The lived experience of newly-qualified nurses in the delivery of patient education in an acute care setting

Transcription

1 The lived experience of newly-qualified nurses in the delivery of patient education in an acute care setting Karen Fawkes Dr. Jaqualyn Moore April 2016

2 Background Global increase in non-communicable disease (WHO 2008) Aging population increasing chronic disease prevalence (Barker 2012 ) Challenges to nurses meeting patient need for knowledge, skill and understanding include- *Shorter in-patient length of stay *Time pressures *Poor pedagogical preparation (Kääriäinen & Kyngäs 2010).

3 Aim of the research study To explore and understand the experience of newly-registered adult nurses in the delivery of patient education in acute care.

4 Objectives To identify the meanings attached to those experiences To identify the barriers, facilitators and incentives to patient education delivery To explore the feelings, attitudes and values attached To examine the role of pre-registration education in the development of the necessary skills

5 Methods A qualitative approach using Interpretative Phenomenological Analysis (Smith, Flowers & Larkin 2009) The detailed examination of personal lived experience, the meaning of experience to participants and how participants make sense of that experience. (Smith 2011, p.9)

6 Interpretative Phenomenological Analysis Inductive Idiographic Centrality of the analyst Clear stages of analysis Identification of generic themes across cases

7 Recruitment Purposive sampling Eligibility criteria Registered adult nurse 6-12 months post-qualification BSc. or post-graduate diploma from a UK university Working in the acute sector for a minimum of 3 months

8 Data Collection Seven newly qualified nurses from one Central London hospital Semi-structured, one-to-one interviews Use of an interview topic guide

9 Participants Participant No. Pre-registration Months qualified Area of practice programme P1 PGDip 6 Surgery P2 BSc 6 Medicine P3 PGDip 6 Medicine /Surgery P4 BSc 8 Medicine P5 BSc 10 Medicine P6 BSc 7 Medicine P7 BSc 9 Medicine

10 Data Analysis Each individual transcript was analysed using- Line-by-line analysis Emergent theme identification Relationships between themes identified Super-ordinate theme identification Repeated for each transcript Identification of patterns across cases Sub-themes nested within super-ordinate themes

11 Themes Identified

12 The Professional Self Nursing Identity I give advice and educate them about such things.i see it as a nurse's role (P6) It s all about keeping people informed of what is happening to them. it s almost like a right (P2) Having that confidence to know that you ve got to be right, you can t give false information (P4)

13 The Professional Self Clinical Knowledge I suppose for me the big thing would be gaining the knowledge, your ability to give patient education depends on your knowledge (P7) It s really important for people to be aware of what s happened to them. It s not a secret for only us to know (P2)

14 The Professional Self Personal Growth That patient is, in some instances, doing stuff because you have actually said, well, this is better for you..that s actually a nice little kick when you get that. (P5) I find if I don t know the answer that s something you can go away and find out about and it s expanding your knowledge (P7)

15 The Professional Self Pedagogical Skills I think it s just from experience really... It s like pre-empting what you think they re going to need (P3) Patient education is something that we do on purpose or inadvertently, like, all the time.so I think that throughout a shift you will be giving patient education (P2)

16 The Professional Self Pedagogical Skills I think we were taught a lot about how important patient education is, but not necessarily that much about how to deliver patient education (P4) I think as you go along you practice...by practising everyday it will just come to you (P1)

17 The Ward Environment Time Constraints and Workload You don t have time to do the smaller things and patient education sometimes ends up coming to the bottom of the pile (P4) Where the patient has full understanding, that s not something you have control over, so it s kind of starting a race that you don t know when the end [is] (P2)

18 The Ward Environment The Multi-disciplinary Team [I refer to] specialists in the particular field because they will have much more knowledge than I would have (P2)

19 The Ward Environment Conflict with Colleagues [They re] just a band 5 as well, maybe, why are you doing that, it s not your job, you don t have to do it (P5) I always go to the senior staff nurses. They re so good at knowing where to get the information from (P3)

20 The Ward Environment Environmental Constraints Our facilities and the things to improve the patient s health isn t limited here compared to when they get home (P6) Sometimes they re going to be discharged, we have to sit them out in the day room and and they re just whisked off by transport before you ve had chance (P3)

21 The Nurse-Patient Relationship Knowing your Patient I think the more patient interaction, the more I know about patients as well, like the tiny things that make a difference to them (P5) You just get a sense that they don t really want to change. There are other people where you sense that actually they would be open (P7)

22 The Nurse-Patient Relationship Knowing your Patient Maybe they re not ready to learn anything but just showing that you re ready and open if they re ready, that that makes a big difference (P4)

23 The Nurse-Patient Relationship Fear of patient reaction It s difficult if it then comes across as sort of judgemental on how they currently live (P7) You re on a bariatric bed and..i m not sure you should be drinking that and it s how do you say that politely (P5)

24 The Nurse-Patient Relationship Challenging Patients I suppose cognitive ability and complex conditions that they may have.. how do you then make sure that they have understood all the necessary information (P7) Some people, they don t want to take responsibility for their care or they don t feel like it s something they should know so that will then be a barrier (P2)

25 Recommendations Increased profile of patient pedagogy in pre-registration curricula Increased support from senior management for patient education delivery Preceptorship programmes to include support for patient education Increase the availability of teaching resources

26 So where to now?

27 Future Research Research within other care settings, particularly primary care Use of simulated patient education activities in pre-registration education Action research into the impact of pedagogical training on nurses clinical practice within patient education

28 References Barker D.J.P. (2012) Developmental origins of chronic disease. Public Health 126 (3), Ivarsson B. & Nilsson G. (2009) The subject of pedagogy from theory to practice: the view of newly registered nurses. Nurse Education Today, 29: 5, Kääriainen M. & Kyngäs H. (2009) The quality of patient education evaluated by the health personnel. Scandinavian Journal of Caring Sciences 24: 3, Smith J.A., Flowers P. & Larkin M. (2009) Interpretative Phenomenological Analysis: Theory, Method and Research. London: Sage. World Health Organisation (2008) : Action plan for the global strategy for the prevention and control of noncommunicable diseases. Available from: pdf?ua=1 (accessed on 15 th December 2015).

29 Thank you