Nurses' informal teaching practices: their nature and impact on the production of patient care.

Nurses' informal teaching practices have been viewed as secondary to formal teaching. This article places them at the centre of professional nursing practice. On the basis of extended observation of 12 experienced surgical nurses, I assert they teach inexperienced physicians as well as patients, that their teaching is planned but more often informal and embedded in other work, and that their intent is to produce both understanding of health and illness practices and compliance with institutional policies and procedures. Nurses' informal teaching practices are essential to the ongoing production of patient care.

Profile of a leader: Margaret Mary Hunter CM, CStJ, CD, RN.

Margaret Mary Hunter (1918-1991) was Chief Nursing Officer for the St.John Ambulance Association from 1965-1981. She vigorously promoted the Association's Home Nursing course believing every Canadian household should have some one trained in home nursing. Her greatest achievement came in 1976 when, at her initiative, the Department of National Health and Welfare awarded 1,000,000 dollars jointly to the Association and the Canadian Red Cross Society to develop the multi-media program "There' s No Place Like Home for Health Care". Unfortunately this award-winning instructional program was never widely implemented and, following her retirement, home health care training in the Association declined in importance. Margaret Hunter's efforts to effect change illuminate the complex challenges facing nursing leaders of all generations.

Developing a sensation information message for femoral arteriography.

Sensation information is proposed as a way of decreasing the patient's distress during a threatening health care event. A first step in developing a sensation information message is to determine the content of the message. This study, using a systematic theory-based methodology, was conducted to describe and validate the common physical sensations experienced by patients undergoing the diagnostic procedure of femoral arteriography. (A conceptual framework based on how an individual perceives or senses a situation was used.) A three-stage survey design was used including: (1) tool development following observation of the procedure and pilot-testing of the interview schedule, (2) interview of patients who had undergone femoral arteriography about the sensations experienced during the procedure, and (3) validation of the responses. Twenty-one steps in the femoral arteriography procedure of which patients were aware were identified. Nine 'feeling' sensations commonly experienced during the procedure and the sights and sounds associated with the procedure were determined. The sequencing and duration of procedure steps were observed and the environment in which the procedure was performed was described.

The nurse's role in patient education: incongruent perceptions among nurses and patients.

The purpose of this study was to describe the amount of congruence in the perceptions of 38 matched nurse-patient dyads concerning the nurse's role in patient education. The perceptions of nurses and patients from two hospital settings were measured with two complementary sets of questions, developed for this study; t-tests were used to compare the mean responses of nurses and patients within and between the two settings to each set of complementary questions. The results indicated that incongruencies existed between nurses' and patients' perceptions of the nurse's role in patient education. Patients identified a general teaching function for nurses. When asked who they preferred to have teach them the specific information related to their condition, patients most frequently chose a physician. Nurses most frequently chose a nurse as the current and most desired patient teacher. Nurses incorrectly assumed that the desires of their patients for patient education were similar to their own. The results suggest that nurses need to develop a clear definition of their role in patient education, to validate patients' desires for teaching, and to examine organizational factors influencing their performance of the patient teaching role.

Early discharge and return to work following myocardial infarction.

Individuals who have experienced a myocardial infarction (MI) account for the largest component of all hospitalization costs and foregone earnings due to cardiac disease. Early return to full employment and premorbid activity level should be the focus of cost-effective rehabilitative programs. Yet the economic benefits of vocational rehabilitation have not been directly researched. Therefore, issues of import regarding activity after MI include the timing of ambulation, discharge and return to work. Studies of early mobilization and discharge are contrasted in terms of methodology and outcome. These cite economic, social and psychological advantages, yet these factors are examined in isolation of other variables. A review of the literature reveals that there is a reluctance by many health professionals to institute such practices based in part on the dilemma surrounding selection of specific indicators and risk factors. Yet analysis reveals that the contention surrounding these exclusion criteria is perhaps unfounded, as the variance is less than is commonly assumed. Recurrent themes likewise emerge regarding the multiplicity of variables associated with the timing of resumption of employment, which is considered to be the most precise index of recovery following an MI. Of these, only early intense rehabilitation, directed at attitudinal and behavioural change, is amenable to modification by health professionals. Related research endeavours have examined employment following aortocoronary bypass surgery, risk factors in the work environment and work stressors which occur following MI. Controversy arises regarding the correlation of age and personality factors with return to work. Discrepancies in research findings are attributed to the diverse approaches to data collection, obstacles encountered in measuring psychological states, lack of operational definitions, differences in degree of rehabilitation and length of follow-up and the absence of controlled trials. Clearly, experimental research focusing on the job-related economic and human cost impact of specific rehabilitation programs must be conducted.(ABSTRACT TRUNCATED AT 400 WORDS)

Factors affecting the use of self-instructional material by patients with ischemic heart disease.

This study addressed three questions concerning the feasibility of self-instruction by patients with ischemic heart disease in an acute-care teaching hospital. (1) Do patients complete a linear self-instructional booklet under conditions normally prevailing on a hospital ward? (2) Do patients perceive that activity in the ward environment and symptoms of illness affect use? (3) What aspects of activity and symptoms do patients report affect use? One hundred patients, 60 men and 40 women with an average age of 59 years, hospitalized with ischemic heart disease (acute myocardial infarction or unstable angina) were interviewed an average of six days after distribution of a self-instructional booklet as a component of a standard teaching program. Three subjects claimed not to have received the booklet; nine made no use of it; 73 made partial use of it; and 15 made complete use of it. Fifteen subjects claimed activity in the ward environment and 25 subjects claimed symptoms of illness affected use. Interruption, a noisy, busy atmosphere on the ward, and physical symptoms of ischemic heart disease were reported most frequently as factors affecting use. Results of the study suggest that a small percentage of patients will complete a self-instructional booklet. In addition to activity in the environment and symptoms of illness, factors not identified in this study also appear to influence the use of self-instructional material.

Teaching the patient with ischemic heart disease: a systemic approach to instructional design.

Does a systematic approach to the design of instruction for patients with ischemic heart disease (IHD) produce an effective educational product? One hundred patients, 67 men and 33 women with an average age of 57 years, who were hospitalized with IHD (myocardial infarction or unstable angina), were randomly assigned to an experimental or control condition and pretested to determine their knowledge of the disease and its treatment. Experimental subjects received a linear self-instructional program on the nature and treatment of IHD. Control subjects did not receive the program. Two days later a posttest was administered to experimental and control subjects; an average of 14 days after discharge a retention test was given to both groups. Individual test scores revealed that (allowing for a subject effect) patients who completed the program achieved significantly (P less than 0.001) higher posttest and retention test scores than those who did not. Also, patients who completed the program retained the information during the two weeks between the posttest and the retention test. Results of this study indicate that the instructional framework that was effective in the design of a health-education program for pregnant women can be applied to the design of instruction for patients with IHD.