The effect of reinforcing an educational programme using telephone follow-up on health-related quality of life of individuals using warfarin: A randomised controlled trial.

OBJECTIVES: To evaluate the effect of reinforcing an educational programme through telephone follow-up on health-related quality of life and anxiety and depression symptoms in individuals starting warfarin therapy. BACKGROUND: Educational interventions have improved quality of life in individuals using warfarin. Few studies have examined the addition of telephone follow-up to enhance educational interventions. DESIGN: Randomised controlled trial in outpatient setting. METHODS: Hospitalised adults starting warfarin therapy who agreed to participate received an educational programme about the warfarin treatment. At discharge, they were randomised to receive either five telephone follow-up calls (intervention) or no telephone calls (controls). Both groups were evaluated for health-related quality of life (using Duke Anticoagulation Satisfaction Scale) and symptoms of anxiety and depression (using Hospital Anxiety and Depression Scale) at three and six months post-discharge. Groups were compared at each time by independent-samples t test, and over time by repeated-measures analysis of variance, with time (three and six months), groups (intervention and control) and an interaction between time and group as factors. Level of significance was set at 0.05. The Consolidated Standards of Reporting Trials was used for reporting. RESULTS: Fifty-two individuals (26 per group) completed the study. There were no statistical differences between groups in health-related quality of life, anxiety and depression symptoms, at both times post-discharge. Participants who received follow-up telephone calls reported better positive psychological impact (a subscale of quality of life) than controls. CONCLUSIONS: Reinforcing an educational programme with telephone follow-ups did not have an overall effect on health-related quality of life of individuals using warfarin but promoted positive psychological impact. RELEVANCE TO CLINICAL PRACTICE: The low cost of reinforcing educational programmes with telephone calls and the improvement in positive psychological aspects indicate that this type of intervention is still a promising intervention that could be further investigated and improved.

Postsurgical Follow-Up Phone Calls: Worth the Investment?

PURPOSE: To analyze differences in health confidence levels regarding discharge instructions between two groups of same-day surgery patients. DESIGN: Comparative and descriptive design. METHODS: Phone surveys to two groups: those who received follow-up phone calls from a registered nurse (RN) and those who received standard care instructions at discharge only. FINDINGS: In 74 same-day surgery patients (n = 37 per group), all participants expressed high health confidence in implementing discharge instructions. Results revealed no higher health confidence levels in patients who received RN follow-up phone calls, no difference between groups attending postoperative appointments, and no relationships between subject demographics, health confidence level, and postoperative complications between groups. CONCLUSIONS: The use of specialized RNs to conduct postoperative phone calls may not be cost effective. When RNs provide excellent instructions to patients in person, it may lead to sufficient patient health confidence. Personal and nurse-provided education should be considered a standard, and the outcomes of costly follow-up phone calls should be examined.

Optimizing patient education of oncology medications: A descriptive survey of pharmacist-provided patient education in Canada.

BACKGROUND: The incidence of cancer is increasing in Canada due to an aging and growing population. This frequently necessitates chemotherapy, which is a high-risk treatment, often given as a part of a complex regimen with serious side effects. A review of the evidence of pharmacy-provided patient education initiatives targeted to oncology patients revealed that minimal is known about this service. OBJECTIVE: The objective of this study was to determine the different models of patient education of oncology medications delivered by pharmacists to adult oncology patients in a hospital or cancer center in Canada. METHODS: The study design was a descriptive online survey developed by the investigation team and was distributed to pharmacists who provided patient education to adult oncology patients. The primary outcome of this research project was to describe self-reported pharmacist-provided patient education of oncology medications across Canada. The survey data was analyzed quantitatively with Opinio survey software. RESULTS: Sixty-four pharmacists completed the survey. Key findings of the study were that approximately 50% of pharmacists spend up to 25% of their time providing direct patient care and that not all adult oncology patients are receiving education by a pharmacist. CONCLUSIONS: Pharmacists provide patient education at the first treatment, change in therapy, and on request of another healthcare professional. Most cover administration, side effects, their prevention and management, and drug-interactions. Frequently used teaching methods include structured patient education delivery process, customized teaching for each patient, and repetition of key educational points.

Discussing sexuality in health care: A systematic review.

