Developing the nurse's role in patient education: rehabilitation as a case example

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Abstract

Over the past decade considerable emphasis has been placed on the nurse's role in patient education. Despite this numerous studies have suggested that this aspect of nursing practice is under-developed. Using rehabilitation as a case example this paper explores the nursing contribution to patient education in five conditions: multiple sclerosis; arthritis; myocardial infarction; spinal injury and stroke. Although the literature identifies considerable potential for nurses to take a lead role in patient education this is rarely achieved in practice. Analyses of printed curricula from a range of courses indicate that nurses are not adequately prepared for patient education and that a reorientation of nurse education is required.

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

References (98)

  • S.M. Basta

    Pressure sore prevention education with the spinal cord injured

    Rehabilitation Nursing

    (1991)
  • S.M. Basta

    Pressure prevention self-efficacy and outcome expectations: a study of people with spinal cord injury

    Rehabilitation Nursing Research

    (1994)
  • E.K. Beach et al.

    Perceived stressful life events: a factor in recovery after myocardial infarction

    Progress in Cardiovascular Nursing

    (1988)
  • D.G. Best

    The development of a guide for stroke survivors and their families

    Canadian Journal Cardiovascular Nursing

    (1994)
  • J. Bleiberg et al.

    Learning goals during initial rehabilitation hospitalization

    Arch. Phys. Med. Rehabil.

    (1983)
  • B. Booth

    The knowledge nurses need to educate patients about stroke

    Nursing Times

    (1994)
  • B.J. Boss

    The neurophysiological basis of learning: concept formation/abstraction, reasoning and executive functions — implications for SCI nurses… part 2

    SCI Nursing

    (1994)
  • H. Brazier et al.

    Selecting a database for literature searches in nursing: MEDLINE or CINAHL?

    Journal of Advanced Nursing

    (1996)
  • B. Brillhart et al.

    Analysis of the roles and responsibilities of rehabilitation nursing staff

    Rehabilitation Nursing

    (1994)
  • J.M. Buelow

    A correlational study of disabilities, stressors and coping methods in victims of multiple sclerosis

    J. Neurosci. Nurs.

    (1991)
  • C.S. Burckhardt

    The impact of arthritis on quality of life… the impact of pain and functional impairment

    Nursing Research

    (1985)
  • J. Burgireno

    Maximizing learning in the adult with SCI… spinal cord injury

    Rehabilitation Nursing

    (1985)
  • C. Carpenter

    The experience of spinal cord injury: The individual’s perspective — Implications for Rehabilitation Practice

    Physical Therapy

    (1994)
  • J.R. Cassady

    Nursing actions vs. arthritis quackery

    Rehabilitation Nursing

    (1985)
  • S. Challis

    Teaching arthritis the holistic way. Orthodox and complementary treatments

    Professional Nurse

    (1991)
  • N.J. Christman et al.

    Uncertainty, coping and distress following myocardial infarction: transition from hospital to home

    Research in Nursing and Health

    (1988)
  • C. Clarke

    Nursing care for multiple sclerosis

    Orthopaedic Nursing

    (1991)
  • A. Close

    Patient education: a literature review

    Journal of Advanced Nursing

    (1988)
  • V.S. Conn et al.

    Cardiac rehabilitation program participation and outcomes after myocardial infarction

    Rehabilitation Nursing

    (1992)
  • J.M. Corbin et al.

    A nursing model for chronic illness management based upon the trajectory framework

  • N.J. Crigger

    Testing an uncertainty model for women with multiple sclerosis

    Advances in Nursing Science

    (1996)
  • The New NHS

    (1997)
  • A First Class Service: Quality in the New NHS

    (1998)
  • Making A Difference: Strengthening the Nursing, Midwifery and Health Visiting Contribution to Health and Healthcare

    (1999)
  • K.I. Easton et al.

    Developing and implementing a stroke education series for patients and families

    Rehabilitation Nursing

    (1994)
  • R.L. Evans et al.

    Poststroke family function: an evaluation of the family’s role in rehabilitation

    Rehabilitation Nursing

    (1992)
  • R.L. Evans et al.

    The family’s role in stroke rehabilitation: a review of the literature

    American Journal of Physical Medicine and Rehabilitation

    (1992)
  • R.L. Evans et al.

    Stroke: a family dilemma

    Disability and Rehabilitation

    (1994)
  • J. Farrell et al.

    Telling it straight

    Nursing Mirror

    (1985)
  • L. Galarneau

    An interdisciplinary approach to mobility and safety education for caregivers and stroke patients

    Rehabilitation Nursing

    (1993)
  • E.E. Gulick

    Model for predicting work performance among persons with multiple sclerosis

    Nursing Research

    (1992)
  • L. Hanford et al.

    Rehabilitation for Older People: The Emerging Policy Agenda

    (1999)
  • M. Hansen et al.

    Patient-centered teaching from theory to practice

    American Journal of Nursing

    (1998)
  • “Not Because They Are Old”: An Independent Inquiry Into the Care of Older People on Acute Wards in General Hospitals

    (1999)
  • L. Henderson

    Arthritis in Motion: An exercise programme for chronic arthritis sufferers

    Orthopaedic Nursing

    (1989)
  • S. Hewlett

    Using unproven remedies in arthritis — Short Report

    Nursing Times

    (1991)
  • C. Hildingh et al.

    Cardiac nurses preparedness to use self help groups as a support strategy

    Journal of Advanced Nursing

    (1995)
  • J. Hill

    Patient education in rheumatic disease

    Nursing Standard

    (1995)
  • D.P. Hymovich et al.

    Chronic Illness in Children and Adults: A Psychosocial Approach

    (1992)
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