
The study was carried out in Enugu State. Study sites were University of Nigeria teaching hospital and National Orthopaedic Hospital Enugu (UNTH, NOHE). There are four tertiary health institutions in Enugu state namely UNTH, NOHE, ESUTH (owned by the state) and Neuropsychiatric Hospital, Enugu.
National Orthopaedic Hospital Enugu (NOHE), University of Nigeria Teaching Hospital Ituku-Ozalla, Enugu (UNTH) is federal owned Hospitals. University of Nigeria Teaching Hospital Enugu is a cardiothoracic centre of excellence. It is situated along Enugu-Port Harcourt expressway, U.N.T.H is bounded in the East by Ozalla Town, in the west by Ituku town, in the north by extension of Udi Hills and South by the Enugu Port Harcourt Expressway. U.N.T.H is a five hundred (500) bedded hospital, with twenty-four (24) wards seventeen (17) clinics and ten (10) units. Number of admissions in a month is 672 patients. The hospital provides training services to doctors, nurses and other health personnel’s, curatives and preventive health services to the general public.
National Orthopaedic Hospital is a federal government owned Hospital. The bed capacity is 220. N.O.H.E has twelve (12) wards six (6) units and five (5) clinics. Number of admissions per year is 2,364 patients. Average admission per month is 197 patients. N.O.H.E is specialized in Orthopaedics and plastic surgery. Resident doctors and post basic nursing students are trained there. N.O.H.E is located along Enugu-Abakaliki Expressway. It is bounded in the East by Area Command Nigeria Police force, in the West by Nike Grammar School, in the North by Institute of Ecumenical Education Thinkers corner and south by the 82 Division of Nigerian Army Barracks.
Population of the Study
The target population for the study consisted of all the nurses working in the wards and clinics of the two hospitals. They were chosen because they are directly involved in patient care. The total number is nine hundred and seventy-eight (978) comprising 675 nurses in UNTH and three hundred (303) nurses in National Orthopaedic Hospital (see Appendix IV for target population of study).
CHAPTER FOUR
PRESENTATION OF RESULTS
In this chapter, the results of data analyses were presented according to the research objectives and hypotheses set for the study. Four hundred and thirty (430) copies of the questionnaire were retrieved during data collection. Out of this number, 425 copies of the questionnaire returned were properly completed and fit for analysis. The questionnaire return rate was 98%. The high return rate may be attributed to the researcher’s record of nurses to whom questionnaire were administered. Those who misplaced their questionnaire were given a new one to fill and the researcher and the assistants collected them on the spot. Data from the 425 copies were subjected to data analyses and results presented in this chapter are based on this number.
The results on Table 1 show the demographic distribution of the nurses according to the health institutions. Most 415(97.1%) of the respondents were females, many 188(44.2%) fall within the age range of 31-40 years. The mean age for all respondents was 39.8 ±8.3 years.
Majority 311(73.2%) of the respondents were married. Almost all the respondents 414 (97.4%) were Christians.
Majority 222 (57.2%) have double diploma in nursing (Registered Nurse/midwife), followed by 123(28.9%) who were holders of academic certificates (BSC/BNSC Nursing). 35(8.2%) of them have diploma in nursing (Registered Nurses), 27(6.4%) of nurses had Bachelor of Health Education; while 18(4.2%) had MSC in Nursing.
CHAPTER FIVE
DISCUSSION OF FINDINGS
This chapter discusses the major findings of the research work with regard to the set objectives and hypothesis. Included here also are conclusion, limitation of the study, recommendations, suggestion for further studies and summary of this research work.
Discussion of major findings
Nurses knowledge of meaning and approaches to patient teaching.
Majority of the nurses had correct information about meaning and approaches to patient teaching and their major sources of information were from their nursing training schools, seminars and workshops organized for nurses and through continuing education programmes. The reasons adduced to this may be that patient teaching is included in the curriculum for nurses. (N&MCN curriculum, 2006). Also, seminars and workshops and continuing education programmes serve as a refresher courses for nurses. In addition, nurses may have learnt more about meaning and approaches to patient teaching by assessing the internet and other publications.
Limitations of the Study
There was great dearth of literature in this area of study. The paucity of literature was compensated by some relevant literatures from related studies. The researcher encountered some difficulty among the nurses. Some of the nurses were reluctant to fill the questionnaire because they claim they do not have time for it. The researcher also encountered huge financial expenses in carrying out this research.
Summary of findings:
- There is significant difference in the knowledge of patient teaching between nurses in UNTH and NOHE. UNTH nurses are more knowledgeable in patient teaching than Nurses in NOHE.
- There is no significant difference in the attitude of nurses in the two health institution used for the study
- There was significant difference in the methods adopted in patient teaching between nurses of two institutions of study. UNTH Nurses adopted better method of patient teaching.
- There is no difference in the practice of patient among nurses of two health institutions used for the study
- There is highly significant difference in the practice of patient teaching among nurses with different years of work experience. The higher the nurses years of work experience, the better their practice of patient teaching.
- There is highly significant difference in the practice of patient teaching among nurses with different level of educational qualifications. The higher the nurse’s educational qualifications, the better their practice of patient teaching.
- There is no significant difference in the practice of patient teaching between male and female nurses in the two institutions of study.
Conclusion
Based on the findings of this study, the following conclusions were made:
- Majority of the Nurses have good knowledge of patient teaching, but UNTH nurses are more knowledgeable in patient teaching than nurses at NOHE.
- On the attitude of Nurses toward patient teaching, there was no significant difference
- Though there is no significant difference in the types of patient teaching adopted by nurses of the two health institutions, UNTH nurses adopted better method of patient teaching than Nurses in NOHE.
- There is significant difference in the practice of patient teaching among nurses with different years of work experience. The higher the work experience, the better their practice of patient teaching. However, from the findings of this study the researcher conclude that there is fair practice of patient teaching among nurses used for the study because majority of them do not document their patient teaching.
Recommendations:
The following recommendations were made based on the findings of the study;
- The continuing education unit of both institutions of study should imbibe patient education
- The management of both institutions of study should pay all cadres of nurses teaching allowance in order to motivate them to teach patients.
- Employ more nurses to enable nurses have time to teach patients
- Written standardized patient teaching plan should be introduced in both institutions to enable nurses teach patients easily
- Management of the two health instotutions should provide special chart for documenting patient teaching.
Suggestions for Further Studies
Based on the findings of the study, the researcher suggests that studies be carried out to:
- Determine “The constraining factors to effective patient Teaching.
- Knowledge, Attitude and practice of patient Teaching Among Nurses in Tertiary Health Institutions in Nigeria.
- Knowledge, Attitude and practice of patient Teaching among Nurses working in private Hospitals in Enugu.
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