AIMS AND OBJECTIVES: Using the PRISMA guidelines, a systematic literature review was conducted to explore current and relevant evidence regarding factors that influence nurses' provision of sexual healthcare education to patients. BACKGROUND: The World Health Organization and Healthy People 2020 emphasise the importance of sexual health care. Although the nursing profession has the ability to develop a competent level of sexuality education, sexual health care is often ignored in nursing care and education. Many nurses are failing to engage in meaningful conversations about sexual health with patients, and this could lead to negative health events. However, patients would like reliable and nonjudgmental access to education about sexual health. DESIGN: Electronic databases were searched for articles published between 2012-2017. Studies of nurses providing sexual health education in healthcare settings were included. The Melnyk and Fineout-Overholt (2015, Evidence-based practice in nursing & healthcare, Philadelphia, PA: Walters Kluwer) quality assessment framework was used. The researchers independently reviewed 532 studies and agreed upon ten to include in this review. RESULTS: Findings from this systematic review suggest that nurses' provision of sexual health education to patients is influenced by four factors: (a) a lack of knowledge about sexual health, (b) nurses' attitudes and beliefs that sexual health care is private and not a priority, (c) nurses' comfort discussing sexual health, and (d) perceived barriers related to time, responsibility and organisational support. CONCLUSION: The ten articles reviewed were all Level VI descriptive and qualitative studies, as defined by Melnyk and Fineout-Overholt (2015). It is evident that sexual healthcare information is not being widely addressed. To reduce stigma, the positive aspects of sexual health care must be promoted on multiple levels. RELEVANCE TO CLINICAL PRACTICE: Leaders in professional and community-based organizations should be on the forefront of making recommendations for nurses and practitioners, so they could improve their ability to provide sexual healthcare information to their patients.

Using simulated patients as a learning strategy to support undergraduate nurses to develop patient-teaching skills.

BACKGROUND: An increase in the number of patients with long-term conditions has required a greater focus on nurse-led educational interventions to enable patients to develop self-management strategies. However, patient education is frequently taken for granted, and nurses sometimes consider that their undergraduate training does not prepare them to participate in effective patient teaching. AIM: The study aimed to formatively evaluate a simulated role-play scenario facilitated with third-year nursing students to support the development of patient-teaching skills. METHOD: The study combined two approaches to simulation, using high-fidelity and mid-fidelity simulation scenarios sequentially. This enabled students (n=20) to apply the communication strategies learnt to both a skills-based procedural situation and a patient-teaching simulation. A five-item pro forma with four open questions and one closed question was used for formative evaluation. FINDINGS: The results indicated that using a simulated patient to practise patient-teaching skills was perceived by the students to be a valuable method of learning that they could transfer to clinical practice. CONCLUSION: The findings suggested that facilitating learning with a simulated patient is useful in replicating authentic verbal and practical interactions with a patient in practice.

Understanding patients and spouses experiences of patient education following a cardiac event and eliciting attitudes and preferences towards incorporating cardiopulmonary resuscitation training: A qualitative study.

AIM: The aim of this study was to gain a comprehensive perspective about the experience of patient and spousal education following an acute cardiac event. The second objective was to elicit an understanding of patient and spousal attitudes, preferences and intentions towards future cardiopulmonary resuscitation training. BACKGROUND: Patients with cardiovascular disease require comprehensive patient and family education to ensure adequate long-term disease management. As cardiac patients are at risk of future cardiac events, including out-of-hospital cardiac arrest, providing cardiopulmonary resuscitation training to patients and family members has long been advocated. DESIGN: We conducted a qualitative study underpinned by phenomenology and the Theory of Planned Behaviour. METHODS: Semi-structured interviews were conducted with cardiac patients and their spouses (N = 12 patient-spouse pairs) between March 2015-April 2016 purposively sampled from a cardiology ward. Interviews were transcribed verbatim and thematic analysis undertaken. FINDINGS: Nine male and three female patients and their spouses were recruited. Ages ranged from 47-75 years. Four strongly interrelated themes emerged: the emotional response to the event, information, control and responsibility. There was evidence of positive attitudes and intentions from the TPB towards undertaking cardiopulmonary resuscitation training in the future. Only the eldest patient spouse pair were not interested in undertaking training. CONCLUSIONS: Findings suggest cardiac patients and spouses have unmet education needs following an acute cardiac event. Information increased control and decreased negative emotions associated with diagnosis. Participants' preferences were for inclusion of cardiopulmonary resuscitation training in cardiac rehabilitation programs.

