LIF‘RARY ' Michigan State ' University This is to certify that the thesis entitled OPINIONS OF HEALTH CARE PROFESSIONALS CONCERNING PATIENT EDUCATION FOR THE INPATIENT HOSPITAL POPULATION, WITH IMPLICATIONS FOR PROGRAM PLANNING AND STAFF DEVELOPMENT presented by Rosemary S. CaffareTTa has been accepted towards fulfillment of the requirements for Ph.D. Education degree in / Major professor Date January, 1978 0-7639 © 1978 ROSEMARY SHELLY CAFFARELLA ALL RI GHTS RESERVED r..— OPINIONS OF HEALTH CARE PROFESSIONALS CONCERNING PATIENT EDUCATION FOR THE INPATIENT HOSPITAL POPULATION, WITH IMPLICATIONS FOR PROGRAM PLANNING AND STAFF DEVELOPMENT By Rosemary S. Caffareiia A DISSERTATION Submitted to Michigan State University in partial fuifiiiment of the requirements for the degree of DOCTOR OF PHILOSOPHY Department of Administration and Higher Education 1978 ABSTRACT OPINIONS OF HEALTH CARE PROFESSIONALS CONCERNING PATIENT EDUCATION FOR THE INPATIENT HOSPITAL POPULATION, NITH IMPLICATIONS FOR PROGRAM PLANNING AND STAFF DEVELOPMENT By Rosemary S. Caffarella The purpose of this study was to investigate how health care professionals in Maine community hospitals viewed patient edu— cation for hospital inpatients. Twenty-two, approximately one-half, of Maine's community hospitals were selected as a stratified random sample. Equal proportions had and did not have Operating formal patient education programs. All physicians, allied health profes- sionals, and administrators, and one-third of the nurses, from these i hospitals and patient education staff from all of Maine's community hospitals were surveyed by mailed questionnaires. The data generated from the survey were presented in several ways. First a display of the data Showed how all professionals, collectively and by sub-groups, responded in each question area. The data were then analyzed using Chi—square tests of independence to ascertain relationships among judgments of professional sub— groups. Finally, the data were analyzed, again using Chi-square tests of independence, to ascertain how responses varied in relation to four factors (size of hospital, whether the hospital had a formal Rosemary S. Caffarella patient education program, respondents' experience with formal patient education programs, and respondents' training in patient education). Major conclusions of the Study were that health care profes- sionals in community hospitals agree that: 1. Patient education is an important component of patient care; 2. Adequate patient education requires a hospital to develop a program which is comprehensive in that it: a. includes both formal and informal elements intentionally developed and integrated, b. incorporates Significant contributions from each profes- sional group, and C. provides basic educational services for all patients and additional services appropriate to health-related problems of categories of patients, e.g., diabetes or cardiac illness; 3. At least eight general areas of content are important to include in patient education programs: a. b. f. g. explanation of diagnosis and treatment, teaching patients to administer their own treatment, teaching patients self-care independent living Skills, teaching short- and long-term life style adjustments, teaching about appropriate community resources, teaching about general preventive medicine, teaching about financial management of the health problem, and h. orientation to hospital facilities and services; Rosemary S. Caffarella 4. Patient education is a complex process which requires a sysfimmtic effort within the professional health care community in each hospital; 5. Various staff units within the hospital should be represented in planning and execution of patient education activities. Physi— cfians, nurses, and allied health professionals should make the great- estcmntribution, especially in the Operation of patient education activities. 6. Provision should be made for instruction related to at least twelve health problem areas: a. diabetes, b. cardiac-related illness, c. cancer, d. hypertension, e. alcoholism and drug abuse, f. pre- and post-natal care, 9. stroke, h. ostomy care, i. pulmonary disease, j. pre- and post-operative care, k. personal health habits, and l. mental health problems; 7. Patient education staff should facilitate and coordinate the Planning and execution of patient education activities; 8. The involvement of patients and families in planning and conducting patient education Should depend on the health problem; Rosemary S. Caffarella 9. A variety of people and agencies should be involved in the evaluation of patient education; l0. Hospitals and community agencies should work together a)provide educational services for discharged patients; ll. It is feasible to develop or expand organized patient education programs within community hospitals; l2. While there are no insurmountable factors preventing development or expansion, the lack of staff time or Special personnel to coordinate patient education activities are the principal inhibit- ing factors; l3. Health care professionals in community hospitals who have been associated with formal patient education programs, i.e., have training or experience, have more positive reactions to patient education than those not previously associated with it; l4. Because of differential definitions of role by profes- sional groups, special care will be required to diminish intergroup and intragroup conflict on implementing patient education; and TS. The development of an adequate and effective patient education program is essentially a community development enterprise. To my husband, Edward, I dedicate this study. For all of his patience, proofreading, editing, and above all his love and support during my doctoral study. ACKNOWLEDGMENTS I would like to express my appreciation to the following individuals and organizations for their assistance and encourage- ment in the completion of my dissertation. To Professor Russell Kleis I am indebted for the original conceptualization of the study. His long hours of work helped me to understand the importance of a well-designed research study. lfis continual expectation of excellence was a guiding light through— out both my course work and my research. He has been and will con— tinue to be my mentor in the field of continuing education. To Dr. Robert Price 1 am thankful for his guidance concern- ing the Specific topic of patient education and his knowledge of resources in this area. His suggestions for the methodology of the study were most helpful during the design phase. I especially appreciated his continuing guidance and review of the study after leaving Michigan State University to take a new position at the University of Arkansas. > To Dr. Sheldon Cherney and Professor Edmund Alchin I am thankful for exposing me to the areas respectively of international education and community development. Their insights and encourage- ment throughout my course work and execution of this study were helpful in balancing my doctoral program. iii To the Maine Health Education Resource Center for their sponsorship of the mail survey segment of the study and their spe- cific endorsement of the study. To two professional health associations in Maine for their specific endorsement of the study: Maine Medical Association Research and Education Trust of the Maine Hospital Association To the many individual professionals in Maine, both at the University of Maine at Orono and in the health field, who assisted mein working through some of the specific methodology for the study: Dr. Richard Chamberlain Wayne Persons Mrs. Lois Estes Dr. Louis Ploch Dr. Stanley Freeman Dr. John Rosser Dr. Kenneth Hayes Michael Skaling Douglas Kramer Ann Spencer Laurence Nanney To the Maine community hospitals and their professional staff who participated in the study: Blue Hill Memorial Hospital Penobscot Bay Medical Center Calais Regional Hospital Penobscot Valley Hospital Castine Community Hospital Plummer Memorial Hospital Community General Hospital Regional Memorial Hospital Henrietta A. Goodall Hospital Rumford Community Hospital Houlton Regional Hospital St. Andrews Hospital James A. Taylor Memorial Hospital St. Joseph Hospital Maine Medical Center Stephens Memorial Hospital Miles Memorial Hospital Van Buren Community Hospital Mount Desert Hospital Westbrook Community Hospital Northern Maine Medical Center York Hospital To my secretary, Edith Thibault, for all of her support services. To my mom and dad, Mr. and Mrs. R. W. Shelly, from whom came a large part of the inspiration and motivation to undertake a research study in patient education. TABLE OF CONTENTS LIST OF TABLES . . . . .................... LIST OF FIGURES ........................ Chapter I. INTRODUCTION ..................... Purpose of Study .................. Significance of Study . ............... Procurement and Analysis of Responses ........ Limitations of Study ................ Definition of Terms ................. Summary of Chapter I and Overview of Succeeding Chapters ................ II. REVIEW OF LITERATURE ................. Patient Education Defined .............. Informal Patient Education Activities ........ Formal Patient Education Programs .......... Importance of Patient Education ........... Process Model of Formal Patient Education Programs . Identification of Needs ...... . ........ Establishment of Educational Objectives ...... Selection of Educational Methods and Personnel . Implementation . ................. Evaluation . ................... Settings for Patient Education . ........... Hospital-Based Patient Education ......... Community Activities ............... Out-Patient Activities .......... . . . . Inpatient Activities ............... Linkages Between Hospital—Based Programs ..... Content of Patient Education ActTVTtTeS for Inpatients . . . ...... _.. ...... .. . . . Orientation to Hospital Facilities and SerVIces . . Explanation of the Diagnosis oftheliealthProblem . Explanation of the Treatment for the Health Problem ..................... vi Page XV _l oooowpw _ _ Chapter Teaching of the Medical Management of the Health Problem . ................ Assisting Patients to Learn or Relearn Self-Care, Independent Living Skills ............ Teaching Patients and Their Families About Short- and Long-Term Life Style Changes Due to the Health Problem .............. Educating Patients and Their Families About Appropriate Community Resources ......... Teaching About the Financial Management of the Health Problem ................. Teaching of General Preventive Activities ..... Roles of Professional Staff, Patients, and Families of Patients in Hospital-Based Inpatient Education Programs ..................... Physician's Roles ................. Nurse's Roles ................... Allied Health Professional's Role ......... HOSpital Administrator's Role ........... Patient's Role .................. Family Members' Roles . . . . . . . . . . . . . . . Constraints to the Devel0pment and Implementation of Patient Education Activities .......... Need for Further Study ............... Task Assumed in This Study ............. III. METHODOLOGY ...................... Objectives of the Study ............... Endorsements for the Study ............. Pre-Survey ..................... Sample ....................... Instrument ..................... Administration of Instrument ............ Display and Analysis of Data ............ IV. RESULTS OF THE STUDY ................. Respondents ........ .. . . . . . ....... Rating of Importance of Patient Education and Selected Content Areas ... . . . . . ....... General Importance of Patient Education ...... Importance of Selected Content Areas ....... Roles Deemed Appropriate for Health Care Profes- sionals, Patients, and Families of Patients in the Planning and Conducting of Patient Education Activities .......... .. . . . . . . . . . Role Deemed Appropriate for Patient Education Staff ...................... vii Page 42 42 Chapter Roles Deemed Appropriate for Physicians ...... Roles Deemed Appropriate for Nurses Roles Deemed Appropriate for Allied Health Professionals .................. Roles Deemed Appropriate for Hospital Administrators ................. Roles Deemed Appropriate Former Patients Roles Deemed Appropriate Families of Present and Former Patients Ascribed Responsibility for Evaluation of Patient Education Activities Judgments About Organization of Patient Education Activities .................... Types of Patient Education Activities ....... Categories of Health Problems Which Professionals Would Choose First for Developing Organized Patient Education Programs for Hospital Inpatients Ascribed Responsibility of Hospital and Community Agencies for Discharged Patients Who Need Further Educational Services Factors Believed to Impede or Prevent the Development and Implementation of Patient Education Activities for Hospital Inpatients Coordination of Organized Patient Education Programs Summary ........... _ Judgments as to Feasibility of Developing or Expanding Organized Patient Education Programs OOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOO 00000000000 V. SUMMARY, CONCLUSIONS, AND IMPLICATIONS ........ Summary of Purpose and Procedures of Study Review of Findings ......... Conclusions ....... Implications for Practice Implications for Research Reflections on the Study 000000 00000000000000 00000000000000 APPENDICES O O OOOOOOOOOOOO A. PRE-SURVEY FORM AND LETTER B. SUMMARY OF PRE-SURVEY RESULTS AND FOLLOW-UP LETTERS . . PLING C. LETTERS TO HOSPITAL ADMINISTRATORS REQUESTING SAM LIST. THANK—YOU LETTER TO HOSPITAL ADMINISTRATORS FOR LISTS, AND LIST OF PARTICIPATING HOSPITALS viii Page 124 144 166 184 193 197 199 202 203 205 208 208 213 215 216 229 229 231 237 242 245 248 251 258 268 Chapter D. COVER LETTERS AND SURVEY INSTRUMENT .......... E. FOLLOW—UP POSTCARDS AND FOLLOW—UP LETTERS ....... F. PEOPLE CONSULTED 0N DEVELOPMENT OF SURVEY INSTRUMENTS . PERCENTAGE OF RESPONDENTS BY PROFESSIONAL SUB-GROUP WHO INDICATED THAT SPECIFIED CONTENT AREAS ARE IMPORTANT FOR INCLUSION IN HOSPITAL PATIENT EDUCATION PROGRAMS FOR INPATIENTS .......... BIBLIOGRAPHY ......................... Page 272 283 290 291 Table l. LIST OF TABLES Number of Professional Personnel in Maine Community Hospitals by Professional Category and Size of Hospital as of March 1977 . . ............ Distribution of Patient Education Programs in Maine Community Hospitals by Size of Hospital and Stage of Development as of March l977 ........... Number of Hospitals in the Population, in the Survey Group, and From Which Responses Were Received by Hospital Size and Whether the Hospital Had a Formal Patient Education Program . ............. Number of Professional Workers Included in the Survey by Professional Group, Size of Hospital and Whether or Not the Hospital Had a Formal Patient Education Program ........................ Questionnaires Mailed and Returned by Number and Percentage ...................... Numbers and Percentages of Persons in Professional Sub-Groups in Maine Community Hospitals and the Percentages of All Professional Workers, Questionnaire Recipients, and Questionnaire Respondents Represented by Each ........................ Percentages of Professionals and of Respondents Who Practiced in Hospitals With and Without Formal Patient Education Programs by Hospital Size ...... Percentage of Each Professional Sub—Group Involved and Levels of Their Involvement in Formal and Informal Patient Education Activities for Hospital Inpatients Percentage of Respondents by Professional Sub-Groups Who Had Previously Attended Programs or Classes on or Related to Patient Education ............ Page 71 72 74 76 85 88 9O 91 93 Table Page Percentage of Respondents by Professional Sub-Groups and Total Respondent Group Who Accorded Selected Levels of Importance to Patient Education for Hospital Inpatients .................. 95 Percentage of Total Respondent Group Who Indicated That Specific Content Areas Are Important for Inclusion in Hospital Patient Education Programs for Inpatients . . . . . ............ . . 98 Percentage of Patient Education Staff Members Who Judged That Their Own Professional Role Should Include Primary Responsibility for Planning and Conducting Patient Education in Nine Selected Content Areas and Percentages of Four Other Professional Groups and of the Total Respondent Group Who Judged That Patient Education Staff Should Have Such Primary Responsibilities . .................. 109 Percentage of Patient Education Staff Members Who Judged That Their Own Professional Role Should Include Supportive Responsibility for Planning and Conducting Patient Education in Nine Selected Content Areas and Percentages of Four Other Professional Groups and of the Total Respondent Group Who Judged That Patient Education Staff Should Have Such Supportive Responsibilities .............. ll8 Percentage of Physicians Who Judged That Their Own Professional Role Should Include Primary Responsi— bility for Planning and Conducting Patient Education in Nine Selected Content Areas and Percentages of Four Other Professional Groups and the Total Respon— dent Group Who Judged That Physicians Should Have Such Primary Responsibilities ............. l25 Percentage of Physicians Who Judged That Their Own Professional Role Should Include Supportive Respon— sibility for Planning and Conducting Patient Educa~ tion in Nine Selected Content Areas and Percentages of Four Other Professional Groups and the Total Respondent Group Who Judged That Physicians Should Have Such Secondary Responsibilities ......... I35 xi Page l6. Percentage of Nurses Who Judged That Their Profes~ sional Role Should Include Primary Responsibility for Planning and Conducting Patient Education in Nine Selected Content Areas and Percentages of Four Other Professional Groups and the Total Respon- dent Group Who Judged That Nurses Should Have Such Primary Responsibilities . . ........... 145 17. Percentage of Nurses Who Judged That Their Profes- sional Role Should Include Supportive Responsibility for Planning and Conducting Patient Education in Nine Selected Content Areas and Percentages of Four Other Professional Groups and the Total Respondent Group Who Judged That Nurses Should Have Such Supportive Responsibilities .............. 157 18. Percentage of Allied Health Professionals Who Judged That Their Professional Role Should Include Primary Responsibility for Planning and Conducting Patient Education in Nine Selected Content Areas and Percen— tages of Four Other Professional Groups and the Total Respondent Group Who Judged That Allied Health Pro— fessionals Should Have Such Primary Responsibilities . T67 l9. Percentage of Allied Health Professionals Who Judged That Their Professional Role Should Include Suppor- tive Responsibility for Planning and Conducting Patient Education in Nine Selected Content Areas and Percentages of Four Other Professional Groups and the Total Respondent Group Who Judged That Allied Health Professionals Should Have Such Supportive Responsibilities ................... l74 20. Percentage of Hospital Administrators Who Judged That Their Professional Role Should Include Primary Responsibility for Planning and Conducting Patient Education in Nine Selected Content Areas and Percen— tages of Four Other Professional Groups and the Total Respondent Group Who Judged That Hospital Admin- istrators Should Have Such Primary Responsibilities . . I86 2l. Percentage of Hospital Administrators Who Judged That Their Professional Role Should Include Supportive Responsibility for Planning and Conducting Patient Education in Nine Selected Content Areas and Percen- tages of Four Other Professional Groups and the Total Respondent Group Who Judged That Hospital Administra- tors Should Have Such Supportive Responsibilities . . . l89 xii Table 22. 23. 25. 26. 27. 28. 29. Page Percentage of Respondents by Professional Group and for the Total Respondent Group Who Believed that Former Patients Should Have a Role in the Planning and Con- ducting of Patient Education Activities ........ 195 Percentage of Respondents by Professional Group and for the Total Respondent Group Who Believed Families of Present and Former Patients Should have a Role in Planning and Conducting of Patient Education Activities ...................... 197 Percentage of Respondentsby'Professional Groupand forthe Total Respondent Group Who Indicated That Specific Groups or Agencies Should Have a Role in Evaluating Patient Education Programs for Hospital Inpatients . . 200 Percentage of Respondents by Professional Group and for the Total Respondent Group Who Judged That Patient Education Activities Should Be Principally Formal, Principally Informal, or an Intentional Combination of Formal and Informal Activities ........... 204 Percentage of Respondents by Professional Group and for the Total Respondent Group Who Indicated Selected Health Problem Areas as Ones Which They Would Choose First for Developing Organized Patient Education Programs . . . . . ................. 206 Percentage of Respondents by Professional Group and for the Total Respondent Group Who Identified Principal Responsibility for Educational Services to Discharged Patients With Hospitals and With Other Community Agencies ....................... 209 Percentage of Respondents by Professional Group and for the Total Respondent Group Who Believed the Develop- ment and Implementation of Patient Education Activi— ties for Hospital Inpatients Were Impeded or Prevented by Designated Factors ............ 210 Percentage of Respondents by Professional Group and for the Total Respondent Group Who Judged That Organized Patient Education Programs Could Best Be Coordinated in Designated Departments of Hospitals ........ 214 xiii Table 30. B1. GI. G2. G3. G4. 65. Percentage of Respondents by Professional Group and for the Total Respondent Group Who Indicated the Feasibility of Developing or Expanding Organized Patient Education Programs in Their Hospitals ..... Number of Beds, Number of Staff Members in Each Pro— fessional Sub—Group, and Presence of Formal Patient Education Programs in Maine Community Hospitals by Hospital Name and Capacity Category . . ...... Percentage of the Physicians Who Indicated That Specified Content Areas Are Important for Inclusion in Hospital Patient Education Programs for Inpatients . Percentage of the Nurses Who Indicated That Specified Content Areas Are Important for Inclusion in Hospital Patient Education Programs for Inpatients Percentage of the Allied Health Professionals Who Indicated That Specified Content Areas are Important for Inclusion in Hospital Patient Education Programs for Inpatients . . . . Percentage of the Patient Education Staff Who Indi- cated That Specified Content Areas Are Important for Inclusion in Hospital Patient Education Programs for Inpatients . . . . . Percentage of the Hospital Administrators Who Indicated That Specified Content Areas Are Important for Inclu- sion in Hospital Patient Education Programs for Inpatients . . . . ...... uuuuuuuu cccccccccccccc Page 217 263 291 292 293 LIST OF FIGURES Figure 1. Percentage of Nurses and Allied Health Professionals Who Had and Who Had Not Had Special Training in Patient Education Who Rated Selected Content Areas as Extremely Important ............. 2. Percentage of the Total Respondent Group Who Had and Did Not Have Experience With Formal Patient Educa- tion Programs Who Rated Selected Content Areas as Extremely Important . . .............. 3. Percentage of Physicians, Nurses, and Allied Health Professionals Who Had and Did Not Have Experience With Formal Patient Education Programs Who Rated Selected Content Areas as Extremely Important ..... 4. Mean Percentage of Nurses by Hospital Size Who Judged That Patient Education Staff Should Have Primary Responsibility for Planning Patient Education Activities in Selected Content Areas ......... 5. Percentage of Total Respondent Group Who Had or Did Not Have Experience With Formal Patient Education Programs Who Judged That the Patient Education Staff Should Have Primary Responsibility for Planning Patient Education Activities in Selected Content Areas . . ..... . . . . . . ........... 6. Percentage of Nurses by Hospital Size Who Judged That Patient Education Staff Should Have Supportive Responsibility for Planning and Conducting Patient Education Activities in Selected Content Areas 7. Percentage of Nurses Who Had and Had Not Previously Attended Programs on or Related to Patient Education That Judged Patient Education Staff Should Have Supportive Responsibility for Planning or Conducting Patient Education Activities in Selected Content Areas . . . . . . . . . . . . . ............ XV Page 102 104 106 115 117 122 123 1 E. Figure Page 8. Percentage of Total Respondent Group With and Without Experience in Formal Patient Education Programs Who Judged That Physicians Should Have Primary Respon— sibility for Planning of Patient Education Activi— ties in Selected Content Areas . . . . . . . . . . . . 130 9. Percentage of Physicians With and Without Experience in Formal Patient Education Programs Who Judged That Their Own Role Should Include Primary Respon- sibility for Both Planning and Conducting of Patient Education Activities in Selected Content Areas . . . . 132 10. Percentage of Physicians Who Had and Who Had Not Attended Programs on or Related to Patient Education Who Judged That Their Own Role Should Include Primary Responsibility for Patient Education Activities in Selected Content Areas ................ 133 11. Percentage Of Total Respondent Group With and Without Experience in Formal Patient Education Programs Who Judged That Physicians Should Have Supportive Respon- sibility for Planning and Conducting Patient Educa— tion Activities in Selected Content Areas ....... 138 12. Percentage of Physicians With and Without Experience in Formal Patient Education Programs Who Judged That Their Role Should Include Supportive Responsibility for Conducting Patient Education Activities in Selected Content Areas ................ 139 13. Percentage of Nurses With and Without Experience in Formal Patient Education Programs Who Judged That Physicians Should Have Supportive Responsibility for Planning and Conducting Patient Education Activities in Selected Content Areas ............... 140 14. Percentage of Total Respondent Group Who Had and Had Not Attended Programs on or Related to Patient Education Who Judged That the Physician's Role Should Include Supportive Responsibility for Con— ducting Patient Education Activities in Selected Content Areas . . . ................. 142 15. Percentage of Total Respondent Group With and Without Experience in Formal Patient Education Programs Who Judged That Nurses Should Have Supportive Responsi- bility for Planning and Conducting Patient Education Activities in Selected Content Areas ......... 151 xvi l 1 Figure 16. Percentage of Nurses With and Without Experience in Formal Patient Education Programs Who Judged That Their Role Should Include Primary Responsibility for Planning and Conducting Patient Education Activities in Selected Content Areas . Percentage of Physicians With and Without Experience in Patient Education Programs Who Judged That Nurses Should Have Primary Responsibility for Planning Patient Education Activities in Selected Content Areas . . . . . . . . . . . . . . ........... Percentage of Allied Health Professionals With and Without Experience in Patient Education Programs Who Judged That Nurses Should Have Primary Responsi— bility for Planning and Conducting Patient Education Activities in Selected Content Areas ..... . Percentage of Nurses Who Worked in Hospitals With and Without Formal Patient Education Programs Who Judged That Their Role Should Include Responsibility for the Planning and Conducting of Patient Education Activities in Selected Content Areas ......... Percentage of Nurses With Experience and Without Experience in Patient Education Programs Who Judged That Their Role Should Include Supportive Responsi— bility for Planning and Conducting Patient Education Activities in Selected Content Areas ......... Percentage of Physicians With and Without Experience With Formal Patient Education Programs Who Judged That Nurses Should Have Supportive Responsibility for Planning of Selected Content Areas ........ Percentage of Allied Health Professionals With and Without Experience Who Judged That Nurses Should Have Supportive Responsibility for Planning and Conducting Patient Education Activities in Selected Content Areas . . . . . . . . . . . . . . . . Percentage of Allied Health Professionals Who Worked in Hospitals With and Without Patient Education Programs Who Judged That Their Professional Role Should Include the Responsibility for Planning and Conducting Patient Education Activities in Selected Content Areas . . . . . . . . . . . . . . . . xvii Page 153 154 155 161 162 164 165 172 Figure Page 24. Percentage of Allied Health Professionals Who Worked in Hospitals With and Without Patient Education Programs Who Judged That Allied Health Professionals Should Have Supportive Responsibility for Conducting Patient Education Activities in Selected Content Areas 25. Percentage of Total Respondent Group With and Without Experience in Formal Patient Education Programs Who Judged That Allied Health Professionals Should Have Supportive Responsibility for Planning and Conduct- ing Patient Education Activities in Selected Content Areas . . . . . . . . . . . . . . . . . ...... . . 180 26. Percentage of Allied Health Professionals With and Without Experience in Formal Patient Education Who Judged That Their Role Should Include a Suppor- tive Responsibility for the Planning and Conducting of Patient Education Activities in Selected Content Areas . . . . . . . . . . . . . . . 181 uuuuuuuu 27. Percentage of Nurses With and Without Experience in Formal Patient Education Programs Who Judged That Allied Health Professionals Should Have Supportive Responsibility for the Planning and Conducting of Patient Education Activities in Selected Content Areas . . . . . . . . . . . . . . . . . . . 182 28. Percentage of the Total Respondent Group With and Without Experience in Formal Patient Education Programs Who Judged That Hospital Administrators Should Have Supportive Responsibility for Planning and Conducting of Patient Education Activities in Selected Content Areas . . . . . . . . . . . ..... 192 29. Percentage of Allied Health Professionals With and Without Experience in Formal Patient Education Programs Who Judged That Hospital Administrators Should Have Supportive Responsibility for Planning and Conducting of Patient Education Activities in Selected Content Areas . . . . . . . . . . . . . . ; . 194 30. Percentage of Total Respondents by Hospital Size Who Believed It Was Feasible to Develop or Expand Formal Patient Education Programs . . . . . . . . . 220 31. Percentage of Nurses by Hospital Size Who Believed It Was Feasible to Develop or Expand Formal Patient Education Programs . . . . . . . . ..... . 221 xviii Figure 32. 33. 34. 35. 36. Percentage of Allied Health Professionals by Hospital Size Who Believed It Was Feasible to Develop or Expand Formal Patient Education Programs ....... 222 Percentage of Allied Health Professionals Who Worked in Hospitals With and Without Formal Patient Edu- cation Programs Who Judged That It Was Feasible to DevelOp or Expand Formal Patient Education Programs ....................... 223 Percentage of Total Respondent Group With and Without Experience in Formal Patient Education Programs Who Indicated That It Was Feasible to DeveIOp Formal Patient Education Programs in Their Hospitals ..... 225 Percentage of Total Respondent Group Who Had and Had Not Previously Attended Programs on or Related to Patient Education Who Indicated That It Was Feasible to DeveTOp Formal Patient Education Programs in Their Hospitals .................... 226 Percentage of Physicians With and of Those Without Experience in Formal Patient Education Who Indicated That It Was Feasible to Develop Formal Patient Educa— tion Programs in Their Hospitals ........... 227 xix CHAPTER I INTRODUCTION This study was an investigation of the opinions of health care professionals who work in hospital settings toward the topic of inpatient education. The topic of patient education was sub— divided into several questions concerning the various aspects of the subject. The responses to the questions were analyzed within and between the types of professionals, programs, and hospital settings. Patient education is the educational component of patient care. It encompasses education about Specific health problems and ways to prevent or manage the problems. Patient education on an informal basis has long been a part of medical care. Prior to the development of sophisticated medical care treatment and facilities, one of the physicians' prime tasks was to teach patients and family members to care for their own illnesses. The responsibility for one's health was primarily the individual's. With the development of specialized medicine and institutions of health care, the responsibility for health tended to move from the patient and the family to the physician.1 In this shift patient education 197 ) 1Ivan Illich, Medical Nemesis (New York: Pantheon Books, 6 . 4—» “I g mflfivities have become somewhat fragmented and in some cases a lost component of patient care. During the last twenty to twenty-five years, however, Intient education as a formal part of patient care has become a nejor concern of professional health care personnel. This rise in interest has been caused by several reasons including the cost of nedical care, the consumer advocate movement, the increasing rate (H chronic illness, and the need to dispel the myth that all i11- IKSSES can be completely cured or at times even treated.1 This thrust in patient education activities has been towards the development Of organized, formal patient education pro- spams, and away from the informal activities characterized by the 'pld doctor-patient relationship.“ This movement has been espe- cially strong in hospitals.2 The development of formal patient education programs has raised many questions as to what should be the content of these Inograms, how and by whom they should be taught, and who should be served by them. This study sought, from one important perspec— tive, to provide answers to these and closely related questions on patient education programs for hospital inpatients. 1Robert E. Canfield, "The Physician as a Teacher of Patients," Journal of Medical Education 48 (December 1973): 80. 2American Hospital Association, Health Education in the Hospital (Chicago: American Hospital Association, 1964); American Hospital Association, "Overview of AHA Patient Education Project Results," Chicago, 1976. (Mimeographed); American Hospital Asso- ciation, Strategies in Patient Education (Chicago: American Hos- pital Association, 1969). Purpose of Study The purpose of this study was to learn the opinions of professionals collectively and by professional Specialty groups in community hospitals in one state concerning patient education for the inpatient hospital population. The professionals included in this study were physicians, nurses, administrators, allied health professionals, and patient education staff who worked in Maine community hospitals. Answers were sought for the following questions: 1. Do these professionals judge patient education activities to be important for adequate hospital care? 2. How do these professionals define the scope of patient education for the inpatient hospital population? 3. What content areas, as judged by these professionals, should be included in hospital inpatient education programs? 4. How do these professiOnalS define their own roles and the roles of other professionals in the planning, implementation, and evaluation of patient education activities? 5. How do these professionals define the roles of former patients and families of present and former patients in the planning, implementation, and evaluation of patient education activities? 6. What role do these professionals identify for the hospital in the follow—up of discharged patients who need further educational services? 7. What constraints do these professionals see in both the development and implementation of patient educa- tion activities? 8. Which major illness categories do these professionals believe present the greatest need for patient education activities? 9. What hospital department can best coordinate organized hospital patient education programs? 10. Do these professionals believe it iS feasible to develop or expand formal patient education programs? Significance of Study There is a need for a synthesized and comprehensive data base on hospital inpatient education programs. Some literature describing how professionals in hospital settings view patient education has existed previously. However, this material is largely unorganized and seriously limited in scope. Most previous studies have examined patient education from the perspective of one profession or another, and they are reported principally in health education, nursing, and hospital literature. There has been an especially serious lack of material on patient education for hospital inpatients from physicians and allied health professionals. Many of the earlier studies have addressed patient educa- tion in general and have not been specifically related to patient education for the inpatient hospital population. In addition, most of the material written in this area has spoken only to the impor- tance of patient education and not to the issues of program planning and Operation. In conducting this study an attempt has been made both in the review of literature and through the inquiry itself to synthe- size several facets of patient education. AS a contribution to the body of patient education literature, it provides a different way of looking at patient education for the inpatient hospital popula- tion, that of a composite description from the perSpectiveS of all health care professionals involved in the situations studied. Having a composite description of how professionals view patient education can aid in the planning and implementation of patient education programs. Though formal patient education pro— ] the programs for the most grams are developing at a rapid rate, part are aimed only at specific types of illnessesz and not at overall general inpatient hospital populations.3 In dealing with 1American Hospital Association, Patient Education Project. 2Ibid.; Jeanette Simmons, "An Overview of Patient Education," in Patient Education Workshop: Summary Repprt (Atlanta: U.S. Depart- mentiifHealth,Education, and Welfare, Public Health Service, Center for Disease Control, 1976), p. 20. 3Donnell Etzwiler, "The Contract for Health Care (edito- rial)," Journal of American Medical Association 224 (May 14, 1973): 1034; Barbara Redman, The Process of Patient Teaching in Nursing (St. Louis: The C. V. Mosby Company, 1976), p. 18; Michael Skéling, the introduction of a new idea or innovation (general patient edu- cation programs) within an organization, it is important to know the opinions of those who will be carrying through the innovation or will need to change their practices because of the innovation.1 Both the literature and a review of operating programs demonstrate that it is mostly traditional hospital personnel, especially those with nursing backgrounds, who are administering and executing programs.2 The study provides important knowledge of the opinions that traditional hOSpital personnel (especially physicians and nurses) have of patient education for hospital inpatients. The study also provides a data base for conducting contin— uing education programs for patient education personnel. The edu- cational needs of the participants must be considered when designing continuing education programs for professional groups.3 The opin- ions revealed and analyzed in this study constitute a first-level interview held at Project RISE, Waterville, Maine, 3 February 1977; Joan M. Wolle, "Multidisciplinary Teams Develop Programming for Patient Education," Health Services Repprts 89 (January-February 1974 : 8-12. 1American Hospital Association, Strategies in Patient Edu- cation, pp. 28-29; Cyril O. Houle, The Design of Education (San Francisco: Jossey-Bass, 1972), p. 19; Arthur Nichoff, A Casebook of Social Change (Chicago: Aldine Publishing Company, 19661, p. l; Everett Rogers and Floyd Shoemaker, Communication of Innova- tions (New York: The Free Press, 1971), p. 239. 2American Hospital Association, Patient Education Project; Simmons, "Overview of Patient Education,” pp. 21-22 3Houle, pp. 32-34; J. R. Kidd, How Adults Learn (New York: Association Press, 1973), pp. 30-52; Malcolm Knowles, The Modern Practice of Adult Education (New York: Association Press, 19701, p. 23. needs assessment for the various professional groups involved in patient education in community hospitals in Maine. Further, the study provides a model that can be used by other hospitals or groups of hospitals to assess staff opinions of patient education. That way hospitals can generate their own data for Specific program planning and staff development programs. Procurement and Analysis of Rgpponses Mail questionnaires were used to gather data for answering the questions posed by this study. The questions were deve10ped based on information obtained from reviewed literature, outlines of operating programs, and interviews with people actively involved in patient education. The data generated from the survey are presented and analyzed in several ways. First, a display of the data shows how all professionals, collectively and by sub—groups, responded to each question area. The data are then analyzed to ascertain the relationships between the judgments of the professional sub—groups on each of the issues in question. Finally, the data are analyzed to ascertain how responses varied in relationship to four additional variable factors. These were: (1) size of hospital, (2) whether or not the hospital had an operating formal patient education program, (3) the professionals‘ experience with formal patient education, and (4) the professionals' training in or related to patient education. These analyses are done with three of the five professional groups, with and without regard to professional classi- fication. Limitations of Study The study had two principal limitations: 1. The population studied included only those profes— sionals who practice in community hospitals in Maine. Personnel from veteran's hospitals, mental hospitals, and other specialized hospitals or hospitals in other places were not included. 