Open Journal of Nursing, 2015, 5, 500-507

Published Online May 2015 in SciRes. http://www.scirp.org/journal/ojn

http://dx.doi.org/10.4236/ojn.2015.55053

Factors Influencing Practice of Patient

Education among Nurses at the University
College Hospital, Ibadan
Modupe Olusola Oyetunde, Atinuke Janet Akinmeye
Department of Nursing, Faculty of Clinical Sciences, University of Ibadan, Ibadan, Nigeria
Email: [email protected], [email protected]

Received 18 April 2015; accepted 19 May 2015; published 22 May 2015

Copyright © 2015 by authors and Scientific Research Publishing Inc.

This work is licensed under the Creative Commons Attribution International License (CC BY).
http://creativecommons.org/licenses/by/4.0/

Abstract
Patient education is the process of influencing patient behaviour and producing the changes in
knowledge, attitudes and skills necessary to maintain or improve health. Health education may be
general preventive, health promotion or diseases specific education. With an education system in
place, patients will be satisfied with care, patients will be healthier, and will seek medical services
less frequently. There is little or no documentation on the practice of patient education at the
University College Hospital, Ibadan. The aim of this descriptive study was to explore factors in-
fluencing the practice of patient education among nurses at the University College Hospital, Iba- dan.
Stratified and simple random sampling techniques were used in selecting 200 nurses at the
University College Hospital Ibadan. A self-designed questionnaire was used to collect data. Statis-
tical package for social sciences version 15 (SPSS 15) was used in analysing data. The study re-
vealed that the knowledge and practice of patient education among the nurses in University Col-
lege Hospital was high and the knowledge was found to be significantly associated with its practice
(X2 = 7.89, p = 0.017). The working experience of nurses does not determine whether they practice
patient education or not. Almost all the respondents (70% - 90%) in this study affirmed that the
nurses’ experiences, cultural barriers, work place culture, lack of time, heavy workload, insuffi-
cient staffing, and the complexity of patients’ condition were important factors that influenced the
practice of patient education. In conclusion, nurses at the University College Hospital have good
knowledge and positive attitude towards patient education but could not practice effectively. A more
critical approach in addressing heavy workload, insufficient staffing, among others is needed to
improve patient education. Further studies should be carried out on developing nurses’ roles as
patient educators.

Keywords
Patient Education, Patient Education Process, Outcome of Care

How to cite this paper: Oyetunde, M.O. and Akinmeye, A.J. (2015) Factors Influencing Practice of Patient Education among
Nurses at the University College Hospital, Ibadan. Open Journal of Nursing, 5, 500-507.
http://dx.doi.org/10.4236/ojn.2015.55053
 M. O. Oyetunde, A. J. Akinmeye