Challenges in everyday life among recently diagnosed and more experienced adults with type 2 diabetes: A multistage focus group study.

AIMS AND OBJECTIVES: To identify perceived challenges related to self-management among recently diagnosed adults and those with longer experience of type 2 diabetes as a foundation for the future development of a person-centred information and communication technology service. BACKGROUND: Learning self-management of type 2 diabetes includes mastering the skills required to complete complex emotional and physical tasks. A service developed with the participation of stakeholders may be an alternative way to meet rising needs for self-management. DESIGN: Qualitative descriptive design influenced by a participatory approach. METHODS: Multistage focus group interviews among one group of recently diagnosed (≤3 years, n = 4) adults and one group with longer experience (≥5 years, n = 7) of type 2 diabetes. RESULTS: Challenges in self-management in everyday life with type 2 diabetes were identified: understanding; developing skills and abilities; and mobilising personal strengths. Both groups described challenges in understanding the causes of fluctuating blood glucose and in developing and mobilising skills for choosing healthful food and eating regularly. The recently diagnosed group was more challenged by learning to accept the diagnosis and becoming motivated to change habits while the experienced group was mainly challenged by issues about complications and medications. CONCLUSION: Adults with diabetes have different needs for support during different phases of the disease. From a person-centred perspective, it would be desirable to meet individual needs for self-management on peoples' own terms through a technological service that could reach and connect to a large number of people. RELEVANCE TO CLINICAL PRACTICE: Diabetes nurses need to address the knowledge needs of patients with diabetes and support them in developing self-management skills. Consistent with person-centred care, practitioners should also encourage patients' abilities to mobilise their own personal strengths to maintain self-management.

Postoperative pain: knowledge and beliefs of patients and nurses.

AIMS AND OBJECTIVES: To describe patients' and nurses' knowledge and beliefs regarding pain management. Moreover, to explore the effect of information and education on patients' and nurses' knowledge and beliefs regarding pain management. BACKGROUND: In the treatment of postoperative pain, patients' and nurses' inadequate knowledge and erroneous beliefs may hamper the appropriate use of analgesics. DESIGN: A randomised controlled trial and a cross-sectional study. METHODS: In 2013, half of 760 preoperative patients were allocated to the intervention group and received written information about the complications of postoperative pain. The knowledge and beliefs of 1184 nurses were studied in 2014 in a cross-sectional study. All data were collected with the same questionnaires. RESULTS: In the intervention group, patients' knowledge level was significant higher than in the control group, while no differences were found in beliefs. Nurses had higher knowledge and more positive beliefs towards pain management compared with both patient groups. Nurses with additional pain education scored better than nurses without additional pain education. Nurses were also asked what percentage of pain scores matched their impression of the patient's pain, and the mean was found to be 63%. CONCLUSIONS: Written information was effective for increasing patients' knowledge. However, it was not effective for changing beliefs about analgesics and patients and nurses had erroneous beliefs about analgesics. RELEVANCE TO CLINICAL PRACTICE: It is necessary to continue to inform patients and nurses about the need for analgesics after surgery. Such education could also emphasise that a discrepancy between a patient's reported pain score and the nurse's own assessment of the patient's pain should prompt a discussion with the patient about his/her pain.

Predictors of Readiness for Hospital Discharge After Birth: Building Evidence for Practice.

BACKGROUND: Preparation for hospital discharge after birth became a global concern when hospitals in many developing countries began implementing shorter lengths of stay for uncomplicated deliveries. A mother's perceived readiness for hospital discharge may be influenced by many factors that can ultimately shape postdischarge outcomes. AIMS: The purpose of this study was to explore the antepartum, intrapartum, and postpartum predictors of discharge readiness, including nursing educational practices that are predictive of postpartum mothers' perceptions of readiness for hospital discharge. METHODS: The Adaptation to Transitions conceptual framework guided the descriptive correlational study design and measures. A purposive sample of 185 English- and Spanish-speaking postpartum mothers who experienced an uneventful vaginal or cesarean birth of a healthy infant completed demographic, quality of discharge teaching, and readiness for hospital discharge questionnaires prior to discharge. RESULTS: Mothers with three or more children, delivery mode, bottle-feeding, the delivery of education, and the difference between educational content received and needed, were significant predictors that accounted for 42% of the variance in readiness for hospital discharge (R2 = 0.42, F[10,174] = 14.52, p < .001). Nurses' skill in teaching and educational content received were significant predictors even with parity, feeding, and delivery mode in the model. LINKING EVIDENCE TO ACTION: The relationship between quality of discharge teaching and discharge readiness provides evidence of the critical role nurses have in the discharge preparation process. Nurse education programs and evidence-based guidelines should be designed to enhance patient education focused on the adequacy and delivery of teaching content.

