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Sjuksköterskors patientundervisande arbete: Ett otydligt fält
University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Göteborgs Universitet.
2016 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: The overall aim of this thesis is to explore, describe and critically assess conditions for nurses’ patient education work. This was carried out in two stages. In the first stage, the aim was to describe nurses’ experiences and perceptions of patient education work in relation to organisation, environment, professional cooperation and pedagogical competence, as well as describe differences between primary, municipal and hospital care. In the second stage, the aim was to identify discourses in the ways managers speak of the conditions for nurses’ patient education work in primary and hospital care.

Methods: In studies I and II, a randomised selection of nurses (842) received a questionnaire of 47 items concerning factual experiences and perceptions patient education, and 13 background items. Questionnaires were returned by 83 % of the participants. The items concerned organisation, environment, professional cooperation (I), and pedagogical competence (II). Descriptive statistics, non-parametric tests and content analysis for open-ended items were used. In studies III and IV, data was collected from three focus group interviews with managers (n=10) in hospital care, and three focus groups interviews with managers (n=10) in primary care. An explorative, qualitative design with a social constructionist perspective was used. The data was analysed with a critical discourse analysis.

Results: Nurses’ perceptions of conditions for patient education differ between healthcare settings, in favour of primary care (I, II). The nurses in primary care had better conditions and more managerial support, for example in the allocation of uninterrupted time (I). The primary care nurses had an advantage in relation to those in municipal or hospital care when it came to following research in patient education as well as how they perceived their own competences, pedagogical education and post graduate specialisations (II). Due to a heavy workload and a lack of time, the managers in hospital care could neither see the importance of their role as a supporter of the patient education provided by the nurses nor their role in the development of the nurses’ pedagogical competence. The managers used (mainly) organisational, financial, medical and legal discourses for explaining their failure to support the nurses’ providing patient education (III). The discursive practice in primary care comprised a discourse order of economic, medical, organisational and didactic discourses. The economic discourse was the predominant one, to which the organisation had to adjust. The medical discourse was self-evident and unquestioned. The managers initiated reorganisations, generally due to financial constraints. The nurses’ pedagogical competence development was unclear. Practicebased experiences of patient education were considered very important, whereas theoretical pedagogical knowledge was considered less important (IV).

Conclusions: Nurses’ patient education work must be made visible and be given sufficient resources. In this process, support from their managers is considered vital. Managers’ support for nurses’ practical and theory-based pedagogical competence development needs to be strengthened.

Place, publisher, year, edition, pages
Göteborg: Göteborgs universitet, 2016. , 68 p.
Keyword [en]
nurse, manager, patient education, teaching, information, pedagogical, critical discourse analysis
National Category
Medical and Health Sciences Nursing
Research subject
Människan i vården
Identifiers
URN: urn:nbn:se:hb:diva-9555ISBN: 978-91-628-9744-4 (print)ISBN: 978-91-628-9745-1 (electronic)OAI: oai:DiVA.org:hb-9555DiVA: diva2:917551
Public defence
2016-04-29, Sal: Åke Göransson, Medicinaregatan 11, Göteborgs universitet, Göteborg, 13:00 (Swedish)
Available from: 2016-04-07 Created: 2016-04-07 Last updated: 2017-05-04Bibliographically approved
List of papers
1. Registered nurses’ perceptions of conditions for patient education: focusing on organizational, environmental and professional cooperation aspects.
Open this publication in new window or tab >>Registered nurses’ perceptions of conditions for patient education: focusing on organizational, environmental and professional cooperation aspects.
2012 (English)In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 20, no 6, 758-770 p.Article in journal (Refereed) Published
Abstract [en]

AIM: To describe nurses' perceptions of conditions for patient education, focusing on organisational, environmental and professional cooperation aspects, and to determine any differences between primary, municipal and hospital care. BACKGROUND: Although patient education is an important part of daily nursing practice, the conditions for this work are unclear and require clarification. METHOD: A stratified random sample of 701 (83%) nurses working in primary, municipal and hospital care completed a 60-item questionnaire. The study is part of a larger project. The study items relating to organisation, environment and professional cooperation were analysed using descriptive statistics, non-parametric tests and content analysis. RESULTS: Conditions for patient education differ. Nurses in primary care had better conditions and more managerial support, for example in the allocation of undisturbed time. CONCLUSIONS: Conditions related to organisation, environment and cooperation need to be developed further. In this process, managerial support is important, and nurses must ask for better conditions in order to carry through patient education. IMPLICATIONS FOR NURSING MANAGEMENT: Managerial support for the development of visible patient education routines (e.g. allocation of time, place and guidelines) is required. One recommendation is to designate a person to oversee educational work.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Ltd., 2012
Keyword
nursing, nursing leadership, nursing, patient education, patient information, patient teaching, pedagogical encounter, vårdvetenskap
National Category
Nursing
Research subject
Integrated Caring Science
Identifiers
urn:nbn:se:hb:diva-1420 (URN)10.1111/j.1365-2834.2012.01460.x (DOI)000308640800005 ()22967294 (PubMedID)2320/11736 (Local ID)2320/11736 (Archive number)2320/11736 (OAI)
Available from: 2015-11-13 Created: 2015-11-13 Last updated: 2016-06-21Bibliographically approved
2. Perpetuating ‘New Public Management’ at the expense of nurses’ patient education: A discourse analysis
Open this publication in new window or tab >>Perpetuating ‘New Public Management’ at the expense of nurses’ patient education: A discourse analysis
2015 (English)In: Nursing Inquiry, ISSN 1320-7881, E-ISSN 1440-1800, Vol. 22, no 3, 190-201 p.Article in journal (Refereed) Published
Abstract [en]

