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.

12

CHAPTER ONE

INTRODUCTION

Background to the Study

The well known parable “if you give a man a fish, y ou feed him for a day, but if you teach him to fish you feed him for a life time”, is apt f or 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.

13

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

14

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 favourable. 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 theitr 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.

15

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

&   Simm