Becoming an expert carer: the process of family carers learning to manage technical health procedures at home.

AIMS: To describe the learning process of family carers who manage technical health procedures (such as enteral tube feeding, intravenous therapy, dialysis or tracheostomy care) at home. BACKGROUND: Increasingly, complex procedures are being undertaken at home but little attention has been paid to the experiences of family carers who manage such procedures. DESIGN: Grounded theory, following Charmaz's constructivist approach. METHODS: Interviews with 26 family carers who managed technical health procedures and 15 health professionals who taught carers such procedures. Data collection took place in New Zealand over 19 months during 2011-2013. Grounded theory procedures of iterative data collection, coding and analysis were followed, with the gradual development of theoretical ideas. FINDINGS: The learning journey comprised three phases: (1) an initial, concentrated period of training; (2) novice carers taking responsibility for day-to-day care of procedures while continuing their learning; and (3) with time, experience and ongoing self-directed learning, the development of expertise. Teaching and support by health professionals (predominantly nurses) was focussed on the initial phase, but carers' learning continued throughout, developed through their own experience and using additional sources of information (notably the Internet and other carers). CONCLUSION: Further work is needed to determine the best educational process for carers, including where to locate training, who should teach them, optimal teaching methods and how structured or individualized teaching should be. Supporting carers well also benefits patient care.

Perpetuating 'New Public Management' at the expense of nurses' patient education: a discourse analysis.

This study aimed to explore the conditions for nurses' daily patient education work by focusing on managers' way of speaking about the patient education provided by nurses in hospital care. An explorative, qualitative design with a social constructionist perspective was used. Data were collected from three focus group interviews and analysed by means of critical discourse analysis. Discursive practice can be explained by the ideology of hegemony. Due to a heavy workload and lack of time, managers could 'see' neither their role as a supporter of the patient education provided by nurses, nor their role in the development of nurses' pedagogical competence. They used organisational, financial, medical and legal reasons for explaining their failure to support nurses' provision of patient education. The organisational discourse was an umbrella term for 'things' such as cost-effectiveness, which were prioritised over patient education. There is a need to remove managerial barriers to the professional development of nurses' patient education. Managers should be responsible for ensuring and overseeing that nurses have the prerequisites necessary for providing patient education as well as for enabling continuous reflective dialogue and opportunities for learning in practice.

Nurse-led educational interventions on cancer pain outcomes for oncology outpatients: a systematic review.

BACKGROUND: Cancer pain management is still unsatisfactory, although some effective guidelines exist. Educational interventions are reported to be useful in pain relief for oncology outpatients. AIM: The aims of this systematic review were to evaluate the effects of nurse-led educational interventions on improving cancer pain outcomes for oncology patients, and to establish an effective cancer pain protocol for clinical nursing practice in China. METHODS: A three-step search strategy was utilized. Eight databases were searched using the standards provided by the Joanna Briggs Institute that guided article selection, critical appraisal, data collection and data synthesis. RESULTS: A total of 1093 studies were identified through a literature search. Only six studies complied with the inclusion criteria and were found to be methodologically sound. In general, the included studies indicated positive results pertaining to patient's knowledge and attitudes towards analgesics and cancer pain management and decreased pain intensity. Studies reported minimal effects of intervention on anxiety, depression, satisfaction regarding cancer pain management and patient's quality of life. CONCLUSIONS: Educational interventions were reported as effective methods to improve cancer pain outcomes. Analysis of the six included studies demonstrated the overall positive effects of nurse-led educational interventions for improving cancer pain management. IMPLICATIONS FOR NURSING AND HEALTH POLICY: The results suggest that an effective cancer pain protocol for improving cancer pain management can be established in China.

Long-term effects of a nurse-led group and individual patient education programme for patients with chronic inflammatory polyarthritis - a randomised controlled trial.

