French healthcare professionals' perceived barriers to and motivation for therapeutic patient education: A qualitative study

Therapeutic patient education is effective for various patient outcomes; however, healthcare professionals sometimes lack the motivation to carry out patient education. Surprisingly, this issue has rarely been addressed in research. Therefore, this study explores healthcare professionals' perceived barriers to and motivation for therapeutic patient education. Healthcare professionals, mainly nurses, working in different French hospitals were interviewed. Thematic content analysis was performed. Findings included a lack of skills, knowledge, and disillusionment of the effectiveness of therapeutic patient education were features of a demotivated attitude. In contrast, a positive attitude was observed when therapeutic patient education met a need to work differently and more effectively. A key factor motivating professionals was the integration of therapeutic patient education in routine care within a multidisciplinary team. To keep healthcare professionals motivated, managers should ensure that therapeutic patient education is implemented in accordance with its core principles: a patient‐centered approach within a trained multidisciplinary team. In the latter case, therapeutic patient education is viewed as an efficient and rewarding way to work with patients, which significantly motivates healthcare professionals.     

Exploring transformative learning and the courage to teach a values based curriculum

Teaching is a complex art that takes courage to commit to, particularly in the face of stressed students, crowded curricula, tensions in preparation for the graduate role, and ongoing educator shortages. My colleagues and I have been taking on this challenge by imbuing our teaching of nursing with more passion.As Parker Palmer (1998, p. 144), the renowned educationalist once said: “The growth of any craft depends on shared practice and honest dialogue among the people who do it. We grow by trial and error, to be sure – but our willingness to try, and fail, as individuals are severely limited when we are not supported by a community that encourages such risks”. The vision that I have is for nursing educators to come together in communities of practice to talk about the challenging aspects of nursing and ways these challenges can be reframed and reapproached through education. This work is underpinned by the pedagogy of Transformative Learning (TL).At its heart this pedagogy is interested in problematic practices that keep afflicting a discipline such as nursing, and in pondering and revising the educational solutions. In nursing, our biggest problems are where stigma, inequality and inertia persist to make vulnerable communities experience more illness and hardship than others who are more privileged. TL treats students as critical agents – who have the potential to rethink problems and change practices. TL aims to make space within the classroom and online for a dialogue that is affirming so that students believe in their own capacity to make a better world for all people.     

Work beliefs and experiential learning among proficient physical therapists in Japan: developing a method to support belief formation

[Purpose] This study aimed to elucidate the content of work beliefs related to proficiency among physical therapists in Japan. [Participants and Methods] Participants included 50 therapists who met the definition of proficiency to participate in a questionnaire survey conducted between October 2017 and March 2019. Participants were asked to freely describe their daily work beliefs, including their thoughts, values, and ideals. This content was coded and categorized using open coding; a hierarchical cluster analysis (Ward’s method) was conducted of the proficient therapists with the individuals and belief categories as the variables. All belief categories were classified into three groups. [Results] Three work beliefs were identified as follows: 1) practices that emphasize building relationships in the field, 2) broad practices with physical therapist pride (responsibility and enthusiasm), and 3) practices with awareness of treatment outcomes and social benefits. [Conclusion] A better understanding of the three aforementioned work beliefs would facilitate good support for and development of physical therapists. We recommend continuing to elucidate the three work beliefs identified among proficient therapists and verify their educational effects.     

Neutral to positive views on the consequences of nurse prescribing: Results of a national survey among registered nurses,nurse specialists and physicians

Background

Over the last two decades, the number of countries where nurses are legally permitted to prescribe medication has grown considerably. A lack of peer support and/or objections by physicians can act as factors hampering nurse prescribing. Earlier research suggests that physicians are generally less supportive and more concerned about nurse prescribing than nurses are. However, direct comparisons between doctors’ and nurses’ views are scarce and are often based on small sample sizes.

Objectives

To gain insight into the views of Dutch registered nurses (RNs), nurse specialists (with a master's in Advanced Nursing Practice) and physicians on the consequences of nurse prescribing.

Design

Survey study.

Participants

Survey questionnaires were sent to national samples of RNs, nurse specialists and physicians.

Methods

The questionnaire addressed, among others, respondents’ general views on the consequences of nurse prescribing for the quality of care, the nursing and medical professions, and the relationship between the medical and nursing professions.