1. Introduction
Given the changing disease panorama, increasing prevalence of chronic diseases, and escalating health care cost,
patient education becomes more important on the agenda now as ever. The need for nurses to teach others and to
help others learn will continue to increase in the healthcare environment [1]. Patient education has long been
considered a major component of standard care given by nurses [2]. Education is the key to having compliant
patients. It has been proven that education system improves patients’ satisfaction with care, health status, and
reduction in request for medical services [3]. Throughout the history of nursing, nurses have helped patients take
responsibility for their own health [4]. Florence Nightingale attested to teaching as a function of nursing in her
treatises on nursing in 1859 [5]. The quality of nursing care can be measured in part, by the quality of patient and
family education provided [6].
Many studies revealed that nurses regarded patient education as a significant part of everyday practice [7] [8]
and as a specific responsibility [9]. Nurses who perceived higher levels of responsibility in their teaching roles
also performed teaching activities more frequently [10].
Several studies also revealed that patient education was not considered part of routine care, but rather as
con-
ditional to other work demands [11] [12]. In parallel, the educator role was described as difficult to grasp [12].
Even if nurses expressed enthusiasm for their patient-education role, it was not the same as knowing how to teach
[13] [14]. In several studies, knowledge of teaching and learning was considered to be important, and a need for
more education, training and skills to undertake patient teaching was emphasized [15] [16]. Although some
studies [17] [18] show that nurses feel competent in their teaching role, others point to lack of training and lack
of confidence as contributing factors in nurses’ reluctance to conduct patient education [15] [16]. Another aspect
of competence is the significance of having factual knowledge, which means knowing what to teach [16]. In a
study of nurses and physicians [19], 85% of the participants had good knowledge of treating illness, while 68%
had good knowledge of its impact on everyday life. The content of the information nurses gave in counsel- ling
sessions was dependent on their length of nursing experience (49%), ward routines (29%) and professional
training (19%) [19]. A nurse’s positive attitude to patient education improved with length of service [20].
Lack of time was reported as an obvious hindrance to patient education [21]. Adequate time was regarded as
important in creating a trustful relation as was adequate documentation [21]. Patient and family teaching was
ranked as the fifth most time-consuming activity of the eight responsibilities that staff nurses were asked to rank
[22]. A study revealed that nurses working in outpatient units had more time for patient education than those
working in a ward [15]. Good-quality patient education requires appropriate resources of time, facilities and
equipment. The significance of allocating a place for teaching and being left alone without interruptions was
described as important [16].
Supportive administration is needed for the accomplishment of patient education [16]. In a study, 69% of the
nurses agreed that supervisors or managers emphasized the importance of patient teaching [23]. While another
study shows that heavy workload is a barrier to the accomplishment of patient education [24]. Other aspects were
insufficient staffing, lack of organizational support in completing nursing duties to allow time for teaching [25],
nurses taking care of a larger number of patients than recommended, which affected the time given to each
patient, and the complexity of the patients’ disease or health situation [26]. The use of teaching materials is of
importance for successful patient education [26]. Lack of materials, supplies or teaching tools to adequately teach
the patient was reported as frustrating [25]. It is important that the work place culture values education and this
requires organizational support to develop empowerment and to facilitate nurses’ fulfilment of their educa- tional
roles. Organizational development is needed to create high quality patient education.
Anecdotal experience shows that patients appear not to have information about their disease process, nursing
and medical management. This observation was made from the various questions posed by patients for enlight-
enment and clarifications. These are questions that would not have been raised if the patients had been duly
educated. Patient education promotes patients’ compliance, patients’ satisfaction with care, healthy lifestyles and
maximizes patients’ self-care skills among other effects; although these all seem to be grossly deficient in pa-
tients. In an age where patients pay more health care, demand for quality care is on the increase. Efforts to re-
duce patients’ stay and payment among others become a nursing concern. Exploring the factors influencing the
practice of patient education is an attempt to solve this problem. It is against this background that the researchers
seek answers to the following questions.
1) Are nurses knowledgeable about the practice of patient education?
2) Do nurses practice patient education?

501
M. O. Oyetunde, A. J. Akinmeye

3) What factors could influence the practice of patient education?

4) Is there any perceived effect of patient education on outcome of care?

2. Method
This study is a descriptive cross-sectional survey designed to collect information about factors influencing the
practice of patient education among nurses at University College Hospital (UCH).

1. Research Setting
Study setting is the University College Hospital Ibadan with the principal focus on nurses working in the hospi-
tal. This is the first teaching hospital in Nigeria established in 1957. The hospital was established solely to pro-
vide health care services for the masses and to train various health professionals. The vision for its establishment
includes being a stimulus for medical education in West Africa, centre of excellence and scientific research in
nursing and medical sciences. It is national reference centre for all forms of health problems and an institution for
higher learning second to none in Black Africa. The tertiary institution has about 1004 nurses.

2. Target Population
The target population comprises of all registered nurses of University College Hospital, Ibadan. There are about
1004 nurses working in the University College Hospital, Ibadan.

3. Sampling Technique
The study population comprises of nurses working in both inpatient and outpatient departments of University
College Hospital, Ibadan. The study population was selected using stratified and then simple random sampling
technique. The accessible population from the selected strata of units was 507. The units selected were; Medicine,
Surgery, Obstetrics & Gynecology and out-patient departments.