2. Community hospitals in the bed Size category of over 200 beds were under-represented. Only one of the five hospitals 1 in this category was included Since hospital personnel policies made a it impossible to obtain sampling lists from the other hospitals chosen for inclusion in the study. Definition of Terms For the purpose of this study the following definitions were used. Patient Education Patient education is a process whereby patients and in some cases their families: (1) receive information about Specific health problems, (2) learn the necessary competencies to deal with the health problems, and (3) develop accepting attitudes toward the health problems and resulting changes in life style. Patient edu- cation includes both formal and informal educational activities. Formal Patient Education Formal patient education is an organized process with writ- ten goals and objectives. Specially assigned staff members or volunteers execute formal patient education activities. Informal Patient Education Informal patient education consists of educational activi- ties that are not separately planned and organized, but usually happen on an intuitive, episodic, and random basis. These types of activities are usually not identified as "patient education,” but rather are considered as a routine part of health care. Community Hospitals Community hospitals include all Short-term general hospitals whose facilities and services are available to the general public. Excluded are Veteran's Administration hospitals and hospital units of prisons, asylums, and Similar institutions. Short-Term Hospital A Short-term hospital is one in which the average length of stay must be less than thirty days or in which more than 50 percent of all patients are admitted to units where the average length of stay is less than thirty days.1 M 1American Hospital Association, Hospital Statistics, 1976 Edition (Chicago: American Hospital Association, 1976), p. xvii. Professional Hospital Staff Professional hospital staff consists of all hospital per— sonnel with Specialized training in the health field. For the purpose of this study the term professionals refers only to the following groups within the hospital professional staff. Physicians: Physicians (both medical doctors and doctors of osteopathy) who have active staff privileges and/or are employed by community hospitals. Nursing Staff: Registered nurses and licensed practical nurses who are employed at least twenty hours a week in community hospitals. Hospital Administrators: Administrators who are employed by community hospitals as their chief executive officers. Allied Health Professionals: Physical therapists, occu- pational therapists, pharmacists, dietitians, social workers, and speech therapists who are employed either full— or part-time by community hospitals. Patient Education Staff: Staff of community hospitals who are employed either full— or part-time as either coordi— nators (directors) of patient education programs or patient teachers. Summary of Chapter I and Overview of Succeeding Chapters Chapter one provides a basic overview of the entire study. It opens with a brief description of the historical background of 'I' 11 patient education and a general introduction to the study. Next a description is given of the purpose and Significance of the study. This is followed by a section on the procurement and analysis of the responses and the limitations of the study. Finally, the chap- ter provides definitions for the major terms used in the study. Chapter twois a comprehensive review of the literature on patient education. It provides general background information on patient education, information on hospital-based patient education activities, and data that comprise the basis for the specific research objectives. Chapter three describes the objectives, the methodology, and the analytical procedures for the study. Chapterfourprovidesaadescription of the respondents and the major findings of the study. The findings include the opinions of both the total respondent group and each professional group on issues relating to basic concepts, organization, development, and imple— mentation of patient education for hospital inpatients. Chapterfive provides an overall summary, the conclusions, the implications for practice, the implications for research, and a concluding statement. ‘WM CHAPTER II REVIEW OF LITERATURE The review of literature is in the form of a bibliographic essay. It attempts to provide a broad overview of patient educa- tion. Its purpose is three—fold. The first is to provide general background information on patient education. The second is to present material on hospital-based patient education activities. The third is to provide the rationale for the research objectives identified in Chapter Three. The review iS divided into sections as follows: 1. #00 Definition of patient education Informal and formal patient education activities Importance of patient education Process model of formal patient education programs Settings for patient education Hospital-based patient education programs Content of hospital patient education Roles of professionals, patients, and families of patients in hospital patient education I Constraints to the development and implementation of patient education activities in the hospital Need for further study 13 ll. Task assumed in the present study 12. Relating the review to the present study Patient Education Defined Patient education is a process whereby patients and in some cases their families: (1) receive information about Specific health problems, (2) learn the necessary competencies to deal with the health problems, and (3) develop accepting attitudes toward the health problems and resulting changes in life styles. Patient education includes both formal and informal educational activities. Formal patient education is an organized process with written goals and objectives. Specially assigned staff members or volunteers execute formal patient education activities. Informal patient education iS not separately planned and organized and is generally executed as an incidental part of normal hospital routine. Informal Patient Education Activities The informal patient education activities are the most prevalent form of educational activities performed by professionals in the health care field. One example of this is a nurse teaching a stroke patient with a disabled arm to dress himself; a second example is a physician answering a mother's questions about how to care for her sick child. These types of activities are usually not identified as ”patient education,“ but rather are considered as a routine part of health care. Informal patient education activities are not separately planned and organized, but usually l4 happen on an intuitive, episodic, and random basis,1 depending upon factors such as the health care provider's style of practice and the patient's inquisitiveness. Descriptions of informal patient education activities are not widespread in the literature. In most cases patient education is defined only as specially organized or planned educational pro— grams.2 Though informal patient teaching is less orderly and cannot be easily documented, it is an important component of the total patient education process3 for as Redman asks, ". . . what difference does it make to the patient if learning was or wasn't intended?"4 Formal Patient Education Programs Formal patient education is characterized by terms such as planned, organized, and structured. It is a relatively recent 1Maryann Fralic, "Developing a Viable Inpatient Education Program: A Nursing Director's Perspective," Journal of Nursing Administration 6 (September 1976): 31. 2American Group Practice Association, ”Statement on Patient Education" (Alexandria: American Group Practice Association, November 1974) (Mimeographed); Donald J. Breckon, ”Patient Educa- tion Programs for the Aged in Michigan Nursing Care Facilities” (Ph.D. dissertation, Michigan State University, 1977), p. 7; Simmons, "Overview of Patient Education," p. 19; Marguerita Vega, 'New Focus on the Hospital as a Health Education Center,” Hospitals 40 (July 16, 1966): 78-82. 3Lois A. Monteiro, ”Notes on Patient Teaching: A Neglected Area," Nursing Forum (1964): 26; Barbara Redman, “Guidelines for Quality of Care in Patient Education,” The Canadian Nurse 71 (February 1975): 20. 4Redman, ”Guidelines," p. 20. 15 innovation. A comprehensive overview of the historical background of formal patient education is included in two publications by Breckon.1 Early references to formal patient education appeared in the 1950's from the health education field2 and in a report pub— 3 The movement was also lished by the Veteran's Administration. supported during that time by pre-paid health care groups such as Kaiser-Permanente Medical Care Program4 and the Health Insurance Plan of Greater New York. Formal conferences, papers, research reports, and committees on patient education became more prevalent during the 1960's. The Health Education Division of the Society of Public Health held a seminar in 1962 at the University of California on Health Educa- tion in Medical Care: Needs and Opportunities. The American Hos- pital Association held two conferences, one in 1964 and one in 1969 on, respectively, The Role of the Hospital in Health Education 1Donald J. Breckon, "Highlights in the Evolution of Hospital- Based Patient Education Programs,” Journal of Allied Health 35 (Summer 1976): 35-39; Breckon, ”Programs for the Aged." 2John Burton, ”Doctor Means Teacher,” International Journal of Health Education 1 (January 1958): 4—12; Alice M. Johnson and Clifford S. Johnson, "Health Education in the Hospitals," Health Education Journal 10 (July 1952): 175—85. 3U.S. Department of Defense, Veteran's Administration, by George Beauchamp, "Patient Education and the Hospital Program," VA Technical Bulletin (Washington, D.C.: Veteran's Administration, April 27, 1953), pp. 10-88. 4Frances Collen, Blanche Maders, Krikor Soghikian, and Sidney Garfield, "Kaiser—Permanente Experiment in Ambulatory Care," American Journal of Nursipg 7 (July 1968): 1483-85. he 16 and Strategies in Patient Education. The Russell Sage Foundation commissioned the writing and publication Of a series of monographs entitled Newer Dimensions of Patient Care.1 The American Public Health Association appointed a committee on "Education Tasks in Chronic Illness."2 Even though there is a proliferation of literature, there is little evidence that through the 1960's there was much imple— mentation of formal patient education programs. Major programs reported most frequently in the literature include the programs of Kaiser-Permanente in California;3 the United Hospitals of Newark, New Jersey;4 the programs at Charles T. Miller Division of United Hospitals, St. Paul, Minnesota;5 and a Beverly, Massachusetts, Hospital program.6 1Esther Lucile Brown, Newer Dimensions of Patient Care (New York: Russell Sage Foundation, 1965). 2U.S. Department of Health, Education, and Welfare, Public Health Services, Health Resources Administration, A Model for Planning Patient Education (Washington, D.C.: Government Printing Office, 1972). 3 Collen, "Kaiser—Permanente." 4Vega. 5Marian Ulrich, "The Hospital as a Center for Health Edu- cation," Health Education Monographs 31 (San Francisco: Society for Public Health EducatTon, 1972): 99-108. 6Richard Alt, "Patient Education Program Answers Many Unanswered Questions," ospitals 40 (November 16, 1966): 76-78; Dorothy T. Linehan, “What Does the Patient Want to Know?" American gpurnal of Nursing 66 (May 1976): 69-71. 17 Many of the earlier programs did not sustain their momen— tum and closed. Others came close to closing several times.1 The reasons for these difficulties appear to have been lack of staff and lack of institutional commitment to the programs. The 1970's have demonstrated a very different picture of formal patient education programs, both hospital and non-hospital based. The programs are growing and developing at a very rapid rate. A survey conducted by the American Hospital Association in 1972 showed that approximately 15 percent of the community hos— pitals in the United States had formal patient education programs with another 6.5 percent in the process of planning such programs.2 A second survey conducted by the American Hospital Association in 1975 has shown a dramatic increase in community hospital patient education programs in the United States with just over 50 percent of the reporting hospitals having one or more formal patient edu— cation programs for their inpatients.3 Part of this rapid growth in patient education programs has come about following actions of the federal government and various professional associations in the health field. 1Jane S. Shaw, "New Hospital Commitment: Teaching Patients How to Live With Illness and Injury,” odern Hospital 121 (October 1973): 98; D. Etzwiler, M. Tyrell, M. Ulrich, J. Wrynt, and A. Hirsch, "Patient Education in Community Hospitals,” Minnesota Medicine 55 (December 1972): 36. 2"AHA Research Capsules: Patient Education Programs in Community Hospitals," ospitals 46 (December 1, 1972): 102. 3American Hospital Association, "Patient Education Project." 18 A number of official statements concerning the importance of patient education have been developed by a variety of health care associations. These include: the American Hospital Asso- ciation's "Patient's Bill of Rights”; the American Medical Asso— ciation's "Definition and Role of Planned Patient Education Pro- grams"; the American Nurses' Association's “The Professional Nurse and Health Education"; the American Society of Hospital Pharmacists' “Statement on Pharmacist-Conducted Patient Counseling”; the American Hospital Association's ”Statement on the Role and Responsibilities of Hospitals and Other Health Care Institutions in Personal and Community Health Education"; a position paper from the Society for Public Health Education on ”The Concept of Planned Hospital Based Patient Education Programs” prepared for the President's Committee on Health Education; and the Blue Cross Association's "White Paper: 1 Patient Health Education." All of these documents support the 1American Hospital Association, “A Patient's Bill of Rights" (Chicago: American Hospital Association, 1975); American Medical Association, ”Definition and Role of Planned Patient Education Pro- grams” (Chicago: American Medical Association's Department of Health Education, 1975); American Nurses' Association, "The Professional Nurse and Health Education” (Kansas City, Missouri: American Nurses' Association, 1975); American Society of Hospital Pharmacists, "State— ment on Pharmacist-Conducted Patient Counseling”(Washington, D.C.: American Society of Hospital Pharmacists, 1976); American Hospital Association, ”Statement on the Role and Responsibilities of Hos- pitals and Other Health Care Institutions in Personal and Community Health Education" (Chicago: American Hospital Association, 1974); Task Force on Patient Education for the President's Committee on Health Education, "The Concept for Planned Hospital Based Patient Education Programs," in Patient Education, pp. 1—11, Health Education Monographs, Vol. 2, No. 1 (San Francisco: Society for Public Health, Spring 1974); "Summary of Findings and Recommendations of the President's Committee on Health Education“ (Mimeographed), pp. 24-25; Ir 19 process of patient education as an integral and needed part of patient care. Patient education and health education in general has become a public policy question. In September of 1971 President Richard Nixon appointed a committee to study health education. Among the committee's recommendations were two addressing patient education and the professional health care providers of that edu— cation, namely that: l. . . . the nation's hospitals be strongly encouraged to offer health education programs to patients and families, both on an inpatient and outpatient basis; and 2. . . . skill in providing health education be an essen— tial part in the training and continuing education of all health care workers. A third recommendation of the committee was to establish two national health education centers, one public and one private. In reSponse to this recommendation, the Bureau of Health Education was established in September, 1974, at the Center for Disease Control in Atlanta, Georgia.2 The Bureau's staff has been actively involved in gathering data on patient education as well as hosting Blue Cross Association, "White Paper: Patient Health Education“ (Chicago: Health Care Service, Blue Cross Association, 1974) (Mimeographed). 1"Summary of President's Committee,“ pp. 24-25. 2Horace Ogden, "Health Education: A Federal Overview," Public Health Reports 91 (May—June 1976): 203. 20 national and regional meetings on the subject.1 The National Center for Health Education, a private center, was formally brought into being on October 1, 1975, and is located in New York City.2 In addition, patient education was included in two recent Congressional acts. The first, enacted in 1973, contains the federal regulations for Health Maintenance Organizations (HMO'S) that receive federal funds. The Health Maintenance Organization Act of 1973 (P.L. 93-222) mandates that HMO'S have a health educa- tion component. The second, the Health Planning and Resource Development Act of 1974 (P.L. 93-641), authorized a three-year nation-wide program of health planning and resources development. A component of any state health plan, developed as one of the requirements of the law, must provide for health education programs for schools, hospitals, long-term health care facilities, and other types of health settings. Simonds in a keynote address to the American Association of Medical Clinics' Health Counselor's Workshop in 1974 stated that ”We are developing what I would call a 'critical mass'-—a suffi- cient number of key elements that encourage or even require this 1Milton Davis, Documenting the Need. Strategies in Patient Education (Chicago: American Hospital Association, 1969); U.S. _ Department of Health, Education, and Welfare, Public Health Serv1ce, Center for Disease Control, Bureau of Health Education, Patient Education Workshop: Summary Report (Atlanta: Bureau of Health Education, 1976). 2Ogden, p. 201. 21 work (patient education) to grow and develop."1 Many other health care professionals echo his beliefs.2 The results of this increase in programs may not be felt by the "everyday” patient, as the majority of programs are geared towards Specific types of illness such as diabetes and not to the general patient population.3 Imppptance of Patient Education Patient education is recognized as an important component of adequate patient care by both health care providers and the patients themselves. Houston4 in reporting a study on patients' reactions to hospital care, noted that 93 percent of those patients interviewed wished to know as much as possible about what was wrong with them. Alt came to a similar conclusion in a study that surveyed patients just prior to leaving a Massachusetts hospital. He con- cluded that: 1Scott Simonds, Current Issues in Patient Education (New York: Core Communications in Health, Inc. , 1974), p. 2Roy Davis, Director of the Community Program for Develop- ment Division, Bureau of Health Education, Center for Disease Con- trol, Atlanta, Georgia, presentation at Project RISE meeting, Waterville, Maine, 3 February 1977. 3Simmons, ”Overview of Patient Education," p. 20. 4Charles S. Houston and Wayne E. Pasanen, "Patients' Perceptions of Hospital Care," Hospitals 46 (April 16, 1972): 4 "' 22 The hospital patient wants more understanding about treatments, medicines, diets, diagnosis, and numerous 1 personal and health-related questions that go unanswered. Pender, in reporting a study conducted in a community hos— pital setting, indicated that patients related that they had a . need for more information before discharge on how to care for themselves at home, the effect of illness on their daily living habits, possible complications of their present illness, and prevention of future illnesses. Skillern's3 study on patients reactions to a formal patient education program showed that 95 percent of the patients who went through the program found it to be a worthwhile experience. They were pleased both with the opportunity to learn new information and with the experience itself. Patient education is shown by the literature to be an important component of patient care for at least seven reasons: 1. Patients have a right to know what is happening to them. This has been clearly Spelled out in the Patients' Bill of Rights which was adopted by the American Hospital Association in 1973. Specifically statements two, three, and twelve refer to patient education. They are as follows: N 'Ait, p. 76. 2Nola J. Pender, "Patient Identification of Health Informa- tion Received During Hospitalization," Ngrsing Research 23 (May—June 1974): 262—63. 3Penn G. Skillern, ”Patient Education in the Group Clinic: A New Approach,” paper presented at the Third International Congress on Group Medicine, Paris, France, 21-26 June 1976. 23 The patient has the right to Obtain from his physician 1 complete current information concerning his diagnosis, treatment, and prognosis in terms the patient can be reason- ably expected to understand. When it is not medically advis- able to give such information to the patient, the information should be made available to an appropriate person in his behalf. He has the right to know, by name, the physician responsible for coordinating his care. (Statement Two) The patient has the right to receive from his physician infor- mation necessary to give informed consent prior to the start of a procedure and/or treatment. Except in emergencies, such information for informed consent should include but not neces- sarily be limited to the specific procedure and/or treatment, the medically significant risks involved, and the probable duration of incapacitation. Where medically significant alter- natives for care or treatment exist, or when the patient requests information concerning medical alternatives, the patient has the right to such information. The patient also has the right to know the name of the person responsible for the procedures and/or treatment. (Statement Three) The patient has the right to know what hospital rules and . regulations apply to his conduct as a patient. (Statement Twelve) The Association in turn has encouraged member hospitals to adopt The Patient's Bill of Rights as a part of hospital policy. Either this statement or a similar statement has been adopted by a number of hospitals,2 and in one case has become a part of State law.3 Field4 hasalso addressed the question of the rights of patients, more Specifically adult patients. She states that: 1American Hospital Association, “Patient's Bill of Rights.” 2"Sisters of St. Joseph, Wichita, Adopt Hospital-Patient Code," ospital Progress 54 (November 1973): 20. 3"Minnesota Hospitals Must Tell Patients About Their Rights," Modern Hospital 121 (September 1973): 42. 1 4Minna Field, Patients Are Peo 1e (New York: Columbia University Press, 19671. "F— 24 AS part of his right to be considered an adult, the patient has a right to know what is being done for him and why, to express opinions, and to use judgment in making decisions which ultimately will affect his entire future life. 2. Patients are better able to deal with their health problems when better informed. A number of research studies have demonstrated this premise. Egbert, Bettit, Welch, and Bartlett2 studied the effect of educa- tion on ninety—seven surgical patients at Masachusetts General Hospital. They showed that when patients were told what to expect in the way of post-operative pain and taught how to relax post— operatively they needed less narcotic medicines after surgery and remembered the operation more favorably than those who were unin- formed. Levine3 demonstrated that teaching hemophiliacs to care for themselves reduced the number of emergency room visits. He clearly favors the self-therapy model of health care delivery. Based on a study with heart patients receiving treatment in an out-patient clinic, Rosenberg4 concluded that a well—organized treatment and education program does provide better medical care 1Ipid., pp. 147—48. 2Lawrence D. Egbert, George E. Battit, Claude E. Welch, and Marshall K. Bartlett, "Reduction of Post-operative Pain by Encouragement and Instruction of Patients,” New England Journal of Medicine 240 (April 16, 1964): 825-27. 3Peter Levine, "Efficacy of Self-Therapy in Hemophilia: A Study of Seventy-Two Patients With Hemophilia A and B," New Epgland Journal of Medicine 291 (December 1974): 1381—84. 4Stanley Rosenberg, ”Patient Education Leads to Better Care for Heart Patients , " HSMHA Health Reports 86 (September 1971) : 793-802. 25 for patients. Total readmissions and total readmission days were Significantly reduced for patients who participated in the clinic education program. An overview of the above articles and other studies relat- ing to patients being better able to care for themselves is reported by Roccella.1 Roccella also stresses the point that hav- ing patient education programs is one way to deal with the increas— ing costs of health care. 3. Patient education is cost—effective.2 4. Green3 has outlined a number of ways that patient educa— tion could be cost-effective. Among these are that patient educa- tion could reduce the number of broken appointments, help with patient dissatisfaction, reduce unpaid bills, improve speed of diagnosis, and improve patient compliance with medical regimes. 4. Patient education increases health manpower by adding the patient to the health care team. 1Edward J. Roccella, ”Potential for Reducing Health Care Costs by Public and Patient Education,” Public Health Reports 19 (May-June 1976): 223-25. 2Edith Schoenrich, ”Patient Education in Contemporary Health Service Delivery," in Proceedings . . . Workshop on Patient Educa- tion (Washington, D.C.: U.S. Department of Health, Education, and Welfare, 1973), p. 6. 3Lawrence Green, ”The Potential of Health Education Includes Cost-Effectiveness,“ ospitals 50 (May 1, 1976): 57—61. 26 Patient education implies a giving of part of the responsi— bility back to the patient for both the management and maintenance of his/her own health.1 5. Patient education increases compliance by patients with medical regimes. Estimates range from 15 to 95 percent of patients who are non-compliant.2 A number of factors have been given as causes of this non-compliant behavior. Among them are a lack of informa— tion about one's illness3 and a lack of understanding of the doctor's orders concerning treatment.4 6. Patient education is important because there is an increasing incidence of chronic disease and aging. People are generally living longer; and larger numbers are surviving some of the most serious illnesses and accidents that leave them paralyzed, brain damaged, or with a combination of dis- abilities. Unless they are to be permanently institutionalized these people and their families must know how to manage their health problems as they primarily will be in charge.5 1"Roundtable/Patient Education: Making Your Patient a Partner in Care," Patient Care 8 (September 15, 1974): 1084; Schoenrich, ”Contemporary Health Service Delivery," p. 6. 2Davis, Strategies in Patient Education. 3Marshall Becker and Lois Maimex, ”Sociobehavioral Deter- minants of Compliance With Health and Medical Care Recommendations," Medical Care 13 (January 1975): 10-24. 4"Why Patients Don't Follow Orders,” Medical World News (New York: McGraw—Hill, Inc., 1972). 5Schoenrich, ”Contemporary Health Service Delivery,” p. 5. 27 7. The importance of patient education comes also from the increased emphasis on the prevention of illness at all levels, primary, secondary, and tertiary.1 This involves preventing health problems before they happen, early detection and treatment, and the avoidance of disability and attempts to sustain effective functioning of the person who is predisposed to a health problem.2 This preventive process cannot be effectively undertaken unless patients are well informed and involved with the process. Process Model of Formal Patient Education Programs A model for formal patient education programs was developed by the Committee on Educational Tasks in Chronic Illness of the American Public Health Association. The committee developed a comprehensive and interdisciplinary approach to the process of patient education which involved a five—step model. This model includes: (1) Identification of the educational needs of the patient and family; (2) Establishment of educational objectives; (3) Selection of appropriate educational methods; (4) Imple- mentation of the educational program; and (5) Evaluation.3 11bid., p. 4. 2Judith Mausher and Anita Bahn, Ep_demiologyg An Introduc- tory Text t(Phi1ade1phia: W. B. Saunders Co. , 1974),p . 10. 3U.S. Department of Health, Education, and Welfare, Public Health Service, Health Resources Administration, A Model for Plan— ning Patient Education (Washington, D.C.: Government Printing Office, 1972), p 7. 28 Other authors and organizations have also described the process of patient education. Redman1 and Pohl,2 two of the recog- nized spokeswomen in the nursing field, have outlined in detail the process of patient teaching in nursing. Linderman3 and Alexander, Schrader, and Knnedler4 provide guidelines on the more Specific topic of pre-operative teaching. The American Group Practice Association (AGPA) members have adopted and are utilizing a process model that was developed jointly by Core Communications Health Inc. and the American Group Practice Association.5 The patient education process in an ambulatory clinic setting is des— cribed by Herje6 and Kucha.7 Two workshops held on patient education, one sponsored by the Maryland State Department of Health and Mental Hygiene in 1Redman, "Guidelines" and Process. 2Margaret L. Pohl, The Teaching Functions of the Nursing Practitioner (Dubuque, Iowa: Wm. C. Brown Co., 1968). 3Carol A. Linderman, "Influencing Recovery Through Pre— operative Teaching," eart and Lung 2 (July-August 1973): 515—21. 4Carol Alexander, Elinor Schrader, and Julia Knnedler, "Pre—operative Visits: The Operating Nurse Unmasks," AORN Journal 19 (February 1974): 401—12. 5Robert W. Jamplis, ”The Practicing Physician and Patient Education," ospital Practice 10 (October 1975): 93-99. 6Pat Angirk Herje, "The Ambulatory Clinic Patient as a Learner," Biomedical Communications 2 (November 1975): 93—99. 7Delores Kucha, ”The Health Education of Patients: Develop- ment of a System," upervisor Nurse 5 (May 1974): 8-21. M " ' Lena} V- 29 19731 and a second by the Bureau of Health Education in January of 1976,2 also addressed the process of patient education. At the former, Schoenrich3 outlined the components of an organized patient education program. In the latter the components are given in a paper entitled “Planning for Specific Patient Education Pro— grams.”4 Each of these studies contains the same basic five steps outlined in the model prepared by the Committee on Educational Tasks in Chronic Illness. Some studies use different words and a somewhat different ordering, but they all describe the same basic process. Identification of Needs The identification of the patient's educational needs (and in some cases also the family's needs) involves the determina- tion of information, attitudes, and skills necessary to understand their illnesses and their care, and to cooperate and participate in the treatment programs.5 This includes: ceedings . . . Workshop on Patient Education Programming (Washing— ton, D.C.: Department of Health, Education, and Welfare, 1973). 1U.S. Department of Health, Education, and Welfare, Pro- Department of Health, Education, and Welfare, Patient 2U.S. Education Workshop. 3Schoenrich, ”Contemporary Health Service Delivery,” p. 3. 4U.S. Department of Health, Education, and Welfare, Patient Education Workshop. 5U.S. Department of Health, Education, and Welfare, Model, - » :m : ~'--‘;L:‘LA=S-fig 3O 1. becoming familiar with the patient as a person, his social and psychological background;1 2. assessing the patient's knowledge about his/her health;2 3. determining what the patient and the family want to know;3 4. determination by the physician and other health care personnel of what the patient and family needs to know.4 The trend in patient education programs, especially those developed in the last three or four years, seems to be toward the fourth activity mentioned, that of determination of what the patient and family need to know,5 with some Stress on assessing the patient's knowledge of the health problem.6 The first activity (getting to know the patient as a person) and the third (finding out what the > 1Ibid.; Brown, pp. 15-22; Redman, Process, pp. 22-26. 2Schoenrich, ”Contemporary Health Service Delivery,” p. 3; U.S. Department of Health, Education, and Welfare, Model, p. 9; Redman, Process, pp. 22-26. 3U.S. Department of Health, Education, and Welfare, Model, 4Ibid.; Schoenrich, "Contemporary Health Service Delivery,“ 5American Hospital Association, ”Patient Education Project”; U.S. Department of Health, Education, and Welfare, Patient Education Workshop; Lois Estes, interview held at Eastern Maine Medical Center, Bangor, Maine, on 13 January 1977. 6Schoenrich, “Contemporary Health Service Delivery,” 31 patient and family want to know) appear to be lacking in most patient education programs. Establishment of Educational Objectives The establishment of educational objectives for the patient and his/her family involves the development of learning objectives statements that outline what the patient specifically should be able to know and do. These ideally should be formulated based upon the needs identified by the health care team, the patient, and the family.1 Again, in practice, the specific objectives for patient teaching seem to be pre-set for a Specific illness category and developed primarily by professional health care personnel.2 A few of the authors State that as part of the execution of the learning objectives the patient's needs should be determined first.3 The trend, however, appears to be toward fixed learning objective packages with no provision for including the patient learners in the development of the objectives. Selection of Educational Methods and Personnel The selection of educational methods involves choosing the appropriate educational strategies to achieve the specified learning 1U.S. Department of Health, Education, and Welfare, Model, pp. lO—ll; Redman, Process, p. 63. 2American Hospital Association, "Patient Education Project"; Estes; U.S. Department of Health, Education, and Welfare, Model; Vega, p. 79. 3“Patient Education System” (New York: Core Communications in Health, Inc., 1976); Redman, Process, p. 63. 32 objectives. This includes the selection of both appropriate per- sonnel and types of instruction to be offered.1 The personnel may include only one patient teacher, such as a nurse, or a multi— disciplinary team.2 Some patient education programs also use volunteers. The types of instruction that patient education programs use are as varied as the programs themselves. The programs involve one-to-one teaching,3 group instruction,4 access to library and other printed materials,5 and use of videotape instruction.6 Several authors7 have provided excellent descriptions of the types of instruction used in formal patient education programs. 1U.S. Department of Health, Education, and Welfare, Model, pp. 11-14. ZEtzwiler et al., p. 34; U.S. Department of Health, Educa- tion, and Welfare, Proceedings; Simmons, ”Overview of Patient Educa- tion," p. 21. 3Richard M. Caplan, “Educating Your Patient," Archives of Dermatology 107 (June 1973): 837. 4Fra1ic, p. 34; Carol A. Linderman and Betty Van Aernam, "Nursing Intervention With the Presurgical Patient——The Effects of Structured and Unstructured Pre—operative Teaching," Nursing Research 20 (July—August 1971): 319-332. 5Marjorie Bartlett, Ann Johnston, and Thomas Meyer, "Dial Access Library—-Patient Information Service,” The New England Jour— nal of Medicine 288 (May 10, 1973): 994-97; F. Bobbie Collen and Krikor Soghikian, ”A Health Education Library for Patients,” Health Service Reports 89 (May-June 1974): 236-43. 6Illajean Horwitz, “Television Provides Patient Education," Hospitals 46 (January 16, 1972): 57-60; "Patient Education System." 7Carolyn P. Fylling and Donnell D. Etzwiler, "Administra— tive Reviews Health Education,” HOSpitalS 49 (April 1975): 95-98; Simmons, ”Overview of Patient Education," pp. 22-23; Redman, Process, pp. 114—82. 33 Implementation The implementation phase of formal patient education pro- grams involves steps on a continuum; it starts with the individual assessment of needs and continues through the evaluation phase.1 The primary thrust is on the actual teaching/learning process used to carry out the educational objectives that have been developed. Redman and Pohl have provided descriptions of this primary area.2 An ancillary part of the implementation phase is training of staff needed to execute the patient education programs.3 Very little research has been reported on this particular phase of imple- mentation. Evaluation The purpose of the evaluation stage is two—fold. The first is to look at the results of the patient education program in terms of the patient's and family's (if included) learning, and effects of that learning on change in the health behavior of the patient.4 1Anne L. DeCicco, ed., A Guide to the Develo ment of a Hospital-Based Consumer Education Program 1Piscataway, New Jersey: Office of Consumer Health Education, College of Medicine and Den- tistry of New Jersey, January, 1975), pp. 9—13; ”Make Patient Teaching Visible," Inservice Training 5 (August 1976): 20-27; U.S. Department of Health, Education, and Welfare, Model. 2Redman, Process; Pohl, Teaching Functions. 3DeCicco, p. 11; U.S. Department of Health, Education, and Welfare, Patient Education Workshop, pp. 6-7; Vega, p. 79. 4U.S. Department of Health, Education, and Welfare, Model, pp. 14-16; ”Make Patient Teaching Visible"; Schoenrich, "Contempo— rary Health Service Delivery,“ p. 3. 34 The second is to evaluate the patient education program, the per- sonnel, the instructional methods, the objectives, and the overall administration.1 Evaluation involves, among other things, the follow-up of patients after they have been discharged from a health care setting or completed their treatment (especially its educational component). The follow-up may include other health care and community personnel, such as visiting nurses in the field, even though they were not involved in the original program.2 Evaluation is an important com- ponent of patient education programs, but is neither easily nor readily a part of practice. Settings for Patient Education Patient education can take place in a variety of settings. These settings include hospitals, ambulatory care clinics, physi— cians' offices, libraries, public health agencies, university extension programs, and the home. One of the primary places for patient education activities is the hospital setting. Some profes— sionals in the health education field are calling for the hospital . to be the center or the hub of all patient education programs. For example, Dr. Scott Simonds3 feels that hospitals should serve as 1Redman, Process, pp. 183-211. 2U.S. Department of Health, Education, and Welfare, Model, p. 16. 3Scott Simonds, "Health Education and Social Policy,” in Health Education Monographs, Vol. 2, No. 1 (San Francisco: Society for Public Health Education, September 1, 1974), p. 9. 35 centers for the coordination of total health care, including patient education. Hospital—Based Patient Education Hospital-based education serves a number of different kinds of clienteles: inpatients, outpatients who attend medical clinics, and the general community. In the latter area it is usually termed health education and in the former, patient education. Three com- prehensive overviews of hospital patient education programs are included in a Special feature on patient education in the October 1973 issue of Modern Hospital and in publications by Lee1 and . 2 Simmons. Community Activities For the community at large, the programs usually perform principally an informational function. Examples of community pro— grams include A Hall of Health, an exhibit on health—related matters for community groups;3 telephone hotlines which provide tape— recorded answers to people's health problems;4 informational pro- grams on Specific health hazards, such as hypertension, smoking, 1Elizabeth Lee, "Annual Administrative Reviews: Health Education,” ospitals 48 (April 1974): 133—39. 2Simmons, “Overview of Patient Education." 3Zeanette Williams, "A Hall of Health, " Hospital Forum 18 (May 1976): 4—5, 18. 4“Not Primarily a Hospital but a Public School, " HOSpitals 48 (March 16,1974): 36 and drug education;1 nutrition programs for various community groups; and a personalized exercise program for adults.2 Out-Patient Activities Hospital-based activities for the out-patient population also involve a range of activities from doctors giving information 3 to their patients to more structured individual and group sessions with patients. The most popular form of formal instruction for out- patients is represented by classes held for expectant parents.4 Other types of programming include classes for diabetic patients,5 community clubs for former heart and stroke patients,6 group help sessions for cancer patients,7 group instruction for heart patients,8 1"Making the Patient a Part of Patient Care," Modern Hospital 121 (October 1973): 110. 21bid., p. 107. 3H. F. Dowling and David Shakow, “Time Spent by Internists on Adult Education and Preventative Medicine," Journal of the Ameri— can Medical Association 149 (June 1952): 628-31. 4American Hospital Association, "Patient Education Project." 5Diggins, interview held at Sparrow Hospital, Lansing, Michigan, 13 December 1976; Estes; Diana Thompson and Jocelyn Elders, "Education of the Juvenile Diabetic," The Journal of the Arkansas Medical Society 72 (November 1975): 239-46l 6Helen Kelsey and Virginia Beamer, "A Post—Hospital Health Education Program," Heart and Lung 5 (May 1974): 512-14; "Making the Patient a Part of Patient Care," p. 110. 7 "Making the Patient a Part of Patient Care," pp. 106—107. 8Rosenberg, "A Case for Patient Education,“ p. 3. 37 a patient education library service,1 and videotapes on specific health-related subject areas that patients may review with or without the assistance of health educators.2 Inpatient Activities Hospital patient education activities for the inpatient population have been given the most attention in the literature and in present hospital programning. The types of educational activities for hospitalized patients and their families are almost as many and varied as the number and types of hospitals. Nurses giving bedside instructions3 represent probably the most common form of patient education for inpatients. This instruction can cover a wide range of areas from pre-operative assistance4 to how to get out of a hospital bed with a leg in a cast. Other types of inpatient educational activities include patients meeting with professional staff members on a one—to—one teaching basis,5 attending physical or occupational therapy _z____,___,_____,_~__,,.