Documente Academic
Documente Profesional
Documente Cultură
H . H Ä T Ö N E N 1 r n m n s c , R . S U H O N E N 2 r n p h d , H . WA R R O 3 r n m n s c ,
A. PITKÄNEN4 rn mnsc & M. VÄLIMÄKI5 rn phd
1
Doctoral student, University of Turku, Department of Nursing Science/Municipality of Imatra, Hospital District
of South Carelia, 2Professor (acting), 3Ward manager, University of Turku, Department of Nursing Science,
4
Doctoral student, University of Turku, Department of Nursing Science/Pirkanmaa Hospital District, and
5
Professor, University of Turku, Department of Nursing Science/Hospital District of South-West Finland,
Turku, Finland
Abstract
IT-based patient education Yes there was it [patient education] sometimes. I do not
The procedure for IT-based patient education was remember details right now.
described by patients in terms of systematic patient educa- Some patients reported that they did not receive any
tion sessions. This meant that the timing and content of information at all.
patient education were planned in advance and it was a The nurse–patient interaction reportedly lacked discus-
step-by-step process as stated in following quotation: sions on patients’ situation. Some patients reported that the
We had a schedule and in each session a specific topic interaction lacked appropriate respect and individuality.
was discussed. They felt that their information receiving was not sup-
The nurse–patient interaction was described in terms of ported with any educational method and the patients did
individual discussions when the content of patient educa- not mention if the environment had any effect on how they
tion was integrated into the patient’s life situation through received information. Considering the benefits of patient
cooperative discussions. By contrast, interaction was education, patients reported that the information received
described as mechanical information dissemination when was mainly meaningless to them.
it was perceived as delivery of information from nurse to
patient rather than a process responding to patients’ needs.
Suggestions for the further development of
The use of a computer was perceived to give additional
patient education
support to patients’ information receiving, but some
patients were concerned if the use of computer affected the The key elements of patient education were used as a
confidentiality. Patients described an environment that was framework to describe patients’ suggestions for improving
peaceful and suitable for the purpose as supportive for IT-based patient education, conventional patient education
information receiving while an environment with interrup- and patient education according to the standard care.
tions and disturbances was perceived to hinder patients’
information receiving. Considering the benefits of patient IT-based patient education
education, some patients thought that the focus was on Patients’ suggestions related to the development of pro-
patients’ independent coping with illness. However, some cedure were described in terms of individual planning
patients considered the information received to be impor- and more extensive content of patient education. Patients
tant, but useless for everyday coping. reported that their individual situation should be consid-
ered in planning patient education as described in the fol-
Conventional patient education
lowing quotation:
Patients who participated in the conventional patient
In what situation someone is, it is important. If someone
education described the procedure of patient education
is very tired or something, there should be a change to
in terms of planned patient education sessions with the
rest before those sessions.
content based on leaflets as described by one patient:
More extensive content meant including more examples
We had several sessions where we had certain time to go
of patients descriptions in the content.
through those leaflets.
To develop the educational method, patients suggested
The nurse–patient interaction was described by some
that the options of IT should be utilized more widely. This
patients as helpful. This meant open and confidential dis-
meant using more pictures, voice clips and interactive tasks
cussions. By contrast, some patients in this group reported
in the portal. Environment for patient education should be
that interaction was rather passive, a one-way informing
peaceful and undisturbed. Moreover, having computers on
situation. The use of the leaflets was perceived to give
the ward was suggested to support patients’ independent
additional support to patients’ information receiving.
information seeking. No suggestions on interaction or
Patients reported that it was useful to recap information
benefits were mentioned by patients in this group.
received independently from leaflets. The patients did not
mention any effect of the environment on receiving infor-
Conventional patient education
mation. Regarding the benefits of patient education, some
Regarding procedure, patients’ suggestions included
patients thought that the information received was useful
involving patients in planning, recapping of content and
for their independent coping with illness, while some
detailed information. Patients reported that involving them
patients reported that the information seemed rather super-
in the planning of the patient education integrates this into
ficial to them.
their life situations.
Standard care Nurses should actively offer this [patient education] and
The procedure of patient education was described as occa- ask if the patient is ready for it. Then it is easier to
sional informing sessions as one patient put it: participate and think about those different topics.
Patients perceived it as useful that the content of the the impact of organizational factors, professional values
previous patient education session should be recapped at and skills on successful patient education (Deccache &
the beginning of the new session, and requested more Aujoulat 2001).
