Developing the nurse's role in patient education: rehabilitation as a case example
Introduction
Patient education has figured prominently in both the professional literature and policy discourse over recent years and is widely recognised as an important component of the nurse's role (Close, 1988, Noble, 1991, Redman, 1993, Stamler, 1996, Hansen and Fisher, 1998, Turner et al., 1999). Nowhere is this emphasis more apparent than in the field of rehabilitation (Nelson, 1992, Trieschmann, 1988, Turner et al., 1999) with an educative role being described in most nursing related conceptualisations of the rehabilitation process (Waters, 1987a, Corbin and Strauss, 1992, Hymovich and Hagopian, 1992, Brillhart and Sills, 1994).
Recent health care policy in the United Kingdom (UK) is moving towards an explicitly patent-centred model (DoH, 1997) in which the experience of the patient provides one of the key benchmarks of quality (DoH, 1998). Concurrently rehabilitation has re-emerged as a major policy goal with the promotion of independence being one of the UK Government’s primary objectives (HAS 2000, 1999). Recent major analyses have defined rehabilitation as a time-limited intervention intended to restore either function or role (Nocon and Baldwin, 1998; Hanford et al., 1999). This is a process which involves learning or relearning (Nocon and Baldwin, 1998), being based on an educational approach which empowers people (Sinclair and Dickinson, 1998). Furthermore rehabilitation is now seen to embrace a wider range of care environments, with the community emerging as one of the main sites of activity (Sinclair and Dickinson, 1998, Hanford et al., 1999, Royal Commission on Long Term Care, 1999).
The above developments provide considerable potential for an expanded nursing role, particularly in the field of patient education. This approach is consistent with the renewed attention given to preventive health care strategies, especially with older people (Joseph Rowntree Foundation, 1999). However, to realise this potential nurses must possess skills as patient educators and give this aspect of their work a high priority. A number of studies suggest that this is often not the case with nurse education paying relatively little attention to patient education (Close, 1988, Noble, 1991), and practitioners frequently lacking an understanding of key aspects of adult learning (Close, 1988, Hansen and Fisher, 1998, Turner et al., 1999). Consequently patient education is often fragmented and ad hoc (Close, 1988, Turner et al., 1999) a situation exacerbated by a lack of time and heavy nursing workloads (Turner et al., 1999).
This paper is based on a major study of the nurse's role in rehabilitation (Nolan et al., 1997) which highlighted the importance of an educative role. The first section describes a comprehensive review of the literature, which adopted an explicit, theoretically driven model to search the available databases and analyse the literature obtained. This resulted in a conceptual framework outlining the various dimensions of the potential and actual nursing role in rehabilitation (Nolan et al., 1997). The focus of this article is on patient education.
Following this literature review printed curricula from a range of pre- and post-registration courses were interrogated to identify the relative emphasis given to patient education. The results form the second part of the paper.
It should be noted that the terms nurse education and nurse training are used as synonymous throughout this paper.
Section snippets
Searching and analysing the literature
The literature component of the study was used to describe the nurse's current role in rehabilitation within the context of the multidisciplinary team and to identify areas for further development, particularly in relation to chronic illness and disability. An initial search of a single database (CINAHL 1982–1995) suggested that there were at least 5000 references of possible relevance, well beyond the temporal and logistical resources available to the project team.
An explicit and reproducible
Results
The results presented here relate only to the nurse's role in patient education within a rehabilitative context. During the conceptual overview of rehabilitation an educative role figured prominently and also emerged as one of the major themes within the condition specific literature (see Nolan et al., 1997). A brief summary of the main conclusions from each of the five sets of literature is presented below. In addition to expected variation given the deliberately disparate nature of the five
Preparing nurses as patient educators
Despite the deliberately varied nature of the conditions selected for review the analyses of the literature were characterised more by similarity than by differences. All identified a prominent role for the nurse in patient education and there was considerable rhetoric about the nurse being ideally placed to undertake patient education. There was also recognition that patient education involved more than simply imparting information but also required a reasonably sophisticated understanding of
Results of curriculum analyses
For the sake of brevity the results of the pre-registration programmes and the community specialist courses are presented in tabular form (Table 2, Table 3, respectively) with accompanying textual commentary. Due to the lack of specific attention given to patient education within the rehabilitation courses only a brief textual summary is provided.
Discussion
One of the main conclusions to emerge from the initial review was the variety of roles that the nurse supposedly plays in rehabilitation. In addition to the provision of direct care these included, amongst others, a co-ordinating role, an educative role, an advocacy role and a researcher role (Nolan et al., 1997). However while such roles were frequently extolled in the literature they rarely seemed to reflect the reality of practice, as described in the empirical literature. This raises
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