2.4. Sample Size Determination

The sample size was obtained using;
p
Formula n 
1 pp 1 p
A2
 N R
Z2
where
n = sample size;
N = Accessible population;
p = estimated variance in population as a decimal (0.5);
A = precision desired expressed in decimal (0.05);
Z = based on confidence level 1.6449 for 90%;
R = estimated response rate expressed in decimal (0.75 for 75%).
Given N = 570
0.5 1 0.5
n
0.052 0.51 0.5
1.64492 506 0.75
0.25

0.0025  0.25
2.7056 676
0.25

0.000924 
0.000369

0.25
0.00129382

502
 M. O. Oyetunde, A. J. Akinmeye

n = 193
Consideration for attrition; 10% attrition rate,
10% attrition rate = 19.3
n = 193 + 19
n = 212
A proportionate sample of each stratum was
used in the course of distributing the
questionnaires.

5. The Research Instrument

The study utilized a 52 item structured and self-administered questionnaire. The instrument was divided into two
major sections A and B. Section A: dealt with Socio-demographic data of the respondents. Section B addressed
the research questions. i) Knowledge and practice of patient education; ii) Factors influencing practice of patient
education; iii) Relationship between patient education and outcome of care; iv) Perception of ways of improving
patient education among nurses.
The instrument was developed after a thorough review of literature. The face and content validity was ensured
by subjecting the instrument to critical review among colleagues. Suggested corrections were effected. A test
retest at two weeks interval was carried out among 20 nurses with similar characteristics to ensure reliability and
consistency of the instrument. The data were analyzed and a Chronbach’s alpha score of 0.75 was obtained.
Procedure for data collection: Due ethical considerations were given and observed. Institutional and individ-
ual permission were obtained prior administration of questionnaire. Trained research assistant were employed to
distribute and collect questionnaires. At the point of data collection, consent was sought again verbally and 1 out
of 3 nurses who consented was given questionnaire in the selected units. The research assistants made use of the
various shifts moving from one nurse to the other and from one ward to another. The data collection lasted for
three weeks, retrieval rate was 100 per cent but only 90% (200) was valid for analysis.

6. Procedure for Data Analysis

The complete questionnaires were coded and subjected to statistical analysis using Statistical Package for Social
Sciences version 15 (SPSS 15). The hypotheses were tested using Chi square test and the level of significance
was set at alpha 5%.

3. Results
Socio Demographic Variables
This was done by analysing the first seven items on the questionnaire. In all a total of 200 nurses participated in
the study. The mean age of respondents was 34.0 ± 8.6 years, with about 80% of them being 40 years or less.
Fourteen (7.0%) were males while 186 (93.0%) were females. More than 80% of the respondents were Yoruba.
The educational qualification of these nurses is quite high; 46 (24.0%) were registered nurses, 90 (46.9%) were
registered nurses or midwives, 34 (17.7%) had bachelor’s degree in nursing, while others have postgraduate de-
grees such as masters and PhD. The professional cadre of these nurses ranges from Assistant Director of Nurs- ing
(ADN) to nursing officer (NO II). Half of the nurses who participated in this study had been working for eight
years or less; also one hundred (50.0%) work at the medical ward, 40 (20.0%) at surgical wards, 40 (20.0%) at O
& G, and 20 (10.0%) at out-patients department (Table 1).
The knowledge and practice of patient education among the nurses sampled for this study is high. More than
90% stated that they actually practiced patient education and believed that patient education should be included
in their plan of care, nurses are responsible for providing reliable discharge information, that patients should be
informed about their health care options, and that it is necessary to document after patient teaching. About 80%
of our respondents stated that patient education should be individualized, that patient teaching should be done
after identifying their needs, and that they assess their patients for learning needs.
Figure 1 shows the factors that determine the practice of patient education among UCH nurses. A large pro-
portion of these respondents agreed that those nurses’ experiences, cultural barriers, work place culture, lack of
time, heavy workload, insufficient staffing, and the complexity of patients’ condition are factors that influence the
practice of patient education.
Table 2, Figure 2 and Figure 3 were used to report findings of each research question.