__ 1Collen et al., "Kaiser—Permanente.“ 2"Patient Education System.“ 3Margaret Pohl, “A Study of the Teaching Activities of the Nursing Practitioner“ (Ph.D. dissertation, Columbia University, 1963), p. 9; Redman, Process, p. 117. 4Alexander et a1.; Carole Ayers and Linda Walton, "A Guide for the Pre-Operative Visit," AORN Journal 19 (February 1974): 413— 18; Linderman, "Nursing Intervention." 5Elizabeth Bernheimer and Linda Clever, The Team Approach to Patient Education: One Hospital's Ex erience in Diabetes Atlanta: 1 Public Health U.S. Department of Health, Education, and We fare, SerVTce, Center for Disease Control, Bureau of Health Education, 38 sessions, meeting with the hOSpital social worker to discuss a 2 listening to telephone personal concern,1 attending formal classes, taped messages,3 viewing videotape on bedside television sets,4 and having a volunteer who had a similar illness stop in to explain how he or she coped with the illness.5 Not all of the above-mentioned activities may be regarded as educational ones by either the patient or the health care per- sonnel; yet they involve both teaching and learning by the parties involved. These types of activities may also be parts of a formal patient education program, or may happen informally as part of what is considered regular hospital routine. The majority of the formal patient education activities for inpatients are focused primarily on patients with chronic illnesses.65 1977), p. 11; Donald F. Besta, "New Services Generate Teaching Role,“ Hospitals 47 (March 1, 1973), 46; Anne Jernigan, "Diabetics Need to Know More About Diet," HOSpitals 45 (February 16, 1971): 100—102. 1Field. 2Kelsey and Beamer, pp. 513—14; "Making the Patient a Part of Patient Care"; Monteiro, p. 27. 3Bartlett, Johnston, and Meyer. 4Horwitz. 5Breckon, "Hospital Health Education." 6American Hospital Association, "Patient Education Project"; Susan Jane Peters, "A Survey of Health Education Programs in Selected Hospitals in the United States With a Proposed Model for a Comprehensive Health Education Program in a Hospital Setting" (Ph.D. dissertation, Southern Illinois University, 1974), p. 88; U.S. Department of Health, Education, and Welfare, Patient Education Workshop. 39 The diseases that account for the majority of the programs include diabetes, ostomy, mastectomy, and heart problems. Two other very popular forms of hospital education for inpatients are those for patients who will undergo surgery and those for maternity patients and their husbands.1 Linkages Between Hospital— Based Programs There appears to be a lack of linkages, at least on a for— mal basis, between patient education programs for the three types of clientele that hospitals serve. This is especially important in the transition of a hospitalized patient to an out—patient status. The follow—up of the educational activities provided by the hospital and the continuation of needed activities is not well organized. Some formal patient education programs encourage patients to continue coming to the educational activities after being dis— charged.2 Other programs allow for informal communications if the person has a specific educational need related to the illness.3 Still other programs, through the hospital social service or dis- charge planning department, refer the patient to the Visiting Nurse's Association or their local homemakers' service for follow-up and 1American Hospital Association, "Patient Education Project"; Peters, p. 88. 2Diggins; Estes; Kelsey and Beamer. 3Diggins. 40 further activity. Some patients receive no follow-up service, other than visits with their physician. Establishing better linkages between the inpatient hospi- tal education services and the services needed for patients once they have left the hospital is an area that needs further study. Content of Patient Education Activities for Inpatients The areas for patient education are wide and varied. They include topics such as orientation to the hospital, explanation of the diagnosis and treatment of the health problem, and learning about independent living skills and appropriate community resources. Most patients are not involved in all of the content areas, but only a few Specific to their health problem. Orientation to Hospital Facilities and Services This area is covered in a number of ways from the handing out of printed materials to patients and their families to having nurses on the individual floors explain the various hospital ser- vices.1 Volunteers also are relied upon quite heavily to provide this type of information for patients. Explanation of the Diagnosis of the Health Problem This area is primarilydealtwith by the physician, many times prior to the patient being admitted to the hospital. The 1Simmons, ”Overview of Patient Education,” p. 24. 41 extent of this explanation differs depending on the physician's style of working with patients, the patient, and the type of illness.] Explanation of the Treatment for the Health Problem This area also is primarily dealt with by the physician, many times prior to hospitalization, and varies in its nature and completeness.2 In some cases nurses and other allied health per- sonnel are charged with giving part of the explanation. In most cases, however, they will not give out this type of information on their own initiative unless instructed to do so by the physician.3 This is changing, though, with the advent of more formalized patient education programs. One of the components of formal programs includes either full or partial explanation of the medical treatment.4 This is illustrated by the growing number of formal pre- and post-operative patient education programs.5 M D. G. Pocock, “Teaching PatientS--Why and How?” Southern Medicine 62 (February 1974): 9; Lois Pratt, Arthur Seligmann, and George Reader, "Physicians' Views on the Level of Medical Informa- ation Among Patients,” American Journal of Public Health 47 (October 1957): 1279-80. 2Pocock, p. 10. 3Dale C. Levine and June P. Fiedler, "Fears, Facts, and Fan- tasies About Pre- and Post-Operative Care,” ursing Outlook 18 (February 1970): 28. 4U S. Department of Health, Education, and Welfare, Patient Education Workshop, pp. 81—88. 5American Hospital Association, ”Patient Education Project." 42 Teaching of the Medical Management of the Health Problem Medical management of his/her own illness by the patient includes items such as learning about medications,1 the management of medical apparatus such as a catheter for ostomy patients,2 dietary instructions,3 needed self-examinations to watch for recurring medical problems such as breast cancer, and physical exercise so muscles will not become atrophied. These topics are usually taught from a more technical standpoint and are the ones most often included in formal hospital programs. A variety of pro— fessional health personnel including nurses, occupational thera— pists, physical therapists, pharmacists, dieticians and, at times, physicians are involved in the teaching of these topic areas. Assisting Patients to Learn or Relearn Self—Care, Independent Living Skills The educational goals of this area include having patients relearn to walk, talk, eat, read, write, manage household activi- ties, and, in some cases, job Skills. Though this involves the relearning of technical type Skills, the patient must also deal 1Besta. 2U.S. Department of Health, Education, and Welfare, Patient Education Workshop, pp. 91—95; Fralic, pp. 34—36. 3U.S. Department of Health, Education, and Welfare, Patient Education Workshop. PP. 62-68. 43 with various emotional problems1 resulting from loss of bodily functions. This area is usually covered in a formal manner. It involves activities that are planned by the professional staff and are usually carried out only on a prescription from the doctor. Physical therapists, occupational therapists, speech therapists, and nurses are the primary teachers in this area. Teaching Patients and Their Families About Short— and Long-Term Life Style Changes Due to the Health Problem This area involves helping the patients and their families understand the various types of changes necessitated by the nature of the health problem. This includes things such as reducing daily activities, exercise programs, change in dietary habits, the stop- ping of smoking and drinking, and change in or termination of some recreational interests. These topics are covered most often in formal patient education programs. It is especially common for heart patients,2 diabetics,3 and peOple with respiratory conditions. Nurses and physicians tend to be the primary teachers in this 1Franklin C. Shontz, The P§ychological Appects of Physi- cal Illness and Disability (New York: MacmiTlan Publishing Co., 1975); James F. Garrett and Edna S. Levine, Rehabilitation Practices With the Physically Disabled (New York: Columbia University Press, 1973). 2"Cardiac Education Teaching Manual" (Urbana, Illinois: Cardiac Education Section, Patient Service of Carle Foundation Hospital and Carle Clinic Association, 1976); Joy Duncan, Ardith Granbouche, and Ginevra Moody, "A Program for the Teaching of Cardiovascular Patients," Heart and Lung 2 (July-August 1973): 508-11; Fralic, p. 36. 3Estes; Fralic, pp. 33-34. 44 area with some involvement by health educators in the formal programs. The three previous categories cannot always be separated because teaching of one area may involve two or all of them simul- taneously. Educating Patients and Their Families About Appropriate Community Resources This area involves providing information on resources such as the visiting nurses service, extended care facilities, outpatient hospital services, and related home health services. The complete- ness of this kind of patient education depends on the degree to which the hospital program has been formally developed and the amount of time hOSpital personnel have to spend with the patients and/or their families. Instruction has traditionally been done by the hospital social worker. In smaller community hospitals the information might be provided by a staff nurse, a physician, or a public health nurse. This particular content area has not been extensively reported in the patient education literature. Teaching About the Financial Management of the Health Problem This subject has also not been stressed in the patient education literature. Yet it is a topic, with the continued rising cost of medical care, that needs to be addressed more fully. Traditionally, hospital social workers have counseled with patients and their families when help was requested in this area. 45 Teaching of General Preventive Activities This area includes such tasks as the teaching of all women patients how to do breast self-examinations or teaching all patients the importance of a well-balanced diet. The coverage of general preventive health topics does not appear to be a prevalent one in hospital programs for inpatients, nor does there seem to be any great push to organize such programs. Not all patients learn about all of the content areas in the list. Some may never receive education about any of them; others receive information in only one or two of the categories; and still others may be exposed to educational activities in all of the content areas. Roles of Professional Staff, Patients, and Families of Patients in Hospital-Based Inpatient Education Programs AS outlined in the section on inpatient hospital activi« tieS and the content areas covered, almost all professional hOSpital staff members, frequently with the exception of hospital adminis- trators, are involved in either formal or informal inpatient edu- cational activities. Physicians, nurses, dieticians, pharmacists, social workers, occupational therapists, physical therapists, and speech therapists teach patients and, at times, their families. The newest member of the allied health care team to join the hos- pital staff in this endeavor is the health or patient educator. Until recently in hospital settings, the functions now performed 46 by this person were usually incorporated as part of a traditional staff role, often that of a nurse, and even now one is not likely to be hired as a patient educator unless he/she has had background in that more traditional area.1 With the expanding development of more formal patient edu- cation programs for hospitalized patients, many questions have been raised as to what the roles of the patient educator as well as other hospital professional personnel Should be in those pro— grams. Who Should be involved in the teaching activities of which tOpic area? Who Should do the planning and evaluation of programs? Who should have the administrative responsibility for programs? The literature outlines numerous functions for each role but dif- ferences among authors demonstrate a definite lack of agreement on who should be doing what. Physician's Roles The majority of studies state that the physician should be involved in patient education programs for hospital inpatients. PeOple working in the field tend to agree with this general prin- ciple. The type of involvement, however, varies greatly. Physicians themselves have not, for the most part, given much input into what they think their role Should be as educators of inpatients in a hospital setting. One physician states that 1Marle K. Moran and Elizabeth Parris, ”Patient Education Coordination in Greenville, S.C. Hospitals," Public Health Rpports 9 (May-June 1976): 275; Estes. 47 The responsibility of all patient education emanates from the doctor; and this responsibility can and Should be shared and delegated in part to staff residents, nurses of head 1 nurse stature, dieticians, and others in allied services. A similar opinion is given by two other physicians that the physi— cian should remain directly in control of his patients' education and prescribe its content, though "he should not attempt to do it all himself."2 Dr. Etzwiler3 describes patient education programs that use a team in an interdisciplinary approach to patient edu- cation with the physician being a member of that team. Dr. Robert Canfieid4 of Columbia University's College of Physicians and Surgeons does not see a clearer role definition coming from physi- cians in this area until medical schools change some of their basic teaching goals and the ways they teach students. Other types of health care personnel agree with the roles of physicians as directors of patient education teams,5 as members of those teams,6 and as the prescribers for specific patient educa- tion programs.7 Additional roles seen by others include viewing 1Alt, p. 68. 2Jamplis, p. 96; "Roundtable/Patient Education.” 3Etzwiler, ”Current Status." 4Canfield, pp. 85—86. 5Shaw, p. 99; Vega, p. 79. 6Field, pp. 179-81; American Hospital Association, Strate- gig§3 Ulrich, pp. 105—107; Walter J. McNerney, "The Missing Links {3 Health Services," Journal of Medical Education 50 (January 1975): . 7Bernheimer and Clever, Team Approach, p. 8; Diggins; Scott Simonds, "Health Education and Medical Care: Focus on the Patient," 48 the physician as the teacher,1 and as administrator to develop and coordinate the educational programs.2 Nurse's Roles Teaching has long been considered a part of the nurse's role.3 A national study of nurses conducted by Margaret Pohl4 confirms this view. The majority of respondents to her study, which included all kinds of nursing personnel, felt ". . . that teaching is a responsibility of nursing practitioners, that they enjoy teaching and want to teach, and that teaching is as important as other aspects of their work."5 The nurse's role in hospital formal patient education pro- grams has been discussed widely in the nursing literature and by nursing personnel. The nurse is seen first as the primary teacher of patients.6 A second role assigned to the nurse is leader of a Health Education Monograpp(San Francisco: Society for Public Health, 1963), No. 16, p. 38; U.S. Department of Health, Education, and Welfare, Patient Education Workshop. 1Burton. 2Shaw, p. 99. 3Redman, Process, pp. 1-5; Virginia Streeter, "The Nurse's Responsibility for Teaching Patients," American Journal of Nursing 53 (July 1953): 118. 4 Pohl, "Study of Teaching Activities.” 51bid., p. 9. 6Roselle Denison Collins, "Problem Solving: A Tool for Patients Too," American Journal of Nursing_7 (July 1968): 1483; DeCicco, pp. 30-32; Anne Gusfa, Virginia Christoff, and Lorraine Headley, "Patient Teaching: One Approach," Sppervisor Nurse 6 ;.,W_ ...._... - 49 multidisciplinary patient education program.1 A third role is being a member of an interdisciplinary patient education team.2 The nurse is also seen as the chief administrator of all patient educa- 3 To fulfill the patient educator role some hospitals tion programs. require further education by the nurse in health education or a related field. The general consensus from the nursing literature is that nurses do have and should continue to assume a major leader- ship role in hospital patient education programs.4 Other types of health care professionals also identify the roles that nurses should play in formal hospital patient education programs. For the most part they center on the nurse's role as being that of a teacher,5 a member of an interdisciplinary patient education team,6 or as administrator of the patient education team.7 (December 1975): 17; Eleanor C. Lambertson, "Nurses Must Be Teachers and Must Know These Principles," Modern Hoppital 110 (February 1968): 126; Monteiro, p. 26; Pender; Pohl, Teachipg_Functions, p. 9; Joan Royle, "Coronary Patients and Their Families Receive Incomplete Care," Canadian Nurse 69 (February 1973): 3135. 1 Redman, Process, pp. 218-20. 2Howard A. Rusk, "Rehabilitation Belongs in the General Hospital," American Journal of Nursing 62 (September 1962): 62-63; Redman, Process, pp. 218—20. 3Estes; Moran and Parris, p. 275. 4Fralic, p. 30; Redman, Process. 5Field, p. 185. 6Alt, p. 78; Etzwiler, "Current Status"; Vega, p. 79; Ulrich, p. 104. 7American Hospital Association, Strategies in Patient Education, p. 29. 50 Allied Health Professional's Role The allied health professional provides mostly supporting roles in hospital patient education programs. They function pri- marily as individual teachers of patients1 and members of inter— disciplinary patient education teams.2 Hospital Administrator's Role HOSpital administrators perform two primary roles in patient education programs. The first is general policy making, usually conducted at the higher levels of the hospital hierarchy. The hospital's executive director may appoint a committee with titles such as the Patient Education Policy Committee, the Patient Teach- ing Committee, or the Health Education Committee3 to undertake the policy development function; or may prefer to work out such policy with members of the hospital's Board of Trustees. 1Besta, p. 146; Gary Greiner, "The Pharmacist's Role in Patient Discharge Planning," American Journal of Hospital Pharma- cists 29 (January 1972): 72-76; Marianne Ivey, Vonne ISO, and Stanan Tso, "Communication Techniques for Patient Instruction," American Journal of Hospital Pharmacists 32 (August 1976): 828; Jernigan, ”Diabetics,“—p. 93. 2Elaine Cue, "The Hospital Pharmacist's Role in Health Edu— cation," American Journal of Hospital Pharmacy 28 (September 1971): 697-99; Field, pp. 182-92; M. Jinks, l'The Hospital Pharmacist in an Interdisciplinary Inpatient Teaching Program," American Journal of Hospital Pharmacists 31 (June 1974): 569—73; Sister Rosita Schiller, "The Dietitian's Changing Role,” ospitals 47 (December 1, 1973): 97-122; Bernheimer and Clever, Team Approach, p. 7. 3U.S. Department of Health, Education, and Welfare, Patient Education Workshpp, pp. 72-76. 51 Second, in some hospitals full- or part-time administrators are appointed to the position of Patient or Health Education Direc- tor or Coordinator. The administrators of formal patient education programs have varying professional backgrounds as alluded to earlier. They may be physicians, nurses, health educators, social workers, dieticians, physical therapists, or occupational therapists.1 In practice, a nurse most often fills this specific administrative position.2 Patient's Role Health care professionals view the patient's role in formal hOSpital patient education programs in a number of ways. Some see the patient's role as being an active participant in all phases of 3 the program, from needs assessment through evaluation. This type of role implies that the patient must take on part of the responsi- bility for regaining and maintaining his/her own health.4 1American Hospital Association, Strategies in Patient Education, p. 29. 2American Hospital Association, ”Patient Education Project"; Simmons, "Overview of Patient Education," p. 21. 3Collins, p. 1483; Donnell Etzwiler, "The Contract for Health Care (editorial)," Journal of the American Medical Associa- tion 224 (May 14, 1973): 1034; Rosemary Monaco, Linda Salfen, and John S. Spratt, "The Patient as an Education Participant in Health Care," Missouri Medicine 69 (December 1972): 932; Shontz, pp. 51-56; Ulrich, p. 105. 4Etzwiler, ”Contract." 52 Others see the patient as an active participant only in the implementation stage of the formal patient education program.1 In such cases programs are pre—planned for the patient and follow a fairly Specified routine. A third way that the patient is viewed is as a passive recipient of educational information.2 Such a role is present in programs or parts of programs which include handing out of pamphlets or check lists that patients should follow once they are discharged. This latter area tends to be a trait more of non—formal patient education activities than of formal ones. Family Members' Roles Family members are seen by professionals as important in the patient education process3 since illness of one member of the family affects others in the family as well.4 The family's role, however, has not been well defined. It ranges from being learners to be helped to cope with the patient's illness and the changes that illness has brought, to making them an adjunct part of the patient education team.5 It iS a very 1Linderman, p. 516; U.S. Department of Health, Education, and Welfare, Patient Education Workshop, pp. 81—88. 2Laurel A. Copp, ”The Waiting Room—~A Health Teaching Site,“ Nursing Outlook 19 (July 1971): 481 —83. 3Anne Eardley, Frances Davis, and John Wakefield, ”Health Education by Chance,” International Journal of Health Education 18 (1975): 22, C. Hopkins:T“Patient Education: A Part of Quality Health Care," Journal of Arkansas Medical Society 71 (December 1974): 231— 32, Kelsey and Beamer, p. 513. 4Fieid, pp. 207—15. 53 complicated area due to the many different parties involved, from children to grandparents, the varied capacities and needs of family members themselves, and the range of emotions and attitudes family members have toward the patient and his/her illness. Constraints to the Development and Implementation of Patient Education Activities There are a number of constraints that tend to prevent the development and implementation of hospital patient education activi- ties. These may include the lack of acceptance of patient educa- tion by professionals,1 especially physicians, lack of staff com— petence to do patient education,2 lack of Staff time to do patient education,3 cost of patient education,4 lack of necessary facilities and equipment,5 lack of good resource material,6 and lack of third 1Bernheimer and Clever, Team Approach, p. l; Etzwiler et al., p. 36; Jamplis, p. 94; U.S. Department of Defense, Veterans' Admin- istration Medical District 15, "Orientation Conference on Patient Education” (Ann Arbor: n.p., April 29, 1975) (Mimeographed). 2Meg Doolittle, ”Making Patient Education a Reality,” Cross-Reference 5 (June 1975): 4; U.S. Department of Defense, "Orientation Conference”; Elizabeth Hahn Winslow, ”The Role of the Nurse in Patient Education Focus: The Cardiac Patient,“ The Nursing Clinics of North America 11 (June 1976): 217. 3Alexander et al., p. 405; U.S. Department of Defense, "Orientation Conference”; Winslow, p. 217. 4Bernheimer and Clever, Team Approach, p. 1; Estes; Etzwiler et al., p. 36; Peters, p. 111. 5U.S. Department of Defense, ”Orientation Conference.” 6Estes; Skaling. 54 party payments for patient education.1 These constraints need to be taken into account and worked through in order to insure the success of a patient education program. Need for Further Study The review of the literature has demonstrated a variety of needs for further study in patient education. Among the questions it raises are the following: Should patient education programs include both formal and informal patient education activities? If so, how can they be combined? How important is patient education as a component of adequate health care, in the opinion of most health What roles should the various health care professionals have in the planning, implementation, and evaluation of What roles Should patients and their families have in the planning, implementation, and evaluation of patient What content areas Should be included in patient edu- What are the best methods for teaching patients? What constitutes an effective patient education program? l. 2. care professionals? 3. patient education? 4. education? 5. cation programs? 6. 7. l .Jamplis, p. 94. 10. 11. 12. 13. 14. 15. 16. How can patient education programs be made more cost- effective? How can hOSpitals determine cost- effectiveness? What are the factors that inhibit the development and implementation of patient education programs? Should patient education activities be individualized for each patient? If so, how? 00 patients and the general public want to become more actively involved in their own health care? What should be the role of the hospital in patient education? IS it feasible to develop formal patient education pro- grams, especially in the smaller hospitals? To whom should formal patient education programs be directed (i.e., all patients, patients with only cer- tain kinds of illnesses)? Should there be a unified, comprehensive patient educa- tion program including hospitals and other community agencies (i.e., schools, health groups, physicians' offices)? How can health care professionals most effectively be trained or retrained to carry out patient education activities? The literature addresses some of these question areas, but in varying degrees of depth. The literature that is available m. 56 comes from three principal sources: public health education, nurs— ing, and hospital management literature, and most of it is written by people with either nursing or public health education backgrounds. There is especially a lack of material on patient education from the perspective of physicians, allied health professionals, and adult educators. Task Assumed in This Study This study has sought answers to some of the questions raised in the previous section. The study contains an analysis of opinions of hospital professionals (physicians, nurses, adminis— trators, allied health professionals, and patient education staff toward hospital inpatient education. The study has sought judgments of professional workers in Maine hospitals concerning the following areas: 1. Importance of patient education for adequate health care. 2. The scope of hospital inpatient education. 3. Content areas. Roles of professionals in the planning, implementation, 4. and evaluation of patient education. 5. Roles of patients and their families in the planning, implementation, and evaluation of patient education activities. 6. Role of hospital in follow-up of discharged patients who need further patient education. 7. Constraints to the development and implementation of patient education activities. 8. Feasibility of the development or expansion of formal patient education programs. The review of literature helped in formulating the study. First, it helped to define the parameters of the study. The litera-, ture identified three major segments of hospital patient education, including community health education, out-patient education, and inpatient education. The investigator chose inpatient education as the area for this research. Second, the review assisted the investigator in determin— ing which professional hospital staff should be included in the study. The literature stressed the importance of having physicians, nurses, allied health professionals, administrators, and desig- nated patient educators involved in the development and implemen- tation of patient education programs. These groups therefore were chosen to be included in the study. Third, the review helped to identify what Specific objec- tives the study Should include. The objectives were chosen because of a lack of data in the literature on certain aspects of patient education. Fourth, the review assisted in the development and adminis- tration of the questionnaire. It helped to put the questions into the language and context of the hospital health care providers. Fifth, the review provided a foundation for a comprehen- sive conception of patient education by including its history, its importance in the health care field, and the patient education process. ———'~“—kf* * * _,,,,_,ms--__ CHAPTER III METHODOLOGY The general procedure used in this study to achieve the purpose described in chapters one and two was survey research. A mail survey was sent to health care professionals working in Maine community hospitals to ascertain their Opinions about patient education for hospital inpatients. Responses to the ques— tionnaire served as the data base for the analyses Of this study. Chapter three is divided into the following sections: 1. 2. Objectives of the study Endorsements for the study Pre-survey Sample How sample was chosen Instrument Administration of instrument Display and analysis of data Objectives of the Study The Specific objectives the study addressed are outlined below. The term hospital professionals refers to the five cate- gories of hospital professional personnel referred to in chapter one of this study. The term sub-group refers to each of these 59 60 five categories as individual professions. The specific objectives To ascertain whether hospital professionals collectively believe patient education is an important component of adequate inpatient care. To ascertain whether each professional sub-group believes patient education is an important component of adequate »inpatient care. To ascertain whether there are differences of belief among sub—groups on whether patient education is an important component of adequate inpatient care. To ascertain how hospital professionals collectively define the type of patient education for hospital inpatients. To ascertain how each professional sub—group defines the type Of patient education for hospital inpatients. To ascertain Whether there are differences among the sub- groups in the definitions of the type of patient education for hospital inpatients. To ascertain which patient education content areas hospital professionals collectively believe are appropriate for inclusion in hospital programs of patient education. To ascertain which patient education content areas each professional sub-group believes are appropriate for inclu- sion in hospital programs of patient education. 61 To ascertain whether there are differences among the sub- groups in the content areas believed to be appropriate for inclusion in hospital programs of patient education. To ascertain how hospital professionals collectively define the overall roles of professionals in planning, conducting, and evaluating patient education. To ascertain how each professional sub-group defines its role and the roles of other professional sub-groups in planning, conducting, and evaluating patient education. To ascertain whether there are differences among the sub— groups in the roles that they have defined for themselves and other professional sub-groups. To ascertain how hospital professionals collectively define the role(s) of former patients in planning, conducting, and evaluating patient education. To ascertain how each professional sub-group defines the role(s) of former patients in planning, conducting, and evaluating patient education. To ascertain whether there are differences among the_sub- groups in the role(s) that they define for former patients. To ascertain how hospital professionals collectively define the role(s) of the families of present and former patients in planning, conducting, and evaluating patient education. To ascertain how each professional sub-group defines the role(s) of the families of present and former patients 62 in planning, conducting, and evaluating patient educa— tion. To ascertain whether there are differences among the sub— groups in the role(s) they define for families of present and former patients. To ascertain how hospital professionals collectively define the hospital's role in the follow—up of discharged patients who need further educational services. To ascertain how each professional sub-group defines the hospital's role in the follow—up of discharged patients who need further educational services. To ascertain whether there are differences among the sub- groups in the role(s) they define for hospitals in the follow-up of discharged patients who need further educa- tional services. To ascertain what the respondents collectively identify as the constraints inhibiting development and implementation of hospital patient education activities. To ascertain what each of the individual sub-groups iden- tifies as the constraints inhibiting development and implementation of hospital patient education activities. To ascertain whether there are differences among the sub— groups in the constraints they identify as inhibiting development and implementation of hospital patient educa— tion programs; 10. ll. 63 . a. To ascertain whether hospital professionals collectively believe there is a need to initiate or expand formal patient education programs in their hospitals for inpatients. b. To ascertain whether each professional sub—group believes there is a need to initiate or expand formal patient edu- cation programs in their hospitals for inpatients. c. To ascertain whether there are differences of opinion among sub—groups on whether there is a need to initiate or expand formal patient education programs in their hospitals for inpatients. a. To determine which major illness categories pose, in the judgment of hospital professionals collectively, the great- est need for formal patient education programs. b. To determine which major illness categories pose, in the judgment of each professional sub~group, the greatest need for formal patient education programs. c. To ascertain whether there are differences of judgment among sub-groups on which major illness categories pose the greatest need for formal patient education programs. To ascertain the relationship between hospital size and variance in respondents' answers to the following question areas: a. Which patient education content areas hospital professionals collectively believe are appropriate for inclusion in hos- pital programs of inpatient education. 64 b. Which patient education content areas each professional sub— group believes are appropriate for inclusion in hospital programs of inpatient education. c. How professionals collectively define the overall role of professionals in the planning and conducting of patient education. d. How each professional sub-group defines its own role and the roles of other professional sub-groups in planning and conducting of patient education. e. Whether hospital professionals collectively believe there is a need to initiate or expand formal patient education programs in their hospitals for inpatients. f. Whether each professional sub-group believes there is a need to initiate or expand formal patient education programs in their hospitals for inpatients. . To ascertain the relationship between the existence of operat— ing formal patient education programs in hospitals and variance in the respondents' answers to the following question areas: a. Which patient education content areas hospital professionals collectively believe to be appropriate for inclusion in hospital programs of inpatient education. b. Which patient education content areas each professional sub— group believes to be appropriate for inclusion in hospital programs of inpatient education. 13. 65 How professionals collectively define the overall role of professionals in planning and conducting of patient educa- tion. How each professional sub—group defines its own role and the roles of other professional sub-groups in planning and conducting of patient education. Whether hospital professionals collectively believe there is a need to initiate or expand formal patient education programs in their hospitals for inpatients. Whether each professional sub-group believes there is a need to initiate or expand formal patient education pro- grams in their hospitals for inpatients. To ascertain the relationship between hospital professionals' experience with formal patient education programs and variance in their answers to the following question areas: a. Which patient education content areas they collectively believe to be appr0priate for inclusion in hospital programs of inpatient education. Which patient education content areas they, by professional sub-groups, believe to be appropriate for inclusion in hospital programs of inpatient education. How they collectively define the overall role of profes- sionals in planning and conducting of patient education. How they, by professional sub-groups, define their own roles and the roles of other professionals in planning and con- ducting of patient education. 66 Whether they collectively believe there is a need to initiate or expand formal patient education programs in their hospitals for inpatients. Whether they, as professional sub-groups, believe there is a need to initiate or expand formal patient education programs in their hospitals for inpatients. l4. To ascertain the relationship between the amount of training in patient education and/or related areas (e.g., education methods, health education, adult education) respondents report and vari- ance in their answers to the following question areas: a. Which patient education content areas they collectively believe to be appropriate for inclusion in hospital pro- grams in inpatient education. Which patient education content areas they, by professional sub—groups, believe to be appropriate for inclusion in hospital programs of inpatient education. How they collectively describe the overall role of profes- sionals in the planning and conducting of patient education. How they, by sub—groups, define their own roles and the roles of other professionals in the planning and conducting of patient education. Whether they collectively believe there is a need to initiate or expand formal patient education programs in their hos- pitals for inpatients. 67 f. Whether they, as professional sub-groups, believe there is a need to initiate or expand formal patient education pro— grams in their hospitals for inpatients. Endorsements for the Study Various groups and individuals in Maine hospitals and the health education community provided endorsement and assistance for this study. This was sought for four primary reasons. The first was to gain access to statistical materials and other types of data on the hospitals. This material was needed to both determine and carry out the sampling procedures. The second reason was to have assistance in the develOpment and formative review of the questionnaire. The third was to help assure a better return rate on the mail questionnaire. Fourth, the data generated from the study will be disseminated to these and similar interested parties. Specific endorsements for the study were obtained from the following associations and groups: l. Research and Education Trust of the Maine Hospital Association. 2. Maine Health Education Resource Center of the Univer- sity of Maine at Farmington. 3. Maine Medical Association. Pre—Survey A pre-survey of hospital administrators in fifty-one Maine community hospitals was conducted by telephone. The purpose of this pre-survey was threefold: 68 l. to determine the number of professional personnel by categorical groups who worked in Maine community hospitals; 2. to determine which hospitals had operating patient education programs; 3. to obtain names of hospital personnel who were actively involved in patient education programs. For the purpose of the pre-survey, professional hospital personnel included the following groups: Physicians--Physicans (M.D.'s and D.0.'s) who were employed by and/or had active staff privileges at Maine community hospitals. Burgesf-Registered nurses and licensed practical nurses who were employed either full— or part-time in community hOSpitals in Maine. (Only nurses who worked twenty hours a week or more were included in the final survey.) Hospital Administrators-~The chief executive officer of each community hospital in Maine. Allied Health Professionals--Physical therapists, occupa- tional therapists, dietitians, pharmacists, social workers, and speech therapists who were employed either full- or part-time by Maine community hospitals. Patient Education Staff--Staff of Maine community hospitals who were employed either full- or part-time as either coordinators (directors) of patient education programs or patient teachers. 69 A hospital was considered to have a formal patient education pro- gram if it had in operation one or more planned patient education programs with written goals and objectives for its inpatient popu- lation. The pre—survey was conducted by telephone by the investi— gator. Since Maine hospitals receive numerous mail questionnaires, personnel from the Research and Education Trust of the Maine Hos- pital Association advised that the pre-survey be done via telephone. Also the types of data needed necessitated communicating with two or three departments in some hospitals and this was better facili- tated on the telephone. Prior to the telephone call a letter from the Research and Education Trust was sent to the chief executive officer in each hospital indicating that the investigator for this study would be calling and for what purpose. The specific questions on the pre— survey telephone questionnaire relating to patient education were adapted from the American Hospital Association's Survey Form on Inpatient Hospital Education Programs.1 A copy of the letter sent to each hospital and the telephone questionnaire form can be found in Appendix A. All hospitals in Maine, a total of fifty-one, officially listed ascommunity hospitals were contacted. Forty—nine hospitals responded to the telephone pre-survey. One of the forty-nine 1American Hospital Association, "Survey Form on Inpatient Education Programs“ (Chicago: American Hospital Association, l975). 