AIMS AND OBJECTIVES: To investigate the long-term effect of a nurse-led hospital-based patient education programme combining group and individual education for patients with chronic inflammatory polyarthritis. BACKGROUND: Patient education interventions have shown short-term effects, but few studies have investigated whether the effects are sustained for a longer period. DESIGN: Randomised controlled trial. METHODS: Patients with rheumatoid arthritis, psoriatic arthritis and unspecified polyarthritis were randomised to the intervention group (n = 71) or a waiting list (n = 70). Primary outcomes were as follows: Global Well-Being and the Arthritis Self-Efficacy Other Symptoms Subscale. Secondary outcomes were as follows: patient activation, physical and psychological health status, patients' educational needs and a Disease Activity Score (DAS28-3). RESULTS: The intervention group had a statistically significant higher global well-being than the controls after 12 months, mean change score 8·2 (95% CI, 1·6-14·8; p-value = 0·015), but not in the Arthritis Self-Efficacy Other Symptoms Subscale, mean change score 2·6 (95% CI, -1·8 to 7·1; p-value = 0·245). Within each group, analyses showed a statistically significant improvement in DAS28-3, mean change -0·3 (95% CI, -0·5 to -0·1; p-value = 0·001), in the intervention group from baseline to 12 months, but not in the controls. The controls had a statistically significant deterioration in the Arthritis Self-Efficacy Other Symptoms Subscale, mean change -5·0 (95% CI, -8·6 to -1·3; p-value = 0·008), Arthritis Impact Measurement Scales - 2 Social, mean change 0·3 (95% CI, 0·1-0·5; p-value = 0·008), and Hospital Anxiety and Depression Scale total, mean change 1·4 (95% CI, 0·3-2·5; p-value = 0·013). CONCLUSION: A combination of group and individual patient education has a long-term effect on patients' global well-being. RELEVANCE TO CLINICAL PRACTICE: Nurses should consider whether a combination of group and individual patient education for patients with chronic inflammatory polyarthritis is an alternative in their clinical practice. This combination is less time-consuming for the patients, and it includes the benefit of group learning in addition to focusing on patient's individual educational needs.

Information needs among patients with chronic obstructive pulmonary disease at their first hospital admission: priorities and correlates.

AIMS AND OBJECTIVES: To better understand chronic obstructive pulmonary disease patients' informational needs and associated factors using the Predisposing, Reinforcing and Enabling Causes in Educational Diagnosis and Evaluation model. BACKGROUND: Despite the increase in the incidence of chronic obstructive pulmonary disease, little research has been carried out on the information needs from a patient perspective. DESIGN: A cross-sectional, correlational design was used. METHODS: A convenience sample of 107 subjects was recruited from four Taiwanese hospitals. Multiple regression analyses were conducted to identify the total informational needs and related factors. RESULTS: Major findings were that (1) patients' top informational need was daily care, and (2) variables associated with the total information needs were younger age, greater health internal locus of control, less dyspnoea severity and greater social support. CONCLUSIONS: Patients' perceived chronic obstructive pulmonary disease informational needs are not congruent with the information received from healthcare professionals. RELEVANCE TO CLINICAL PRACTICE: Healthcare professionals need to be sensitive to the fact that treatment-related information was not the top priority of patients with chronic obstructive pulmonary disease. Healthcare professionals also need to target the special subpopulation of chronic obstructive pulmonary disease patients with greater total informational need to maximise educational impact.

Registered nurses' perceptions of conditions for patient education--focusing on aspects of competence.

BACKGROUND: It is important to clarify nurses' perceptions of conditions for patient education in daily work as research findings are ambiguous. There is a gap between societal regulations on nurses' competence in accomplishment/achievement of patient education and research findings. AIM: The aim was to describe nurses' perceptions of conditions for patient education, focusing on aspects of competence. The aim was also to describe differences in conditions for nurses working in primary, municipal and hospital care. METHODS: The study is a cross-sectional survey and is part of a project about nurses' patient-education. A randomized selection of nurses (842) received a questionnaire comprising 47 items concerning factual experience and attitudes to patient education and 13 background items. Questionnaires were returned by 83% of participants. Descriptive statistics, non-parametric tests and content analysis for open-ended items were used. RESULTS: Nurses' perceptions of conditions for patient education differ between health-care settings. Primary care nurses are at an advantage in following research in patient education, perception of their own competence (prioritizing and knowing their mandate in patient teaching), pedagogical education and post graduate specializations. CONCLUSIONS: Nurses' patient education must be more visualized and appropriate conditions created at each workplace. In this change process, managers' support is considered vital.

