The invisible nature of learning: Patient education in nursing

BackgroundLearning for patients and their families within nurses’ patient- and family-education practice is an important part of person- and family-centred care. Patients and their families must master health promotional or management strategies to optimise their health outcomes. Support is often provided by nurses, but how nurses facilitate each patient’s and their family’s learning, using cognitive learning principles, seems invisible in the nursing literature.AimThis discussion paper examines the important role of cognitive learning within nurses’ patient- and family-education practice. How learning is enabled, the differences between teaching and learning and the role of learning principles are discussed. Shortcomings are identified and possible ways to address these within nurses’ practice are considered.MethodsThe discussion draws on the limited current literature surrounding cognitive learning principles in nurses’ practice and nurses’ awareness of learning principles. Readers are encouraged to question their current conceptualisation of learning and their perceptions and use of learning principles in their practice.Findings and discussionThe learning process within nursing is overshadowed by explanations of teaching strategies, determinants of learning and the learning principles of one specific theorist. The principles of cognitive learning and their role in patient- and family-education are poorly described and possibly poorly understood. This creates a fundamental knowledge gap in nursing practice.ConclusionA significant rethink about the role of learning principles within nurses’ patient- and family-education practice is overdue. These principles need to be explored further by involving nurses, patients and their families to identify how nurses are perceiving and using learning principles in their practice.     

Relationship between European Mitochondrial Haplogroups and Chronic Renal Allograft Rejection in Patients with Kidney Transplant

Mitochondrial DNA variants may contribute to differences in mitochondrial function, leading to an altered immune system. The aim of this study was to analyze the relationship between mtDNA haplogroups and the development of chronic allograft dysfunction in patients with kidney transplant. A retrospective observational study was carried out on 261 patients who received kidney transplant (114 had stable transplant and 147 patients developed chronic allograft dysfunction). DNA samples were genotyped for 14 mtDNA polymorphisms by using Sequenom''s MassARRAY platform (San Diego, CA, USA). Only European white patients within the N macro-cluster were included. Patients with haplogroups V (odds ratio (OR)=0.32; p=0.037) and J (OR=0.36; p=0.038) showed lower odds for developing CRAD than patients with haplogroup H. After adjusting for the most significant variables, haplogroups V and J tended to statistical significance (p=0.091 and p=0.067 respectively). This is a preliminary study in which mtDNA haplogroups seem to be implicated in susceptibility or protection for developing chronic allograft dysfunction.     

Chronic Childhood Stress: Psychometric Properties of the Chronic Stress Questionnaire for Children and Adolescents (CSQ-CA) in Three Independent Samples

Stress in children and adolescents is common and related to many developmental problems. However, most studies have made no distinction between temporary or chronic stress due to the lack of a suitable questionnaire. This study tested the factor structure, reliability and validity of the 17-item self-report Chronic Stress Questionnaire for Children and Adolescents (CSQ-CA) in three samples, that is, 717 adolescents from the general population, 161 adolescents of parents with a severe chronic medical condition (CMC) like multiple sclerosis, and 113 adolescents with healthy parents. Results showed that a one-factor solution provided a reasonable fit overall. Reliability was good (α = .80 to .88). Convergent validity was supported by positive relations between total stress scores and internalizing and externalizing problem behaviors, experience of daily hassles, and maladaptive emotion regulation strategies and negative relations with quality of life, happiness, mindfulness, self-esteem, and coping skills. Adolescents from all samples, who themselves had a light CMC like asthma, showed higher chronic stress levels than those without a CMC. In line, adolescents of parents with a severe CMC reported more chronic stress than those of healthy parents, and adolescents with a chronic illness themselves and a parent with a chronic illness, showed the highest scores across the two family types. Overall, this study presents good psychometric properties of the first available measure of chronic stress in children and adolescents.