70 respondents was found to be not a community hospital but a long- term health care facility. Thus the total of Maine community hos— pitals comprising the population for the study was forty-eight. Data from the pre-survey indicating the total number of professional personnel found to be working in the professional categories included in the study in Maine h05pitals was as shown in Table l. There was a total of 6,299 professionals working in the 48 Maine community hospitals as of March 1977. The largest number of professionals, 2,6l0, worked in hospitals with over 200 beds, followed by l,706 professionals in the 50-99 bed hospitals, l,299 professionals in the l00—l99 bed hospitals, and 684 profes- sionals in the 0-49 bed hospitals. A detailed breakdown by indi— vidual hospitals of all personnel can be found in Appendix B, Summary of the Pre-Survey Results. i Data indicating whether or not Maine community hospitals in various size categories had formal patient education programs established or in the planning stages are presented in Table 2. Twenty of the hospitals had established formal patient education programs; eight hospitals were in the process of developing formal programs; and the remaining twenty hospitals did not have formal programs. A more complete summary of the patient education portion of the pre-survey can be found in Appendix B. Following the telephone pre-survey a follow-up letter was sent to the chief executive officer in each hospital. The letter thanked each executive for his/her participation in the pre—survey 7l . z—_mFumamm m m w>wuum w>mc mwmcm swag: cw . wmomwwmwwwwmmpwwmwpum cm ucmmmcawc we: mwov umpcoamc mcmwuw u: . . . .mcmTowmzca Acme mzsa mo gangs: _a ._wpwamo; I’ll! m¢_ we om N_m Neqe N ammo we “mm m e_ mm_ mem— o_om m mN_ N N em wa «mm A m N_ w MN NNN_ ”mm e_ woe_ m_ 0 am mow oo_ @— «mm . mquwamo: campm coca o -mewmmw covumuzcm gume: mmmczz amcmwuwnga me532 _apoe _aprmmoz Heavpaa uaw__< wco cmzu wLoE mm m:m_owmxca mo you wspm fililifil'lll mFmpop Lm>o uca mvwa oom mvwa mm_uoo— mvwn monom mums awro I!!! anm Papwamoz _ CM .NN®_ SULGE $0 m0 wwwawoz $0 wNwm U . LOONHMO _MCOPmmeOLQ %D w_GHrQWO£ XHFCJEEOU wcwmz Cw _wCCOmeQ _MCmemw%OLQ $0 meDEJZII _ 0—20— % . . . 72 Ne ON op m Ne ON N _ o o mJIlllfll o m m m N _ m w o_ m up w mN N_ o o m_ N m_aptamox _~< co : mmmpcwocma cone 2 m_epwamoz __< co wmmpcmocma cmnsaz m_apwamoz __< co wmmpcmugma LmnE:z mswcmocacompmuzumpcwwwmm _mEeoa oz gut: mpmpwamoz mEmLmoca cowpmuzcm pcwwpmm Pesto; mcwaopm>wo we mmmum mCTCCNFQ mgu cw WFapwamoz msmgmoga cowumosvm “smegma Peace; emcmr_neummcpw3m_apwamoz ‘1/ mpmpok cw>o ace mvwn oom mumn mm_noo_ mvmn mmiom mums owno f anm _ap_amoz .mmm_ gate: to we pamEaOFm>mu mo macaw use Pmpwqmo; do wNwm an m—mpwamo; xpwcaseoo mcwmz c? mamgmoca cowpmusz pcmwpma mo :owuznwcpmwaln.m wFQoH 73 and for the information provided. Sample copies of the letters ' that were sent are included in Appendix 8. Sample The primary data for the study were generated from a mail questionnaire survey. The questionnaire was sent to a random sample of professionals identified through the pre-survey as work- ing in Maine community hospitals. The five groups of profes- sionals surveyed were as described both in chapter one and in the pre-survey section of this chapter. The community hospitals in Maine were stratified into four size categories according to number of beds. In addition to stratifying the hospitals by size, the hospitals were also clus- tered within those strata by whether or not they had formal patient education programs. This ensured that hospitals with and without programs were selected for the study. Twenty—four hospitals, one-half of which had patient education programs and one—half of which did not, and in numbers as nearly as possible proportional to the number in each size category, were chosen through a random number table for inclu- sion in the study. Hospitals in the process of planning pro— grams were included in the group of hospitals which did not presently have formal operating programs. Distribution of the population and the survey group by hospital size and whether the hospital had formal patient education programs is displayed in Table 3. 74 mF a «F OF mm om "much Lw>o Ucm m _ m F o _ wumn mm~-oo_ v v v v m m mumn mm-om m m m m NF N mvmn mq-o mamcmocm mEmLmoca mEmLmoLa mEmLmoca mEmLmoca msmcmoca cowumuzum cowpmozvm cowpmuzum cowamosum :owumosum :owpmuzum p:m_umm pcmepma pcmyymm pcwwpma pcmmpma pcvamm mNFm fiasco; _mELom FmELOd _mEcom FwELOd FmELOd quwmmox pzocpwz spwz “secpwz 5pm: pao:ww3 cpwz vm>wmuwm mam: mmmcoammmcuwczcacm m_mpwamox to congaz asoco Am>c=m wzp Low :wmocu mquwamoz to Lmnsuz cowumF=aoa :w m_mpwqmoz to conszz .Emcmoca cowuausum pcmwpma _eELo*m um: _muwamogocp Locumcz ucm wNwm Fmpwamo; an Uw>wmuwc mew; mmmcoammc sows: Eocw Ugo .azogm >w>gzmm5p cw .:o_pm_:aoa ecu cw WFvaamo; mo cwnssz--.m mfinmp 75 Five of the hospitals originally chosen declined to par- ticipate in the study. Four of these hospitals could not release names of their employees due to hospital policy. Lists of employees from the fifth hospital, though promised, were never received. Replacements for three of the five hospitals were found, again chosen through a random number table. Two of the hospitals, both in the over 200 bed size, could not be replaced. There was no replacement hospital available for one of those hospitals as it was the only over 200 bed community hospital in Maine that did not have a formal patient education program. The second hospital could not be replaced due to the personnel policies of the remaining over 200 bed hospitals which did not allow names of their employees to be released. The total number of hospitals included in the study thus became twenty—two, with all size categories except that of over 200 beds proportionately represented.1 All of the professionals, except for the nurses, in each of the selected hospitals were surveyed. One—third of the nurses employed by the selected hospitals were chosen by a random table of numbers for inclusion in the study. Due to the low numbers of patient education staff and the nature of the study, all members of this sub-group in Maine, including those in non—selected hos- pitals, were included in the survey. Table 4 describes the dis- tribution of professional workers included in the survey by 1See Appendix C for a list of participating hospitals. 76 .xm>;:m an» cw uwua~ucv ugw: m_ouvamoc Au_:==zau ocwmz xcu Eogw zgomoucu pmcowwmmwoLa mmgu cw «comcwa ppm mm_uu¢amog nouuw_om NN as» on vmuws_y ac: mew: wwaum cowumuzum u:w_ucao awn «Na o w_m —m_ MNF mQF oN_ mm mm mpmuo» was me mpcpe F_ F_ - F F m a a o m u waw_mmwn .. .. acumum cow» _ mm .. v— _ F m o icosum acmwuom m mac—mmw o; _m m__ -- Nw a N_ o_ m, o m gh_aar umwppm um_ mmm -- «mp mm Fa mw _~ mm NN mwmcsz cw— mmw .. “mm _m m_p om mm me NN mcm_0wmx;a Emgmogm Emcmogm Enema»; Emgmocm Emcmoca Emgmocm EQLmoca Eocmoca Emgmoca Emgmoca cowumuavm :o_umu:vm cowpcuavm cowumuzum cowucuacm :owumuzcm cowumuzuw cowumoacm :o_umu=cm co_umo:uu bedroom acetone ueowuma acetone u=m_uea u=a_uma u=w_pma beawuma “corona acmwuaa pastel ~m=§ou Fasten _wccom _mecom _mELou Pegged pesto; Pascal ”mELom a uaocu_2 saw: unocuw: saw: usozuwz saw: unocuw: cum: usozpwz gum: ~mcopmmuwoga ANN u 2v A. " 2v Av " zv Am " zv Am " zv . Pouch Lo>o a muwm com muwm amploop wvwm mm-0m mvwm ovio _mu_amo= co m~_m .Emcmoga co¢umosvm acmwuma _mELow m to: quwqmo; mg» go: go cwguwgz use qu_amo; we m~_m .azocm pacowmmmwogu x2 am>czm mzu :_ kuspu:_ wwaxoz chowmmmwoca mo Luasaz--.v anmp 77 professional group, size of hospital, and whether or not the hos- pital had a formal patient education program. The lists of professionals were obtained by sending a letter to the chief executive officer of each hospital chosen, outlining the study and asking for cooperation in the study.1 The letter was followed up by a telephone call from the investi- gator. As stated above, lists were provided for all except two hospitals. W The survey instrument was a mailed questionnaire. It consisted mostly of closed ended, multiple choice type questions.2 The questions were developed based on information obtained from the literature reviewed, outlines of operating programs and inter- views with people actively involved in the patient education field.3 The questions focused on the importance of patient edu- cation; roles of professionals, patients and families of patients; evaluation; program content and organization; and feasibility of developing patient education programs. There were also questions on the respondents' professional background, their experience with formal patient education, and their attendance at educational programs in or related to patient education. The instrument was six pages in length and professionally printed on yellow paper. 1See Appendix C for a copy of the letter. 2See Appendix D for a copy of the instrument. 3See Appendix F for a list of the people consulted. Me Sc WE mu ho se Do ma inl 78 A team of individuals reviewed the preliminary draft of the survey instrument for content and face validity. After the pre—testing of the instrument it was revised and the same team reviewed it again. The team represented both the kind of profes- sional people who received the instrument and specialists in survey research. The reviewers included: (l) Dr. William Bristol, M.D., Medical Care Development, Augusta, Maine; (2) Mrs. Lois Estes, R.N., Director of Inservice and Patient Education, Eastern Maine Medical Center; (3) Mr. Larry Nanney, Director of Long Range Planning, Mid—Maine Medical Center; (4) Ms. Ann Spencer, Director of Occupational Therapy, Eastern Maine Medical Center; (5) Mr. Michael Skaling, Director, Project RISE, Waterville, Maine; (6) Dr. John Roser, Executive Director, Maine Health Education Resource Center; (7) Dr. Louis Ploch, Professor, Department of Agricultural and Resource Economics, University of Maine at Orono; and (8) Dr. Kenneth Hayes, Director, Social Science Research Institute, University of Maine at Orono. Changes were made in the instrument according to their recommendations. The pre—test of the instrument was done with a Maine com- munity hospital that had not been chosen as part of the group of hospitals to be surveyed. This hospital had on its staff repre— sentatives of all of the professional groups that were in the population. A total of fifty-seven people, which is approxi— mately 5 percent of the number in the surveyed group, were included in the pre-test group. 79 Administration of Instrument The survey instrument was sent through the mail to all professionals chosen to be part of the study. A return self- addressed stamped envelope was included with each questionnaire. The return envelopes were pre-coded to indicate the size of hos- pital, whether or not the hospital had a formal patient education program, and to whom it had been sent. A different cover letter was used for each professional group. The hospital administrators' cover letter was from the investigator, as she had had numerous contacts with this group concerning the proposed study. The cover letter to physicians was on stationery of the Maine Health Education Resource Center (HERC) of the University of Maine at Farmington and was signed by Dr. Richard Chamberlin. Dr. Chamberlin, a physician, was a member of the Advisory Board of HERC and the medical advisor to Maine's Professional Standards Review Organization for physicians. The cover letter for nurses and patient education staff was also on HERC stationery and was signed by Dr. John Roser, the executive director of that organization. The cover letter to the allied health professionals was on stationery from the Research and Education Trust of the Maine Hospital Association. It was signed by Douglas Kramer, Program Coordinator of the Research and Educa— tion Trust. Copies of the cover letters are included in Appen- dix D. Three separate mailings were sent. The first mailing included the survey instrument, cover letter, and a self—addressed 80 stamped envelope. The second mailing consisted of a reminder postcard. It was sent three weeks after the first mailing to those who had not returned the survey form. The coding system permitted this determination to be made. The third mailing con- sisted of a second cover letter, with another c0py of the survey instrument and return envelope. This mailing was sent two weeks after sending the follow-up postcard and only to those who had not returned the survey form. Follow-up cards and letters were signed for each sub-group by the same person who had signed the original cover letters. Copies of the follow-up postcards and letters can be found in Appendix E. Display and Analysis of Data The data generated from the mail survey are displayed and analyzed in the following chapter. The display shows how all professionals, collectively and by each professional sub-group, responded to each question. The first analysis included both an examination of how each sub-group responded and a comparison among the sub-groups to determine if there were differences among sub-groups in the way that they responded to each of the questions. Further analyses investigated the responses to selected questions in relation to four additional variables.' Two of the variables related directly to the employing institution (size and whether or not the hospital had a formal patient education pro- gram). The other two variables centered on the background of the professional staff (their experience and training in patient 81 education). Three question areas (content, roles of the profes— sionals and feasibility of developing or expanding formal patient education programs) were the focus for these analyses. Data on the first variable, the size of the hospital, were analyzed to determine if differences in the ways respondents answered the questions were correlated with the size of the hos- pitals where they worked/practiced. The hospital size was divided into four categories: (l) l-49 beds, (2) 50—99 beds, (3) lOO-l99 beds, and (4) 200 beds and over. As only one over 200 bed hospital was included in the study, the investigator has little confidence that the opinions of professionals in that size category are generalizable. Data on the second variable, whether the hospital had an operating formal patient education program, were obtained from the pre-survey reports.1 They were analyzed to determine if there were relationships between the ways respondents answered the ques- tions and whether their employing hospitals had formal patient education programs. Data on the third variable, whether or not professionals had had experience with formal patient education programs, were obtained from the general information section in the question— naire. Experience with formal patient education programs included present or past involvement with such programs. This third analysis determined if there were relationships between the 1See Appendix B, Summary of Pre—Survey Results. 82 ways respondents answered the questions and whether or not they had had some involvement with formal patient education programs. Data on the fourth variable, whether professionals had had special training in patient education or related educational areas (e.g., adult education, educational theory and method, health education) were also obtained from the general information section of the questionnaire. This fourth analysis determined if there were relationships between the way respondents answered the ques- tions and whether or not they had had some training in patient education or related educational areas. The three professional sub-groups included in these four analyses, except for the one involving hospital size, were physicians, nurses, and allied health professionals. The responses of the two other professional sub-groups, patient education staff and hospital administrators, were examined but because of the group's small sample sizes meaningful statistical analysis was not possible. The responses of the allied health professionals were also not fully analyzed in relation to hospital size. This was due to the very small number of those workers in hospitals, especially those under 50 bed capacity. The data analyses were done using the Statistical Package for the Social Sciences at the University of Maine Computing and Processing Service. The description of how all professionals collectively and how each sub-group responded to the questions was done in simple percentages. Chi square tests of independence were used to ascertain whether there were relationships between 83 the various factors and the variance in respondents' answers to chosen questions. In most cases a significance level of .05 was used in the chi square analyses. The findings and the interpretations of the data are presented in chapter four. The data are presented in several ways. First a display shows how all professionals, collectively and by sub-group, responded to each question concerning patient education. The data are then analyzed to ascertain the relation— ship between professional sub—groups in their judgments on each question. Finally, the data are analyzed to ascertain how responses varied in three of the questions in relation to four other variable factors (size of hospital, whether the hospital had a formal patient education program, experience of respondents with formal patient education programs, and respondents' training in patient education). This is done both with and without regard to professional classification. A summary of the study, the conclusions, and the impli- cations for research and practice follow in chapter five. CHAPTER IV RESULTS OF THE STUDY Chapter four includes a description of the respondents and the major findings of the study. The major findings include the opinions of both the total respondent group and each professional sub—group on issues relating to the organization, development, and implementation of patient education for hospital inpatients. The chapter is divided into six sections: (l) respondents; (2) ratings of importance of patient education and selected content areas; (3) roles deemed appropriate for health care professionals, patients, and families of patients in the planning and conducting of patient education activities; (4) ascribed responsibility for evaluation of patient education; (5) judgments about organization of patient education; and (6) judgments as to feasibility of developing or expanding patient education programs. Respondents The respondents are described by: (l) professional group, (2) size of hospital where they practiced, (3) whether they practiced in a hospital that had a formal patient education program, (4) their involvement in patient education activities, and (5) their previous attendance at classes on patient education or related educational areas. 84 85 The data on professional groups, size of hospital, and whether or not each hospital had a formal patient education program were obtained from available records and from the pre-survey as pre— sented in chapter three. They were precoded and combined with data from the questionnaire. The data on professional background, respon- dents' involvement in patient education activities, and respondents' previous study in patient education or related educational areas were obtained from the general information section of the question- naire. One thousand, three hundred and eight questionnaires were sent in the original mailing. Sixteen of these were returned as not deliverable. Of the l292 presumed to have been delivered, 762 were returned, for a total return rate of 59%. Of the returns, 720 were usable, for a usable return rate of 56%. These data are dis— played in Table 5. Table 5.—-Questionnaires mailed and returned by number and percentage. Number Percent Mailed l308 lOO Not delivered 16 l Presumed delivered l292 99 Returned 762 59 Not usable 42 3 Usable L 720 56 86 The forty—two non—usable questionnaires were returned without the requested data. Twenty-two were returned incomplete with no explanation. Twenty were returned incomplete with one of the fol- lowing reasons given: (l) do not have the time to complete, (2) do not work with hospital inpatients, (3) do not work/practice in the hospital, or (4) questionnaire too complex. Non-respondents included persons from whom there were no replies and those whose question- naires were received after the closing date. The closing date was July l5, l977, eight weeks after the original mailing (May 22, 1977). Basic data for this investigation, except as otherwise specified, came from the 720 usable questionnaires which represented 56% of those contacted and l3% of the overall population of profes- sionals in Maine community hospitals. The numbers of usable responses as a percentage of either populations or numbers surveyed across the five professional groups were not equal. They did, however, provide reasonably proportional representation for all five groups. The patient education staff and hospital administrators had the highest response rates, 87% and 82% respectively, of those surveyed. These were followed by the allied health professionals (69%), nurses (58%), and physicians (49%). Physicians, with an estimated population of l325, were represented in the study by 298 respondents (22% of their popula- tion) and constituted 41.3% of the respondent group. Nurses, with an estimated population of 3835, were represented by 278 respondents (7% of their population) and constituted 38.6% of the respondent group. Allied health professionals, estimated to number 328, were 87 represented by 100 respondents (30% of their population) and consti- tuted 13.9% of the respondent group. Hospital administrators, a much smaller population (50), were represented by 18 respondents (36% of their population) and comprised 2.5% of the respondent group. Because the patient education staff from all community hos— pitals in the state (30 in total) were included in the survey, the 26 respondents comprised 87% of the population. However, they con- stituted only 3.6% of the respondent group. In sum, the final sample, comprised of 720 respondents, represented approximately one-eighth (12.9%) of the health care professionals in Maine community hospitals. The largest profes- sional sub-groups, physicians and nurses, comprised the largest portions of the responding sample; hospital administrators and allied health professionals had representation roughly proportional to their populations; and patient education staff, though repre— sented much more heavily in relation to their small population, comprised the next to smallest portion of the final sample. Data on respondents in each professional sub-group as a percentage of the population, of those surveyed, and of the final sample of 720 respon— dents, are presented in Table 6. Both in hospitals with formal patient education programs and in those without programs, numbers of respondents were closely pro- portional to numbers in practice in each of the several bed-size hospitals. The 50 to 99 bed hospitals, both those with and those without formal patient education programs, were slightly over .nnmp we coca: cw gouuuwuma>cw use an uwuw_nsoo m—mu_amo; wcwa: we Au>g=muuga ms» soc» must :0 women mLmz wmuae_umw mgh .Louumwumm>:_ wgu an uwumewumm ma: mnaocuinzm —m:owmmomocn An mpmuwnmo; xuwcassoo wcmmz :_ mcmxco: Fucowmmmwogn mo cowum_=noa wchm 92.. 92 3 OS 92: N.NN Na: 9.2: 83 238 3 9: Na 2 ON 93 NN o. 8 -WEEB human . m m an 0.8 g 8 ON 0.2: cm m on 8.58:3 2&8“; MW . . . . . mpm:o_mmwwocu a 2 c on 8 2: o : N s. m: m m mNm £22 8:: 3m -- 8 SN EN 9N, 8.. 98 £3 82:: ms CNN 3 RN 9:. NS NS .28 mNS 2:22.: mucmvconmux :owumpzaoa mucwwawuom mucwwa_umx —~< cowum~zao¢ mpacovmmwwOLa we «cwugma we acoogwa co ucmucwm consaz we ucwucwm mo acmucmm Luaszz prmo acmugwa Loganz —mcMnmmwmocn mucoucoammz mgwmccowumwso wucwwa_uwm mgwmccowummao acomum_:aoa . .gumm an caucwmwgaoc mucwvcoamwc wc_mc=owumw=c can .mucmwawumg mcpmccowummzc .mgmxcoz chowmmmmoga ~p~ we mwmmucwocwa wgu use mpcqumo; zuwczssou wcwmz cw mnaogmunsw —m:owmmmmocq cw mcomcwq to mwmoucwucmq van mgwnE=zui.w mpaah 89 represented, while hospitals with 100-199 beds were slightly under represented. Data are presented in Table 7. Table 8 presents data on distribution and level of respon- dents' involvement in both formal and informal patient education activities. The patient education staff were the most active in formal patient education programs for inpatients with 88.5% of the respondents reporting very active or somewhat active involvement. The allied health professionals displayed the second highest rate of involvement with 43.4%, followed by the physicians (33.5%), hos— pital administrators (31.3%), and nurses (26.5%). All of the responding groups described themselves as more active in informal patient education activities than in formal ones. One hundred percent of the patient education staff reported ”very active" or ”somewhat active” involvement in informal patient edu- cation. Of the nurses 79.7% described themselves as involved there, followed closely by allied health professionals at 78.1%. Sixty- eight percent of the physicians and 35.3% of the hospital adminis— trators reported themselves involved in informal patient education activities. A large percentage of patient education staff indicated they had attended programs or classes on patient teaching (72%) and/or on topics related to patient education (82.6%). Approxi- mately one—third of each of the remaining groups, except for adminis— trators, had previously attended classes or programs on or related to patient education. The data concerning respondents' previous Fr 90 -- -- o.nm N.mm Lm>o use mums oom m.m_ N.ON m.N N.m . mean ¢m_-oo_ m._w p.mF N.__ N.m mums mm-om o._— m.o~ w.m ¢.m mums mv-_ mpcwncoammm m_m:0wmmmmoga mucwucoammm mfimcowmmmmoca mamcmoca :owumosum pcmvuma PmELom usospwz mEmLmoca cowumozum pcwwpmm FmELom :pwz mpmpwqmo: c? umowpomca _ap.amoz to aN.m .mem Fmpwamo; kn mEaLmoca :owpmusvm pcwwpma —oscom “segue: Ucm Luv: wrapwamo; cw vmowpowca 0:3 mpzmucoammc do vcm m_m:owmmmmoca to mmmmpcmocwa-u.N mFDmH 91 m.mm N.m¢ _.mm N.mm m.¢m w.m asocm pcwucoqmmc Fmpop 5% «.mN 3 0.8 W: 0. 28255552 5558: 0. N2 mg 9: N2 m2 .53... 85828 5652 EN 93 gm 2... SN 9.: 228380: 5:2 8:2 m.oN m.nm w._N m.mm o.N_ m.m mmmcsz o.~m ¢.mm m._m m.om N.¢N m.m mcmwumeca $.52 $.52 $.52 $.52 2.52 2.52 poz pmczmsom Acm> poz pmszweom xsm> 8.5.5.52 8.5.5.52 covpmo=UM pcwwpma _mELO$:H covpmosum pcmw5ma _wELod .mpcmwpmacw quTQmo; Low wwwpw>wpum :owpmuzcm pcmwpma FmELowa new Foecow cw pcmem>_o>cw swag“ mo m~w>m_ ucm um>Po>cquocm-nzm_m:owmmwwocq Loam we mmmpcmucma--.m anmp m masoco-n:m chowmmmmoga " i _ 92 involvement in programs or classes on patient education or related areas are found in Table 9. The types of programs or classes on patient education and related areas attended by respondents covered a wide variety of tOpics and had many formats. The topic areas most often listed were diabetes, cardiac rehabilitation, ostomy care, prenatal care, and patient teaching. The types of formats included college courses, television courses, hospital staff meetings, conferences, workshOps, pre-professional medical training, audio-tapes, and hospital classes. In summary, the final sample included 720 respondents, representing approximately one—eighth (12.9%) of the health care professionals in Maine community hospitals. Physicians (41.3%) and nurses (38.6%) comprised the largest portions of the responding sample, followed by allied health professionals (l3.9%), patient education staff (3.6%), and hospital administrators (2.5%). Both in hospitals with formal patient education programs and in those without programs, numbers of respondents were closely proportional to numbers in practice in each of the several bed-size hospitals. All respondents had more involvement in informal than formal patient education programs. Patient education staff had the most involvement in both formal and informal programs. Patient education staff also had most often attended programs on or related to patient education. ' __..;...'. .;m.za__v_;. .. 93 _.om . . covpmuzcm w wF w Nw m._m m.om m.mN pcmwpma o» cmpm_mc momma—o Lo mEmLmoca c a o o I 0 o Q 2 om m Fm o NN m _m o mN m mN cmWWMMflwmcwcmhwmmomM masocw mcoumcp wmmpm mchowmmwwoga __< 40 -mwcwsv< cowumuzvm :mem: mmmcsz m:m_umeca :58 2538: 5552 8:2 . . .cowpmosnm pcmwpma op umpNch go :o mmwmm~u Lo msmcmoga umucmuum szaow>qu we: on: mazogm-n:m chormmmwogq >n mpcmucoamwc to wmmpcmucma--.m m_nmh 94 Rating of Importance of Patient Education and Selected Content Areas This section describes both the respondents' views on the general importance of patient education as a component of patient care and the importance of eight selected content areas as elements of a hospital's patient education program. General Importance of Patient Education A large proportion (79%) of the total respondent group believed patient education to be an extremely important component of patient care for hospital inpatients. As shown in Table 10, 44% believed it to be extremely important for all patients, while 35% believed it to be extremely important for some patients. Most physicians rated patient education as an important component of care for hospital patients, but not all of them did so. Approximately two—thirds of them believed patient education to be extremely important (30.7% for all patients, and 36.9% for some patients). Another one-fourth of the physicians believed it to be of moderate importance, but 4.5% believed it was either of little importance or undesirable. Three percent indicated that they did not know. Nurses were more fully agreed about its importance. Eighty- six percent of them believed patient education to be an extremely important component of patient care; 55.1% believed it to be extremely important for all, and 30.4% extremely important for some. Approximately 12% of the nurses believed it to be of moderate 95 o.N o. o. 2.2 2.2 _.m 30:2 5.202 2. o. o. o. o. 2.5 aNnmeNmmuea . . . . . . mocmpcoasw N 5 o o o N m m a_555_ No mEom Now 2.2 o. o. o.N 2.m N.N_ 522550252 22mpmcmooz __2 Loo N.QN N.2_ 2.2 o.__ N.m 2.N2 5225;0255 22mpmemooz meow Now N.2m 2.2m N.22 o.m2 2.2m 2.2m 522550222 apmsmcuxm :m Low 2.m2 2.22 2.2N 2.22 _.mm m.om 5ca5eoaeN 22msmcuxm NONuz NNHZ oan oo_uz 2NNuz NNNuz . ozogw mcopogp Ntopm mpmcowmmwmoga mucoucooEH pcoocoamom -mwcwso< cowumoaom guFMm: momcsz mcmwowmxna 2o Pm>o4 .mpoN .2522moz 5222522 222222 .mpcmwpoocw Nmpwamo: com cowpmoaom ucmwpma op oucmpcoos2 mo m_m>mp oopom_mm omogooom oz: ozogm pcmocoammc Fmpou ocm monocmipam PocowmmoNoNa >3 mpcmocoammc yo mmmgcmogmmni.o_ mNnmN 96 importance, with less than 1% indicating patient education was of little importance. None believed it to be undesirable. The patient education staff indicated overwhelmingly (96.1%) that patient education was an extremely important component of patient care. Seventy-seven percent of them believed it to be extremely important and 4% believed it to be moderately important for all patients, while 19% believed it to be extremely important for some patients. Allied health professionals and hospital administrators had very similar responses. Approximately four—fifths of them believed patient education to be an extremely important component of patient care for hospital inpatients. Two-fifths of these groups believed it to be extremely important for all patients and two-fifths of them extremely important for some patients. Another 12% of allied health professionals and 16.7% of hospital administrators believed patient education was moderately important as a component of patient care. Physicians showed the lowest percentage of respondents who believed patient education to be an extremely important component of patient care. Fewer than one—third of them rated it so for all patients and slightly more than one~third rated it so for some patients. Another one—fourth rated it as moderately important. One percent even rated it as undesirable and 3.5% saw it as of little importance for all patients. In contrast, more than three—fourths of patient education staff believed it to be extremely important for all patients, and nearly one—fifth rated it so for some patients. lll T_,—_ 97 Only one patient education staff member rated it as moderately important; and none gave it a lower rating. Importance of Selected Content Areas A large number of the total respondent group, as indicated in Table 11, believed all but one of eight selected content areas to be extremely important for inclusion in hospital inpatient education activities. Approximately four-fifths of the respondents indicated the following content areas to be extremely important and more than 94% judged them to be at least moderately important: (1) explana- tion of diagnosis and treatment (79.4% and 94.4%); (2) teaching patients to administer own treatment (86.1% and 97.9%); and (3) teach- ing patients self-care independent living skills (85.3% and 98%). Seventy-two percent of the total respondents indicated teaching about short- and long-term life style adjustments to be extremely important and another 24% rated it moderately important. Approximately 66% indicated that teaching about appropriate community resources and general preventive medicine were extremely important and another 31.4% and 27.8%, respectively, rated each area as moderately impor— tant. Fifty-six percent indicated teaching about financial manage- ment of the health problem to be extremely important and another 35.5% rated it moderately important. Fifty-four percent of the total reSpondents rated one con— tent area, orientation to hOSpital facilities and services, as only moderately important but another 28.2% rated it extremely important. Sixteen percent believed this area to be of little or no importance. Table ll.--Percentage of total respondent group who indicated that 98 specific content areas are important for inclusion in hospital patient education programs for inpatients. Content Areas Of No Importance Of Little Importance Moderately Important Extremely Important Teaching patient to administer own treatment Teaching patient self-care inde- pendent living skills Explanation of diagnosis & treatment of health problem Teaching about short & long term life style adjustments Teaching of general preventive medicine Teaching about appropriate community resources Teaching about financial management of health problem Orientation to hospital facilities & services 2.4 2.5 2.6 6.0 2.2 4.8 13.7 11.8 12.7 15.0 24.0 27.8 31.4 35.5 54.0 86.1 85.3 79.4 72.1 68.8 65.5 55.9 28.2 99 Very few respondents rated any of the other areas as being of little or no importance. In general, the five professional groups tended to agree as to the level of importance for each content area. Nurses and allied health professionals seemed to be in especially close agree— ment. There was, however, some minor variance in ratings of importance of these areas among the other groups. Physicians and hospital administrators were not in full agreement with the other three professional sub-groups. A majority of physicians and hospital administrators rated only five out of the eight content areas as extremely important. These areas were explanation of diagnosis and treatment, teaching patients to admin- ister their own treatment, teaching about short- and long-term life style adjustments, teaching patients self-care independent living skills, and teaching about appropriate community resources. Almost consistently a lesser percentage of physicians and hospital administrators than of nurses, allied health professionals, and patient education staff rated the content areas as extremely important, while a greater percentage rated them to be of little or no importance. A greater percentage of patient education staff than of the other professional groups rated all content areas, except one, to be extremely important. Five out of the eight content areas were rated by over 90% of patient education staff as extremely important for inclusion in hospital programs of patient education. |ITIIIIIIIIIllllllIllIIIE:—————--——————————————2 5-2-525 100 Detailed data describing how each professional group saw the importance of each content area are given in Tables 61-65 in Appendix 6. Further analyses were done to investigate differences in these ratings of importance of content areas within the total respon- dent group and within three of the professional groups in relation to several variables. The three professional groups were the larger groups and those who showed larger differences in ratings, namely physicians, nurses, and allied health professionals. The variables were size of hospital, whether hospital had a formal patient education program, whether respondents had participated in special training for patient education, and whether they had experi- ence in patient education. Only with the allied health professionals was there a significant correlation between size of hospital and ratings of importance of one of the selected content areas. Twenty-two percent more of the allied health professionals who practiced in hospitals with over 100 beds than of those in hospitals with under 100 beds believed the inclusion of teaching patients about life style adjustment to be extremely important. When both the moderately important and extremely important ratings were tabulated together, statistically significant correlations were not noted. Size of hospital seems not to have been a major factor in relation to respondent ratings of importance of content areas in patient edu- cation. 101 For only two groups, physicians and allied health profes- sionals, was a positive relationship demonstrated between ratings of importance of selected content areas and whether the hospital in which they practiced had a formal patient education program. About 10% fewer of the physicians in hospitals with formal patient education programs than of those in hospitals without such programs believed one content area (orientation to hospital facilities and programs) to be of little or no importance. Approximately 17% more of the allied health professionals in hospitals with programs than of those in hospitals without programs believed it was extremely important to include the teaching of short- and long-term life style adjustments. Again, when both the moderately important and extremely important ratings were tabulated together, no statistically significant correlations were noted. Professionals' ratings of importance of various areas of content in patient education seemed to bear little relationship to the presence or absence of formal patient education prbgrams in hospitals where they practiced. In two of the professional groups there were apparent posi- tive relationships between the respondents' previous attendance at educational programs on or related to patient education and their ratings of importance of selected content areas. As illustrated in Figure 1, approximately 10% more of the nurses who had previously attended programs than of those who had not believed the teaching of the patients to administer their own treatment to be an extremely important content area. Likewise, a much greater percentage (20%) of allied health professionals who had previously attended programs 102 1:] Had not attended programs fill Had attended programs Nurses Allied Health Professionals 901 85 ' 80‘ w 704 D? :3 60< C CD 2 501 <1.) “- 404 301 20. 10 Teaching Teaching Teaching Teaching patientS'UJ about about about administer life community financial their own style resources management treatment changes Content Areas Figure 1.-—Percentage of nurses and allied health professionals who had and who had not had special training in patient edu- cation who rated selected content areas as extremely important. 1103 than of those who had not believed the teaching of three content areas (life style adjustments, community resources, and financial management of the health problem) to be extremely important. When both the moderately important and extremely important ratings were tabulated together, no statistically significant correlations were noted. One must wonder, of course, whether participation in special training tends to heighten the ratings of importance, or whether persons who believe patient education is important are more likely to seek out special training. Whichever is the case, there appears to be a relationship between the two. A positive relationship was also demonstrated between ratings of importance by the total respondent group and by each of three professional groups and their experience or lack of experience with formal patient education programs. In four of the nine content areas, orientation to hospital facilities and services, teaching self-care skills, teaching about community resources, and teaching about financial management (as illustrated in Figure 2), a greater percentage of all respondents who had experience than of those who did not rated the content areas as extremely important. No statis- tically significant relationship was demonstrated between the variables when the ratings of both moderately and extremely impor- tant were taken into account. In each of the three professional groups a greater per- centage of those who had experience with formal programs than of those who did not also believed specified content areas to be extremely important to include in hospital patient education programs. 104 D Without experience m With experience 100 90 80 70 60 50 Percentage 40 3O 20 10 Orientation Teaching self— Teaching about Teachingabout to hospital care skills community financial facilities resources managementof & services healthproblem Content Areas Figure 2.--Percentage of the total respondent group who had and did not have experience with formal patient education programs who rated selected content areas as extremely important. 