Patient education in Western European hospitals: a comparison of the Netherlands, Flanders and England.

OBJECTIVE: This research describes the organization of patient education in hospitals and the conditions that influence this in the Netherlands, Flanders and England. METHODS: The research consists of document analysis and interviews. RESULTS: On the organizational level, there can be a patient information desk (England and the Netherlands) and/or a specialized officer on patient education (the Netherlands and England). In the three countries/regions, the organization of patient education on the program level, for patient groups, is characterized by consultations of specialized nurses, patient information materials and patient education policy. Expert centers stimulate patient education through training and quality projects. Lobbying by patient organizations is important for the setting up of patient education. Both expert centers and patient organizations are financially dependent on and respond to policy of the government. CONCLUSION: Patient education is mostly organized on the organizational level or the program level, or both. Patient organizations and expert centers are conditions that are dependent on the government. Government policy and subsidies are considered as the most important conditions for the organization of patient education in hospitals. PRACTICE IMPLICATIONS: Commitment of officers working in patient education to the Health Promoting Hospital project and the European Association for Communication in Healthcare could stimulate patient education.

Doctor-parent-child relationships: a 'pas de trois'.

Adult participants play a pivotal role in doctor-parent-child interactions at the general practitioner's (GP's) surgery. The child's opportunities to participate are rather limited and parental speaking for the child is, in a way, institutionally co-constructed. This study aimed at further characterizing the relationships within this triad by developing a typology of doctor-parent-child interactions, which classified adult behavior in terms of supporting versus non-supporting child participation. The child's participation was described in terms of display of involvement and turning for support. Analyses of 105 videos show that in most consultations, both GP and parent displayed non-supportive behavior. Despite the GPs' initial efforts to involve the child in the interaction, 90% of the consultations ended up in a non-participatory way. During this last segment of diagnosis and treatment information, the child's voice was hardly heard, as reflected in the minimal involvement displayed and the absence of turning to the parent for support. It is concluded that the bi-directional perspective chosen in this analysis allowed for a better understanding of the underlying mechanisms leading to the stereotypical picture in both literature and actual practice of triadic medical interactions being dominated by both adult participants. The low degree of child participation should not solely be seen as a consequence of adult behavior, but rather as a co-construction of all three participants. The results are discussed from a pedagogical perspective, and implications for medical practice are formulated.