503
M. O. Oyetunde, A. J. Akinmeye

Table 1. Socio-demographic characteristics of the respondents.

Variable Frequency Percentage
Unit/ward
Medicine 100 50.0
Surgery 40 20.0
O&G 40 20.0
Out-patient 20 10.0
Age (years)
≤30 71 35.5
31 - 40 84 42.0
41 - 50 19 9.5
>50 26 13.0
Mean ± SD 34.0 ± 8.6
Gender
Male 14 7.0
Female 186 93.0
Tribe
Yoruba 162 83.9
Igbo 29 15.0
Others 2 1.0
Educational qualification
RN* 46 24.0
RN/RM** 90 46.9
BNSc*** 34 17.7
Others 22 11.4
Cadre
ADN 9 4.5
CNO 8 4.0
PNO 27 13.6
SNO 19 9.6
NO I 63 31.8
NO II 72 36.4
Years of experience
≤8 100 51.0
>8 96 49.0
Mean ± SD 9.5 ± 7.2
RN: registered nurse; **RN/RM: RN and registered midwife; ***BNSc: bachelor of nursing science.
*

Table 2. Knowledge and practice of patient education among the respondents.

Variables Yes (%) No (%)
Teaching is a primary role of nurses. 84.3 15.7
Nurses are highly responsible for patient teaching. 93.4 6.6
Nurses are the only health professionals responsible for patient teaching. 11.1 88.9
Patient education should not be limited to patients but involve significant others. 98.0 2.0
Patient education should be individualized. 88.9 11.1
Educating patients should be included in the patients’ plan of care. 94.5 5.5
It is the nurses’ responsibility to provide reliable discharge information. 92.0 8.0
Patients should be informed about their health care options. 99.0 1.0
It is necessary to document after patient teaching. 93.0 6.0
Do you educate your patients? 93.0 7.0
Do you assess the patient for learning needs? 85.5 14.5
Is patient teaching done after identifying a learning need in patient? 83.6 16.4
Does your patient education include significant others? 86.3 13.7
Do you document after a teaching session? 60.0 40.0

504
 M. O. Oyetunde, A. J. Akinmeye

85%
98%
Nurses experiences
Ward routines
Work place culture
Lack of time
54.2%
60% Heavy workload
Insufficient staffing

26.8%
54.6%

Figure 1. Factors that determine practice of patient education.

102%
100%
98%
96%
94%
92%
90%
88%
86%
84%
82%

Figure 2. Perceived effects of patient education on outcome of care.

100%
80%
60%
40%
20%
0%

YES

NO

Figure 3. Suggested ways of improving practice of patient education.

4. Discussion of Findings
The term “patient education” in this study refers to formal and informal interactive activities performed by health
care professionals, aiming at achieving better health outcomes for patients. This is achieved through the provision
of information, knowledge and skills that are necessary for the management of their health and illness

505
M. O. Oyetunde, A. J. Akinmeye

concerns. Despite the fact that nurses are often regarded as the best health care professionals for effective patient
education, their capacity to do this has been frequently questioned [3] [14].
This study reveals that knowledge of patient education was found to be significantly associated with its prac-
tice (X2 = 7.89, p = 0.017). This is contradictory to the results that nurses’ knowledge and skills were largely
inadequate but their attitudes to patient-education were positive [12].
In this study it was found that the year of working experience of nurses whether high or low will not deter-
mine whether they practice patient education or not. This contradicts the opinion that a nurse’s positive attitude to
patient education improved with length of service and that the content of the information nurses gave in
counselling sessions was dependent on their length of nursing experience (49%), ward routines (29%) and pro-
fessional training (19%) [15]. Nevertheless, experienced nurses and those with advanced degrees were more
comfortable teaching patients about diagnosis and treatments.
Similar factors stated in other studies that influences the practice of patient education include insufficient
staffing, lack of organizational support in completing nursing duties to allow time for teaching, nurses taking care
of a larger number of patients than recommended, which affected the time given to each patient, and the
complexity of the patients’ disease or health situation [16], poor coordination of education, inadequate time, and
work place culture, and lack of forums for discussion and clinical supervision of educational activities [12] and
organizational development [23].
In this study, nurses affirmed that the use teaching materials are of utmost importance for successful patient
teaching. 82% of their respondents evaluated their command of written counselling as good, but computer-aided
counselling and audiocassettes were used very little [15]. Lack of materials, supplies or teaching tools to ade-
quately teach the patient was reported as frustrating [6].
The nurses also stated that the involvement of other medical disciplines will improve patient education. The
significance of interdisciplinary cooperation is emphasized in several studies but obstacles are also described [8].