105 As illustrated in Figure 3, about 14% more of the physicians with experience than of those without gave "very important" ratings to three content areas, namely orientation to hospital facilities and services, teaching self-care independent living skills, and teach— ing about community resources. Fifteen percent more of the nurses did so in one content area (teaching about community resources). Approximately 20% more of the allied health professionals gave such ratings in three content areas, namely explanation of diagnosis and treatment, teaching about financial management, and teaching general preventive medicine. Again, like the total respondent group, no statistically significant relationship was demonstrated between the variables when the ratings of both moderately and extremely important were taken into account. In summary, professionals overwhelmingly agreed that patient education is an important component of patient care. Thirty-five percent of the total respondent group believed patient education to be extremely important and another 6.5% believed it to be moderately important for some patients, and 44% extremely important and another 10.8% moderately important for all patients. A variety of content areas were judged by professionals to be appropriate to include in hospital patient education programs. All professionals rated the most important areas as teaching patients to administer their own treatment (86.1% extremely important and 11.8% moderately important), teaching patients self-care independent living skills (85.3% extremely important and 12.7% moderately impor- tant), and explanation of diagnosis and treatment of the health 106 .5copgooer AFmEoLuxo mm women peopcoo omuoormm omflmw . oxm m>og no: uwo oz: msmcmoga compoozoo pcmvpmo 2msgow cum: mocmwgm 1-. no; oz: m_m:o2mmmwogo £5226; 662222 ocm .mmmczc .mcmwuwngo 2o mmmucmogmm m mczmwu momg< acoucou ocwuwowe .umE acmEuomLu mmuczomwc mmogzommc m—pwxm mmuwogmm .ucm>mta .cmcwm one .EEou .EEoo oNQUINme . a on» Pogmcwm ozone mwmocmowo psono ozone ucmwpmo omo; op :ummp :oooh. .ucovco mm 002 mm mm mpmco2mmmwocm zupmo: ooT__< momtsz mcmwowmx:m wocmtmnxm :33 E 852328 53932: D afiequaouad 107 problem (79.4% extremely important and 15% moderately important). Every one of the selected topics was judged to be at least moderately important by more than 80% of all respondents. Roles Deemed Appropriate for Health Care Professionals, Patients, and Families of Patients in the Planning and Conducting of Patient Education Activities This section describes the roles deemed appropriate for themselves and each other by patient education staff, physicians, nurses, allied health professionals, and hospital administrators, and the role they believe to be appr0priate for patients and families of patients in the planning and conducting of hospital patient educa- tion activities for inpatients. Respondents were asked to identify the primary and suppor- tive responsibilities that each professional group should have in selected patient education content areas. Each health care pro— fessional group's role is described in three primary ways: (1) how the total respondent group defines the role, (2) how the profes- sional group defines its own role, and (3) how the other four pro- fessional groups define the role of that professional. Each sub-section on the roles of health care professionals contains a report of further analyses of respOnses of the total respondent group and of the three largest professional groups, physicians, nurses, and allied health professionals, in relation to four other variables: (1) size of hospital, (2) whether or not the respondents' hospitals had operating formal patient education lg 108 programs, (3) the respondents' previous attendance at programs on or related to patient education, and (4) the respondents' Vexperience with formal patient education programs. Relationships were reported only when the variances in respondents' Opinions concerning role were noted in at least one-third of the selected patient education content areas. The respondents' Opinions on whether or not the patients and the families of patients should be included in the planning and conducting of patient education activities are also reported. Role Deemed Appropriate for Patient Education Staff Primary role.--Approximately 36% of the total respondent group, as shown in Table 12, judged that patient education staff should have primary responsibility for planning, and 30% judged that they should have primary responsibility for conducting patient education activities. In each of the selected content areas, the patient education staff's role was defined, especially by the patient education staff themselves, more as planner than as conductor of patient education activities. In one content area (orientation to hospital facilities and services), however, a majority (approxi- mately 58%) of reSpondents judged that patient education staff should have primary responsibility for both planning and conducting the activities. In comparing how the small group of patient education staff defined their own role with the way other professional groups defined the patient education staff role, it appears that a much larger 1(39 2.22 . . . 2_N_22 222>2_ _ _m N 22 P 2N m.mm m.~m o.m~ 2:2uua2cou 2:22:2222cw 2.2m . . . 2222-».22 2 NM 2 mm 2 N2 2.22 N.m~ m._2 222::222 2:222222 2. . . . ucwsumwcu :30 2_ N 2N 2 NN 2 2N 2.2N 2.N_ 2.N2 2222222222 2252222222 . . . op 22:22222 2 2N 2 NN 2 22 N.22 2.22 N.2F 2.22 22222222 22222222 MH2_ 2H2. _H_P N.N— 2.2_ p.m— _.om 2:222:2cou 222522222 22 _N N 2N N NN 2.2N N.2N 2.22 2.22 222222N2 22222222222 MHNN m.__ 2.2_ 2.2 N.N_ 2.N_ o.oN mc2uu=2:ou 222°:2222 22 m oN m.m_ _.__ N.mm m.NN N.2_ m.22 222::222 :owumcmpoxm 22o2>222 2:2 N.22 2.22 2.22 2.22 2.22 2.22 2.22 2225222222 22252_2222 22522222 25 2.22 2.22 2.22 2.2N 2.22 2.22 2.22 222222N2 22252522222 moeuz Nmenz wpuz Nmuz momuz mman emuz 22°22 >22>N222__ou 2222222 222:o22222o22 22222 2222222222 222222 2 -22:2E2< 22222: 2222:: 2:22222222 222222222 :o222222 222< 2:22:22 22222 _252222: 2222.2 2222222 222222 222222222222 22:2o .22222—2222:oa222 2225222 2222 2>2: 222222 22222 :o2222222 2:22222 22:» 222222 2:: 2:222 2:22:02222 22222 222 20 2:2 222222 ~2:o_2222222 22:22 2:22 we 22222222222 2:2 222:2 2:22:22 22pu2_22 2:2: :_ :22222222 2:22222 2:222:2222 2:2 222::222 Lo» 222—2222:2222» 2225222 223—2:2 2_:o:2 2222 22:222222222 :32 222:» 22:2 222222 2:: 2222525 22222 :02222222 2:22222 mo 2222:22222--.N_ 2222» 1'10 . . . . . . 2222222222 22222 2222 . 2 22 2 22 2 22 2 on 2.22 W.WM ”.mm m.N¢ w.®m m.O¢ M.wN D @m mewcco—n— L0>O :50: 22222225 . . . . 2.22 2.22 2.22 2222222222 2>2222>222 2 mm 2 mm 2 22 o 22 2222222 2.22 2.22 2.22 2.22 2.22 2.22 2.22 22222222 22 22222222 2222222 222222 . . . . 2.2m N.22 2.22 2222222222 22 2225222225 2 22 N 22 2 22 2 mm 22222222» . . . 2.22 2.22 2.22 2.22 22222222 22222 2 mm 2 22 N _2 2222222» 222222222 2.22 2.22 2.22 2.22 2.22 2.22 2.2m 2222222222 222225522 22222 2.22 m.~2 2.22 2.22 2.22 2.22 2.22 22222222 22222222 2225222222 2.22 2.22 2.22 2.22 2.22 2.22 2.22 2222222222 22222 2222 5222-22222 222 2.22 2.22 2.22 2.22 2.22 2.22 2.22 22222222 -222. 22222222 m22uz 222": 22»: 22uz mmmuz 22~uz 2Nuz 22222 2222222 2222222222222 22222 2222222222 22mewwmpw22 -222252< 22222: 222222 2222222222 222222222 22222222 222< 2222222 22222 2222222: 222222 2222222 222222 _22222222222 22222 .222222222--.2_ 22222 111 percentage of patient educators believed they should have primary responsibility for planning programs, but a slightly smaller per- centage believed they should have primary responsibility for conduct- ing them. Fifty-nine percent of patient education staff members indicated that they should have primary responsibility for planning patient education activities in the nine content areas, while 28.6% indicated they should have primary responsibility for conducting such activities. Nearly 70% of them believed that they should have primary responsibility for planning orientation to hospital facili- ties and services, planning for teaching patients to administer their own treatment, and planning for teaching of general preven- tive medicine. In contrast, there was only one content area, orienting patients to hospital facilities and services, in which a majority (54.3%) of them believed they should have primary responsi- bility for conducting the activities. The other four groups were not in full agreement with patient education staff about the role of patient education staff. Physicians had the greatest differences of Opinion. Fewer than one-third of them judged that patient education staff should have primary responsibility for planning and conducting patient educa- tion activities in general. Only about one-sixth of them believed that patient education staff should have primary responsibility for planning and conducting explanations of diagnosis and treatment and for teaching patients to administer their own treatment. In only one activity, conducting orientation to hospital facilities 112 and services, did a majority (55%) of physicians ascribe primary responsibility to patient education staff. With respect to planning, less than one-half as large a percentage of physicians as of patient education staff, in general, ascribed primary responsibility to patient education staff. Though the percentages varied, this difference was significant and consis- tent across all nine content areas. with respect to primary responsibility for conducting patient education, however, the differences between physicians and patient education staff were not nearly as great, nor were they all in the same direction. In three content areas: teaching long- and short-term life style adjustment, teaching about community resources, and teaching about financial management, significantly larger per— centages of physicians than of patient education staff ascribed primary responsibility to patient education staff. It appears that many physicians saw an important role for patient education staff but that their definition of that role was different from the role definition patient education staff described for themselves. Nurses, allied health professionals, and hospital adminis- trators were in close agreement among themselves, but in less close agreement with patient education staff and physicians about respon- sibilities of patient education staff for planning. Approximately 40% of them judged that patient education staff should have overall primary reSponsibility for planning of patient education activities. 113 About 30% of them, a percentage very similar to that of physicians and patient education staff themselves, believed that in general the patient education staff should have primary responsibility for conducting patient education activities. In one area, orientation to hospital facilities and services, a clear majority of the nurses, allied health professionals, and hospital administrators agreed with most physicians and most patient education staff that patient education staff should have primary responsibility for planning and conducting the activity. Fifty-five to sixty percent of hospital administrators also believed that patient education staff should have primary reSponsibility for the planning of five of the nine content areas. But as was true of physicians, nurses, and allied health professionals, a very small percentage of the administrators believed that patient education staff should have primary respon- sibility for either planning or conducting explanations of diagnosis and treatment. Patient education staff defined roles for themselves that were different from roles defined for them by the other four profes- sional groups. A much larger percentage of patient education staff (59%) than of the four other professional sub-groups collectively (35.5%) believed they should have primary responsibility for planning patient education activities. This difference was apparent in all but two of the nine content areas specified. Although the percentagesm_ . . . . . . o.o< mcwuuzucou ucwvcmnwvcm m m, m s_ o N_ A VF N e_ w m. atau-c_am Q.N_ _.~_ m.m s.mp o.m w.mp N.m_ m:_==m_a mcwcuaoh ucmsumwgu :zo m.m_ m.~_ N.o_ m.N_ w.NF m.m_ o.Nm mewuozucou Laom+=+5ua cu mucwwuma o.o_ N.o~ ~.NN m.m_ m.m_ m.w_ o.NF megccapa mc_;umap N.NP v.w_ ~.o_ q.wp N.q~ m.NF o.mm m=_pu=ucou “assuage“ to P.e, m.m_ _._F m.mF o.~_ m.m_ N.mp m:_==apa =o_ua=mpaxm m.w_ _.o. _.__ m._~ N.m_ ¢.o_ o.mm m:_uu=u=oo atmoemmwu co F.m_ m.s_ N.NN o.w_ o.N_ m.m_ ~.m_ mcvc=a_a =o_umempaxw mmu_.>me Uco ¢.P_ m.__ F.FP v.m N.F_ m.__ «.m_ m=_uo=ucoo ma_uw__oac Pauwamo; 0» m.m_ m.m_ P.__ N.F_ _.mF o.- o. u=_c=a_a eowuaueawao moeuz “mo“: w_nz “mnz mwwuz mmmnz wmnz azogw x w>p um o mcoumca mFQcowmmwwoga mwaum ucwucoqmmm _mamwg _p u -mwcmsv< cppmw: mwmczz mcmwuwmxcm :owumozvm cowuucsu mmg< ucwucou _mu0P a v _au_amoz uaw__< Heady”; masocw _mcowmmwwoga Lmzuo w>¢ugoanzw guzm w>mc upzozm mwmum cow gmzuo gzou mo mommucwogmq vcu mmmgm «emu m>_ugoaq=m ova—u:_ cpsocm mpoc FocoPmmmmoga : .mw+uw__nwmcoqmwg unusuw ucwwumn “as“ ummvzfi oz: qzocm ucmuzoamwg _muou mg» ucm quogm Pmcowwmmwoga coo cwuum_mm mcvc cw cowumozuw ucwwuoa m:_po=vcoo use mc_:=m_a Low xu_Fwo_mcoammg 30 wacu umgu vwmusn oz: mgwnswe wmmum =o_umu=vw ucowuma mo wmmucmocwa--.m_ m_DMH 119 N.N_ m.ep m.N_ m.NF N.o_ «.mp o.mm m=_ou=u=ou mamza mew: m.m_ e.m_ o.m_ ~.m_ m.m_ m.m_ s.m_ mc_==a_a Lm>o cam: . wcwowuos p.o_ N.m_ o.m m.e_ e.w_ m.m_ 0 mm ac_uo=ueou a>duca>wta . . . . . . . m Fogwcwm N e_ _ e, N mm P m_ o m_ a m, o mp cvccm_a to m=_;umap Em_DOLa go_aa; ~.PN a.a_ m.m~ o.- ~.m~ o.mF o.Nm aewuozwcou do acmeamacae puwucwcww N.ow <.m_ m.m~ m.- o.a_ o.N_ o.ov assess—a ozone mcwzumm» meLSOwwL o.K_ m.w_ w.NN o.m_ m.~_ m.op 0.0m mcwuosueou suw==EEOU :0 M N.~F _.NF _.__ o._N o.e_ m.w_ o.o~ screen—a mcwwu~MP :0 m: H. M m.oN m.mp w.- m.m~ N.mp o.mF o.oe mcwuusucoo w_»ww www_ . . . . . . . enau-oto;m new m op m w_ P __ m n_ _ m, m or o em m=m=:a_a -m=o_ @558F moon: “no": w_uz “a": mom”: mmwuz @Nuz azocw x w>P om o mgoumcu m_mcowmmm+oca mumum ucwvcoammm Fmamwgupw u -mvcweu< zupmwz mwmczz m:m_u_mxc¢ :owuouavm cowuucsm mwg< ucmucoo _moop _euwamo= umw__< pca_uma wnzocw _m:owmmwwogm ;m:~o .uw==_u=ou--.mp wreak 120 (16.5%) believed their role should include a supportive responsi- bility for the conducting of patient education activities. This dif- ference was apparent in all but one of the nine content areas. In only one content area, teaching about the financial management of the health problem, did a large percentage (52%) of patient education staff believe they should have a supportive role for conducting the activity. With respect to planning, patient education staff and the other four professional groups differed principally in two of the content areas. A greater percentage (40%) of patient education staff than of the other four professional groups collectively (19.4%) believed that patient education staff should have a supportive role in planning in the area of financial management of the health prob- lem. The opposite was true for planning of orientation to hospital facilities and services. None of the patient education staff believed that their role should be a supportive one in that area, while 15.9% of the other four groups believed that patient educa- tion staff should play a supportive role there. That is the area, it should be recalled, in which a majority of all groups, including physicians and patient education staff, ascribed primary responsi- bility to patient education staff. There was very little relationship between the variance in the respondents' judgments concerning the supportive role of patient education staff and whether the respondents practiced in hospitals with or without patient education programs, or whether i 121 or not respondents had experience with formal patient education programs. Nurses' responses concerning supportive responsibilities of patient education staff varied in relationship to the two remain- ing variables, size of hospital and previous training in patient education. As illustrated in Figure 6, a greater percentage of nurses in hospitals with 50 to 199 beds believed that the patient education staff should have a supportive role than did those in the hospital with over 200 beds or those with under 50 beds. This was seen in their ratings of both planning and conducting functions in three of the nine content areas. There was also a relationship shown between whether the nurses had previously attended programs on or related to patient education and variance in the nurses' answers concerning the suppor— tive responsibility of the patient education staff. As illustrated in Figure 7, about twice as many of the nurses who had previously attended these programs as of those who had not believed that patient education staff should have a supportive role in planning for two content areas, orientation to hospital facilities and services and teaching life style adjustments, and in conducting in two other areas, explanation of diagnosis and explanation of treatment. In summary, patient education staff were believed by nearly two—fifths of professionals in other groups to have primary respon- sibility for the overall planning of patient education activities, and by nearly one—third of them to have primary responsibility for conducting such activities. They were seen by about one-sixth of 122 mmPuw>muum :o_umu=vm ucmvuma mcwuozvcou ucm mcwccmFQ Low Aump mcwumcme .mmwgm ucmpcoo umpumpwm cw wnwmcoamwg w>_pcoaa:m m>ms upaonm wemwm :owpooavm pcmwpma was“ vmmcaw 0:3 m~wm quwamo: >5 mmmgzc do mmmpcmugmauc mmwg< pcwucou “caspmmgu :30 w:PUwva ucmsummeu czo w>wpcm>mgq wppwxm memwcwsum m>_p:w>mgq m__wxm cmumvcwevm ngmcmm mgmu-m_wm ou ucwwpma Pagocmm mgmo-4_mm op “cmwuma acmsoamp mcwzummh mcwguow» mcwcuwm» mcwzommh newcomm» mcwpozncou mcwccmpa m thm m Hump m_ pp N E om . mm a mm 82 SN .55 M £8 21-2: E 32 3-8 a. was 8 .525 U .2 .8 .8 :5. .o mgzmwm abequaouad 101 10.1 :0- ,0, 504 Spa 104 30~ 20« 123 IO igu [:3 Without previous training m With previous training Plannin Conducting Orientation Teaching Explanation Explanation to hospital life style of diagnosis of treatment facilities adjustments & services Content Areas re 7.-~Percentage of nurses who had and had not previously attended programs on or related to patient education that judged patient education staff should have supportive responsibility for planning or conducting patient education activities in selected content areas. 124 those in other professional groups as having major supportive roles in both planning and conducting patient education. In only one content area, orientation to hospital facilities and services, were patient education staff believed by a majority of those in other professional groups to have primary responsibility for both planning and conducting programs. Three-fifths of the patient educators themselves believed they should have primary responsibility for plan— ning programs, but only 26.6% believed they should have primary responsibility for conducting them. The greatest differences of opinion concerning the role of the patient education staff were between the physicians and patient education staff. The percentage of physicians believing that primary responsibility for planning patient education programs should reside with the patient education staff was only half as large as the per- centage of patient education staff who believed they should have such responsibility. The percentagesPF ucmocwgoucw m.om m.mp m.NN w.om R.NP N.m v.—m ucwcco—a mgou-wpmm mcwcumm» m.¢_. O.m N.NN m.- m._._. Tm ©.NN mcfiwuzflcou ucgwwLu :30 a goum_cwscc .m _.oe m.om v.ve o.~m m.wm ¢.NN e.¢m newccmpm ou mucmwuag mcpzumwh m._n m.mm cmvm muck muco mfluw o.m~ mcwuusvcou pcmsummgu yo p.5N m.eN m mm m om q mm m mu _._w mcwccm—m cowumcm_axu _.mu ¢.m~ ¢.vm m.mm m.mm w.mn o.w~ mcwuuavcoo mwmocmmwu be N.om m.mN o.oo_ N.Na c._m N.NN m.Nm mcwccaFa cowuacapaxm :23 . . . . . . . mmow>cwm ucm F m o e o m o _ m a v m m mcwpusvcou mm_uwpwumc . . . . . . . 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FMLOCUD mo wcwcummp Em 20.5 5282 m.m m.m o. o.e ¢.N o.~ w.¢ mcwuozucoo mo ucweomccwe meucm=_w 2 9m .3 ON 92 7m 9m 9.2%.: page mcwgowmp 6 . . . . a 3958?. mm N.¢ N.< —.—F o v F v v m v m :wuuzccou xumczczau . . . . 9:0 m m.: m.NF 5.2 o m e w— m m m : mcwccw—a mcwcuaMP . . . . . . pewEumzflum m; e o _ : o 2 :w m e N Z 3:328 2.5 8.: N.oN 72 NNN on 98 mg: :m 9.25.: 58-22.... 2;. locop mcwgummh IIIIIIIIIITIITIII1IIl1IIIiIIITIIIIIIIIIIIIIIIIIIIII mmouz woe": wpuz oan “muz mwmuz mman use; mcouacu Necum mpmcowmmmmocm «cmucogwmm a_mmwuwm__ou -m_cmEc< cowumuzum ;w_cw: mmmgzz mcmvowmxsa cowuuczd amg< ucmucou :58 w o a 4 Sigma: 232.5 8:: museum chowmmmeoLa gmguo ysicians should have primary responsibility in the conducting of ose activities. An especially large percentage (70 to 80%) of spondents in the five groups believed that physicians should have imary reSponsibility in both the planning and conducting of those eas of patient education involving explanation of diagnosis and neral treatment for the health problem. A smaller but still major rcentage (57.2%) believed that physicians should have primary sponsibility for planning the teaching of general preventive medi- ne to inpatients. Among the large group of physicians themselves, 43.8% judged 1at they should have primary responsibility for planning of patient iucation activities, in general, while 28.3% indicated that they iould have primary responsibility for conducting those activities. 1 especially large percentage of physicians believed that they lOU1d have primary responsibility for four areas: both planning Id conducting explanation of the diagnosis (82.9% and 78.6%, espectively), both planning and conducting explanation of the treat- ant (81.1% and 75%, respectively), planning for the teaching of :neral preventive medicine (64.3%), and planning for the teaching ' patients to administer their own treatment (54.4%). The judgments of the four other professional groups concern- 9 the primary role of physicians in the planning of patient edu— tion activities were very similar within three of the four areas. other areas there was not such strong agreement. Overall approxi- tely one-third of respondents in the four groups, as compared to .8% of the physicians, believed that physicians should have primary 128 responsibility for planning of patient education activities. A somewhat lesser percentage of the nurses (21.8%) and allied health professionals (24.8%) and very similar percentages of patient edu— cation staff (29.9%) and hospital administrators (33.3%), as compared with 28.3% of physicians themselves, believed that physicians should have primary responsibility overall for conducting patient education activities. Differences among the four groups, and between them and physicians, were noted in several specific areas. Principal differ- ences appeared between nurses and physicians. A smaller percentage of nurses than of physicians, in every case, believed that physi- cians should have primary responsibility for planning and conducting patient education. The differences seem not to be significant in the four areas mentioned above. However, for five of the nine areas the percentage of nurses ascribing primary responsibility for planning to physicians is less than half of the percentage of physicians doing ;so. Similarly, in four of the content areas, the percentage of 1nurses ascribing primary responsibility to physicians for conducting patient education activities is less than half the percentage of physicians doing so. Physicians defined roles for themselves that were different from roles defined for them by the other four professional groups. Approximately 10% more of the physicians (43.8%) than of the other professional groups collectively (32.8%) judged that their role should include primary responsibility for the planning of patient education activities. The major differences of opinion can be seen 129 in three of the content areas (teaching patients to administer own treatment, self-care independent living skills, and long- and short- term life style adjustments). Although overall the physicians and the other four profes- sional groups had similar beliefs about the primary responsibility of physicians in conducting of patient education activities, they did differ somewhat in one content area. Almost a fourth of the physi- cians judged they should have primary responsibility for conducting the teaching of patients to administer their own treatment, while only one-tenth of the other four professional groups responded in that way. There was very little relationship between variance in definitions of the physician's role by any of the groups and either of two factors: the size of hospital where respondents practiced or whether the respondents practiced in hospitals with or without patient education programs. A relationship was demonstrated between respondents' experi— ence with formal patient education programs and variances in the total reSpondent group's and physicians' responses concerning the primary responsibility of physicians. A somewhat greater percentage of the total respondent group, as illustrated in Figure 8, who had experience with formal patient education programs than of those who did not judged that physicians should have a primary role in the planning of four of the content areas, namely explanation of diagnosis, teaching of self—care skills, teaching of life style changes, and teaching about community resources. Percentage 130 E] Without experience my With experience 100- 90- 85 80- 78 70— 60‘ 50‘ 40‘ 31 27 301 24 19 10 f V I 7 I Explana- Teaching Teaching Teaching tion of self-care llfe about . diagnosis skills style commun1ty changes resources Content Areas Figure 8.—-Percentage of total respondent group with and without experience in formal patient education programs who judged that physicians should have primary responsibility for planning of patient education activities in selected content areas. 131 About 14% more of the total respondent groups with experi- ence than of those without also believed that physicians should have primary responsibility for conducting one of the content areas, the teaching of preventive medicine. A greater percentage of physicians, as illustrated in Figure 9, with experience in formal patient education programs than of those without such experience judged that they should have pri- mary responsibility for planning three content areas (teaching patients to administer their own treatment, teaching life style adjustments, and teaching about community resources) and conducting of three content areas (teaching patients self-care skills, teaching life style adjustments, and teaching general preventive medicine). No other statistically significant relationships appeared to exist between the respondents' experience with patient education and their definitions of role for physicians. There was also a relationship, as shown in Figure 10, between the physicians' previous attendance at programs on or related to patient education and their answers concerning their own primary role in patient education. Approximately 14% more of the physicians who had attended programs than of those who had not judged that they should have primary responsibility for three of the content areas, namely planning the teaching of self-care skills, planning the teaching about community resources, and conducting the teaching of preventive medicine. No other statistically significant relation- ships appeared to exist between respondents' previous attendance at rograms on or related to patient education and their responses 132 .mmmem a we mzwpuzucoo use mcw::m_a cpon :0 mecp pmcp uwmuzw 0:3 mEmLmoca ecu gpwz mcmvowmxcq we mmmucmogmau-.m mgzmru “cmpcoo umpum—mm cw mmwuw>mpom cowpwuzcm pcovpm Low quFNDchoqmmL acmENLq musrocw U_:o;m mFOL : cowpmuzvm pcmwpma flagged cw mocwwgmaxm pso;p_3 mmmc< pampcou mprwxm .pwmcp wcwuwvme .pmsncm memo mmoL30mmL .pmzhum :30 .ucm>wea wF>pm -wpmm .Eeou _m_>um .Euw op _mcm:mm m$WF mpcwwpmg pzonm lamw~ mpcmwpmq m:w;omwh mewcummh m:w;ummh mcwgummh mcvgumwb m:_gommh mavpuzucou mcwccm_a o S S 2 RN em mm g mm d 3. m 3 m. m 5 a mucwtmaxm 5E E 133 [:1 Had not attended programs [m Had attended programs l i 41 l fivvuz . 111111 26 mm 1m 1 - NW 14 Planning Planning the teach- the teach- ing of ing about self-care community skills resources Content Areas Conducting the teach- ing of pre- ventive medicine Figure lO.-—Percentage of physicians who had and who had not attended programs on or related to patient education who judged that their own role should include primary responsibility for patient edu- cation activities in selected content areas. 134 arning responsibilities of physicians for planning or conducting ant education activities. Supportive role.——0nly a small percentage of the total undent group, as shown in Table 15, judged that physicians should supportive roles in planning and conducting patient education vities for hospital inpatients. Twelve point five percent eved they should have supportive responsibility for planning and % believed they should have such responsibility for conducting e activities. Among the large group of physicians themselves, only 13% ed that they should have supportive responsibility for planning 18.2% judged that they should have supportive responsibility for ucting patient education activities. The largest percentage of (26.7%) believed they should have a supportive role in teaching ents to administer their own treatment. The judgments of the four other professional groups con— ing the supportive role of the physicians in both the planning conducting of patient education activities were very similar to e of the physicians. Twelve point one percent of the other ps believed physicians should have a supportive responsibility planning and 14% believed they should have such responsibility conducting patient education activities. There was no statistically significant relationship between ondents' judgments concerning the supportive role of the physi- and the size of hospital where they practiced, or whether they 1135 mpp_xm m=.>._ o.m_ a.m_ N.NN o.sN o.mp o.m_ N.PN m=.uu=u=ou “cavemaaucw . . mgmu-mpmm m.N_ ¢.N_ _.__ N.m_ o.mp m o_ o N_ mcwccapa m=_;u~op . ucmsmeu :30 m.mN P._N N.mm _.NN N.mN N.NF N 8N m=PNU=ucou Laum_=.58a . o» mpcmwuma o.m_ m.mp N.o_ o.NP N.m_ m.N_ N m_ mewccmpa mcwcuaap m.m m.m o. ¢.m_ N.N N.o_ w.m mewuusucou pcosuoagu co o.m m.w _.,_ m.__ N.m m.N m.N newccm_a cowumcapaxm _.N v.8 o.m N.m _.N m.m N.N ocwuuaucou mwmocmawu do m.N _.N o. m.m N.N m.N N.N mcwccmpa cowuwca_axu mmu _. >me cm m.e_ N.N_ N.o_ P.mN m.m_ m.o_ m.mp mewuuaucou ma.»._.wac a Fame 0 o.mp m.s, N.op P.NN s.mp o.¢_ o.NP mewccwpa howwaucmwew moouz qoeuz NF": oNuz No.2 moNuz amNuz azoco x m>puum cu mgoumgu wmmum mpmco_mmmwocm ucmuconmm pmamogwpp -mw:_sv< :o_umo:um cwpmm: mmmgaz mcmwuwmAca covuucad mwg< ucmpcoo _NNOH v _N3_amo= u=m_uaa uawp_< mazogo pmco_mmmwoga cwzuo .mm_uw__nmmcoqmmg xgmucoumm use mqsoga _ocommmwwoga Loguo Lao» mo mwmo com »u_Fwawmcoqmwg m>PuLoaaam mus—ucw up seam m>mc upzozm meowowmxga was» ummuaw as: qsocm ucwucoammg .mp0» mcu ucwugwa vac mmmgm acoucoo umuumme mew: c w cowumusvw ucwpuma mcwuuzucou can acrccmpa aocm mpog pmco_mmm$oga czo Ewan» was“ towns“ on: mcmqumxzq we mmmucwogmauu.mp mpnmh . __-.——u— 1136 N.oN m.eN N.NN m.oN o.NN N.mN N.wN chNusucou mamta meN: m.NN N.NN N.mN N.NN m.NN N.NN o.mN acheaNN Nw>o cum: . . . . . . . chuNumE m NN N NN N 0N 0 ON N «N a 0N N NN chNusucou a>Nuem>mta . . . . . . . chmcmm N NN N NN N NN o 4N m NN N oN o NN meNccmNN No chcuaoN eaNooNa NNNNm; N.mN 4.0N m.mm o.NN m.eN m.eN N.oN chNusucou No Ncosmmacus pmwucmcwm m.mN ¢.mN m.NN o.¢N m.NN m.sN m.mN meNccaNN usage mcwcommh . . . . . . . mwogaomwg o NN N mN N 0N o mN o NN m NN m mN chNuaucou NuNcssEoo . . . . . . . Nzoom m NN e NN N NN o om N a m m m 4N chccmNN chguomN . . . . . . . “cwEumzwcm N mN o NN N NN o ON m 4N m «N e NN chNosucou wNNNm NNNN . . . . . . . ENmu-uNozm new 0 «N N «N N NN o NN m NN m NN m mN checmNa -mcoN cheomaN mmouz New": wNuz QNHZ Nmuz moNuz Nman aaogu mgoumcu NNmum mchonmmNoga a o>N om o . “concoammm NmnmwgoNW u -mN:_Eu< cowuousuw zuwaI mmmgzz m:m_o_mxna corpocsm mmc< ucmucoo NNNON NNNNamoz NemNNNN uaNNN< mazogo chowmmmmoga chpo 137 lcticed in hospitals with or in hospitals without patient education >grams. A statistically significant correlation was demonstrated :ween the respondents' experience with formal patient education lgrams and their responses concerning that role. This relationship ; seen in the responses of the total respondent group, the physi- lns, and the nurses, but not in those of the allied health pro— :sionals. Approximately 9% more of the respondents, as illustrated Figure 11, who had experience with formal patient education pro- lms than of those who did not have such experience judged that rsicians should have supportive responsibility for planning patient [cation activities in seven of the nine content areas, and 11% ieved they should have supportive responsibility for conducting' :ivities in six content areas. A greater percentage of the physicians who had experience :h formal patient education programs than of those who did not re such experience believed that they should have a supportive e in patient education activities. This was especially so in r conducting of patient education activities as pictured in lure 12. From 13% to 19% more of the physicians with eXperience in of those without judged that they should have supportive respon— iility for five of the nine content areas. A somewhat greater percentage of the nurses, as illustrated Figure 13, who had experience in formal patient education programs :n of those who did not also judged that physicians should have a .mwmgm ucwucou umpomNmm cw mmNNN>wuum cowumozuw «:wwuma mcwuusvcou new mcwccm_a LON XNNNanmcoqmmN w>wugoaa3m m>mc stogm mammowmx5Q pmcu ummvan on: mEmNmoga =owumo=uw ucwwuma NmELoN cw mocmwgwaxw “socuwz use new: azogm ucmccoammg Nmuou we wmmucmugwm--.NN wczmwu .umwgu chuNqu .mwc .umahvm mNNNNW czo .ucw>mga .EEou meNm mLmu .Evm cu ngmcom uaoom mNN— -wpmm mucwwuma commh cumwh zucmh sommp some» mcwuozucou 138 .>wa N maNN -NNNUNN 0» NeaNNo mmmg< ucwucou w:_owvw5 .u:w>mca Nogwcwm :ommh .ummgu .>me .mwN .umznno m—NNNm :30 w mNNN .=Eoo waum wNmu .Eum op -NNNUNN Nzonm wwwp -NNwm mucwwumn op somop comwk zoom? :umwk NewNNo mcwccmNa wucmwgwaxm saw: an wocmmgwaxw unocuwz HUN .ow .om oo— abenuaoaad .mmmgm Newpcoo uwpomNmm :N mmwpw>wpom cowpmozum pcwwuma mcwpuzucoo Now szNNDchoammg 0>NNN0003m muzNocN 0—305m 0N0; Lchp pmcp nmmvzn 0:3 mEmN00L0 :0Np00100 pcmwpma NNENow c? 00:0NN00xm NzogpN3 0:0 :NN3 mcmwowmxgn m0 mmwpcwogmm--.mN mxsmwm N mmmL< pcmpcou pcmsmmmcme mmoxsommg Newspmahum .Nmmgp :30 N0N0000N+ .Esou mNzum mNNNxm .500 ON . Nzonm #3000 wmwfi 0300-+N0m mpcwwpma goomh cummk commp gummh cummk L . S , NN 0N 0N .oN NN MN .8 0N om mm Fm mm row .8 w 3 .8 ma. 4+ .9 non ,w .ow .¢m wochNmaxw N . $.35 #02 mocmequm Naocpwz mug 140 El Without experience m With experience 100. 901 80- 70- ’ 60‘ 50‘ 40“ 301 20 21 17 24 21 Planning Conducting Teach Teach Teach Teach Teach Teach Teach life self— general patient self- life about style care prevent. to adm. care style comm. adjust. skills medicine own skills adjust. res. treat. Content Areas ure l3.--Percentage of nurses with and without experience in formal patient education programs who judged that physicians should have supportive responsibility for planning and conducting patient education activities in selected content areas. 141 pportive role in planning and conducting patient education activi- es. Approximately twice as many nurses with experience than of ose without experience had this opinion about physicians‘ supportive 1e for planning in three of the content areas and for conducting I four of them. Only within the total respondent group, as shown in Figure -, was there a statistically significant relationship between whether he respondents had attended educational programs on or related to itient education and their responses concerning the supportive role ’ physicians. A somewhat greater percentage (approximately 8% more) ’ all respondents who had attended programs than of those who had 1t judged that physicians should have a supportive role in the con- Icting of patient education in three of the nine content areas, lmely orientation to hospital facilities and services, teaching lOUt community resources, and teaching financial management. When 1e sub-groups were analyzed individually, no statistically signifi- ;nt relationships appeared to exist between respondents‘ previous :tendance at educational programs on or related to patient educa- on and their responses concerning responsibilities of physicians 1r planning and conducting patient education activities. In summary, physicians were believed by nearly one-third ' professionals in other groups to have primary responsibility for 1e overall planning of patient education activities, and by nearly le-fourth of them to have primary responsibility for conducting lCh activities. They were seen by somewhat more than one-tenth of lose in other professional groups as having major roles in both 142 90 a D Had not attended programs 80 . M Had attended programs 21 , ........ ‘ mum 11111111 111111111 1111111 111111111 1111111 11111111 11111111 mmw 111mm Orientation Teaching Teaching to hospital about about facilities community financial & services resources management Content Areas Figure 14.—-Percentage of total respondent group who had and had not attended programs on or related to patient education who judged that the physician's role should include supportive responsibility for con- ducting patient education activities in selected content areas. 143 ning and conducting of patient education. In two content areas, nation of diagnosis and explanation of treatment, physicians ascribed by a large majority of those in other professional ps to have primary reSponsibility for both planning and conduct- he activities. They were also believed by these professional 5 to have primary responsibility for planning the teaching neral preventive medicine. Over two-fifths of the physicians themselves believed they d have primary responsibility for planning programs, but only % believed they should have primary responsibility for conduct- them. The physicians' opinions concerning their responsibility the planning and conducting of the explanation of diagnosis and tment and the conducting of general preventive medicine were similar to the opinions of the other four groups. Physicians believed they should have primary responsibility for the plan- of teaching patients to administer their own treatment. The greatest differences of opinion concerning the role of hysicians were between the nurses and the physicians. The ntage of nurses believing that primary responsibility for plan- and conducting patient education programs should reside with 'cians was only half as large as the percentage of physicians elieved they should have such responsibility in at least half e content areas. 144 Roles Deemed ApprOpriate for Nurses Primary role.--Approximately one-fourth of the total respon- dent group, as shown in Table 16, judged that nurses should have pri- mary responsibility for planning patient education activities. About a third of the group believed they should have primary responsibility for conducting those activities. In one content area, teaching patients to administer their own treatment, a much larger percen- tage (69%) of the total respondent group judged that nurses shou1d whave primary responsibility for conducting patient education. In defining their own role, about 30% of the nurses judged that they should have primary responsibility for planning, while 37% indicated that they should have primary reSponsibility for conduct- ing patient education activities. About half of the nurses believed they should have primary responsibility in three areas: both plan- ning and conducting the teaching of self-care independent living skills, planning for teaching patients to administer their own treatment, and conducting the teaching of general preventive medi- cine. Almost three—fourths of the nurses judged that they should have primary responsibility for conducting the teaching of patients to administer their own treatment. 0f the other four groups, allied health professionals and hospital administrators were most nearly in agreement with the nurses about the overall role of the nurses. About 22% of the allied health professionals and 27% of the hospital administrators believed that nurses should have overall primary responsibility for planning patient education activities, and approximately 30% of mNNNNm 000>NN 0.04 0.00 0.00 N.00 0.04 0.N0 0.4m 00N0000=00 000000000=N 0:00-0N0m 0.Nm 4.00 4.44 0.00 4.00 0.0N 0.04 00N==0N0 00N0000N 0:02000La :30 o.mm m.m© w.00 N.m© m.¢o m.Nm m.mm mcwwozvcou LmumwcwEum . 00 00:00000 N N4 4.N4 0.00 0.00 0.04 0.0N 0.0m 00N=00N0 00N0000N 0.4N 0.NN 0.NN 0.N0 0.4N 4.NN N.0N 00N0000000 000000000 00 0.0N 0.NN 0.00 0.44 N.0N 0.NN N.NN 0:00:0N0 =0N0000N0x0 m.mN N.0N N.0N 0.0m 4.NN m.mN F.0N 0000000000 0000:0000 00 N.0N 4.mN 0.NN 0.4m 4.NN 0.0N 0.0— 0:w::000 :0000:0N0x0 1115 m0uw>g0m 0:0 0.00 4.0N N.N0 0.40 N.0N 0.0N N.04 00_0000000 00N0_NN000 . . . 000000; 00 0 0N 0 0N 0 00 0.00 0.0N N.4N N.0N 00N0=0N0 wo_00000000 “00.2 004": 0Nuz 0N": N012 00an 00Nuz 00:0 0:0 0: 0 0>Nuu0 0 u N 00000 0N0:0000000:0 0:00MOM000 N000000Nw 0 -0N00000 :0N000000 00N000 000N000000 000000 00N0000N 00:0 0000000 N N N N0NN0000 000N000 00NNN< 000000 N0:0Nmm000:0 :0000 .m0wuwpwawmconm0: 0:0ENNQ 0000 0>0: 0N00:m 000:0: 00:0 000000 0:3 000:0 0:00:0000: 0:0wawwcm:w 0:0 000000 N0:0000000:0 :0000 :00» 00 00000000000 0:0 000:0 0:00:00 00000N0m 0:0: :4 :00000000 0:00000 0:00000:00 . N :00 >00N0000:0000: 0005000 000N004 0N0000 0N0: N0:0Nmm00000 :0000 00:0 000000 0:3 000:0: 00 0000:00:00--.0N 0N00N 11. . . . . 0:400:0cou 000:0 0:N: . . NMm mom QON ONM . . .Nm 0 NN 0.Nm . . . .0 0:0::0N0 N0>0 :00: ”.mm 4.0— m NN N 00 0 NN N 0N N N . . 0:000005 . 0.00 N.NN 0.00 N.00 N 00 N 00 0=N0000000 0>N000>0N0 0 me NON0c00 N.00 4.4N 0.0N 0.04 0.0N 0.0N 0.04 0000=0N0 :0 00N0000N :0N0000 00N000 . . . . . o.~ 0.0 0:00000:0o 40 a:0E000:0E 0 0 N 4 o o m N 0 ~0Nuc0:_m . . . . .0 0.N 0.0 00N000N0 00000 N m N 0 o o NN m 0:_:u00~ . . 000:0000: MW N.NN N.mN o. m.Nm 0.0N o 0N 0 cm 0:00000cou xu_:0esou 11 . . 000 0 0.4N 0.NN N.NN 0.N0 0.0N 0 0 0 0N 00N=00N0 00N000MN . . . . :0 000 0 N.0N N.0N N.NN o 00 m 4N 4 0N 0 mm 0:00000:0u waww 0NWN 5:0 1 :0 m :0 N.0N 0.0N N.0N 0.04 0.0N 0.NN N.NN 0=N==0N0 -00wN000u00me moouz ooqnz 0Nuz 0an N0uz mmmuz mmmuz 000:0 0N0>4000NN00 0:000gu $0000 0N0:0000000:0 0:00:00000 000000 0 -00:NE0< :0NN00000 :NN00: 0:040000:0 000:02 :0000:00 00:< 0:00:00 N000N N00N0mo= 000N000 00NNN< 0000:w N000000000NN :0000 .000:_u:0u--.0N 0N00N 147 0th groups believed they should have such responsibility for conduct- ng those activities. Like the nurses, a large percentage of both he allied health professionals (64.9%) and hospital administra- ors (77.8%) judged that nurses should have primary responsibility or conducting the teaching of patients to administer their own reatment. The two groups' Opinions differed slightly from those f the nurses concerning some of the other content areas, but no ajor differences were apparent. The principal differences of opinion appeared between he physicians and the nurses, and between the patient education taff and the nurses. Only about l5% of the physicians, as compared to 29.7% f the nurses, judged that nurses should have overall primary esponsibility for planning of patient education activities and nly 20% of the physicians, in comparison to 37% of the nurses, udged that nurses should have overall primary responsibility for onducting those activities. In none of the specified content reas did a majority of physicians believe that nurses should have rimary responsibility for either planning or conducting patient ducation. With reSpect to planning within the selected content reas, less than one-half as large a percentage of physicians as f nurses, in general, ascribed primary responsibility to the rses. Although the percentages varied, this difference was sig- ificant and consistent across all of the nine content areas. 