Results

The net response rate was 66.0% for RNs (n = 617), 28.3% for nurse specialists (n = 375) and 33.7% for physicians (n = 265). It was found that all groups agreed that nurse prescribing benefits nurses’ daily practice and the nursing profession. There were few concerns about negative consequences for physicians’ practice and the medical profession. Nurse specialists gave significantly (P < 0.05) more positive scores on most items than RNs and physicians. We found relatively little difference in views between RNs and physicians. It was only on issues surrounding the quality of care and patient safety that doctors showed more concerns, albeit mild, than RNs and nurse specialists.

Conclusions

RNs, nurse specialists and physicians generally hold neutral to moderately positive views on nurse prescribing. This is beneficial for the implementation and potential success of nurse prescribing in practice, as a lack of peer support and/or objections from physicians can be a hampering factor. However, concerns about the consequences of nurse prescribing for the quality of care and patient safety remain a point for attention, especially among physicians.     

The I Will Help You mental health initiative: A pedagogy for nursing leadership and a call to action for nurses

Mental illness is a major cause of morbidity and mortality in society. Undergraduate nursing students designed and implemented a mental health awareness campaign called the I Will Help You initiative as part of their senior leadership nursing course. The aims of the initiative were to: spread awareness on mental illness; give the general public the skills and resources needed to identify and assist individuals who are struggling with mental illness; and decrease the stigma surrounding mental illness. A website, four online educational modules, four social media accounts, and two videos were designed by the students in order to promote the initiative. One month following the initiative's launch, the website had over 4000 page views, the videos had over 20,000 views, there were over 200 pledges, and the educational modules had 60 users. The initiative received substantial media attention and was featured via a variety of platforms including: a local news story, numerous health blogs, the state nurses' website and across the university campus. The I Will Help You initiative provided real life application of nursing leadership to an undergraduate student population while building a sustainable, evidence-based tool that can be used as a public health resource for mental illness.     

Work disabilities and unmet needs for health care and rehabilitation among jobseekers: a community-level investigation using multidimensional work ability assessments

Objective: Comprehensive understanding of the prevalence and quality of work disabilities and unmet needs for health care and rehabilitation to support return to work (RTW) among jobseekers.

Design: Community-level, cross-sectional analysis with multidimensional clinical work ability assessments.

Setting: Paltamo, Finland.

Participants: Unemployed citizens either participating in the Full-Employment Project or long-term unemployed (n?=?230, 81%).

Main outcome measures: Based on data from theme interviews, patient records, supervisors’ observations of work performance and clinical examinations, a physician concluded the individual’s work ability, categorised into four groups: good work ability, good work ability expected after RTW support, able to transitional work only or unable to work. These groups were cross tabulated with primary diagnoses, types of plans to support RTW, as well as categories of social functioning and motivation, for which sensitivity and specificity scores in detecting work disability were calculated.

Results: Only about half of the jobseekers had good work ability, 27% were found unable to work in the open labour market and 15% even eligible for a disability pension. For 20%, care or rehabilitation was seen necessary to enable RTW. Poor supervisor- and self-rated performance at work or poor social functioning appeared as sensitive measures in detecting work disability.

Conclusions: Work disabilities and unmet needs for health care and rehabilitation are highly prevalent among jobseekers, as depicted using a multidimensional work ability assessment procedure inspired by the International Classification of Functioning (ICF). Further development of work ability assessment practices is clearly needed.

• KEY POINTS

• Although the association of unemployment with poor health is well known, evidence on the work ability of the unemployed remains scarce.

• Work disabilities are common among the unemployed.

• Multidimensional work ability assessment among the unemployed reveals unmet needs for care and rehabilitation to support return to work.

• Context sensitivity may add to the accuracy of the doctor’s conclusions on work ability.

     

Using a competency-based approach to patient education: achieving congruence among learning, teaching and evaluation

Millions of Americans are living with, and managing, their chronic health problems. Patient education plays an essential role in promoting safe self-management practice. To ensure that patients attain the required abilities, patient education needs to be competency-based. When developing and applying a competency-based patient education lesson/program, each nurse must answer questions concerning essential competencies, optimal teaching methods, best method to evaluate patient achievement, and documentation of evidence. This article describes how the authors used these questions as a guide to achieve congruence among intended learning, instruction, and evaluation to design and implement a patient education program, Managing Heart Failure, at a local hospital.     