5. Conclusion
In conclusion, the study revealed that nurse’ experiences, cultural barriers, work place culture, lack of time,
heavy workload, insufficient staffing, and the complexity of patients’ condition were the factors influencing the
practice of patient education. Findings from this study revealed that, the knowledge of patient education deter-
mined the practice of patient education; the working experience did not determine practice of patient education;
the educational qualifications of nurses influenced the practice of patient education among nurses in the Univer-
sity College Hospital, Ibadan.

References
1 Avsar, G. and Kasikci, M. (2011) Evaluation of Patient Education Provided by Clinical Nurses in Turkey. Internation-
al Journal of Nursing Practice, 17, 67-71. http://dx.doi.org/10.1111/j.1440-172X.2010.01908.x
2 Balcou-Debussche, M. and Debussche, X. (2008) Type 2 Diabetes Patient Education in Reunion Island: Perceptions
and Needs of Professionals in Advance of the Initiation of Primary Care Management Network. Diabetes and Meta-
bolism, 34, 375-381. http://dx.doi.org/10.1016/j.diabet.2008.03.002
3 Bird, A. and Wallis, M. (2002) Nursing Knowledge and Assessment Skills in the Management of Patients Receiving
Analgesia via Epidural Infusion. Journal of Advanced Nursing, 40, 522-531.
http://dx.doi.org/10.1046/j.1365-2648.2002.02409.x
4 Carpenter, J.A. and Bell, S.K. (2002) What Do Nurses Know about Teaching Patients? Journal of Nursing Develop-
ment, 18, 157-161. http://dx.doi.org/10.1097/00124645-200205000-00009
5 Deccache, A. and Aujoulat, I. (2001) A European Perspective: Common Developments, Differences and Challenges in
Patient Education. Patient Education and Counseling, 44, 7-14. http://dx.doi.org/10.1016/S0738-3991(01)00096-9
6 Fitzpatrick, A. and Hyde, A. (2005) What Characterizes the “Usual” Preoperative Education in Clinical Contexts?
Nursing and Health Sciences, 7, 251-258. http://dx.doi.org/10.1111/j.1442-2018.2005.00244.x
7 Friedman, A.J., Cosby, R., Boyko, S., Hatton-Bauer, J. and Turnbull, G. (2011) Effective Teaching Strategies and Me-
thods of Delivery for Patient Education: A Systematic Review and Practice Guideline Recommendations. Journal of
Cancer Education, 26, 12-21. http://dx.doi.org/10.1007/s13187-010-0183-x
8 Gregor, F.M. (2001) Nurses’ Informal Teaching Practices: Their Nature and Impact on the Production of Patient Care.

506
 M. O. Oyetunde, A. J. Akinmeye

International Journal of Nursing Studies, 38, 461-470. http://dx.doi.org/10.1016/S0020-7489(00)00081-X