148 With respect to primary responsibility for conducting patient education in the selected content areas, the differences between physicians and nurses were similar to those related to planning, though even greater difference existed for one of the content areas, teaching patients to administer their own treatment. It appears that physicians do not see a very important primary role for nurses, especially in the planning of patient edu- cation activities. Approximately 40% of the patient education staff judged that nurses should have primary responsibility for planning patient education activities and about half judged that they should have such reSponsibility for conducting those activities. An especially large percentage of patient education staff (80%) believed that nurses should have primary responsibility for conducting the teach- ing of preventive medicine, while from 64% to 69% believed that they should have primary responsibility for conducting teaching in four additional areas: orientation to hospital facilities and services, teaching patients to administer their own treatment, teaching patients self-care independent living skills, and teaching long- and short-term life style adjustments. Close to half of the patient education staff also believed that nurses should have primary responsibility for conducting the explanation of treatment and for planning in three other areas: teaching patients to administer their own treatment, teaching self—care independent living skills, and teaching of general preventive medicine. 149 With respect to planning, patient education staff believed nurses should have a greater responsibility than did the nurses for six of the nine content areas. The differences were most apparent in the planning for conducting of explanation of diagnosis and treat- ment, where about twice as large a percentage of patient education staff as of nurses ascribed primary responsibility to the nurses. With respect to primary responsibility for conducting patient education, the differences were somewhat greater. In general, the patient education staff ascribed a greater primary responsi- bility to the nurses than did the nurses themselves. Although the percentages varied, these differences were significant and consis- tent for eight of the nine content areas. In the ninth area, teaching patients to administer their own treatment, patient edu- cation staff and nurses were in very close agreement. It appears that patient education staff saw an important role for nurses, and that their definition of that role was more primary than the role nurses defined for themselves. In summary, nurses defined roles for themselves that were different from roles defined for them by the other four profes— sional groups, especially those defined by physicians and the patient education staff. Approximately l0% more of the nurses than ofifiweother four professional groups collectively judged that they should have an overall primary responsibility for both planning and conducting of patient education activities. Their major dif- ferences of opinion were seen in three of the content areas (teaching self—care independent living skills, long- and short—term l50 life style adjustments, and general preventive medicine). A much greater percentage of nurses than of physicians believed they should have primary responsibility for both the planning and con- ducting of patient education activities. In contrast, a much lesser percentage of nurses than of patient education staff had this opinion, especially in relationship to the conducting of patient education activities. There was very little relationship between definitions of the primary role of the nurse by any of the groups and three of the factors: (l) the size of hospital there they practiced, (2) whether they practiced in hospitals with or without patient education pro- grams, or (3) whether they had attended educational programs on or related to patient education. There was a significant relationship demonstrated between the respondents' experience with formal patient education programs and their answers concerning the nurses‘ role. This was seen in the responses of the total respondent group, physicians, nurses, and allied health professionals. About l3% more of the total respon- dents, as illustrated in Figure l6, who had experience with formal patient education programs than of those who did not have such experience judged that nurses should have primary responsibility for both planning and conducting patient education activities. This was apparent in all content areas for planning patient education activities and in all but one of the content areas for conducting those activities. l5] 0:0 000::000 :00 0:00:0 :00000000 00 0000:00:00--.m0 0:0000 .000:0 0:00:00 00000000 :0 00000>0000 000000000 0000000 0000000000 000_0000:0000: 0>00:00000 0>0: 000000 000:0: 00:0 000000 0:3 05 0:00000 005:00 :0 00:00:00x0 0000003 0:0 :00: 000:0 0:00:0000: 00000 000:0 0:00:00 .>:00 .000: 5.00 000.5 0 .000 0:000005 .00: .000000 000000 :30 0 .000 0:000005 .005 .00: .000 000030 . :30 . 00:0 .0000 .000: .0:0>0:0 .0550 0.000 0:00 .:0500 .000:0 .0000 .000: .0:0>0:0 .:0:00 .5500 00000 0:00 :w50M 0 0 00. 00 00000 00000 0:: -0000 3.000 .6 00 B 0080 0080 00000 0:: -0000 8 00 00:30 00:5 000...: £0000. £0000. £0000. £0000 0000.0 £00008 £00000 0500.5 5000... £000... £000.— 500... 50000 2000.0 — . m:_0000:00 mc0::0_0 o 9— cm on o0 om om afieauaoaad ON om om oop 00:00:00x0 :00: mm 00:0 0:00.00 000:0 .03 D l52 A much larger percentage of the nurses who had experience with formal patient education programs than of those who did not have such experience judged that their own role should include primary responsibility for both planning and conducting patient edu— cation activities. As shown in Figure l6, approximately 26% more of the nurses with than of those without experience believed they should have a primary role in planning, and 20% more of those with than of those without experience believed that they should have a primary role in conducting patient education activities. The differ- ences of opinion among the nurses were especially apparent in regard to planning for teaching patients self—care skills and life style adjustment, and to conducting of teaching patients self-care skills. As shown in Figure l7, a somewhat greater percentage of physicians (approximately 9% more) with experience in formal patient education programs than of those without such experience judged that nurses should have primary responsibility for planning patient education activities in five of the nine content areas. No differ- ences in opinion among the physicians were noted concerning the nurses' primary role in the conducting of the activities in rela- tionship to this variable. Approximately ll% more of the allied health professionals, as illustrated in Figure 18, with experience than of those without judged that nurses should have primary responsibility for planning three of the nine content areas, and 16% more of those with experi- ence judged that nurses should have primary responsibility in 153 0:0 0:0:0000 :00 00000 050:00:0 000000000 0000000 0:000005 .0:0>0:0 00000 :000h .00: .5000 00000 :0000 .000000 0.000 0000 :0005 .mwwLw .000:0 0000x0 :30 0:00 .00500 :0—00 00 .000 £000» £0005 mcwuuaucou .ummLu .00p0xm .0000 00 .:0_0xm .>:00 0.000 .000: 00 0:00:0 000:< 0:00:00 00000005 .0:0>0:0 00000 :0000 0:00:00 00000000 :0 00000>0000 :00000000 0:00000 0000000:00 000:0000: 0:050:0 0000000 0000:0 000: :00:0 00:0 000000 0:: 005:00 :0 00:00:00x0 000:003 0:0 :00: 000:0: 00 0000:00:00--.00 0:0000 .0mmL0 .>:00 .005 .00: .000 00—000 :20 0 .000 .00000 40:00 00000 0:00 .00500 .000:0 .0000 .000: 00000 00000 0:0: -0_00 00.000 00 :0 00 :0000 :0005 :0000 :0000 :0000 .0000xw .:000xm 0:0_:o 00000000 00:00:00.8 :00: a 00:0 .0 :00x0 000:0 .0: D 0— cm on 00 om oo 00 cm 00 090 154 0:00000 0:0::000 :00 00000000:0 05000000 :00000000 0:00000 :0 00:00 0:000005 0>00:0>0:0 000:0 0:0:0000 .00000 0:00:00 00000000 :0 00000>0000 :00000000 000: 0005000 0>0: 0000:0 000:0: 00:0 000000 0:3 000:< 0:00:00 000:0000: 0000>000 0 000:05500 0000x0 0000:0000 00000—0000 00000 0:00-0000 00 :000 0000000: 00 0:0:0000 0:0:0000 -0:0_0xm :00000:00:o N0 00 wr .50.. 080.7088 :00: E 00:0.C00x0 000:003 D r T T :00x0 000:003 0:0 :00; 0:000000:0 +0 0000:00000--.00 000000 0— ON cm 00 om 8591U83J8d oo 00 ow om 000 m .000:0 0:00:00 00000000 :0 00000>0000 :00000000 0:00000 0:00000:00 0:0 0:0::000 :00 00000000:0000: 0:050:0 000: 0000:0 000:0: 00:0 000000 0:3 050:00:0 :00000000 0:00000 :0 00:00:00x0 000:003 0:0 :003 000:0000000:0 :0000: 000000 00 0000:00:00--.m_ 0:0000 000:< 0:00:00 .000:0 .>:00 .000:0 .>:00 0:000005 .00: .000000 :30 0.000 :30 0.000 .0:0>0:0 .5500 00000 .:0500 .000: .:0500 .000:0 .000: 00000 000:0 0000 00.000 00 00.000 00 00 :0000 :0000 :0000 :0000 0:00:o :0000 .:000xm 0:00:o 0:00000:00 0:0::000 00 “N 00 om 1 00 00 .d a J 00 a w. 00 ,w a 00 cm 00 000 00:00:00x0 :00: 5 0802088 000:0.03 D l56 conducting five of the nine content areas. The differences were especially apparent in regard to conducting of two of the content areas, teaching about community resources and preventive medicine. Supportive role.--Approximately one-third of the total respondent group, as illustrated in Table l7, judged that nurses should have an overall supportive responsibility for both planning and conducting patient education activities. In two of the content areas, explanation of diagnosis and explanation of treatment, about half of the group believed that nurses should have a supportive role in both planning and conducting those activities. In defining their own role, 39% of the nurses believed they should have an overall supportive responsibility for planning patient education activities and 36.6% of them believed they should have an overall supportive responsibility for conducting those activities. Over half of them believed they should have supportive responsibility for both planning and conducting patient education activities in two content areas, explanation of the diagnosis and explanation of the treatment of the health problem. The largest percentage (67.6%) believed they should have a supportive role for conducting the explanation of the diagnosis. The other four professional groups for the most part were in agreement with the nurses about the supportive role of the nurses in both the planning and conducting of patient education activi- ties. Approximately one-third of each of the groups, except for hospital administrators, believed that nurses should have supportive 157 0:30 05>: :00 0.00 0.00 0.00 0.00 0.00 0.00 05000008 050000005 ULMUI GM :0 0.00 0.00 0.00 0.00 0.00 0.00 00.200: 0500:0000 :0 MUL :30 700 :0 0.00 0.00 0.00 0.00 0.00 00500008 0 ”NEWER. . . . . . . . 0 8. 300.500 0 00 0 00 0 00 0 00 0 00 0 00 0 00 FEE: 00.20000 0.00 0.00 0.00 0.00 0.00 0.00 0.00 00500008 000.500: 00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0550: 85002000 0.00 .00 0.00 0.00 0.00 0.00 0.00 00:30:00 0.500020 00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 00.500: 0800:2000 mwu >me cw 0.: 0.00 0.00 0.00 0.00 :0 0.00 05000008 00.005.00.090 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 00.200: “Mmhmmzw 000uz 000": 0:2 00uz 00L: 000": 000": 000:0 0:000:0 00000 000:0000000:0 0:00:00000 00MDMww0p—0o -00c050< :000000vm :0000: 0:000000:0 000:02 :0000:00 00:< 0:00:00 0300 0 0 03.5.8: 000200 000:0 0000:o _0:0000000:0 :0:0o .0000000000:0000: 0>00:00000 :000 0>0: 0000:0 000:0: 00:0 000000 0:: 000:0 0:00:0000: 00000 0:0 0:0 0000:m _0:0000000:0 :0:00 :000 00 00000:00:00 0:0 000:0 0:00:00 00000000 0:0: :0 :00000000 0000000 0:000:0000 0:0 m:_::0—0 :00 00000000:0000: 0>00:00000 000—0:0 0000:0 000: _0:0000000:0 :00:0 00:0 000000 0:: 000:0: 00 0000:00:00--.00 00000 1558 0H00 0.00 0.00 0.0m 0.00 0.00 0.00 0:0uuancou 00000 0:0: 0 00 0.00 0.00 0.00 0.00 0.00 0.00 00000000 00>0 0002 . . . . 0:000 05 0 00 0 00 0 00 0 00 0.00 0.00 0.00 0000000000 0>0000>wg0 . . . . mgmcmm 0 00 0 00 0 00 0 00 0.00 0.00 0.00 00000000 00 0h000000 . 5000000 £0000: 0 00 0.00 0.00 0.00 0.00 0.00 0.00 0000000000 00 0005000000 . meu:0:0m 0 00 0.0. 0.00 0.00 0.00 0.0. 0.00 00000000 00000 m:_:ummh . . . a 0 0 00 0 00 0 00 0.00 0.00 0.00 0.00 0000000000 mmwnamsww . . . . . :o 0 0 00 0 00 0 00 0 00 0 00 0.00 0.00 00000000 0:0uomm0 . . . . . . . 0002000000 0 00 0 00 0 00 0 00 0 00 0 00 0 00 0000000000 00000 0000 . . . . . . . :cmp-u:o:0 0:0 0 00 0 00 0 00 0 00 0 00 0 00 0 00 00000000 -0000 00000000 000uz 000": 00“: 00n2 00n2 000": 000uz 000:0 . 0000000 0 0 m> 00 pm 0_0:o00000o00 ucmucoqmmm PmawwWMPWOU -00:05u< :o_umu::m :u_0m: 0:0000mxca 000032 :owuu::0 mmg< ucmucou 00000 0000000: 0000000 000000 manage 00:000000000 00:0o .umzcwucoui-.0p m_:mp l59 responsibility for both planning and conducting patient education. A greater percentage of hospital administrators (45%) judged that nurses should have primary responsibility for conducting the activi- ties. Consistently the largest percentage of each of the four groups believed that nurses should have supportive responsibility for both planning and conducting the explanation of the diagnosis and of the treatment of the health problem. About half of the patient education staff also judged that nurses should have supportive responsibility for planning the orien- tation to hospital facilities and services, while about half of the hospital administrators judged that nurses should have supportive responsibility for conducting the teaching of general preventive medicine. The nurses and the four other professional groups differed somewhat in opinion in two of the content areas. A greater percen- tage of the nurses (67.6%) than of the other four professional groups collectively (52.l%) judged that they should have supportive respon- sibility for conducting the explanation of the diagnosis. Similarly la greater percentage (l0% more) of nurses than of the other four ‘groups believed they should have supportive responsibility for both planning and conducting the orientation to hospital facilities and services. There was very little relationship between the respondents' judgments concerning the supportive role of the nurses and the size of hospital where they practiced, or whether they had attended educational pr09rams on or related to patient education. 160 A partial relationship was demonstrated between nurses' responses concerning the supportive responsibility of the nurse and whether they practiced in hospitals with or without formal patient education programs. No statistically significant relationship appeared to exist between the answers of the total respondent group, physicians, or allied health professionals and this variable. A greater percentage of the nurses, as illustrated in Figure 19, who worked in hospitals with formal patient education programs than of those who did not judged that their role should include supportive responsibility for planning and conducting patient education activities. This was especially so in regard to planning. Approximately 13% more of the nurses who worked in hospitals with formal programs than of those who worked in hospitals without such programs believed that they should have this supportive role in plan- ning five of the nine content areas. A significant relationship was also demonstrated between the experience professionals had with formal patient education pro— grams and their responses concerning the supportive role of the nurses. This relationship was apparent primarily in the responses of the nurses, but also in those of the physicians and allied health pro- *fessionals. As pictured in Figure 20, approximately 12% fewer of nurses who had experience with formal patient education than of those who did not believed they should have supportive responsibility for planning in four content areas and conducting in two areas. In an additional two content areas about l5% more of the nurses with than .mmmgm pcmpcoo umpow_wm cw mmwuw>wpom cowpmuanm pcmwpma we mcwpoancoo vcm chc:m_a mgp com Apepwnwmzoamwc mes—oz? u_:o;m wFOL vagu was“ Ummuzn 0:3 msmcmogn covumosvm pcmvpmq FmELow psocpcz ccm goes mFmpeamo; c? cwxcoz 0:3 mmmczc mo mmmpcmocmm--.mF weaned mmwc< pcwpcou .pmmcp .pmmgu .pms czo .me .pmshum mrpwxm :30 .cmcww .cvsvm .cm:ww mpzpm memo .Cwenm .mwwc pzonm op.pma pzonm wwa -wam cp.pma mo Loewe :omwh Somme sommh gummy Loewe .:m_axm mewposucou mcwccmFQ abequaauad msmcmoca spwz mpwpwamoz ma mamcmoca “30:“?2 m_mpwamoz mu .mmmgm pcmucoo cmpoopmm cw mmwpw>epom cowpmozum pcwwpma as? com xuw_wnwm:oammc w>wpcouazm mus—oz? quogm oFoc wacp pmzp cowpwozcw pchpmq :w mocmwcmaxm pzogpwz ucw wocwwgquw :pwz m “usvcoo new mckccmfia uwmwzn 0:2 msmcmoca mmgac mo mmcucmocwa--.om mgsmFm mmmg< pampcou .pmwgp .pmmc .35 .mm: 2E; :30 .35 .me 58.28 22% 55W .cac_» .EEoo memo .cwscm mewowvme .cmCTw .Eeoo mFApm memo .CFEum 38... 25% .t3 8&8 .296: ”:59... page 8.: .33 89a LUGOH SUMOH LUMQH Lowmh LUQQH SUMOH SUMQP Suwwk Lumwk SUMQH m2wuo=vcoo mcwccmFQ abequaoaad mucmvcmaxw saw: mam mocwpcqum paocpfiz and l63 of those without experience judged that their role should include this supportive responsibility for both planning and conducting those activities. As shown in Figure 2l, about l0% more of the physicians with experience in formal patient education programs than of those without judged that nurses should have primary responsibility for planning four of the nine content areas. As illustrated in Figure 22, approximately 16% more of the allied health professionals who had experience with formal patient education programs than of those who did not judged that nurses should have supportive responsibility for planning four of the nine content areas and conducting five of the nine areas. This was especially so in conducting the teaching about life style adjustments and community resources. In summary, nurses were believed by nearly one-fifth of professionals in other groups to have primary responsibility for the overall planning of patient education activities, and by over one- fourth of them to have primary responsibility for conducting such activities. They were seen by about one-third of those in other professional groups as having major supportive roles in both planning and conducting programs. About 30% of the nurses themselves believed they should have primary responsibility for planning programs and 37% believed they should have primary responsibility for conducting them. The greatest differences of opinion concerning the role of the nurses were between the physicians and the nurses and the patient education staff and the nurses. In general, the percentage of 164 C] With experience 100 i m Without experience 90+ 80‘ 701 :°60i E40« 30 i 20* 107. O - Orient Teaching Teaching Teaching to about about about hospital community financial preventive facil. & resources mgt. medicine services Content Areas Figure 2l.--Percentage of physicians with and without experi- ence with formal patient education programs who judged that nurses should have supportive respon- sibility for planning of selected content areas. 165 [:l Without experience m with experience lOO ‘ 90‘ 801 701 8. i C CD 50* 44 44 8 * 39 40 39 33 40i ‘ 27 27 27 30‘ 26 '-— 26 . zoi 9 I4 10“ 0 s _ _ f _ IN, Planning Conducting Orient Teach Teach Teach Orient Teach Teach Teach Teach to pat.to about about to pat.to life about about h05p. admin. finan. prev. hOSp. admin. style comm. prev. fac.& own mgt. med. fac.& own adjust. res. med. serv. treat. serv. treat. Content Areas igure 22.--Percentage of allied health professionals with and without experience who judged that nurses should have supportive responsibility for planning and conducting patient educa- tion activities in selected content areas. 166 physicians believing that primary responsibility for planning and conducting patient education should reside with nurses was only half as large as the percentage of nurses who believed they should have such responsibility. In contrast, a much greater percentage of patient education staff than of nurses believed that nurses should have primary responsibility for both planning and conducting patient education activities. Roles Deemed ApprOpriate for Allied Health Professionals Primary role.--About 30% of the total respondent group, as shown in Table 18, judged that allied health professionals should have primary responsibility for planning and conducting patient edu- cation activities. More than half of all respondents believed that allied health professionals should have primary responsibility for planning and conducting teaching about long- and short-term life style adjustments, teaching about community resources, and teaching about financial management of the illness. In comparing how the allied health professionals defined their own roles with the way other groups defined allied health pro- fessional staff roles, it appears that a somewhat larger percentage (about l2% more) of the allied health professionals believed they should, in general, have primary responsibility for both planning and conducting patient education programs. Thirty-seven percent of the allied health professionals, as compared with 25.5% of all other respondents, indicated that they should have primary responsibility for planning, while 4l.6% of them,euscompared to 29.6% of all other li57 wNNNxm o=N>NN . . . . . . . m N Ne N am 0 mm N am m cm N NN m me cNuosecou pcmvcwawucN . . . . . . . «Naoanmm O on 0 mm N NN N NN m NN 0 ea 0 mm chccmNa m=NcummN . . . . . . . acmEuomgu :30 e N. o mN N o_ N NN e NN m eN N ow OCNNusecou coumNchum . . . . . . . o» muzmwuma N «N N NN N eN o NN N ON N NN o NN chccmNN ueNcummN m.m N.N m.m m.NN N.m N.w m.mN ocNuuaocou “smegmacu co m.m N.o o.m N.NN N.m 0.0 N.oN chccmNN coNumcaNaxN N.o N.m o. m.m o.m o.m m.m mcwuosccou mwmocmmwo co ¢.e e.m e.m N.N o.m N.m N.mN achcmNa compmceNgxw . . . . . . . moor>cmm vco e m_ N mN N NN e mN a N. N mN m NN mcwuosueou maNNNNNomc . . . . . . . Nmuwamoc o» N oN m oN N DN 0 N o N N NN m N NewccmNN coNpmuchLO Noouz com": NNuz eNuz NoNuz mmNuz Nmnz azogw xpw>Nuomppou mcoumcu mcmum mpmconmwwocm ucmvcoammm mamogo c -mwcw5v< cowumuzum mmmczz mcm_uwmxcq 59—mw: cowuocam mwN< pcmucou NmNON NmuNnmoz u:m.uoa um_NN< masoco .mcowmmmwocm Nmzpo .mmNHNNVnchoamwc xcwENLa cozm m>mc upzosm mchowmmmmocq zupmm; wow—No was» vwmcaw on: azocm “coccoamwg Nmuou on» van mgaocm chommmmwoga cmzuo Lao» we mummucmogmq can mmmgm acoucou vmuuwpwm mew: cw cowumoacw acmwpma mcwuoaucoo vac mcwccmpn Lo» xuwpwnwmcoammc xcaspcq wcspocw upzozm ope; chowmmmwoca cwmzu was» uwmnzn on: mpmcowmmwwoca cupmm; vwWF—m mo wmwpcwucmaii.mN mNow» 1(37 . . . . . . . a: u NNNNxN ocw>wp N NN N NN N NN N NN N NN N NN N NN NN.=NNON pcwucmamucN . . . . . . . m ocoouwNmN o NN 0 mm N NN N NN N NN 0 ON N NN cNecmNN NNNNUNNN . . . . . . . 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Nmow>cmm new N NN N NN N NN N NN N NN N NN N NN NcNuoancou NNNNNNNUNN N.NN N.NN N.NN N.N N.N N.NN N.N NNNNNNNN NNNNNNON 0N . cowumucmmgo NNNuz NNNuz NNuz NNuz NNNuz NNNuz Nmnz aaocw NNN>NaomNNou NLoNNNu Nwmum NNNcoNNNmNoNQ ucmvcoammm, Namogo N -NNcwEv< coNuNoaum Nwmgzz N:NNUNNxca zuNNm: cowuocam ch< pcmucou NNNON NNNNNNOI NNNNNNN NNNNNN Naaocw NNCONNNNNNLQ Noguo .NNNNNNNachoaNoN acmsNNa cozm m>Nz npzocm NchoNNNmNoLQ cuNNm; vow—Na umcu vmmuan oz: aaocm ucmucoqmmg Nmuou on“ use Naaocm choNNNmNoca Nozuo Lao» No mmmmucmocwq ucm NNNLN acmucoo vmuumNmN mew: :N coNNNoaum ucmNNNa mcwuosucoo use mcwccmNa Low xuw—Nnchoang NLNENNQ muaNocN uNzogm mNoL choNNNmNoNa NNmzu was» uwmvaw on: NNocoNNwaoca cuNNo; now—Na we mmmucwocma--.mN NNNNN l68 NNmLN wcwc NHNN N.NN N.NN N.NN N.NN N.NN N.NN 2:328 N NN N.NN N.NN N.Nm N.NN N.NN o.~m NNNNNNNN Nw>o New: . . . . . chuNumE N NN N NN N NN N NN N NN N.NN N.NN 95828 3.55;: . . . . . «chmm N NN N NN N NN N N.N N NN N.NN N.NN 2.2.5.: No NFNNBN . ENNEN 528: N NN N.NN N.NN N.NN N.NN N.NN N.NN 9.52.28 No 22.322. . . Nmrocmcww N NN N NN N.NN N.NN N.NN N.NN N.NN NEENNN SEN chgonN N.NN N.NN . . . . . quczommc N NN N NN N NN N NN N NN 9:328 SEES N.NN N.NN N.N . . . . :2; N N NN N NN N NN N NN 9.2%: 9:63: N.NN N.NN N.NN o.N . . . Newsumahum N N NN N NN N NN 3:328 2.? 8.: N.NN N.NN m.mm N.N . . . EquiuNozm New N N NN N NN N NN 3.2%: .32 9:63; MNNuz NNNuz NNuz NNuz NNNuz NNNuz Nan :oLw Ncouwcu m NNN>NNowNNou N» am NNNcoNNquoNN acmucoammm . -NNNNE . Na: . . u< zowueozvm Nmmcsz NcmNoNNN mm NNNNN ocw N NNNNNNNI NNNNNNN 2N ”WMNNH NNNNNN=N ch< ucmuzou Nazogo NNcoNNNwNoLN chuo .uwacwucouuu.mp when» l69 respondents, indicated they should have primary responsibility for conducting patient education activities. Over half of the allied health professionals believed they should have primary responsibility for planning for the teach- ing of self—care independent living skills (53.6%), long— and short- term life style adjustments (63.3%), community resources (6l.9%), and financial management of the health problem (57.4%). A somewhat larger percentage of them believed they also should have primary responsibility for conducting three of these four activities: teach- ing of long- and short-term life style adjustments (78.6%), teach- ing about community resources (70.l%), and teaching about financial management of the health problem (64.9%). The judgments of three of the other professional groups concerning the overall primary role of allied health professionals in the planning and conducting of patient education activities were very similar. Approximately one-fourth of the physicians, nurses, and hospital administrators, as compared to 37% of the allied health professionals, believed that allied health professionals should have primary responsibilities for planning patient education activities. Close to one-third of the physicians, nurses, and hos- pital administrators, as compared to 4l% of the allied health pro- fessionals, indicated that allied health professionals should have primary responsibility for conducting those activities. The patient education staff were more in agreement with the allied health professionals. Thirty-one percent of the patient education staff indicated that allied health professionals should l70 have primary reSponsibility for planning patient education activi- ties and an almost identical 4l% indicated that they should have primary responsibility for conducting them. At least half of each of the groups agreed that allied health professionals should have primary responsibility for both planning and conducting of teaching about community resources. The groups differed somewhat in their beliefs concerning the role of the allied health professionals in the other content areas. The major differences of opinion were between the patient education staff and the other groups. This was especially apparent in the teaching of self-care independent living skills and teaching about financial management of the health problems, where a much larger (approximately 30% larger) percentage of patient education staff than of the other groups indicated that allied health professionals should have primary responsibility for conducting those activities. In summary, allied health professionals defined roles for themselves that were moderately different from roles defined for them by the other four professional groups. As mentioned earlier, approximately 12% more of the allied health professsionals than of the other four professional groups collectively believed their pro- fessional role should include primary responsibility for both plan- ning and conducting patient education activities. These differ— ences of opinion were apparent in eight of the nine content areas. The differences in percentages were especially large in regard to planning and conducting the teaching of long- and short-term life style adjustments. About 63% of the allied health professionals l7l indicated they should have primary responsibility for planning that activity, while only 43.2% of the other four professional groups collectively indicated this. In conducting that activity 78.6% of the allied health professionals indicated they should have pri- mary responsibility, while only 54.l% of the other four groups indi- cated allied health professionals should have this responsibility. Patient education staff were more in agreement than were the other three professional groups with the allied health profes- sionals. This was especially so in regard to conducting patient education activities. There was very little relationship between definitions of the allied health professionals' role by any of the groups and the following three factors: (l) the size of the hospital where pro- fessionals practiced, (2) whether they had experience with formal patient education programs, or (3) whether they had attended edu- cational programs on or related to patient education. There was a relationship, as illustrated in Figure 23, between whether respondents practiced in hospitals with formal patient education programs and answers of the allied health pro- fessionals concerning the primary role of the allied health profes- sionals. A greater percentage (20%) of allied health professionals who worked in hospitals with programs than of those who did not judged that they should have primary responsibility for planning for teaching about financial management. In three content areas, namely orientation to facilities and services, teaching life style adjust- ments, and teaching about financial management, about l5% more of l72 [:] Hospitals without programs m Hospitals with programs lOO- 90 i 80- 70‘ 60‘ 501 401 30‘ 20 2 0- Won 8 mm 104 “W.” 0, RAMMH _ , Conducting Planning Orient Teach Teach Teach to life about about hosp. style finan. finan. fac. & adjust. mgt. mgt. serv. Content Areas gure 23.~—Percentage of allied health professionals who worked in hospitals with and without patient education programs who judged that their professional role should include the responsibility for planning and conducting patient educa- tion activities in selected content areas. 173 this same group indicated they should have primary responsibility for conducting those activities. No other significant relation- ships appeared to exist between whether respondents practiced in hospitals with or without formal patient education programs and their reSponses concerning responsibilities of allied health staff for planning or conducting patient education activities. Supportive role.-—Slightly over one-fourth of the total respondent group, as shown in Table l9, judged that allied health professionals should have supportive reSponsibility for planning and conducting patient education. In none of the content areas did a large percentage of the total respondent group believe that allied health professionals should have a supportive role, though 20 to 37% of all respondents indicated this group should have supportive reSponsibility in each of the content areas. Approximately one- fourth of the allied health professionals themselves also judged that their professional role should include supportive responsibility for planning and conducting patient education activities. Physicians, nurses, and hospital administrators had similar opinions about the supportive role of the allied health professionals in both planning and conducting patient education activities and were in agreement with the allied health professionals' own judgments. Between 25 and 33% of each of the three groups believed they should have supportive responsibility for both planning and conducting patient education activities. 'l74 03$” miom mimm w. . m m NN . . NNNNN NNNNN N.NN N NN N NN N NN NNNNNNNNNN NNNNNNNNNNN N.Nm N.NN N.NN . . . mgmo-w_wm N NN N NN N NN NNNNNNNN NNNNUNNN o.Nm N.NN 0.0m . . . . acmEummLu :30 w mm m 3 m on _. om mcwuusucou LmummcmEno N.om N.NN N.NN . . . . op Nucmwqu N NN N NN N NN N NN NNNNNNNN NNNNUNNN mHNN mflmm NHMN N.NN N.NN N.NN N.NN Neruozocou acmEuNmLu mo N ON w NN N Nm N.NN N.NN N.NN N.NN NchNNNN :oNuchNNxm NHNN NHNN N.NN N.NN N.NN N.NN N.NN NNNNNNNNNN NNNNNNNNN N0 N NN N NN N.NN N.NN N.NN N.NN N.NN NNNNNNNN :NNNNNNNNNN N. m . . . . . . Nmow>cmm ucm N N NN N NN N NN N NN N NN N NN NNNNNNNNNN NNNNNNNUNN . . . . . . . NNNNNNNN NN N NN N NN N NN N NN N NN N NN N NN NNNNNNNN NNNNNNNNNNN NNan NNNuz NNuz NNuz NNNuz NNNuz NNuz aaogw Ncouccu Nwmum NNNcoNNNmNoNN ucoccoammm NpmmeWMNNoo -NNcNEu< cowuwozum Nmmcaz NcNNoNNN:N zuNmm: :oNuoczu NNN< Ncmucou NNNNN N NNNNNNNN NNNNNNN NNNNNN Naaocw NNNNNNwaoNN Nwzuo .NNNNNNNNNNNNNNNN w>NNNoNNNN cozm N>Nz NNNNNN NNNcoNNNmNoNN NNNNNN umNNNN umgu vmmozn on: Nzocm “coucogmmg Nmuou oz» can NNNoNN NNNNNNNNNNNN gmguo NNNN we NNNNNNNNNNN NNN NNNNN ucwucoo umpoonN New: :N cowumoanm ucmNNNN Ncwuozucoo ocN NNNNNNNN Now NNNNNNNN -NoquN N>NNNNNN=N musNocN uNaocN «No; NNNNNNNwNoNN NNNNN Nag» Nwmvsn oz; NNNcoNNNwNoNN cuNmmg cmNNNN No mmwucmocmaiu.m— mNNNN l75 Till) . . mmem. 05.: N.NN N.NN N.NN N.NN N.NN N NN N NN NNWNUNBNN t: :3: N.NN N.NN N.NN N.NN N.NN N.NN N.NN PENN: wcwowvws N.NN N.NN N.NN N.NN N.NN N.NN N.NN 9.52.28 9:53: NNchmm N.NN N.NN N.NN N.NN N.NN N.NN N.NN 9:55: No 9:52: 5:83 NWNNE . . . . . . . chuozu:oo Lo Ncmsm acme N NN N NN N NN N NN N NN N NN N NN NNNNNNEN N.NN N.NN N.NN N.NN N.NN N.NN N.NN 9.2.5: 26% NchocmN . . . . . . . Nwocaommc N NN N NN N NN N NN N NN N NN N NN NNNNNNENN SEES - I - n u a I Do a N NN N NN N NN N NN N NN N NN N NN NEENNN NNNUNNMN N.NN N. . . . . . 2253:; NN N NN N NN N NN N NN N NN NNNNUNNSN NNDN N.N: N.Nm N.NN . . . . . ENNN-NN0:N ucw N NN N NN N NN N NN N NN NEENNN -NNNN NFENNNN NNNuz NNan NNuz Nan NNNuz NNan NNuz azocw NNo NN NNm>NuowNNou u u mmmum NchoNNNwwogm ucwucoammm . -NN:NEu< :oNNNozvm NNNN: NNNNNNNN :38 3.6.5 N NNNNNNNI NNNBNN z . . NE “WWW“ NNBNNE 85 23:8 Nasogw choNNwaogm Lozuo .nmacNucou--.mN mNoNN ll l76 Among the patient education staff a slightly higher percen- tage accorded supporting roles to the allied health professionals. About 4l% of the patient education staff indicated that allied health professionals should have supportive responsibility for planning and 34.2% indicated that they should have such responsibility for con— ducting patient education activities. The largest percentage of patient education staff (65%) believed that allied health profes- sionals should have supportive responsibility for the planning of both teaching patients to administer their own treatment and self— care independent living skills. About half of the patient education staff also believed the allied health professionals should have supportive responsibility for planning the orientation to hospital facilities and services, and the teaching of long- and short-term life style adjustments. It appears that patient education staff were more inclined to define a supportive role for allied health professionals, espe- cially in the area of planning patient education activities, than were the allied health professionals themselves or members of the other three professional groups. The judgments of the four other professional groups col- lectively and the allied health professionals themselves were very similar concerning the supportive role of the allied health pro— fessionals in patient education. In only three of the content areas did their opinions differ greatly. Approximately l3% more of allied health professionals than of the other four professional groups collectively indicated that they should have supportive l77 responsibility for planning patient education activities relating to the explanation of the treatment procedures. Just the reverse is true in two other content areas (planning and teaching of self- care independent living skills and long- and short-term life style adjustments) where lO% more of the other four professional groups collectively than of allied health professionals believed they should have a supportive role. There was very little apparent relationship between defini- tions of allied health professionals' role by any 0f the groups and either of two factors: (I) the size of the hospital where profes- sionals practiced or (2) whether they had previously attended edu- cational programs on or related to patient education. Only for the allied health professionals, as shown in Figure 24, was there a statistically significant relationship demon- strated between their responses concerning the supportive role of allied health professionals and whether they practiced in hospitals with or without formal patient education programs. In three of the nine selected content areas about l7% fewer of the allied health professionals who worked in hospitals with patient education pro- grams than of those who worked in hospitals without programs believed that their role should include supportive responsibility for conducting those activities (orientation to hospital facili- ties and services, teaching patients to administer their own treat- ment, and teaching of life style adjustment). There was a relationship between respondents' experience with formal patient education programs and the answers of respondents rulccucayc l78 100* [:]Without patient education programs 90‘ “With patient education programs 80* 701 601 504-5-9——~- 46 40‘ 32 ..N. ' MW ,0. «mm MW). m. WW 7 ’(l‘l’lWl‘ 0‘ . (mm Orientation Teaching Teaching to hospital patients to life style facilities administer adjustments & services own treat. Content Areas Figure 24.—~Percentage of allied health professionals who worked in hospitals with and without patient education programs who judged that allied health professionals should have supportive responsibility for conducting patient educa- tion activities in selected content areas. L l79 concerning the supportive role of allied health professionals. As illustrated in Figure 25, about 7% more of the total respondent group with experience than of those without experience believed that allied health professionals should have supportive responsibility for both planning and conducting teaching of patients to administer their own treatment. In two additional content areas (teaching self—care skills and teaching about community resources), approxi- mately 8% more believed they should have supportive responsibility for planning and in two other content areas (explanation of diag- nosis and of treatment) 10% and 9%, respectively, believed they should have such responsibility for conducting patient education activities. Approximately l7% more of the allied health professionals, as illustrated in Figure 26, who had experience with formal patient education programs than of those who did not, judged that their role should include supportive reSponsibility for planning in three content areas (explanation of treatment, teaching patients to adminis- ter their own treatment, and teaching of financial management) and 25% more of them believed that they should have such responsibility for conducting in three areas (explanation of diagnosis, explana- tion of treatment, and teaching patients to administer their own treatment). A greater percentage of the nurses, as shown in Figure 27, with experience than of those without it also believed that allied health professionals should have supportive responsibility for plan- ning and conducting patient education activities in selected content l80 C] Without experience m With experience OO« 904 80‘ 70% 604 50i 42 0~ 37 4 32 3] 3l 30 303.11 25 ' 20 22 20 ‘l l0 , g _ _ _ Planning Conducting Teach Teach Teach Teach Explan. Explan. pat. to self; about pats to of“ of admin. care comm. admin. diag. treat. own skills res. own treat. treat. Content Areas Figure 25.-«Percentage of total respondent group with and without experience in formal patient education programs who judged that allied health professionals should have supportive responsibility for planning and conducting patient education activities in selected content areas. N.N . ”l .NNNNN :0 :00 :N NNNNN>NN0N :NNNNNNNN #:0NNNN N0 N:Npo:0:00 0:N NchcmNM NHN NOWNMWWMWN -choammN 0>NNNNNNNN N 003N0:N 0N00:N 0N0: NN0:u pm:p NNNNNN 0:3 :0NNN0300 N:mppmm NNENNN :N NNNNNNNNXN NNN:NN3 NNN :NN3 NchoNNNNNNNN :NNNN: uwNNNN No NNNp:mwNm: .NN NNNNN . -- .N NNNL< N:NN:00 .NNNLN .NNmNN :30 .NNE :30 .:NENN .NNNNN .NNNN .:N:Nm .NNEUN .NNNLN ou.pN0 No N0 0:000 0».NNN N0 :NNNN .:NNNxm , .:NNNxm :NNNN :NNNN .:NNwa 9% 3 ON ON mm om 0N .d om m 3 8m 1. D... oN .w ow 0N OON 00:0NN0Nx0 :pNz mwm 00:0N300x0 p:0:pN3 flu .NN0N0 p:0p:00 00900N0m :N N0NNN>NNUN :0N»00=00 #:0NNNN m0 chpozvcoo 0:0 N:N::0NN 0:» NoN NNNNNNNN:00N0N 0>NNN0NNNN 0>N: 0N00:N NchoNNN0N0NN :NNN0: 00NNN0 00:p 00000m 0:3 NENNNNNN :0NN00000 “:0NNNN NNELNN :N 00:0NL0Nx0 “20:0N3 0:0 :0N3 NONNN: N0 0NNN:00N0N--.NN 0::NNN N00L< p:0p:0u .me N00N=0N0N NNNNNN N00LNNN0N NNNNNN .:N:Nw .EEoo 0:00 Nwmocmwwu .EEoo 0NNO NNNo:m0N0 psonN Nzonm INN0N No uzonm -0N0N N0 :000N :000N :0N0N .:NN0xm :0N0N :000N .:NNwa mcwposucou m:N::NNN ON ON om ON l82 om om abeluaoxad on om om ooN 00:0NN0Nx0 :pNz awn 00:0.E0Nx0 N.NofiNz D l83 areas. Approximately l4% more of them judged that allied health professionals should have supportive responsibility for both plan- ning and conducting the explanation of diagnosis, teaching self-care skills, and teaching about community resources, and for just con— ducting the teaching about financial management of the health problem. No statistically significant relationships appeared to exist between the physicians' experience with formal patient educa— tion programs and their responses concerning responsibilities of allied health professionals for planning or conducting patient edu— cation activities. In summary, allied health professionals were believed by just over one-fourth of professionals in other groups to have primary responsibility for the overall planning and conducting of patient education activities. Thirty—seven percent of the allied health professionals themselves believed they should have primary respon- sibility for planning programs and 41.6% believed they should have primary responsibility for condUcting them. Allied health profes- sionals were seen by about one-fourth of all professional groups, including themselves, as having major supportive roles in both plan- ning and conducting patient education. Allied health professionals believed more frequently than did physicians, nurses, and hospital administrators that their pro— fessional role should include primary responsibility for both planning and conducting patient education activities. They were in close agreement with all other professional groups concerning their supportive responsibilities in both planning and conducting. / inf-H l84 Patient education staff more frequently than the other three pro- fessional groups accorded allied health professionals responsibility for patient education. Roles Deemed Appropriate for Hospital Administrators Primary roles.