Flexible learning: Evaluation of an international distance education programme designed to build the learning and teaching capacity of nurse academics in a developing country

The professional development of nurse academics has been high on the agenda in many of the Asia-Pacific's developing countries including Vietnam. In collaboration with the Vietnamese Nurses Association, an Australian university designed and delivered a distance learning programme (DLP). The DLP sought to build academic capacity with a specific focus on the skills required to develop, implement and deliver a new national nursing curriculum. This paper will describe the design and delivery of the DLP as well as report on programme evaluation survey findings. Of the 175 surveys administered 112 were returned yielding a response rate of 64%. The majority of Vietnamese nurse academics identified all DLP modules as ‘very well’ designed and easy to learn from (range 63.9%–84.2%). Predominantly, academics also found the module content to be ‘of great use’ to their professional practice (range 73%–89.5%). Asked specifically about the benefit of the DLP online discussions, 106 (95.5%) participants stated they found the online discussions to be of use. An explanatory comment was also requested to explore this question and responses yielded three themes: ‘networking and collaboration’; ‘acquiring new knowledge’; and ‘improving English’. When asked if they had changed their academic practice as a result of DLP participation, 105 (94.6%) academics stated they had – change was focussed on student centred learning and building a staff community of practice. While these study results indicate the DLP to be successful, it will be how Vietnamese academics utilise and build these skills which will measure the real success of the programme in the future.     

Attitudes and barriers to a Medical Emergency Team system at a tertiary paediatric hospital

Aim

To determine the attitudes and barriers to an established paediatric Medical Emergency Team (MET) system among nurses and doctors.

Methods

Invitation to all clinical staff in a paediatric hospital to complete an electronic 41-item branched survey. Responses were graded on a Likert scale.

Results

407 staff completed the survey (280 nurses, 127 doctors). The MET system was highly valued for obtaining urgent assistance for the seriously ill patients by 85% of nurses and 83% of doctors. However, barriers to MET activation included; preference to contact the covering (attending) doctors by 80% of nurses and 45% of doctors, active discouragement to activating a MET by 41% of nurses and 12% of doctors, and fear of criticism by 17% of nurses and 9% of doctors if the patient was not deemed seriously ill by the MET attendees. Less experienced staff were significantly more likely to report barriers to calling a MET. Negative attitudes from MET attendees were reported by nurses (24%) and doctors (6.5%). Failure to recognize serious illness was revealed by unwillingness of 47% of doctors and 32% of nurses to activate MET when activation criteria were attained and by retrospective realization by 30% of doctors and 15% of nurses that they had failed to activate MET when needed.

Conclusions

Cultural and behavioral barriers to MET activation and inability to recognize serious illness may explain in part the failure of a MET system to completely eliminate unexpected cardiac arrest and death. Unless these issues are addressed, the full benefits of a MET system may not be realised.     

Development and psychometric testing of the Attitudes,Subjective Norms,Perceived Behavioural Control,and Intention to Pursue a Career in Mental Health Nursing scale

The aim of the present study was to develop and test the psychometric properties of the Attitudes, Subjective Norms, Perceived Behavioural Control, and Intention to Pursue a Career in Mental Health Nursing (ASPIRE) scale, an instrument to assess nursing students' intention to work in mental health nursing. Understanding the factors influencing undergraduate nursing students' career intentions might lead to improved recruitment strategies. However, there are no standardized tools to measure and assess students' intention to pursue a career in mental health nursing. The present study used a cross‐sectional survey design undertaken at a large tertiary institution in Western Sydney (Australia) between May and August 2013. It comprised three distinct and sequential phases: (i) items were generated representing the four dimensions of the theory of planned behaviour; (ii) face and content validity were tested by a representative reference group and panel of experts; and (iii) survey data from 1109 first‐ and second‐year and 619 third‐year students were used in exploratory and confirmatory factor analyses to test the factorial validity of the scale. Internal consistency was measured using Cronbach's alpha. Items generated for the ASPIRE scale were subject to face and content validity testing. Results showed good factorial validity and reliability for the final 14‐item scale. Principal axis factoring revealed a one‐factor solution, the hypothesized model being supported by confirmatory factor analysis. The ASPIRE scale is a valid and reliable instrument for measuring intention to pursue a career in mental health nursing among Bachelor of Nursing students.