Jenifer Wilson-Barnett

Studies evaluating patient teaching: implications for practice.

From a representative selection of evaluative studies in patient teaching, 23 out of the 29 reviewed found some benefits for teaching patients. Despite some methodological weaknesses, this body of research provides evidence that care should include teaching. It may seem obvious to many that patients need information about their condition, treatment and recuperation, in order for them to cope and participate in their care. Sadly patients frequently report this need unsatisfied and remain ignorant, anxious and uncertain about what they should do (Skeet, 1970; Roberts, 1975; Reynolds, 1978; Wilson-Barnett, 1981). Information giving may not be the same as teaching, the latter inferring an interactive process whereby learning takes place which may subsequently be used to influence behaviour. In which case, sensitive assessment and fulfilment of patients’ information needs redefines patient teaching. This paper addresses the questions, “How does teaching help patients?” and “Why is it that nurses tend not to teach patients about their illness and treatment?” ‘Diabetic’, ‘Cardiac’ and ‘drug’ teaching predominates in earlier studies, demonstrating how highly staff value compliance to treatment. More recent work aims to approach teaching in ways which will alleviate anxiety and help patients’ adjustment to life at home. Such research evaluates teaching in terms of emotional and physical outcome rather than knowledge increase and attempts to indicate the most effective ways of teaching in the hospital or home setting. Most recent work emphasises the value of a continuous relationship with a teacher and recommends several opportunities for teaching to encourage understanding and questioning from patients. Opportunities for a continuous teaching relationship are afforded to those in most contact with patients.

Interventions to alleviate patients' stress: A review

Many events occurring in hospital have been found to be stressful for patients. Interventions aimed at alleviating these reactions have, in the main, been evaluated by psychologists and nurses. Methods used and contrasting approaches are reviewed. Although surgery has been the main event for this research, special investigations, treatments and hospital admission and discharge have also been studied. Outcome criteria have varied with physical measures being used more by nurses. Emphasis has been placed on preventing complications rather than enhancing recovery. Recent work has tended to compare types of intervention. Focused positive reappraisal and information on sensations are provided rather than procedural details as they have been found more successful in alleviating stress.

A review of research into the experience of patients suffering from coronary thrombosis

There is now a substantial volume of literature on how patients respond to a heart attack, to admission to a coronary care unit (CCU), transfer to a hospital ward and their subsequent recovery at home. The issue of what factors in the early stages in this illness affect degrees of rehabilitation has also been explored and there are suggestions that anxiety generated in the CCU determines a pattern of cardiac invalidism and debility. However, the relationship is difficult to test and research in this whole area has often produced conflicting results. This subject is mainly discussed in medical journals, yet it is of utmost importance to nurses who have the potential ability to prevent anxiety and therefore influence rehabilitation. For this reason a review of the research on this subject should emphasise its relevance to nursing practice. Many factors obviously influence a patient’s responses to and recovery from myocardial infarction (Ml). Miller and Brewer’s (1969) discussion included the full range of medical, psychological and social factors which are operative in rehabilitation. Severity of the MI, age of onset, previous history and other illnesses may all act against a speedy recovery whereas supportive relationships with staff and from the family can have a very positive effect. When considering psychological factors, the lack of motivation to recover or gain from illness behaviour and an inflexible personality are considered to be major difficulties. Patients’ perception of their illness, influenced by community opinion, can also influence recovery. Misconceptions about heart attacks are very prevalent and usually pessimistic, but iatrogenic disturbances are equally destructive. In their paper Miller and Brewer (1969) considered that “over treatment”, particularly prolonged rest with restrictions on many personal activities such as washing and feeding, demonstrated to the patient that he was desperately ill. Misdiagnosis of stabbing chest pain as angina is apparently frequently made. These pains which do not radiate and are not indicative of cardiac pathology are non-specific muscular pains often brought on by anxiety, but cause many doctors to advise bed rest “for safety”. Caution on advising