This study aimed to explore the conditions for nurses' daily patient education work by focusing on managers' way of speaking about the patient education provided by nurses in hospital care. An explorative, qualitative design with a social constructionist perspective was used. Data were collected from three focus group interviews and analysed by means of critical discourse analysis. Discursive practice can be explained by the ideology of hegemony. Due to a heavy workload and lack of time, managers could ‘see’ neither their role as a supporter of the patient education provided by nurses, nor their role in the development of nurses' pedagogical competence. They used organisational, financial, medical and legal reasons for explaining their failure to support nurses' provision of patient education. The organisational discourse was an umbrella term for ‘things’ such as cost-effectiveness, which were prioritised over patient education. There is a need to remove managerial barriers to the professional development of nurses' patient education. Managers should be responsible for ensuring and overseeing that nurses have the prerequisites necessary for providing patient education as well as for enabling continuous reflective dialogue and opportunities for learning in practice.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Ltd., 2015
National Category
Nursing
Research subject
Integrated Caring Science
Identifiers
urn:nbn:se:hb:diva-1976 (URN)10.1111/nin.12085 (DOI)25327764 (PubMedID)2320/14479 (Local ID)2320/14479 (Archive number)2320/14479 (OAI)
Available from: 2015-11-13 Created: 2015-11-13 Last updated: 2017-03-21Bibliographically approved
3. Registered Nurses’ Patient Education in Everyday Primary Care Practice:: Managers Discourses
Open this publication in new window or tab >>Registered Nurses’ Patient Education in Everyday Primary Care Practice:: Managers Discourses
2015 (English)In: Global Qualitative Nursing Research., ISSN 2333-3936, Vol. 2Article in journal (Refereed) Published
Abstract [en]

Nurses’ patient education is important for building patients’ knowledge, understanding, and preparedness for self-management.

The aim of this study was to explore the conditions for nurses’ patient education work by focusing on managers’ discourses

about patient education provided by nurses. In 2012, data were derived from three focus group interviews with primary care

managers. Critical discourse analysis was used to analyze the transcribed interviews. The discursive practice comprised a

discourse order of economic, medical, organizational, and didactic discourses. The economic discourse was the predominant

one to which the organization had to adjust. The medical discourse was self-evident and unquestioned. Managers reorganized

patient education routines and structures, generally due to economic constraints. Nurses’ pedagogical competence

development was unclear, and practice-based experiences of patient education were considered very important, whereas

theoretical pedagogical knowledge was considered less important. Managers’ support for nurses’ practical- and theoreticalbased

pedagogical competence development needs to be strengthened.

Place, publisher, year, edition, pages
Sage Publications, 2015
Keyword
discourse analysis, education professional, health care primary, teaching
National Category
Medical and Health Sciences
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-3954 (URN)10.1177/2333393615599168 (DOI)
Available from: 2015-12-09 Created: 2015-12-09 Last updated: 2016-08-12Bibliographically approved
4. Registered nurses’ perceptions of conditions for patient education: focusing on aspects of competence.
Open this publication in new window or tab >>Registered nurses’ perceptions of conditions for patient education: focusing on aspects of competence.
2014 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 3, 523-536 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: It is important to clarify nurses' perceptions of conditions for patient education in daily work as research findings are ambiguous. There is a gap between societal regulations on nurses' competence in accomplishment/achievement of patient education and research findings. AIM: The aim was to describe nurses' perceptions of conditions for patient education, focusing on aspects of competence. The aim was also to describe differences in conditions for nurses working in primary, municipal and hospital care. METHODS: The study is a cross-sectional survey and is part of a project about nurses' patient-education. A randomized selection of nurses (842) received a questionnaire comprising 47 items concerning factual experience and attitudes to patient education and 13 background items. Questionnaires were returned by 83% of participants. Descriptive statistics, non-parametric tests and content analysis for open-ended items were used. RESULTS: Nurses' perceptions of conditions for patient education differ between health-care settings. Primary care nurses are at an advantage in following research in patient education, perception of their own competence (prioritizing and knowing their mandate in patient teaching), pedagogical education and post graduate specializations. CONCLUSIONS: Nurses' patient education must be more visualized and appropriate conditions created at each workplace. In this change process, managers' support is considered vital.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Ltd., 2014
National Category
Nursing
Research subject
Integrated Caring Science
Identifiers
urn:nbn:se:hb:diva-1980 (URN)10.1111/scs.12077 (DOI)23992371 (PubMedID)2320/14498 (Local ID)2320/14498 (Archive number)2320/14498 (OAI)
Available from: 2015-11-13 Created: 2015-11-13 Last updated: 2016-06-21Bibliographically approved

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