Comparison of Nurses' and Patients' Readiness for Hospital Discharge: A Multicenter Study.

Decision to discharge is often based solely on clinical criteria but readiness for discharge is multifactorial and perceived differently by patients, families, nurses, and physicians. This is an analytical cross-sectional study aimed to compare perceptions of readiness to discharge 452 patients and their assigned nurses on the day of hospital discharge. To compare perceptions of readiness to discharge patients and their assigned nurses on the day of hospital discharge via readiness for hospital discharge (RHD) self-reported questionnaire. The biggest difference between nurses and patients' perception scores was in the knowledge subscale. The results of linear regression model showed that patients' gender, education, occupation, ward, nurse's age, and marital status predict the difference between nurses and patients' perception of readiness. Hospitalization in ear, nose, and throat (ENT) department with increasing difference and the older age of nurses is associated with a decrease in the difference between the perception. Assessment of nurse's self-readiness can help with the development of care and education planning tailored to patients' needs before discharge.

Decreasing Readmission Rates in Patients With Immune-Mediated Toxicities Using an APRN-Led Discharge Teaching Program.

Patients with cancer are at increased risk for readmission, which can be associated with increased healthcare costs and poor patient outcomes, because of the nature of the disease, treatment complexity, and symptom management.

Multimedia in preoperative patient education for adults undergoing cancer surgery: A systematic review.

PURPOSE: The purpose of this systematic review was to determine whether adequate research evidence exists to support utilizing multimedia technology in the preoperative education of adult cancer patients. METHODS: A systematic search of Medline, CINAHL, Web of Science, and PsycINFO databases from 2010 through September 24, 2020, was performed. The review included quantitative studies that examined whether education delivered by multimedia impacted levels of anxiety, knowledge acquisition, satisfaction, and compliance. The research quality was evaluated using the Joanna Briggs Institute Critical Appraisal Tool specific to the study design. RESULTS: The database search identified 529 scientific articles, of these nine studies met the eligibility criteria (n = 5 randomized controlled trials; n = 4 quasi-experimental studies). The education interventions included a variety of researcher-developed, multimedia modalities, consisting of video (n = 7), a computer program (n = 1), and a tablet application (n = 1). The methodological rigor varied among these studies. Multimedia patient education resulted in decreased anxiety and improved knowledge acquisition within groups; however, there was no significant difference when compared to traditional methods. Patients were also similarly satisfied and compliant with both education methods. CONCLUSIONS: In all studies, the healthcare provider played a prominent role in both multimedia and traditional interventions, revealing the strong influence of the interpersonal connection in the delivery of preoperative education. Future research is needed to investigate whether more interactive technology could improve patient outcomes.

Excellence in Patient Education: Evidence-Based Education that "Sticks" and Improves Patient Outcomes.

The patient education process has 4 equal components to be addressed by the nurse: assessment, planning, implement, and evaluation. Excellent patient education is an "art" and "science" using nuances and evidence-based strategies to effectively educate. The assessment and evaluation components often use nuanced approaches (motivational interviewing, teach back) to engage the patient/caregiver respectfully, whereas planning and implementation rely more on evidence-based strategies such as the Patient Education Assessment of Materials. Nurses should provide education that is simple, patient centered, and multimodal to meet the health literacy needs of patients/caregivers.

Nursing students' perceptions of preparation to engage in patient education.

Patient teaching is a key component of graduate nursing practice. Nurses sometimes believe that their undergraduate teaching does not prepare them to engage in effective patient teaching. In addition, nursing students often do not use teaching resources when engaging in patient teaching. The aim of this focused ethnographic study was to determine if students in a CBL/PBL based learning undergraduate nursing program engage in patient teaching when they are in the clinical area. Focus groups and shorter individual interviews were used to ensure in-depth data collection. Data saturation was reached with a sample of 28 undergraduate students. Emerging themes included: Whose responsibility? When patient teaching does happen, when patient teaching does not happen and improving the culture of patient teaching in the teaching setting. It was clear that students in this context-based learning nursing teaching program valued and were engaged in patient teaching. However, they did not necessarily feel that they had been taught the skills necessary for engaging in effective patient teaching. They also expressed concern that workplace conditions for nurses were not always conducive to patient teaching.