Research paper
ED-HOME: Improving educator confidence and patient education in the Emergency Department

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Summary

Background

Barriers to effective patient communication in the emergency department (ED) are well recognised; time, resources and staff and consumer expectations. This project aimed to improve the quality of health education provided in the ED by increasing nurses’ confidence as educators.

Method

By providing a staff information package including the introduction of a new structured education tool; ED-HOME, and by assessing the confidence and self-efficacy of the nurses in the process, we hoped to determine if an improvement in practice and confidence was achieved. A quantitative, pre and post-test questionnaire comparison study was undertaken before and after a four week implementation period. The project examined the attitudes and practices of registered emergency nurses and was conducted in one metropolitan emergency department.

Results

Results indicated that nurse confidence and self-efficacy improved by using the new structured ED-HOME format and both staff satisfaction and education competence increased. Participants positively responded to the new tool and recommended future use in the ED.

Conclusion

This project demonstrates that if emergency nurses feel more confident with their educating practices and by using a structured format, patients will benefit from better quality patient education provided in the ED.

Introduction

Communication and patient education in the Emergency Department (ED) is recognised as an ongoing challenge for health professionals due to the uniqueness of the clinical environment and the diversity and unpredictability of emergency medicine. Effective communication plays a crucial role in meeting staff, patient and community expectations. Patient education is one area that, if attended well, can influence patient satisfaction, promote patient self-care and improve community health [1]. Nurses working in ED are obliged to complete clinical tasks as well as provide education to their patients for safe discharge into the community. Information should be shared throughout the attendance regarding department processes, treatment plans and discharge instructions. Barriers such as time constraints, lack of resources and nurses’ level of knowledge and communication skills limit their performance and confidence as educators [2].

In 2011, an internal Education Needs Assessment was conducted in a metropolitan hospital emergency department in Victoria, Australia. A community survey was conducted concurrently by the state government and both surveys identified that staff and community felt patient information could be improved [3]. This raised questions as to how patient education could be enhanced and facilitated, including addressing barriers such as time constraints, resource limitations and lack of knowledge and skills for nurses as educators. Although patient education has been studied previously in the literature; addressing health literacy, learning styles, communication and media; there are no studies that have examined the nurse educators’ practice and attitudes towards public education in the ED.

This paper reports on a project aimed to improve ED nurses’ confidence and efficiency as educators by using a structured approach to patient education based upon the conceptual framework from Bandura's Self Efficacy theory which claims that; when confidence exists in one's own skills and ability to achieve a desired result, one is more likely to attempt it and succeed [4]. For this study we tested the assumption that a structured educational delivery model would enhance nurse confidence and motivation as educators, hence improving educational outcomes for their patients.

Section snippets

Literature review

The existing literature highlighted concerns in providing patient education specific to the ED, including communication skills, health literacy levels of patients and education materials being used [1], [2], [5]. Further, patient and community expectations and levels of satisfaction relating to effective communication and processes including waiting times, treatment plans and health care options are explored [6], [7], [8]. Other studies have shown that the majority of consumers were respectful

Design

A quasi-experimental design was used with a pre and post-test questionnaire for comparison of ED nurses’ responses in regards to practice and attitudes towards patient education being provided in the ED. Data was collected before and after the implementation of a staff education session, including introducing a new education tool; ED-HOME.

Setting

The project was conducted in a single metropolitan emergency department in Victoria, Australia. The 36 bed department is part of a secondary referral

Attitudes

Results relating to awareness and attitudes of nurses towards patient education in the ED show 71% (n = 10) of the pre-test sample felt patient education was very important. Following the education session, this significantly (p = 0.046) increased to 86% (n = 12). Only 64% (n = 9) of the sample thought it was done well/very well in their department in the pre-test, compared with 93% (n = 13) in the post test, as shown in Table 1. Using the Wilcoxin signed rank test, this was also found to be

Discussion

This study had a number of positive key findings, in particular, an improvement in nurse confidence, attitudes and practice following the introduction of the ED-HOME education package. Although the sample size was small and one of convenience, this pilot study showed that when education is broken down into principles of technique, resources and environment, nurse confidence in educating increased. Using a structured format incorporating; assessment, planning, implementation and evaluation,

Conclusion

This pilot study highlights the importance of a structured, systematic approach to patient education leading to patient satisfaction, understanding and improved quality of care. Implementation of the ED-HOME education package provided emergency nurses with the necessary skills and attributes in order to improve education practices in a busy emergency environment. Nursing staff reported an increase in confidence and self-efficacy which was reflected in their attitudes towards providing concise

Author contribution

Author 1 was responsible for the study conception, literature review, development of the questionnaire and education package, data collection, analysis and drafted manuscript. Author 2 and 3 provided expert guidance, assisted with data analysis, manuscript draft and editing. Author 1 and 2 made final revisions to the paper and submitted.

Provenance and conflict of interest

The authors declare that they have no conflict of interest. This paper was not commissioned.

Funding

This research received no specific grant from any funding agency in the public, commercial or non-for-profit sectors.

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