—-In general, as shown in Table 20, a very .small percentage of all professional groups judged that hospital l I ‘ l ' administrators should have primary reSponsibility for planning and : conducting patient education activities. Only 6% of the total a respondent group believed hospital administrators should have primary ; responsibility for planning, and 3.l% believed they should have such responsibility for conducting these activities. In all but two of the content areas, less than 5% of the respondents judged that they should have primary responsibility. In the two areas, planning the orientation to hospital facilities and services (24.l%) and planning and conducting the teaching about financial management of the health problem (l9.2%), slightly larger portions of the several groups, including the administrators themselves, believed that hospital administrators share primary responsibility. The small group of hospital administrators very much mir- rored the responses of the total respondent group. Overall, 9.4% of the hospital administrators indicated they should have primary responsibility for planning and 4.4% indicated they should have it for conducting patient education activities. The largest percen- tage of administrators judged that their role should include plan- ning (44.4%) and conducting (16.7%) of orientation to hOSpital NNNNNN N=N>NN N. N. o. o. o. N.N o. N:N0000:00 0000:00000N . . . . . . . N 0:00-0N0N N N N N N N N N N :NNNNNN NNN:NN00 . . . :0 00: :30 N N N N. N. N. N. NNN0NNNNNN 0 WWNNNWNENN . . . . 0 N :00 00 N N o 0 N N. N. 0. 0:00:00: 0 mw0:0w00 N. N. o. N.N o. N. 0. 0:000:0000 000200000 00 N.N N.N N. N.N N. N.N N. NNNNNNNN :NNNNNNNNNN no N” N. o. N.N N. N. o. 0:000:0coo N0N0:0000 00 90 N N N.N 0. N.N N.N N.N o. 0:00:0NN 000000000x0 o. . . . . . . N000>N0N 0:0 N N N N N N N N N N NN N NN NNNNUNNNNN N0N0NNNNNN N.NN N.N . . . . . N0000N0: 00 N N NN N NN N NN N NN N NN NNNNNNNN :oNNNNNNNNN NNNuz NNNuz NNuz NNuz NNNuz NNNuz anz 000:0 00000 N 0:0NNN0 0: N 0>N000 0 c N . w 0 N000NN0 0:00:00N0m NNNNNNNNW N 000000=0N :0NN0: N0N:=z N00000NN:N -N00050< 0000000: N0:< 0:00:00 NN0NN 0:0N0NN NNNNNN NNNNNNNI NqsoNN N0000NN0N00N 00:00 .N0N000000N000N0N NNNENNN :NNN 0>N: 00:0:N N000NN0N000500 00000N0: 00:0 0000=N 0:3 000:0 0:00:00N0: 00000 0:0 0:0 NNNNLN 00:0NNN00000 00:00 0:00 00 N0000000000 0:0 N00NN 0:00:00 00000N0N 0:0: :N 000000300 0000000 0000000000 0:0 0:00:0N0 :00 N0NNNNNN00000: NNNENNN 000N000 0N=0:N 0N0: choNNN00000 :00:0 00:0 00000N 0:3 N000NN0N000000 00000N0: 00 0000:0000auu.om 0NNNN li36 .liilliriIiIillIiililiiiiiliiiiliilillrli. iiiitliililli a. N.N N.N NHN NHN 0000000000 N0000 0:0: N.N N.N N.N N.N N.N N N N N NNNNNNNN 0000 0N0: . m. o N . . . . m: 00 00000005 N.N o. o N N N N N N N 00 0:00 0>0000>000 N.N . . . 0000000 N.N N.N N.N N N N N N N 00000000 00 0:0:0000 N.N 50—0000 00—00: . N.NN N.NN N.NN N.NN mcw0u0ucou 00 0005000005 N.NN N.NN N N NNNNNNNN0 . N.NN N.NN N.NN N.NN NNNNNNNN NNNNN N.NN N.NN 0 N0 0:0:000P . N00000N00 . o. 0.0 N.N N.N 0 0000000000 30:05:00 N.N N N . 0 00000 N.N N.N N.N N.N N.N N N 0000000 0:0:000N N.N . 0005000000 . N. N. N. N.N N NNN0NNNNNN 0NN0N NNNN N. N E000:000:m 0:0 .0 o. 0.0 N. N.N o. 0:00:000 -0000 0:0:0000 N.N N NNN z NNNuz NNuz Nan mNNuz NNNuz NNuz u MLOHMLU N 0:00NN00000 000 :0 :0 00000 N 0>N0000000 0000” N 0 N0: N0N00z N:NN0NNN:0 -N00050< 00000000 N 0 0 N 00000 N 000000 0N : — 000N000: 0:0mu000 N0000N N 0000000 000000 . N0000N 00:00NN00000 00:00 .000000000--.om 0N000 l87 facilities and services and planning (29.4%) and teaching (l7.6%) about the financial management of the health problem. None of the hospital administrators believed their role should include primary responsibility for five of the nine content areas, and only one or two of them claimed any responsibility in the remaining areas. The four other professional groups were in full agreement with hospital administrators about the overall role of hospital administrators in patient education. They did, however, differ somewhat with respect to the two content areas on which the adminis- trators saw a role for themselves. Only about half as large a per- centage of the other four professional groups collectively judged that the administrators' role should include primary responsibility for both the planning and conducting of orientation to hospital facilities and services and only about two-thirds as large a per— centage judged that it should include primary responsibility for planning the teaching about financial management of the health problem. There was very little or no relationship between defini- tions of hospital administrators‘ role by any of the groups and any of the four other variables: (l) the size of the hospital where professionals practiced, (2) whether the hospital where they prac- ticed had a formal patient education program, (3) whether the respon- dents had experience with formal patient education programs, and (4) whether they had previously attended educational programs on or related to patient education. l88 Supportive role.-—Less than 10% of the total respondent group, as shown in Table 21, judged that hospital administrators should have overall supportive responsibility for planning and con- ducting patient education activities. In none of the content areas did more than 17% believe they should have this supportive role. The small group of hospital administrators viewed their supportive role somewhat differently than did the other groups, except for patient education staff. Approximately 16% of them judged that their professional role should include supportive responsibility for both planning and conducting patient education activities. The largest percentage of them, about one—third, indicated that their role should include supportive responsibility for both planning and conducting teaching about the financial management of the health problem. Physicians, nurses, and allied health professionals were not in full agreement with hospital administrators concerning the overall supportive role of hospital administrators. Less than 10% of each of the groups, as compared to 16% of the hospital administrators them- selves, indicated that hospital administrators should have overall supportive responsibility. Their differences of opinion were espe— cially apparent in the content area on teaching about the financial management of the health problem. Patient education staff and hospital administrators had very similar Opinions concerning the overall supportive role of the hos— pital administrators. They differed modestly in two of the content 0.N N.N N.NN N.N N.N N.N N.NN 0:00u0vcou NNNNNN 0:0>NN . . . . 0:00:08 N.N . N.N N.NN N N N N N N N NN 0.5.2:: 23.0”...” N N 0:0:000N . N.N N.NN N.N N.N N.N N.NN 0:000:0000 000500000 :30 0 N . . . 000N000500 . N.N N.NN N N N N N N N.NN NNNENNN 8 35.58 N N 0:0:0000 . N.NN N.N N.N N.N N.NN 0000000000 .0 m o . . . . . .0ch09; +0 N.N N.N N 00 N N N N N N N NN 000::0N0 0000000—0xm . N.N NHNN NHN NHN NHN NHNN 0:000:0000 NNNNNNNNN 00 mm w.m 0.0 N 00 N N 0 N N N N NN 0:0::NN0 00000:000xm 1| . . N.NN N.NN N.NN N.NN N.NN 000000 :0 N000>00N 0:0 N 00 N NF 0 0 0000:5000 . . . N.NN N.NN N.NN N.NN NSEN N838: 8 0 00 N N_ o 0N . 00 00000000000 (fill/l mNNuz NNNuz Nmnz Nmuz NNNuz NNan man 0000N NN0:00NN00000 N000N00 00000 NN0>0000N000 000000000 :0000: N0N00z 0:000NNN:0 -N00050< :000oc00 000 0:0 :0 0:00:00N00 N00000 N 0 < 0 0 N0000 0000000 00NNN< 0000 N0: N00000 N0000NN00000 00:00 .N0N0NNN0NN:00N00 0>0000000N :00N 0>N: 0000:N N000N00NN:NENN N00N0N0: 00:0 000000 0:3 00000 0:00:00N00 N00o0 0:0 0:0 N00000 chmemwmo00 00:00 0000 00 N0000c00000 0:0 N000N 0:00:00 00000—0N 0:0: :0 000000000 0000000 0000000000 0:0 00000000 000 N0NNNNNN:00N00.0>0000000N 0000000 0000:N 0000 00:00NN00000 000:0 00:0 000000 0:: N000000NN:NENN 00000N0: +0 0000000000--.NN 0N00N 0.0 N.N N.NN N.NN N.N N.N N.NN ch0u00:0u m00:0 0:0: N.N N.N m.NN N.N N.N m.m N.NN 0:0::0Nn L0>o :00: . . . . . 0: .8 .N 005 N.N N.N 0 NN m N 0 m m 0 N NN 0:N0000=00 0>N0=0>000 . . . . . ng0c0m N.N N.N 0 ON N N N N N N N NN 0:N::0N0 00 0:0:000N :0N00:0 :0N00: N.NN N.NN N.NN m.NN N.NN N.NN m.mm 0:00000cou 00 0:0E0mm:ma N000:0:NN N.NN N.mN N.NN N.NN N.NN N.NN N.NN 0:N::0N0 000:0 0:0:000N . . . . . . 900.530: mw N N N w m NN N N m N N N N NN ch0u00cou 000:05500 1| . . . . . . . 000:0 0 m N N 0 0N N N 0 0 N N N NN chccmNN chzumwN . . . . . . . 0:0:0m0000 N N N N 0 NN N m N N N 0 N NN 0:N0000:00 0N00m 00NN . . . . . . . 2:00-000:m 0:0 , N w o m o NN N m N m o N N NN 0:N::0NN -m:0N 0:0:000N NNNuz mNNuz NNuz Nmuz mNNuz mmNuz wNuz 000:0 0000m mN0:0Nmm000:0 m:000:0 0:00:0000N NNMDMWWMNwou :0N00000N :0N00: 000002 mchume:0 -wN:NEO< :oN0oc0N 00:< 0:00:00 NapoN 000N000 00NNN< N00N0m0: 0000NN N0:0Nmm000:0 00:00 .000000000--.NN 0N0~N 19] areas (teaching about financial management of the health problem and general preventive medicine). There was very little relationship between definitions of hospital administrators' role by any of the groups and either of two factors: (l) whether they practiced in hospitals with or without formal patient education programs and (2) whether they had previously attended educational programs on or related to patient education. A very modest relationship was demonstrated between hospital size and physicians' responses concerning the supportive responsi— bility of hospital administrators. In regard to planning in five content areas, l% or less of the physicians who practiced in hos- pitals with l-49 beds or lOO-l99 beds believed that hospital adminis— trators should have supportive responsibility. In hospitals with 50-99 beds about 6% of physicians believed this and in hOSpitals with over 200 beds l2% believed it. No other statistically signifi— cant relationships appeared to exist between size of hOSpital and definitions of role for hospital administrators. There was also a relationship between respondents' experi- ence with formal patient education programs and answers of the total respondent group and the allied health professionals concerning the supportive role of hospital administrators in patient education. Approximately 5% more of the total respondent group, as illustrated in Figure 28, who had experience than of those who did not have experience judged that hospital administrators should have supportive responsibility for both planning and conducting patient education .00000 0:00:00 00000N00 :N m0N0N>N000 :00000000 0:00000 No 0000000:00 0:0 0:00:0N0 000 00NN0000:0000N 0>N000000m 0>0: 0N00:m 0:000:0mNcN500 N00N0mo: 00:0 000000 0:3 05000000 :00000000 05500 N05000:.N 00:0200x0 000:003 0:0 :003 00000 0000000000 N0000 0:0 000 0000:00000--.NN 000000 mmde. Hcmucou .ummLu ”#6me .>me .005 .000 mNNNxm :30 .005 .000 mNNNxm :30 N .000 .>000 0N00m 0000 .:0500 .0000 .>0L0 0N00m 0000 .:0500 .00000 .0000 .000: .:00 mNNN -NN00 00.000 00 .:00 mNNN -NNmm 00.000 00 00 00 :000N :000N :000N :000N .:0N0xm :000N :000N :000N :000N .:0N0xm .:0N0xm 000000 0000000cou ch::0N0 192 00000000x0 :003mmu 00:00:00x0 000:003HHH l93 activities. This was apparent in regard to planning in seven and in regard to conducting in five of the selected content areas. About l2% more of the allied health professionals, as shown in Figure 29, with experience than of those without experience indi- cated that hospital administrators should have supportive responsi- bility for planning teaching patients life style adjustment and for both planning and conducting the explanation of treatment and teach— ing of preventive medicine. No other significant relationships appeared to exist between respondents' experience with formal patient education programs and their responses concerning responsibilities of hospital administra- tors for planning or conducting patient education activities. In summary, hospital administrators were believed by less than l0% of each of the professional groups, including hospital administrators themselves, to have overall primary responsibility for either planning or conducting patient education activities. They were also seen by less than l0% of the physicians, nurses, and allied health professionals and about l6% of the patient education staff and hospital administrators themselves as having supportive roles in planning and conducting of those activities. No major dif- ferences of Opinion were apparent among the groups. Roles Deemed Appropriate for Former Patients Approximately one-third (32.5%) of the total respondent group, as shown in Table 22, believed that former patients should l94 .00000 0:00:00 00000000 :0 00000>0000 :00000300 0:00000 00 0:000:0:00 0:0 0:0::0_0 000 0000000m:00m00 0>000000sm 0>0: 00:0:0 000000000:0500 0000000: 00:0 000000 0:3 05000000 :00000200 0:00000 005000 :0 00:00000x0 0300003 0:0 0003 000:000000000 00000; 000000 00 0000:00000--.0m 002000 m000< 0:00:00 .000000 0:000005 0:0500000 0:000005 00000 0:0500000 0>00:0>000 00 :000 0>00:0>000 0000 00 :000 0:0:0005 -0:000xw 0:0:0000 0:000000 -0:000xm 0:000:0:0u 0:0::0_0 0...... :z: . o 00:: .00.: 0. N : 0 N e 3.0:: 1 .0 0.0.0.000... . a 000:: m: 00 m0 2 row w 00 m..."v r00 0. ,0 0 0:00000x0 00000.02 E . 00 00:00000x0 0 . 50.3 D .. om 195 be involved in planning patient education activities and 22.5% believed they should be involved in conducting those activities for hospital inpatients. Over half of these professionals believed that the involvement of former patients should depend on the health problem. Table 22.-~Percentage of respondents by professional group and for the total respondent group who believed that former patients should have a role in the planning and conducting of patient education activities. Definitely Should Involvement Should Professional Depend on Group Be Involved Health Problem Planning Conducting Planning Conducting PhySlCla“ 22 8 14 6 55 9 58 1 N = 262 o 9 O 0 Nurses N 2 268 38.7 29.6 53.9 58.4 Allied Health Professionals 39.2 26.5 5l.5 52.0 N = 97 Patient Education Staff 53.8 23.l 38.5 61.5 N = 26 Hospital Administrators 23.5 ll.8 58.8 58.8 N = 18 Total Respondent Group 32.5 22.5 54.l 57.7 N = 670 39 in of ac he l96 More than half (53.8%) of the patient education staff, 39.2% of the allied health professionals, and 38.7% of the nurses indicated that former patients should be involved in the planning of patient education activities. A smaller percentage of hospital administrators (23.5%) and physicians (22.8%) indicated this. Over half of each of these groups, except for the patient education staff (38.5%), indicated that involvement in planning patient edu- cation by former patients should depend on the health problem. Approximately one-fourth of the nurses (29.6%), allied health professionals (26.5%), and patient education staff (23.l%) indicated that former patients should be involved in the conducting of patient education activities. Again a smaller percentage of physicians (l4.6%) and hospital administrators (ll.8%) indicated this. Over half of each of the professional groups indicated that involvement in conducting patient education by former patients should depend on the health problem. In general a lesser percentage of physicians and hospital administrators than of other professional groups believed that for- mer patients should be invOlved in planning and conducting patient education activities, regardless of the health problem. In con- trast, a greater percentage of patient education staff than of all other groups believed that former patients should be involved, regardless of the health problem, in planning patient education activities. T'———— l97 Roles Deemed ApprOpriate for Families of Present and Former Patients Nearly one-third (29.0%) of the total respondent group, as illustrated in Table 23, believed that families of present and former patients should be involved in planning patient education activities and 22% believed they should be involved in conducting those activities. About half (47.5%) of these professionals believed that involvement of such families in planning should depend on the health problem. Table 23.—-Percentage of respondents by professional group and for the total respondent group who believed families of present and former patients should have a role in planning and conducting of patient education activities. . . Involvement Should f t l Sh ld Professional De gg‘lfivg,vegu Depend on Group Health Problem Planning Conducting Planning Conducting Physicians N = 260 20.4 14.6 45.4 48.8 Nurses N 2 268 36.8 3l.l 46.8 49.8 Allied Health Professionals 3l.6 l8.9 48.4 46.3 N = 95 Patient Education Staff 36.0 l6.0 60.0 68.0 N = 25 Hospital Administrators l2.5 l2.5 62.5 62.5 N = l6 Total Respondent Group 29.0 22.0 47.5 49.9 N=664 l sion fami ning cian FrOI ll l98 About one-third of the nurses (36.8%), allied health profes- sionals (31.6%), and patient education staff (36.0%) indicated that families of present and former patients should be involved in plan- ning patient education activities. A smaller percentage of physi~ cians (20.4%) and hospital administrators (12.5%) indicated this. From 45% to 63% of these same groups indicated that involvement in planning patient education by such families should depend on the health problem. Fewer of the physicians (14.6%), allied health professionals (18.9%), patient education staff (16.0%), and hospital administra- tors (12.5%) indicated that families of present and former patients should be involved in conducting patient education activities. 0f the nurses, 31.1% indicated this. From 46% to 68% of each of the groups indicated that involvement in conducting patient education by such families should depend on the health problem. In general a somewhat lesser percentage of physicians than of most other professional groups believed that families of present and former patients should be involved in planning and conducting patient education activities. Conversely, a greater percentage of patient education staff than of most of the professional groups believed in the involvement of families of present and former patients. In summary, a large percentage of professionals believed that former patients and families of present and former patients should be involved in both planning and conducting patient education activities. However, the involvement of both groups should be 199 dependent, for the most part, on the health problem of the patient. The patient education staff reacted the most favorably to the inclu- sion of these groups. Ascribed Responsibility for Evaluation of Patient Education Activities Over half of the total respondent group, as shown in Table 24, believed that a variety of pe0ple and agencies should have a role in the evaluation of patient education activities. The groups included physicians, nurses, allied health professionals, patient education staff, patients and/or their families, and community home health agencies. The largest percentage of the total group indicated that patients and/or their families (76.3%) and physicians (68.8%) should be involved in evaluating programs. Of the physicians, 71.6% and 64.8%, respectively, believed that they themselves and patients and/or their families should have a role in evaluating patient education activities. Somewhat lesser percentages of them believed that patient education staff (54%), allied health professionals (47.9%), nurses (45.2%), and community health agencies (36.9%) should have such a role. Only 21.1% would include hospital administrators in the evaluation. A large percentage (84.8%) of the nurses indicated that patients and/or their families should have a role in the evaluation process. Approximately 70% of the nurses believed that both they themselves and physicians should have a role. A large number of them also saw a role for patient education staff (64.3%), allied health professionals (58.4%), and community home health agencies (56.2%). 0000:000 :0000: 0.00 0.00 0.00 0.00 N.0m 0.00 050: 000:05500 . . . 00000500 000:0 MoON Foqm Momm m ON w vw m we X0\v:m WHCQWHMQ . . 000000000:0500 o.mm 0.Nm m.m0 0.00 0 00 0 0m 0000000: . . . 00000 :000 0.00 0.00 0.00 m 00 m 00 0 00 100000 0:00000 . . . . 000:000000000 0 m“ 0.00 0.00 0.00 0.00 0.00 0.00 000002 0.00 0.00 0.00 0.00 0.00 0.00 0500000055 Fmonz 00uz mmuz m0uz 00Nuz 00Nuz 00000 0000000 00000 000:000000000 0:00:00000 100:050< :00000000 :0000: 000002 0:00000x:0 00:00< 00 00000 00000 0000000: 0500000 00000< 000000-000 .00:00000:0 0000000: 000 05000000 :00000000 0:00000 0:0000_0>0 :0 0000 0 0>0: 0000:0 0000:000 00 000000 00000000 0000 0000000:0 0:3 00000 0:00:00000 00000 0:0 000 0:0 00000 00:000000000 00 00:00:00000 00 0000:00000--.0N 00000 Only trat sion own edu pat hea hos .___ _ __~__ 20l Only 18.1% of the nurses saw a role here for hospital adminis- trators. Approximately three—fourths of the allied health profes- sionals believed that both patients and/or their families and their own professional group should have a role in evaluating patient education activities. A large number of them also saw a role for patient education staff (67.3%), physicians (60.2%), community home health agencies (57.1%), and nurses (50%). Only 30.6% would include hospital administrators. A very large percentage of patient education staff believed that patients and their families (92.3%), nurses (88.5%), patient education staff themselves (84.6%), and physicians (80.8%) should be involved in evaluating patient education activities. A large number also believed that community home health agencies (76.9%) and allied health professionals (65.4%) should also have a role. Hospital administrators would be included by 42.3% of them. An overwhelming majority of hospital administrators (94.1%) believed both physicians and patients and/or their families should have a role in the evaluation process. A somewhat lesser percen— tage believed that nurses (76.5%) and patient education staff (70.6%) should have a role. Approximately half of the hospital administrators also believed that community health agencies, hos- pital administrators themselves, and allied health professionals should also be involved in the evaluation. Professional sub—groups were not in complete agreement as to who should have a role in the evaluation of patient education at an ph fa si ha th ce "l 202 activities. A much greater percentage of patient education staff and hospital administrators than of other groups believed that physicians, nurses, patient education staff, patients and/or their families, and community home health agencies should have a role. A lesser percentage of the physicians than of the other groups con- sistently believed that all parties, except for themselves, should have a role in evaluating patient education activities. In summary, the largest percentage of the professionals believed that patients and their families (76%) and physicians (68%) should have a role in evaluating patient education activities. Except for the physicians, a large percentage of the professionals also believed that nurses, patient education staff, allied health profes- sionals, and community home health agencies should be involved in the process. Hospital administrators were included by lesser per- centages of each of the groups. Judgments About Organization of Patient Education Activities This section describes five issues relating to the organi— zation of patient education for hospital inpatients. Respondents first indicated what type of patient education activities, formal or informal, they would include within hospital patient education pro- grams. Second, they indicated which categories of health problems they would choose first to develop organized patient education activities. The third issue focused on was the respondents' opinions on whether the hospital, community agencies, or a combina- tion of the two should have the responsibility for providing needed educ on t ment Tabl shou educ shou prin cons tip! the tha Opi ill! of an 203 educational services for discharged patients. The fourth centered on the factors that impede or prevent the develOpment and imple— mentation of patient education programs. The fifth issue focused on was who should coordinate organized patient education programs for inpatients. Types of Patient Education Activities About 80% of the total respondent group, as shown in Table 25, judged that patient education for hospital inpatients should consist of an intentional combination of formal and informal educational activities. About 12% believed that the activities should be principally informal, while 8% believed they should be principally formal. Most physicians (70%) agreed that patient education should consist of an intentional combination of formal and informal educa- tional activities. However, one-fifth of the physicians judged that the activities should be principally informal, and one-tenth judged that they should be principally formal. Nurses and allied health professionals shared similar opinions concerning how patient education activities should be organized. Approximately 85% judged that there should be an inten- tional combination of formal and informal activities. Only about 8% of each group believed the activities should be principally informal and 6 to 8% indicated that they should be principally formal. An overwhelming percentage of patient education staff (92.3%) and hospital administrators (94.4%) judged that patient 204 005000:0 0:0 . . . 005000 00 0 00 0 00 0.00 0.00 0.00 0 00 :0000:0:500 00:000:00:H . . 005000 0 0 0.0 0.0 0.0 0.0 m 00 0000000:000 . . 005000:0 0 m0 0. 0.0 0.0 0.0 0 om 0000000c000 mmouz 00uz omuz 00nz momuz mmmuz 00000 0000000 00000 000:000000000 00000>000< 0:00:00000 100:050< :00000000 :00001 000002 0:000000:0 00 00000 00000 0000000: 0500005 00000< .00000>0000 005000:0 0:0 005000 00 :0000:0:500 00:000:00:0 :0 00 .005000:0 0000000:000 .005000 0000000:000 0: 0000:0 0000000000 :00000000 0:00000 00:0 000000 0:3 00000 0:00:00000 00000 0:0 000 0:0 00000 00:000000000 0: 00:00:00000 00 0000:00000--.mm 00000 C0P0D0P0 205 education should consist of an intentional combination of formal and informal activities. No hospital administrator and only a very small percentage (3.8%) of patient education staff believed the activities should be principally informal. A very small percentage (4.6%) of both groups believed the activities should be principally formal ones. Physicians' Opinions differed the most from the other profes- sional groups on how patient education activities should be organ- ized. More than twice the percentage of physicians as compared to other groups judged that patient education activities should be principally informal, and a moderately larger percentage judged that they should be principally formal. The majority of physicians (69.6%), however, agreed with the other groups (83.5% to 94.4%) that patient education programs should include an intentional com- bination of both formal and informal activities. Categories of Health Problems Which Professionals Would Choose First for Developing Organized Patient Education Programs for Hospital Inpatients The findings concerning which health problem areas should receive priority in the development of organized or formal patient education programs are presented in Table 26. Respondents were asked to choose, out of a list of twenty health problem areas, the five areas which they would choose first for developing programs. The largest percentage of the total respondent group chose the following five health problems: (1) diabetes (67.7%), (2) cardiac (58.6%), (3) cancer--general (45.1%), (4) hypertension (‘r“r o. 0.0 0.00 0.0 0.5 0.0 050000: 0 500000 0.0 0.0 0.0 0.0 0.0 0.0 0000000 00:00000:0000000 o. o. N.—0 0.0 0.0 0.0 00:00x . . . . . . 000000:0 0 m 0 m 0 00 0 m 0 0 0 0 0 0000000 000000:00o o. o. 0.00 0.00 0.0 m.0 000000:0 0000 00:000 0.0 0.0 0.0m 0.0 0.00 0.m_ 00000:00< 0.00 0.00 0.00 N.00 0.0 0.00 050000000: 0.00 0.0m 0.0m 0.00 0.00 0.00 :0000: 000:0: N.NN 0.00 0.00 0.00 0.00 0.0m 000:0: :0000: 00:00000 0.00 0.00 0.00 0.00 0.00 0.00 0000 0>0000000-0000 0 -000 0.00 0.0m 0.0m 0.0m 0.00 0.00 0000000 000:05000 N.NN o.mm 0.00 0.00 0.00 m.0m 050000 0.00 0.00 0.00 0.0m 0.0m 0.0m 000000 0.00 0.00 0.00 0.0m 0.00 0.00 0000:10000 0 -000 0.00 0.00 0.00 0.00 0.00 0.00 0000 0 50000:000< 0.00 0.00 0.00 0.00 0.00 0.00 :000:00000xz 0.00 0.00 0.00 m.om 0.00 0.00 000:00 0.00 N.00 0.00 0.00 0.00 0.00 0000000 0.00 0.00 0.00 0.00 0.00 0.00 00000000 00uz omuz N0nz Ammuz 00muz 000uz 0000000 00000 000:000000000 . 00000 000< 5000000 -00:050< :00000000 :00001 000002 0:00000>:0 0:00:00000 :0000: 0000000: 0:00000 00000< 00000 .05000000 :00000000 0:00000 0000:0000 0:00000>00 000 00000 0000:0 0000; 00:0 :00:2 00:0 00 00000 5000000 :0000: 00000000 0000000:0 0:3 00000 0:00:00000 00000 0:0 000 0:0 00000 00:000000000 0: 00:00:00000 00 0000:00000--.0m 00:00 ll 207 (40.2%), and (5) alcohol and drug dependency (39.7%). At least one—fourth of the respondents also indicated that programs in mental health, ostomy care, personal health habits (e.g., smoking), pre- and post-natal care, pre- and post-operative care, pulmonary dis- ease, and stroke should be among the first to be included. The largest percentage of all of the professional groups chose diabetes and cardiac-related illnesses as the highest priority categories in which they would first develop organized patient edu- cation programs. There were differences of opinions among the groups concerning the other priority areas. Ten additional categories of health problems were indicated by one-fourth or more of most of the professional groups as ones which should be included. These areas were: (l) cancer (all groups); (2) hypertension (all groups); (3) alcoholism and drug abuse (nurses, physicians, allied health professionals, and hospital administrators); (4) pre- and post-natal care (all groups); (5) stroke (all groups); (6) ostomy care (all groups); (7) pulmonary disease (physicians, allied health profes- sionals, and hospital administrators); (8) pre- and post-operative care (nurses and patient education staff); (9) personal health habits (physicians); and (l0) mental health (allied health profes- sionals and patient education staff). As outlined above, professional groups responded somewhat differently concerning which five priority categories they would first choose to develop organized patient education programs. Patient education staff and hospital administrators in contrast to the other three professional groups exhibited the greatest differences of 208 opinions. A much lower percentage (only ll.5%) of patient education staff than of the other four professional groups chose alcoholism and drug abuse as one of the top five categories. In contrast, a much higher percentage of the patient education staff (50%) indicated pre- and post—Operative care within their top five choices. A much larger percentage of the hospital administrators (50%) than of the other four professional groups indicated stroke as one of their t0p five choices. Ascribed Responsibility of Hospital and Community Agencies for Discharged Patients Who Need Further Educational Services The majority of the respondent group (59.4%), as shown in Table 27, believed that both hospital and community agencies should provide needed educational services for discharged patients. A large percentage of professionals (39.9%), though, believed that patients should principally be referred to appropriate community agencies upon discharge. ll very small percentage (l.2%) believed that principally the hospital should provide these services. The professional groups for the most part were in agreement with each other concerning this issue. Factors Believed to Impede or Prevent the Development and Implementation of Patient Education Activities for Hospital Inpatients A large number of the total responding group, as shown in Table 28, believed that the following factors tend to impede or llllllllllllllli )lI‘IIII||lI||II|I|IIIl-“IJ 00000000 0.00 0.00 . . . . 000005500 000 0 mm 0 mm m mm m 0m 0000000; 0000 00 00000000200 0.0m . . 00000000 0 00 0 00 0.00 0.00 0.00 00000m000 00 0000000 00000 9 mm 0.0 0. 0. . 0000>000 o 0. 0.0 0000M000 0000 00: ommuz u 0000a 0MM0M00 mmnz 00uz mmmuz mmmuz 0000000000 -0000000 cowwmwm0 0000000000000 000000000000 00000 0000000: 00000000 wwwmwu 000002 0000000000 00000000000 .00000000 000005200 00 0003 00000000 00 . 000 0002 000 00000000 00000 0:00:0000W 0MMMW0W0 00 0000>000 00000000000 000 00000000000M00 000000000 00 000 000 00000 000000000000 00 00000000000 00 0000:00WMm000M000 002 -a. m 00000 l l (+£(w4rtcw rn+wCuC£ SC$ wa+w>w+cm CCwHMUJU® “waflmc WC CC++n+£(E000 00 0000050 0003 0000000000 00000000 000 00000>0000 0000000 . . . . . . 00 0000000 00 00000000500050 :0 00500 00000 00000 000 000 000 00000 000000000000 00 00:00:00m00 W0 000%mmwm0mmw.mw>mwmwm 003 00000 0:00: ["K ac st th of ci ed ne tc ac 2ll prevent the development and implementation of patient education activities: (l) lack of staff time (80%), (2) lack of identified staff to coordinate patient education activities (67%), (3) lack of third-party payments for patient education activities (5l%), and (4) cost of patient education activities (50%). Approximately 40% of these same professionals believed lack of acceptance by physi- cians of patient education; lack of staff competence to do patient education; lack of staff interest in patient education; and lack of necessary facilities, equipment, and resource materials to be fac- tors. About one-third of the professionals believed that lack of acceptance by hospital administrators was a factor. A majority of the physicians agreed that lack of staff time (70%), lack of identified staff to coordinate (60.4%), lack of third- party payments for patient education (59.8%), and cost of patient education (53.8%) were factors. Approximately 45% also believed that lack of necessary facilities, equipment, and resource materials and lack of staff interest were factors. A large percentage of the nurses (88.3%) believed lack of staff time and a lack of identified staff (7l.8%) to be factors that can impede or prevent the develOpment and implementation of patient education activities. Forty—five to forty-eight percent of the nurses believed cost of patient education and a lack of necessary equipment, facilities, and resource materials to be factors. Approxi- mately two~fifths of the nurses also saw lack of staff interest and competence, lack of acceptance by hospital administrators and phyf als les dir 212 physicians, and lack of third-party payments for patient education as factors. A large percentage of the allied health professionals (80.2%) also agreed that lack of staff time was a factor, while a somewhat lesser percentage (69.5%) believed lack of identified staff to coor- dinate was a factor. About half of the allied health professionals judged lack of third-party payments and cost of patient education to be factors. Somewhat over one-third of them believed lack of neces- sary resource materials, lack of staff interest, and lack of accep- tance by physicians to be factors. Sixty-five percent of the patient education staff agreed that the lack of staff time was a factor. About half of them believed lack of identified staff to coordinate and lack of accep- tance by physicians to be factors. Approximately two-fifths of the patient education staff saw lack of third-party payments and staff competence as factors. All of the hOSpital administrators agreed that lack of staff time was a factor. A large percentage of them judged that the cost of patient education (88.2%), lack of identified staff to coordinate (80%), lack of third-party payments (75%), and lack of necessary facilities and equipment (68%) were factors. About half of the hos- pital administrators believed lack of necessary resource materials, staff competence, and acceptance by physicians to be factors. Professional groups had somewhat differing opinions concern- ing the factors that can impede or prevent the development and implementation of patient education programs. A smaller percentage 213 of patient education staff than of most other professional groups saw lack of third-party payments, cost, lack of equipment and facili- ties, or lack of necessary resources as impediments. More frequently than other groups they saw lack of acceptance by physicians and nurses as the problem. A much greater percentage of hospital administra- tors than of the other groups saw numerous impediments. They, like patient education staff, more frequently than the other professional groups believed that lack of acceptance by physicians was a factor. Coordination of Organized Patient Education Programs The respondents were asked to indicate which hospital depart- ment was best equipped to coordinate an organized patient education program. Half of the total respondent group, as shown in Table 29, judged that a separate education department could best coordinate an organized patient education program. Approximately 30% of them believed that nursing was the best department to coordinate such a program. The professional groups were in general agreement. Each group judged that a separate education department would be best. The second highest percentage of each of the professional groups indicated that the nursing department could best coordinate such programs. The nurses indicated a slightly stronger preference for the nursing department; conversely, the allied health professionals indicated a weaker preference. N.m o. e.m_ m.m_ e.o N.N_ tango o.o~ 8.“? o. ©.o_ m.a ©.e_ mauw>cmm _quom m. o. o. N.m a. w. _m::omemm m” m.mm e.mm a.©N m.N_ m.mm o.om mcwmcsz m.me m.mm N.Nm ©.om N.Ne m.©e cowpaosem wemuz N_nz omnz emuz mmmuz oemnz azocm mgopmcu wmmpm m_m:owmmmwoca pcmaugmamo “coccoammm -mwcwsu< cowpmozuu gppmm: mmmasz mcmeowmx;a FmpPamoz _mpoe _mbwamoz acetama ema_~< . .mpmpwamo; to mpcmswcmawn vmpmcmwmmn :w cmmeAULooo mp pmmn nrzoo msmcmoga cowumuaum pcmwpma umecmmLo wasp wmmuzm 0:3 azogm pcmucoammc PapOp asp Low mam asoxm chowmmmmocq an mpcmucogmmc to mmmpcmocmanu.mm m_nww j": ci si ac mc pi i l Summary In summary, a large percentage of professionals (approxi— mately 80%) believed that patient education programs should consist of an intentional combination of formal and informal activities. Only 12% of them believed the activities should be principally for- mal, while 8% believed that they should be principally informal. Physicians differed the most on how they believed patient education activities should be organized. At least twice the percentage of physicians as of other groups judged that patient education activities should be principally formal. While a smaller percentage of physi— cians than of other groups believed that such programs should con- sist of an intentional combination of both informal and formal ‘l activities, a majority of them agreed that such a combination was most appropriate. Diabetes and cardiac-related illnesses were chosen by the professionals as the two health problem areas with highest priority in organizing patient education programs. Other priority categories given by the professional groups included cancer, hypertension, alcohol and drug abuse, pre- and post—natal care, stroke, ostomy care, pre— and post—operative care, personal health habits, and mental health. A majority of the professionals (about 59%) agreed that a combination of the hospital and appropriate community agencies should have the responsibility for providing further educational services to hospital inpatients following discharge. There was a large minority (about 39%), however, who indicated that only the 2l6 community agencies should have responsibility for further educational services needed by discharged patients. Lack of staff time and a person to coordinate patient edu- cation activities were given by the professionals as the two major factors that impede or inhibit the development and implementation of organized patient education programs. Other factors also agreed upon by a large number of professionals included cost of patient education, lack of third—party payments, and lack of acceptance by physicians. The professional groups responded somewhat differently as to which factors inhibit the development and implementation of organized patient education programs. The patient education staff and hospital administrators exhibited the greatest differences of opinion from the other groups. About half of the professionals believed that a separate educational department would be the best department to coordinate an organized patient education program. A minority, however, of all of the professional groups except the allied health professionals indicated that the nursing department would be better able to do this. Judgments as to Feasibility of Developing or Expanding Organized Patient Education Programs Approximately three-fourths of the total respondent group, as shown in Table 30, believed that it was feasible to develop or expand organized patient education programs in their hospitals. m.¢_ m.mm o.o m._m w.m n.m_ swapcmocs _.N w.- 0.0 N.N n.m m.w oz o.wk N.¢m o.oo~ . _._N m.¢m ¢.Nm mm> _/. mu Iniililiillilriliiiliiill Foouz m_uz mmuz nonz momuz mmmuz azoco mcoumgp eempm umcowmmmwoLa ucmucoqmwm -mwcwEv< cowumuzum cppww: mmmgsz mcmwowmzzm zuwpvcwmmwm _apoe _mpwamo= pcmwpaa uaa_r< .mflapaamo: Laws“ cw mamgmoga coepmusum pcwwpma uvacmmLo mcwvcmaxm Lo mcwao~w>mn mo prpwnwmmmm mcp umucowvcr oz: azocm pcmucoamwa have“ ecu so» use azogm chowmmmmoca xn mucwucoammc mo ammucmugmm--.om opamh 218 Only 7.l% believed these types of programs could not be developed or expanded, while l5% were uncertain. Although physicians, allied health professionals,annihOSpital administrators were not quite as positive as the nurses and patient education staff, all groups agreed that it would be feasible. More than 70% of the physicians and allied health professionals and 64.7% of the hospital administrators believed it was feasible, as did 84.5% of the nurses and l00% of the patient education staff. Professionals who responded ”no" or ”uncertain" to this ques- tion were asked to explain briefly the rationale for their answers. The reasons most often given by all professional groups were: (l) lack of funds to support patient education programs, (2) lack of staff to do patient education, (3) lack of knowledge concerning hospital's patient education activities or hospital Operations in general, (4) the small size of the hospital, and (5) lack of staff interest in patient education. Physicians noted two additional fac- tors: (l) lack of proven cost—effectiveness of patient education and (2) that patient education was the physician's responsibility. Nurses also noted two other factors: (l) lack of staff training in patient education and (2) patient education was a low priority of the hospital's administration. Further analyses were done to investigate differences in judgments of the professionals on the feasibility of developing or expanding patient education programs. These analyses were done within the total respondent group and within three of the profes— sional groups in relation to several variables: size of hospital, 2l9 whether the hospital had a formal patient education program, whether respondents had participated in specific training for patient edu- cation, and whether they had experience with patient education. The three professional groups were the larger groups and those who showed larger differences in ratings, namely physicians, nurses, and allied health professionals. The total respondent group (see Figure 30), nurses (see Figure 3l), and allied health professionals (see Figure 32) who practiced within the larger hospitals were more in agreement than those in smaller hospitals lNlth the premise that it was feasible to develop or expand formal patient education programs. The physi- cians demonstrated no major variance in their responses in relation- ship to the size of the hospital where they practiced. Size of hos- pital seems to be a significant factor in relationship to respon- dents' judgments of the feasibility of expanding organized patient education programs. For only one of the groups, allied health professionals, was there a significant relationship between their judgments concern- ing the feasibility of developing or expanding organized patient education programs and whether the hospital in which they practiced had a formal patient education program. Approximately 30% more of the allied health professionals, as illustrated in Figure 33, in hospitals with formal patient education programs than of those in hospitals without programs judged that development or expansion was feasible. 