detailed information. In order to support patients to receive information in
Patients noted that interaction could be improved by psychiatric care, guidelines have been developed to enhance
creating active interaction through open communication the integration of patient education into treatment (NICE
and clearing up issues about which patients may be con- 2002, APA 2004, Duodecim 2008). However, the use of
cerned. They suggested that different educational materials standardized treatment procedures has emerged as a
should be used to support their information receiving. No concern about the loss of individuality (Miller & Kearney
suggestions for improving the environment and benefits 2004), which may put patients in a passive role. This is an
were made. important aspect in psychiatric care, where patients often
have problems in actively participating in their own treat-
Standard care ment (Hill & Laugharne 2006). In this study, patients
Patients’ suggestions for improving patient education pro- perceived interaction to be passive if information was
cedure were described in terms of systematic individual delivered to them through one-way mechanical sessions. As
practices. The patients were of the opinion that patient other studies have shown, interaction between patient and
education should be offered systematically to all patients nurse is an essential element of patient education (Crowe
taking into account their individual situation. Development et al. 2001, Pollock et al. 2004). Building a unique, thera-
of interaction included descriptions of individual interac- peutic and trusting relationship with each patient is crucial
tion. Patients considered that nurses should be active in in nursing (McQueen 2000). Therefore, staff’s skills in
creating respectful communication based on patients’ indi- providing systematic patient education through patient-
vidual situations. centred communication demands attention (Maguire &
To develop educational methods, patients wanted to Pitcheathly 2002).
receive information from different sources such as leaflets In this study, patients mentioned a need to use different
and the Internet as stated by one patient: patient education methods to support their information
And more different leaflets and new technology could receiving. This has already been found to be an effective
be used. (Murray et al. 2005, Haynes et al. 2008) and accepted
Patients also wanted to receive information from differ- method among patients (Jorm et al. 2003, Chou et al.
ent professionals and from other patients to get different 2004). IT especially as a part of patient education is quite
viewpoints. Patients in this group did not provide sugges- new in the field of psychiatric care (Lewis 2003). In good
tions for development of environment and benefits. hands the use of IT may shift the role of the patient from
that of a passive recipient to that of an active consumer of
health information. Therefore, it is important that health
Discussion
professionals are ready for this transformation and have
Patients’ perceptions of the patient education intervention the skills to guide patients to use the health information
varied depending on whether they had participated in available on the Internet safely (Mc Mullan 2006).
IT-based patient education, conventional patient educa- Regarding the limitations of this study, the number of
tion or standard care. Earlier studies have also shown that patients who refused to participate in this study was high
patients’ experiences of patient education vary (Feldmann (50%). Thus, the patient selection may have been biased
et al. 2002). In the present study, patients participating in that less motivated and incompetent patients were
in IT-based or conventional patient education perceived excluded from the study. Participants were also younger
education as a systematic and planned process. However, than patients in psychiatric hospitals in general (National
especially patients in the patient education group applying Research and Development Centre for Welfare and Health
standard care perceived patient education as occasional 2008) and age-related computer literacy might contribute
information dissemination situations. These results may be to the successful realization of IT-based patient education
signs of psychiatric illness and poor insight (Zygmunt et al. (Or & Karsh 2009). These results might therefore give too
2002). On the other hand, our study showed that patients positive impression of patient education methods used in
with similar psychiatric illness in the same patient educa- this study. Additionally, the length of the interviews varied
tion group perceived patient education differently. We may a lot, potentially affecting the quality and depth of data.
therefore assume that there are aspects, other than the Patients with schizophrenia may also have severe manifes-
illness itself, affecting patients’ perceptions of patient edu- tations of psychiatric illness affecting their responses in the
cation. This is also supported by literature mentioning interviews. However, to ensure the quality of the data, the
interviews were carried out by one research assistant with Bodenheimer T., Lorig K., Holman H., et al. (2002) Patient self-
extensive experience in psychiatric nursing and trained in management of chronic disease in primary care. The Journal of
the American Medical Association 288, 2469–2475.
data collection. The analysis was carried out by the first
Chou M.H., Lin M.F., Hsu M.C., et al. (2004) Exploring the
author, which may affect the results because of an emphasis self-learning experiences of patients with depression participat-
on the researchers’ own perceptions. To overcome this, the ing in a multimedia education program. Journal of Nursing
results were read by all members of the research group and Research 12, 297–306.
analysis was corroborated with quotations from the origi- Clarke A. (2001) Evaluation research in nursing and health care.
nal data. Because of these limitations, the findings remain Nurse Researcher 8, 4–14.
Crowe M., O’Malley J. & Gordon S. (2001) Meeting the needs of
tentative. Despite the limitations, the results still provide
consumers in the community: a working partnership in mental
valuable knowledge about the elements and the variations health in New Zealand. Journal of Advanced Nursing 35,
in patients’ perceptions of patient education carried out on 88–96.
psychiatric wards. Deccache A. & Aujoulat I. (2001) A European perspective:
common developments, differences and challenges in patient
education. Patient Education and Counseling 44, 7–14.
Conclusions Declaration of Helsinki (2004) Ethical principles for medical
research involving human subjects. Available at: http://
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ETENE (2001) Shared values in health care, common goals and
forgetting interaction between patient and nurse, which
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Acknowledgments
1371–1385.
This project was supported by the Academy of Finland Haynes R.B., Ackloo E., Sahota N., et al. (2008) Interventions for
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(207384), the Hospital District of South Carelia special
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Tampere University Hospital, the South Carelian Cultural Hill S.A. & Laugharne R. (2006) Decision making and informa-
Foundation and the Finnish Foundation of Nursing Edu- tion seeking preferences among psychiatric patients. Journal of
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