9 Hubley, J. (2006) Patient Education in the Developing World—A Discipline Comes of Age. Patient Education and
Counseling, 61, 161-164. http://dx.doi.org/10.1016/j.pec.2005.02.011
10 Joint Commission on Accreditation of Health Care Organizations (2001) Hospital Accreditation Standards, Oakbrook
Terrace.
11 Jones, R.A. (2010) Patient Education in Rural Community Hospitals: Registered Nurses’ Attitudes and Degrees of
Comfort. Journal of Continuing Education in Nursing, 41, 41-48. http://dx.doi.org/10.3928/00220124-20091222-07
12 Kääriäinen, M. and Kyngäs, H. (2010) The Quality of Education Evaluated by the Health Personnel. Scandinavian
Journal of Caring Science, 24, 548-556. http://dx.doi.org/10.1111/j.1471-6712.2009.00747.x
13 Kendall, S., Deacon-Crouch, M. and Raymond, K. (2007) Nurses’ Attitudes toward Their Role in Patient Discharge
Medication Education and Toward Collaboration with Hospital Pharmacists: A Staff Development Issue. Journal for
Nurses in Staff Development, 23, 173-179. http://dx.doi.org/10.1097/01.NND.0000281416.04731.3e
14 Latter, S., Rycroft-Malone, J., Yerrell, P. and Shaw, D. (2000) Evaluating Educational Preparation for a Health Educa-
tion Role in Practice: The Case of Medical Education. Journal of Advanced Nursing, 32, 1282-1290.
http://dx.doi.org/10.1046/j.1365-2648.2000.01599.x
15 Lipponen, K., Kyngäs, H. and Kääriäinen, M. (2006) Surgical Nurses Readiness for Patient Counselling. Journal of
Orthopaedic Nursing, 10, 221-227. http://dx.doi.org/10.1016/j.joon.2006.10.013
16 Marcum, J., Ridenour, M., Shaff, G., Hammons, M. and Taylor, M. (2002) A Study of Professional Nurses’ Percep-
tions of Patient Education. Journal of Continuing Education in Nursing, 33, 112-118.
17 Moret, L., Rochedreux, A., Chevalier, S., Lombrail, P. and Gasquet, I. (2008) Medical Information Delivered to Pa-
tients: Discrepancies Concerning Roles as Perceived by Physicians and Nurses Set Against Patient Satisfaction. Patient
Education and Counseling, 70, 94-101. http://dx.doi.org/10.1016/j.pec.2007.09.011
18 Park, M.Y. (2005) Nurses’ Perception of Performance and Responsibility of Patient Education. Journal of Korean
Academy of Nursing, 35, 1514-1521.
19 Park, M.Y. and McMillan, M.A. (2000) Patient Education in the Face of Work Constraints. Paper Presented at the 1st
Asia-Pacific Nursing Congress, Seoul.
20 Sally, H., Karen, D. and Fran, L. (2005) Patient Education in Health and Illness. 5th Edition, Lippincott Williams &
Wilkins, Philadelphia.
21 Sigurdardottir, A.K. (1999) Nurse Specialists’ Perceptions of Their Role and Function in Relation to Starting an Adult
Diabetic on Insulin. Journal of Clinical Nursing, 8, 512-518. http://dx.doi.org/10.1046/j.1365-2702.1999.00279.x
22 Thoma, G.B. (1999) A Comparison of the Role of Patient Educator to Other Nursing Roles: Identifying Influences Af-
fecting the Attainment of the Patient Educator Role among Staff Nurses. Microform University of Memphis, Memphis.
23 Zakrisson, A.B. and Hägglund, D. (2010) The Asthma/COPD Nurses’ Experience of Educating Patients with Chronic
Obstructive Pulmonary Disease in Primary Health Care. Scandinavian Journal of Caring Science, 24, 147-155.
http://dx.doi.org/10.1111/j.1471-6712.2009.00698.x
24 Turner, D., Wellard, S. and Bethune, E. (1999) Registered Nurses’ Perceptions of Teaching: Constraints to the Teach-
ing Moment. International Journal of Nursing Practice, 5, 14-20.
http://dx.doi.org/10.1046/j.1440-172x.1999.00147.x
25 Halse, K.M., Fonn, M. and Christiansen, B. (2014) Health Education and the Pedagogical Role of the Nurse: Nursing
Students Learning in the Clinical Setting. Journal of Nursing Education and Practice, 4, 30-38.
26 Abdi, A., Izadi, A., Vafaeei, K. and Lorestani, E. (2014) Assessment of Patient Education Barriers in Viewpoint of
Nurses and General Physicians. International Research Journal of Applied and Basic Sciences, 8, 2252-2256.
www.irjabs.com

507