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F F F i . mF o uwzuooowumo N NF F FoF FonmF .< mason o - - z N F m N No NF oF F sz FFooooo .o ouqucco: m -- :FccoFo oz quNcou N F N F N No FFF Nm F FwF Fmgmcou oum=m=< Eogmogo .m.o- NuNFooFozF Ncoxcoz mcoFu NNNFO NuNFoozm . . . . zF NumFooLoze mzoFu moo oz N FNELoo o>mx commom FoFuom -FumFo -NsLozo FocoFNoozuuo quszzo m.zoz N.zz iszzo -chweow wwwEwu oENZ FouFomoz FF " zF Noam ooF-ooF .o .ooooFoooo--.FN oFooF 266 Follow-Up Letters to Hospitals on Pre-Survey Letter I--TO hospitals with Operating patient education programs Dear I am writing to thank you for your hospital's cooperation in assisting me to gather the initial data that is needed to conduct my research study on patient education. Your operating patient eflucation programs sound very interesting. I enjoyed learning about t em. A summary of the data collected can be obtained from the Research & Education Trust of the Maine HOSpital Association. Again, thank you for your cooperation. Sincerely, Rosemary S. Caffarella Letter II--To hospitals in the process of planning patient education programs Dear I am writing to thank you for your hospital's cooperation in assisting me to gather the initial data that is needed to con- duct my research study on patient education. I was glad to hear that your hospital is in the process of developing a formal patient education program. If I can be of any aSSistance in that process, please feel free to contact me. A summary Of the data collected can be Obtained from the Research & Education Trust of the Maine Hospital Assoc1ation. Again, thank you for your cooperation. Sincerely, Rosemary S. Caffarella 267 Letter III--To hospitals without patient education programs Dear I am writing to thank you for your hOSpital's cooperation in assisting me to gather the initial data that is needed to con- duct my research study on patient education. It is my understand- ing that your hospital does not presently have a formal patient education program, but conducts patient teaching on an informal basis. A summary Of the data collected can be obtained from the Research & Education Trust of the Maine Hospital Association. Again, thank you for your cooperation. Sincerely, Rosemary S. Caffarella APPENDIX C LETTERS TO HOSPITAL ADMINISTRATORS REQUESTING SAMPLING LIST, THANK-YOU LETTER TO HOSPITAL ADMINISTRATORS FOR LISTS, AND LIST OF PARTICIPATING HOSPITALS APPENDIX C i LETTER TO HOSPITAL ADMINISTRATORS REQUESTING SAMPLING LISTS ‘ UNIVERSITV OF MAINE at Orono Office of (looperuliu- Education ‘ ()flicc at: Field Expt'rii-m-v 251 Aubert. ()ronu (207) 53l-2640 [ruin-nil} nf Maim- ;il Urmm Dear (Personally Addressed to each Hospital Administrator) Recently you provided some preliminary information of the patient education programs in your hospital for a study that I am undertaking in COOperation with the Maine Hospital Association's Research & Education Trust. We are now moving into the major section of the data collection and I would again like to enlist your support. The data collected in this stage will involve surveying randomly selected physicians, nurses (RN's and LPN's), hospital administrators, and allied health professionals (i.e., occupational therapists, physi- cal therapists) that work and/or practice in Maine hospitals. They will be surveyed through a short mail questionnaire. The purpose of the questionnaire is to determine the Opinions that hospital profes- sionals have of patient education (i.e., how they define it, what their professional role should be). In order for me to carry through this phase of the study I will need your assistance in obtaining the names of the following profes- sionals that work and/or practice with your hospital: Active Physician Staff a. b. Registered Nurses that work a minimum of 20 hours per week c. Licensed Practical Nurses that work a minimum of 20 hours per week ' d. Physical Therapists e. Occupational Therapists f. Dietitians 9. Social Workers h. Pharmacists i. Speech Therapists The lists that I obtain will be kept confidential and returned to the hospital after the study is completed. 268 269 The data that will be generated for the study will not be identified nor displayed by individual hOSpital. Rather the data will be shown by composite groups only (i.e., by professional staff grouping, size of hospital). . Your hOSpital will of course be given credit for their par- ticipation in the study. I will also be happy to share a copy Of the draft questionnaire with you so that you can see the types of questions. I will plan to call you in the next week to discuss further the study and the possibility of Obtaining the lists of names from your hospital that I need. I will be more than happy to meet with you at your convenience to further outline the purpose of the study if that would be helpful to you. Thank you for your consideration and assistance. Sincerely, Rosemary S. Caffarella Director Cooperative Education/ Field Experience (on leave of absence) 27O THANK-YOU LETTER--HOSPITAL ADMINISTRATORS UNIVERSITY OF MAINE at Orono Uflici: of (Loupu‘uiin- I':(ill('iflinll ”Hicc- at: Fit‘ldl "prt‘l'ivflk'i‘ 251 Aubert, Orono liniu'rsily‘ (if Maim- :il ”rum: (207) 581-2640 Dear (Personally Addressed to each Hospital Administrator) Thank you for sharing with me a list of your hospital's personnel for my study on patient education. Your cooperation in this matter was really appreciated. Enclosed are your original lists. Sincerely, Rosemary S. Caffarella Director COOperative Education/ Field Experience (on leave of absence) 27l LIST OF HOSPITALS PARTICIPATING IN THE STUDY Blue Hill Memorial Hospital, Blue Hill Calais Regional Hospital, Calais Castine Community Hospital, Castine Community General Hospital, Fort Fairfield Henrietta A. Goodall HOSpital, Sanford Houlton Regional Hospital, Houlton James A. Taylor Memorial HOSpital, Bangor Maine Medical Center, Portland Miles Memorial, Damariscotta Mount Desert Hospital, Bar Harbor Northern Maine Medical Center, Fort Kent Penobscot Bay Medical Center, Rockland Penobscot Valley Hospital, Lincoln Plummer Memorial Hospital, Dexter Regional Memorial Hospital, Brunswick Rumford Community Hospital, Rumford St. Andrews Hospital, Boothbay Harbor St. Joseph Hospital, Bangor Stephens Memorial Hospital, Norway Van Buren Community Hospital, Van Buren Westbrook Community Hospital, Westbrook York Hospital, York '5 APPENDIX D COVER LETTERS AND SURVEY INSTRUMENT II I. APPENDIX D COVER LETTERS AND SURVEY INSTRUMENT APPENDIX D COVER LETTERS AND MAIL SURVEY INSTRUMENT ./ UriversivoiMc'ned EXECUTIVE DIRECTO john Rosier Ed.D. AD VISOR Y BOARD OF DIRECTORS Stanley L. Freeman Eda/Chairman Kenneth W. AllcnP . Fletcher Bingham M.D. William J. Camry Richard T. Chamberlin M.D. Walter P. Christie M. D. Neil Rolde William E. Schumachcr M.D. MAINE HEALTH EDUC4TION RESOURCE CENTER dedcokzd lo the health mien of the told able/207778350687) A research study on hospital patient education is quSmm being conducted by Rosemary Caffarella. The purpose of F. Ernest Stall orth ' - - MRkaB;pn this study is to develop a description of how hospital administrators, nurses, and allied health pro- EXOHVOOMEMWMS fessionals view patient education for inpatients. Dr. Ema: A. Olun. Pren'denl, UMF mJlQmmdmuJMehwflmnCaffarella is on the faculty at the University of Maine Dr. Dawd Fearon, Dean. . . Public Strain Division, UMF Un 1vers lty . ‘“#”*Am”LUMF .at Orono and a doctoral candidate at Michigan State The study has been endorsed by the Maine Health Education Resource Center, and the Maine Medical Associa- tion. The information generated from this study will be used by these and other health related organi Maine in the development of patient education programs. Your response to the study as a physician is especially needed to ensure the comprehensiveness of the study. Please complete the enclosed survey form and return it to Mrs. Caffarella in the enclosed envelo June 10, 1977. As you may notice there is a number on the return envelope for record keeping purposes only. The confidentiality of your responses will b insured by separating the envelope and survey form when they are returned. I would appreciate your cooperation in this study. Sincerely, W34" Richard T. Chamberlin,’M.D. comm/mama Fcrrri'ngOO/lGD MdiSircd 04938 Sioddcrd Flouse/m'x/czrslyof Mc'ncz dAugUle 272 .- um.- 273 WINE HE4LTH EDUC4TION RESOURCE CENTER dedcoted to the heolrh educorm of the Iord mic/2077783501687) Urmzrsiy of Mom 0* Fanmgbn EXECUTIVE DIRECTOR John Rosser EdD. AD VISOR Y BOARD OF DIRECTORS Stanley L Freeman Etta/Chairman hmthAhnMfl. May 20’ 1977 Fletcher Bing ham William j.C Richard T Chamberlin M. D. Pearl R. Fisher R.N. Harland Goodwin JohnA. LaCaise GmmeT-wa ' P fessional: Daniel K. Onion M.D. Dear N‘JrSIng r0 Robert H R y wanna: A research study on hospital patient education is Illiam F Schumachch. D . 5m ,m being conducted by Rosemary Caffarella. The purpose of thmsmMmm this study is to develop a description of how nurses, ”*de‘hp" physicians, hospital administrators, allied health profes- Exornaommmam_ sionals, and patient education coordinators View patient Bfififizhfifil’fififilfiflf education activities for inpatients. Mrs. Caffarella is AuamaAmmLumr ' on the faculty at the University of Maine at Orono and a Dr. David Fearon. Dean ”uk&mwowmhlum doctoral candidate at Michigan State UniverSity. The study is supported by a number of health related groups in Maine including the Maine Health Education Resource Center. The information generated from the study will be used by these groups in the development of patient education programs and staff development activities on patient education. Your response to the study as a nurse that practices in a hospital setting will be especially useful. Please complete the enclosed survey form and return it to rs Caffarella in the enclosed envelope by Friday, June 10,1977. As you will see there is an identification number on the return envelope for record keeping purposes only. The confidentiality of your response will be insured b separating the envelope and the survey form when they are returned. We would appreciate your cooperation in this study Thank you. Sin;er 1y, ohnfi Rosser, Ed. D Executive Director DufiyHam/mversaydmd Fahhgon/IGDh/msrm 04938 Stoddcrd Ebuse/mvcrsiyochnedAuguslo 274 UNIVLRSHV 01': I .l/liNE mm ...._.A..._..... .. .“—-. —__....—..._.__ w-..__.._.-. .— w—m —-——.-—...* .— -. _ l’llu‘c c-l (:wvlui >l3n i‘..lllc;lliun Inf”... i”. .ESl \ulr'lf. (ll-mm (207 ‘I 3:} l ~36 ll! l‘io'ltl l.'.lh'lic'1lt'l' l Min-nil) nl “:Inu' :0! “rum: I am writing concerning the research study that I am conducting on patient education. The study is being done in cooperation with the Research & Education Trust of the Maine Hospital Association and the Maine Health Education Resource Center at the University of Maine at Farmington. The enclosed survey is being used to gather the major data for the study, the focus of which is how health care professionals view patient education activities for inpatients. I would like you to respond to the survey as an individual hospital administrator and not as a representative of your specific hospital. Please place the completed survey form in the enclosed envelope and return it by Friday, June 10, 1977. As you may notice there is an identification number on the return envelope for record keeping purposes only. The confiden— tiality of responses will be insured by separating the envelope and survey form when they are returned. Your continuing cooperation in this study is appreciated. Thank you. Sincerely, (Hnmunmuisc5.Cngpmnlln- Rosemary S. Caffarella Director (on leave) 275 if. Research and Education Trust F A Maine Hospital Association J 151 Capitol Street 0 Augusta, Maine 04330 0 207-622-4794 May 20, 1977 Dear Allied Health Professional; A research study on hospital patient education is being conducted by Rosemary Caffarella. The purpose of this study is to develop a description of how allied health professionals, physicians, nurses and hospital administrators View patient education for inpatients. Mrs. Caffarella is on the faculty at the University of Maine at Orono and a doctoral candidate at Michigan State University. The study has been endorsed by the Research & Education Trust of the Maine Hospital Association and the Maine Health Education Resource Center of the University of Maine at Farmington. The information generated from the study will be used by these and other health related organizations in Maine in the development of patient education programs. Your response to the study as an allied health pro— fessional that practices in a hospital setting will be especially useful. Please complete the enclosed survey form and return it to Mrs. Caffarella in the enclosed envelOpe by Friday, June 10, 1977. As you may notice there is an identi— ficatior number on the return envelope for record keeping purposes only. The confidentiality of your responses will be insured by separating the envelope and survey form when they are returned. We would appreciate your COOperation in this study. Sincerely, WIMIW Douglas Kramer Program Coordinator EXECUTIVE DIRECTOR John Rosser E .D. ADVISOR Y BOARD OF DIRECTORS Stanley L Freeman d. . C airman Kenneth W. Allen Ph.D. Fletcher Binghlm M.D. William]. Carney Richard T. Chamberlin M. D. Walter P. Christie M.D. Wendell Eaton Pearl R. Fisher RN. Harland Goodwin Neil Rolde William E. Schumachcr M.D. Halsey Smit F. Emcsl Stallwurth Erik Van dc Bogart EX OFFICIO MEMBERS E r A. Olsen. President. UMF Conrad Rice, Vice President, Davi Fearnn. Dean, Publir Service Division, UMF 276 MAINE HE4LTH EDUC4T|ON RESOURCE CENTER dedeated to the heath educdton of the tdd able/2077788501687) unmw of tvtdre d Fahram A research study on hospital patient education is being conducted by Rosemary Caffarella. The purpose of this study is to develop a description of how nurses, physicians, hospital administrators. allied health professionals, and patient educa- tion coordinators view patient education activities for inpatients. Mrs. Caffarella is on the faculty at the University of Maine at Orono and a doctoral candidate at Michigan State University. The study is supported by a number of health related groups in Maine including the Maine Health Education Resource Center. The infonnation generated from the study will be used by these groups in the development of patient education programs and staff development activities on patient education. Your contribution as a patient education coordinator/teacher will be especially valuable. Mrs. Caffarella would be more than happy to share a swnnary of the results of her study with you and/or share the literature research on patient education that she completed. If you are interested in either materials, please return the enclosed post card with the survey form. Please complete the enclosed survey form and return it to Mrs. Caffarella in the enclosed envelope by Friday, June to, 1977. As you will see there is an identification number on the return envelope for record keeping purposes only. The confidentiality of your response will be insured by separating the envelope and the survey form when they are returned. We would appreciate your cooperation in this study. Thank you. Sincerely, John Rosser, Ed.D. Executive Director DuffyHouse/Umrzrslyof Mane d EdmngOfi/TGD MahStreet ©4938 Stoddard Hoose/therstyd Mate a Augusto 277 PATIENT EDUCATION SURVEY The purpose of the study is to determine the opinions professional hospital staff have of patient education for hospital inpatients. Please answer the sur- vey as completely as possible and return it in the enclosed envelope. Patient Education for Hospital Inpatients l. How important is patient education as a component of patient care for hospital inpatients? (Please check the ppg_response which best expresses your Opinion.) Undesirable (definitely should not be done) Of little importance Moderately important for some patients Moderately important for all patients Extremely important for some patients Extremely impartant for all patients ___Don't know If you have checked "Undesirable", "0f little importance", or "Don't know", please go directly to question 13. If you checked any of the other lines please continue to question number 2. 2. Do you believe that patient education for hospital inpatients should consist of (Please check one response): principally informal (incidental) educational activities. principally formal (specifically planned and organized) educational activities. . ___an intentional combination of formal and informal educational activities. 3. In your opinion, how important is it that a hospital provide inpatient education activities in each of the listed areas? (Please check tpg most appropriate pp; for each item and add any additional responses.) OF NO OF LITTLE MODERATELY EXTREMELY IMPORTANCE IMPORTANCE IMPORTANT IMPORTANT UNCERTAIN Orientation to hospital facilities and services (i.e., printed materials, __ tours, video tapes) ...... [:] ......... L_] ......... [Z] ......... [:J ........ [:] Explanation of the diag— nosis and treatment of the health problem ....... [:] ......... [:j ......... [:J ......... [:] ........ [:J Teaching the patient to administer own treat- ment as prescribed by [j ......... [:1 ......... [j ......... [j ........ [:1 physician .......... . ..... Teaching the patient self-care, independent living skills ............ [:J ......... [:] ......... [:] ......... [:] ........ [:] 278 OF NO OF LITTLE MODERATELY EXTREMELY IMPORTANCE IMPORTANCE IMPORTANT IMPORTANT UNCERTAIN e. Teaching about needed short a long term life style adjustments (i.e., social. vocational, dietary) ..... [Z] ......... [Z] ......... [Z] ......... [Z] ........ [Z] f. Teaching about appropriate conmunity resources for discharged patients ...... [Z] ......... [Z] ......... [Z] ......... [Z] ........ [Z] 9. Teaching about financial management of the health problem .................. [Z] ......... [Z] ......... [Z] ......... [Z] ........ [Z] h. Teaching of general pre- ventive medicine ......... [Z] ......... [Z] ......... [Z] ......... [Z] ........ [Z] i. Others {:1 ......... [j ......... [j ......... [J ........ [j [j ......... Cl ......... D ......... [j ........ C] 4. Which professional hospital staff(s) should have the responsibility for the planning and conducting of inpatient education activities in each area? Insert []Z]in each box for Group(s) with PRIMARY responsibility for each activity Insert [ZZIin each box for Group(s) with SUPPORTIVE responsibility for each activity Leave 31] other boxes blank (For the purpose of this question allied health professionals include dietitians, occupa- tional therapists, physical therapists, pharmacists, social workers & speech therapists.) PATIENT EDUCATION ALLIED HEALTH HOSPITAL STAFF PHYSICIANS NURSES PROFESSIONALS ADMINISTRATORS Orientation to Hospital Facilities 8 Services a. Planning the orientation [Z] ........ D ....... E] ......... [Z] ............ [Z] b. Carrying through the orientation ............. [Z] ........ [Z] ....... [Z] ......... [Z] ............ [Z] Explanation of the Diagnosis offithe Health Program c. Planning of the explanation ............. [Z] ........ [Z] ....... [Z] ......... [Z] ............ [Z] Giving the explanation.. [Z] ........ [Z] ....... [Z] ......... [Z] ............ [Z] d. Explanation of the General Treatmenthbr the Health Problem Planning the explanation [Z] ........ [Z] ....... [Z] ......... [Z] ............ [Z] [Z] ........ [Z] ....... [Z] ......... [Z] ............ [Z] e. f. Giving the explanation . 279 PATIENT EDUCATION ALLIED HEALTH HOSPITAL STAFF PHYSICIANS NURSES PROFESSIONALS ADMINISTRATORS Teaching the Patient to Admin- istrator Own Treatment as Prescribed by Physician 9. Planning the activity... [3 ........ [Z] ....... D ......... [Z] ............ D h. Conducting the activity. [Z] ........ [Z] ....... [Z] ......... [Z] ............ [Z] Teaching the Patient Self-Care Independent Living Skills Planning the activity... [Z] ........ [Z] ....... [Z] ......... [Z] ............ [Z] j. Conducting the activityu [Z] ........ [Z] ....... [Z] ......... [Z] ............ [Z] Teaching About Needed Short &‘ Long_Term Life Style Adjust- ments (i.e., social, vocation- i. al, Tamily, dietary) k. Planning the activity... [Z] ....... [Z] ....... [Z] ......... [Z] ............ [Z] 1. Conducting the activityu [j] ........ [j] ....... [j] ......... [j] ............ [:j Teaching Aboutpflpprqpriate Comanity Resources for Discharged Patients m. Planning the activity... [Z] ........ [Z] ....... [Z] ......... [Z] ............ [Z] n. Conducting the activity. [I ........ [j ....... [Z] ......... [Z] ............ 1:] Teaching About Financial Manage- ment of the Health ProfiTem 0. Planning the activity... [Z] ........ [Z] ....... [Z] ......... [Z] ............ [Z] p. Conducting the activity. [Z] ........ [j ....... [Z] ......... [Z] ............ [Z] Teaching of General Preven- tive Medicine q. Planning the activity... [Z] ........ [Z] ....... [Z] ......... [Z] ............ [Z] r. Conducting the activity. [Z] ........ [Z] ....... [Z] ......... [Z] ............ [Z] 5. Should former hospital patients be involved in the planning and conducting of hospital inpatient education activities? (Please check the most appro- priate box for each item.). DEPENDS ON THE _Y§§_ NQ_ HEALTH PROBLEM UNCERTAIN a. Planning the activities .............. [Z] .[Z] ........ [Z] .......... [Z] b. Conducting the activities ............ [Z] . [Z] ........ [Z] .......... E] 280 Should families of present and/or former hospital patients be involved in the planning and conducting of hOSpital inpatient education activities? DEPENDS ON THE 1§§_ NQ_ HEALTH PROBLEM UNCERTAIN Planning the activities .............. [Z]. [Z] ....... [Z] ........... [Z] .[Z] ....... [Z] ........... [Z] Who should be involved in the evaluation of the effectiveness of patient education activities for inpatients? (Please check one or more Of the items as you see appropriate.) a. b. Conducting the activities ............ [Z] ___Allied Health Professionals ___Patient Education Staff ___Community Home Health Agencies ___Patients and/or their families .___Hospital Administrators ____Nurses ___]Physicians What should the responsibility Of the hospital be for inpatients Who will need further educational services once they are discharged? (Please check the pp; response which best expresses your Opinion.) principally have the hospital continue tO provide the services once the patient is discharged. principally refer the patient to appropriate community agencies upon discharge. __Za combination of both activities, having the hospital continue to provide the services and referral to appropriate community agencies. Which of the following factors, in general, prevent the development and implementation of inpatient education activities? (Please check the most apprOpriate box for each item and add any additional reasons. AGREE DISAGREE UNCERTAIN Lack Of acceptance Of patient education by a. l. Administrators ............................. [Z] ..... [Z] ........ [Z] 2. Allied Health Professionals ................ [j ..... C] ........ [Z] 3. Nurses ..................................... [Z] ..... [:J ........ [Z] 4. Physicians ................................. [j ..... [j ........ [:l 5. Other Staff (Specify) . [Z] ..... [Z] ........ [Z] b. Lack of staff competence to do patient education ...................................... [Z] ..... [Z] ........ [Z] c' 2335303???TIT???HEREIN??? ........ [j ..... [:1 ........ [:1 Lack Of staff time to do patient education ..... [Z] ..... [Z] ........ [Z] 28] AGREE DISAGREE UNCERTAIN e. Lack Of an identified staff member to coordinate patient education ................... [Z] ..... [Z] ........ [Z] f. Cost of patient education ...................... [Z] ..... [Z] ........ [Z] 9. Lack of necessary facilities and equipment ..... [Z] ..... [Z] ........ [Z] ' h. Lack Of necessary resource materials (i.e., printed, audio-visual) .................. [Z] ..... [Z] ........ [Z] i. Lack of patient interest in patient education activities while they are hospitalized ......... [Z] ..... [Z] ........ [Z] j. Lack Of,in most cases,third party payments for patient education .......................... [Z] ..... [Z] ........ [Z] k. Others [Z] ..... ‘[Z] ........ [Z] lO. If you were to develop an organized patient education program, which five of the following health problem areas would you choose to develop programs first? (Please check only five.) ___Alcohol & Drug Dependency ___Ostomy ‘ _Z_Arthritis ____Personal health habits (i.e., smoking) ___Cancer (General) ___Pre & Post Natal .___Cardiac ___Pre & Post Operative (General) ___Oiabetes ___Pulmonary Disease ___Gastrointestinal diseases ___Speech & Hearing ___Hypertension ____Spinal Cord injuries ____Kidney ___Stroke ___Mastectomy ___yision Others Mental Health Orthopedic diseases & injuries Which hospital department in your Opinion can best coordinate an organized patient education program? (Please check ppg_response.) ‘___Education ____Personnel ___Nursing .___Social Services ___Other (Please specify) ll. Is it feasible in your Opinion to develop or expand organized patient education programs in your hospital? ___YES __:iO ___DNCERTAIN l2a. (If NO or UNCERTAIN) Please briefly explain l2. 282 General Information In this section Of the survey we would appreciate your answering several questions pertaining to your professional activities. The purpose Of requesting this information is to aid us in the analysis of the data secured in this survey. What is your professional background? (Please check the appropriate response(s).) l3. ____Dentist ___Pharamacist ___Dietitian Physical Therapist I___Health Educator I___Physician (0.0.; ___Hospital Administrator ___Physician (M.D. ___Nurse (L.P.N.) ___Social Worker .___Hurse (R.N ) ___Speech Therapist ‘___Occupational Therapist ___Other (Please specify) l4. Are you presently active or have you been active in educational activities for hospital inpatients? VERY SOMEWHAT NOT ACTIVE ACTIVE ' ACTIVE a. Informal patient education activities ...... [Z] ........ [Z] ....... [Z] b. Formal patient education program ........... [Z] ........ [Z] ....... [Z] 15. Have you ever attended an educational program/class specifically concerned with patient education or an area related to patient education (i.e., educa- tion methods. health education, adult education, program evaluation)? X§§. HQ a. Program/class on Patient Education ..................... [Z] ....... [Z] b. Program/class on Area Related to Patient Education ..... [Z] ....... [Z] c. (If YES to either l5a or le) Please briefly describe the program(s)/ class(es) If a program/class on hospital patient education were to be held, would you l6. be interested in attending such a program? YES ___No ___UNCERTAIN 4— THANK YOU FOR YOUR COOPERATION! APPENDIX E FOLLOW-UP POSTCARDS AND FOLLOW-UP LETTERS APPENDIX E FOLLOW—UP POSTCARDS AND FOLLOW-UP LETTERS M to WINE HEALTH EDUC4T©N RESOURCE CENTER dedcded To The hedlh QdUClefl of the lord oldie/2077788501 (387) Unversly of Mane d Farmgon Dear Physician: About a week ago you received a survey form on patient education from the Maine Health Educa— tion Resource Center. If you have already completed the survey, our sincere thanks for your help. If you have not yet had a chance to complete and return the survey, could you please do so at your earliest convenience? Thank you. Sincerely, (’ \A‘ {”0 Richard T. Chamberlin, M.D. WINE HEALTH EDUQZTTION RESOURCE CENTER dedcded lo the health edocdoh of the rdd able/207778850 (387) Unversry of Mom d Formnglon Dear Nursing Professional: About a week ago you received a survey form on patient education from the Maine Health Educa- tion Resource Center. If you have already completed the survey, our sincere thanks for your help. If you have not yet had a chance to complete and return the survey, could you please do so at your earliest convenience? ank you. Si lziily, ohn Rosser, Ed.D. xecutive Director 283 284 @I Research and Education Trust Maine Hospital Association I H A 151 Capitol Street 0 Augusta, Maine 04330 0 207-622-4794 Dear Allied Health Professional: About a week ago you received a survey form on patient education from the Research 5 Education Trust of the Maine Hospital Associa— tion. If you have already completed the survey, our sincere thanks for your help. If you have not yet had a chance to complete and return the survey, could you please do so at your earliest convenience? Thank you. Sincerely, VBV-1abtfiun~vca\ Douglas Kramer Program Coordinator Office of Co-op/Field Experience U. of Maine at Orono Dear About two weeks ago you received a survey form on patient education. If you have already com- pleted the survey, my sincere thanks for your help. If you have not yet had a chance to complete and return the survey, could you please do so at your earliest convenience? Thank you. Sincerely, Rosemary Caffarella EXECUTIVE DIRECTOR John Rona Ed.D. AD VISOR Y BOARD OF DIRECTORS W William E. Schumncher M.D. rm F. Erna! Slallworth 'k an e o n 285 MAINE HEALTH EDUC4T|ON RESOURCE CENTER dedcdcgf Which (Zoucdion of me Told Tomb/2077788501687) June 17, 1977 Dear Physician: About four weeks ago we sent you a survey relating to patient education in the hospital setting. The study is being conducted in cooperation with the Maine Health Education Resource Center and the Maine Medical Association. axornaomamsns _ Since we have not received your completed questionm m.£mnA .OmAhuflthW naire we are assuming that it may not have reached you P'-P°“"d““3“‘"m*"- 0 We are therefore sending A endemic A/fam DI. David Fear on. Dean. Public Service Divilion. UMF r may have been misplaced. you another survey and a postage-paid return envelope. We would appreciate it if you would take a few minutes to fill out and return the enclosed form. You may be assured that all responses will be kept confidential. If you have already returned the survey, you may want to keep this second copy for your file. Thank you for your cooperation in this very important study. Sincerely, .W . « Richard T. Chamberlin, M.D. mm/mmdde/mvmsrm 04938 SloddOdHouse/mvcrsiydeied/Atgisio 286 TWINE EEALTH EDUC4TION RESOURCE CENTER dedcokzd biffel‘mlhedicdiondiheloidptbic/QO7-778-BSOK387) mmyochhedFamgon EXECUTIVE DIRECTOR John loner Ed.D. June 17 ' 1977 AD VISOR Y BOARD OF DIRECTORS Stanley L Freeman Ed D. [Chairman Flathzr Binghlm M.D William]. Camey Richard T. Chamberlin M. D. Walter P. Chrillie Pearl R. Fisher R. N. Harland Goodwin fiMA.uQme Dear Nursing Professional: George T. Nilaon Daner K. Onion M.D. anfikmy About four weeks ago we sent you a survey $33E5¢NM¢HMD relating to patient education in the hospital setting. Sm im The study is being conducted in cooperation with the ;?fi:$fl::T Maine Health Education Resource Center and other health related groups in Maine. EX OFFICIO MEMBERS , . Einar Olnen.P1endenl, (IMF ‘ ' Dru anndmquehmwm. Since we have not received your completed question— ‘“*”””fi”w WF naire we are assuming that it may not have reached you or Dr. David Fearo on.Dean. muusmuowanwr may have been misplaced. We are therefore sending you another survey and a postage-paid return envelope. We would appreciate it if you would take a few minutes to fill out and return the enclosed form. You may be assured that all responses will be kept confidential. If you have already returned the survey, you may want to keep this second copy for your file. Thank you for your cooperation in this ver important study. Sin rel I Y yer/ax ohn Rosser xecutive Director Maine Health Education Resource Center mflyHase/Lhwrsiydmdtamm/mmmsmt 04938 SioddadHouse/LhwrslyofMdichungio 287 [I]. Research and Education Trust A ' Maine Hospital Association 151 Capitol Street 0 Augusta, Maine 04330 0 207-622-4794 June 17, 1977 Dear Allied Health Professional: About four weeks ago we sent you a survey relating to patient education in the hospital setting. The study is being conducted in cooperation with the Research and Education Trust of the Maine Hospital Association and the Maine Health Education Resource Center. Since we have not received your completed questionnaire we are assuming that it may not have reached you or may have been misplaced. We are therefore sending you another survey and a postage-paid return envelope. We would appreciate it if you would take a few minutes to fill out and return the enclosed form. You may be assured that all responses will be kept confidential. If you have already returned the survey, you may want to keep this second copy for your file. Thank you for your cooperation in this very important study. Sincerel , WRW Douglas Kramer Program Coordinator 288 UNIVERSITY Oi: MAlNE .1; Orono “Hire of Cunpt'i'uliH‘ l‘irllu‘niinn ("lim- at: 251 Aubert. Orono (207) 581-2610 l‘l"l(l lixpr-rir-nrv l "in-nil} of 'llninr :II Urmm About four weeks ago I sent you a survey relating to patient education in the hospital setting. The study is being conducted in cooperation with the Research and Education Trust of the Maine Hospital Association a the Maine Health Education Resource Center. Since I have not received your completed question— naire I am assuming that it may not have reached you or may have been misplaced. I am therefore sending you another survey and a postage~paid return envelope. 1 would appreciate it if you would take a few minutes to fill out and return the enclosed form. You may be assured that all responses will be kept confidential. if you have already returned the survey, you may 'wish to keep this second copy for your file. Thank you for your cooperation in this very important study, 33.-wilt v nly. (,5, C‘JMUNQLLQQ\_ Rfisimuva) Rosemary S. Caifarella Director Cooperative Education/ Field Experience 289 WINE HEALTH EDUQ4TION RESOURCE CENTER dcdcdcd lo the main mom of the bid able/2077783501687) Uriversiy of Male d Earringon EXECUTIVE DIRECTOR John Rosser Ed.D. ADVISORYROARD OF DIRECTORS June 17. 1977 lanley L Freeman Ed. ./Char'rmon Kennelh W.A All PhD Fineullchcr Bingham M. D am] Camry Richard T Chamberlin M.D. whim 0"?!“er Dear Patient Education Coordinator/Teacher: Purl R. FishcnrRN. ”fridge-3:" About four weeks ago we sent you a survey relat- 0°,ng N...on ing to patient education in the hospital setting. The R b MmOnionMD study is being conducted in cooperation with the Maine "2.1.”? "’y Health Education Resource Center and other health Willi-m EifzhumchuM-D‘ related groups in Maine. F. limes! Sullwunh Eri Since we have not received your completed ques- EXOmeMb—MEMS tionnaire we are assuming that it may not have reached Dr.EmarA.019e_n.Pn_ndznt.!lMF you or may have been misplaced. we are therefore send- “ 1" ing you another survey and a postage-paid return envelope. Dr. David Furor-.9931. He would appreciate it if you would take a few minutes to “‘“"5""'"D'”"""‘ ”MF fill out and return the enclosed form. assured that all responses will be kept confidential. If you have already returned the survey, youma want to keep this second copy for your file. Thank you for your cooperation in this very important study. Sincerely. John Rosser Executive Director Maine Health Education Resource Center mm/mwdmdmgm/mmmsmom Sioddadi—buse/thersiyofMdied/kgisro a... wfi """".‘_."“. _.‘— "I. 3": J“ ‘J . APPENDIX F PEOPLE CONSULTED ON DEVELOPMENT OF SURVEY INSTRUMENTS ~ APPENDIX F PEOPLE CONSULTED 0N DEVELOPMENT OF SURVEY INSTRUMENTS Dr. Stanley Freeman-~University of Maine faculty; Eastern Maine Medical Center Trustee; Chairman of Advisory Council for Maine Health Education Resource Center; member of Health Systems Agency Advisory Committee Lois Estes--R.N.; Patient Education & Staff Education Coor- dinator, Eastern Maine Medical Center, Bangor, Maine Mike Skaling--Director, Project RISE, Waterville, Maine John Johnson-~Associate Director, Eastern Maine Medical Center; Chairman, Maine Hospital Association Douglas Kramer--Staff Association, Research & Education Trust of the Maine Hospital Association Dr. John Rosser—~Director, Maine Health Education Resource Center Edward Miller--Bureau of Health Education, State of Maine Earnest Stallworth--Director of Education, Maine Health Systems Agency Dr. Richard Chamberlin-—Medical Director, Pine Tree Organi- zation for Professional Standards Review; member Advisory Committee, Maine Health Education Resource Center Dr. Kenneth Hayes—-Acting Director, Social Sciences Research Institute, University of Maine Dr. Dennis Watkins--Associate Professor, University of Maine, Department of Agricultural & Resource Economics Dr. Louis Ploch, Professor, University of Maine, Department of Agricultural & Resource Economics Larry Nanney, Director of Long Range Planning, Mid-Maine Medical Center, Waterville, Maine Ann Spencer, Director of Occupational Therapy. Eastern Maine Medical Center, Bangor, Maine 290 APPENDIX G PERCENTAGE OF RESPONDENTS BY PROFESSIONAL SUB-GROUP WHO INDICATED THAT SPECIFIED CONTENT AREAS ARE IMPORTANT FOR INCLUSION IN HOSPITAL PATIENT EDUCATION PROGRAMS FOR INPATIENTS Table GT.-—Percentage of the physicians who indicated that specified content areas are important for inclusion in hospital patient educa- APPENDIX G tion programs for inpatients. Content Areas Of No Importance Of LittTe Importance Moderately Important Extremely Important Orientation to Hospital Facilities and Services Epranation of Diagnosis and Treatment Teaching Patient to Administer Own Treatment Teaching Patient Self—Care Independent Living Skills Teaching About Short— and Long—Term Life Style Adjustments Teaching About Appropriate Community Resources Teaching About Financial Management of the Health Problem Teaching of General Preventive Medicine 4.8 19.8 6.4 5.5 2.2 4.1 5.5 49.5 18.7 16.5 35.5 21.9 43.5 45.2 35.2 24.2 68.5 80.5 56.8 73.7 51.3 43.4 47.3 291 292 Table GZ.——Percentage of the nurses who indicated that specified content areas are important for inclusion in hospital patient edu— cation programs for inpatients. Content Of No Of Little Moderately Extremely Areas Importance Importance Important Important Orientation to HOSPIta‘ 1.5 9 7 55 6 31 7 Facilities and Services Explanation of Diagnosis .4 .0 12.5 86.7 and Treatment Teaching Patient to Administer .7 .0 9.6 80.9 Own Treatment Teaching Patient Self-Care .0 .7 l5.6 83.3 Independent Living SkiIls Teaching About Short- and Long-Term .4 .0 4.9 94.8 Life Style Adjustments Teaching About Appropilate .0 .7 21.6 77.7 Commun1ty Resources Teaching About Financial Management of -0 the Health Problem Teaching of General, .0 1.9 11.6 86.2 Prevent1ve Medicine __________‘___—. 293 Table G3.—-Percentage of the allied health professionals who indi— cated that spec1f1ed content areas are important for inc1usion in hosp1tal patient education programs for inpatients. Content Of No Of Little Moderately Extremely Areas Importance Importance Important Important Orientation t0 H°5p1t31 1.0 8 2 A 57 1 33 7 Facilities and Services Explanation of Diagnosis .0 .0 23.5 87.7 and Treatment Teaching Pat‘ent to .0 2.0 7.1 89.9 Administer Own Treatment Teaching Patient Self-Care .O .0 l8.2 8l.8 Independent Living Skills Teaching About Short— and Long-Term .O .0 9.3 90.7 Life Style Adjustments Teaching About APPVOPf‘ate .0 1.0 26.3 71.7 Commun1ty Resources Teaching About Financial Management of -0 5.1 the Health Problem Teaching of General_ ,0 1.0 l9.2 78.0 Prevent1ve Medicine _______________—-—-—‘ 30.3 62.6 294 Table G4.:-Percentage of the patient education staff who that spec1f1ed content areas are important for inclusion patient education programs for inpatients. indicated in hospital Content Areas Of No Of Little Importance Importance Moderately Important Extremely Important Orientation to Hospital Facilities and Services Explanation of Diagnosis and Treatment Teaching Patient to Administer 0wn Treatment Teaching Patient Self-Care Independent Living Skills Teaching About Short- and Long-Term Life Style Adjustments Teaching About Appropriate Community Resources Teaching About Financial Management of the Health Problem Teaching of General Preventive Medicine 65.4 7.7 .0 4.0 3.8 7.7 24.0 7.7 23.1 92.3 100.0 92.0 96.2 84.6 72.0 92.3 295 Table G5.T—Percentage of the hospital administrators who indicated that spec1f1ed content areas are important for inclusion in hospital pat1ent education programs for inpatients. Content Of No Of Little Moderately Extremely Areas Importance Importance Important Important Orientation to HosP‘ta1 .0 22 2 55 6 22 2 Facilities and Services Explanation of Diagnosis .0 .0 11.2 76.5 and Treatment Teaching Patient to Administer -0 -0 16-7 83.3 Own Treatment Teaching Patient Self-Care .O 5.9 35.3 52.9 Independent Living Skills Teaching About Short- and Long-Term .O 5.6 22.2 72.2 Life Style Adjustments Teaching About APPrOPr‘ate .0 5.6 61.1 33.3 Community Resources Teaching About Financial Management of .0 16.7 33.3 38.9 the Health Problem Teaching of General. ,0 5.6 38.9 50.0 Prevent1ve Medicine BIBLIOGRAPHY BIBLIOGRAPHY "AHA Research Capsules: Patient Education Programs in Community Hospitals." Hospitals 46 (December 1, 1972): 102. Alexander, Carol; Schrader, Elinor; and Knnedler, Julia. "Pre- Operative Visits: The Operating Nurse Unmasks.“ AORN Journal 19 (February 1974): 401-12. Alt, Richard. 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