Greetings from Jyväskylä, Finland,
Human technology city
Leena Liimatainen 19.5.2005
Empowering hospital patients for
developing healthy lifestyles – what can
the Jyväskylä PEDE-project contribute?
Leena Liimatainen, Ph.D.
Head of the Postgraduate degree program,
Principal Lecturer in Health Promotion, Jyväskylä
Polytechnic, Finland
Dublin, Ireland 19.5.2005
Leena Liimatainen 19.5.2005
Challenges in lifestyle counselling, patient
education and intervention planning
Leena Liimatainen 19.5.2005
1. In health promotion, empowerment is a process
through which people gain greater control over
decisions and actions affecting their health (WHO
•
•
•
•
1998).
counselling is based on principles of health promotion
key issues are partnership, networking and reciprocal conversation in
a confidential relationship
recognize patients’ competence, resources, and explanations of
action styles as well as coping and support networks
patients have an opportunity to plan what to do next, how to go on,
and to construct their own solutions to health issues
Leena Liimatainen 19.5.2005
2. Lessons from meta-analyses exploring the
effects of patient education and
implications for educational interventions
(Cooper et al. 2001, 2003)
•
The educational interventions tested were poorly
described and failed to adhere to theoretical models.
->interventions were described by their content (diet,
exercise, stress management) rather than their
learning/ teaching activities
Leena Liimatainen 19.5.2005
* There is a need to develop educational initiatives
that utilise the principles of adult education, which
aspire to affect feelings, thinking and behaviour.
* Practitioners need to use theoretically based
teaching strategies to empower patients to make
informed choices so that they can transform their
knowledge into practice
* Theoretical models of behaviour need to be
integrated into models of education.
Leena Liimatainen 19.5.2005
• The outcomes measured were limited by a
biomedical approach to education.
* Interventions need to be designed also addressing
outcomes such as quality of life, personal models of
illness and empowerment in spite of physical outcomes
and compliance with self-care instructions
Patient Education Development Project
(PEDE-project)
Leena Liimatainen 19.5.2005
To meet the challenges, the Patient Education
Development Project (PEDE –project 20022004) was started in the internal medicine units
of the Central Finland Health Care District.
The project involved about 350 nurses and 23
internal medicine units
The aims of the project
Leena Liimatainen 19.5.2005
1. The nursing staff will acquire new
empowering patient education skills
2. The counselling practices, materials,
networks and quality assuring methods are
renewed in the working units.
Theoretical framework
of the project
Leena Liimatainen 19.5.2005
• Action research project
• Experiential (Kolb 1984) and transformative (Mezirow
1991) learning models were used to facilitate both
individual and organisational learning and change
processes in the project
• The project realized the “HPH” –programme with a special
emphasis on promoting the health of the patients and staff
by creating a health-promoting and empowering nursing
culture.
• Principles: Health Promotion, Empowerment, Participation
Experiential learning model (Kolb 1984)
as the framework of the PEDE-project
Leena Liimatainen 19.5.2005
Developing patient education by studying the practice
Experiences from daily
practice, Action
Observation,
Reflection, Evaluation
Experimentation,
Application
Understanding,
New models of action
Learning Results: Changes
Individual
- Knowledge, skills
- Attitude,
- Experience
Team
Organisation
- Knowledge, skills,values
- Attitude, experience,
- Working practice,
culture
- Knowledge,
- Way of action
- Process, culture, value
- Experience
The implementation of the project
Leena Liimatainen 19.5.2005
PEDE - Project
Patient education development in the
working units (n=23)
New empowering patient education
skills for the nursing staff
Exploring the development needs of patient
education practice using self-evaluation
questionnaires and consultations
Education programmes
Planning, implementation and evaluation of the
patient education development projects
(n=19) in the wards
Co-operation with change agents, staff,
managers from hospital, patient
organisations, students, tutors from JYPOLY
Changes in patient education practices within
internal medicine units of the Central
Finland Health Care District
Information technology and evidence
based counselling skills programme
(n=56)
Education programme for change agents
(n=56)
Empowering patient education
programmes (n=198)
New empowering patient
education competence
Empowering patient education programme
Leena Liimatainen 19.5.2005
•
was based on a context-bound training method and experiential
learning process using videotaped counselling situations from
everyday patient education practice.
• Interactive and reflective workshops, distance and self-guided
learning.
The contents of workshops:
1. The principles of empowering counselling (Poskiparta,
Liimatainen et al. 2001, Kettunen 2001)
2. Interventive interviewing (Tomm 1988) and the Stages of
change –model (Prochaska & DiClemente 1983) facilitating
health behaviour changes
3. Teaching ageing patients; constrains and challenges.
From Self-evaluation of patient education
practices to development plans and changes
Leena Liimatainen 19.5.2005
Evaluation Targets
1. Value basis
2. Structural factors
PEDE-project. Self-evaluation of patient
education practices, ward 31
3. Education process
(1= non-existent, 2= being planned, 3= partly realisable, 4= fully
realisable)
4. Life-style counselling factors
4
Self-evaluation Form
Each main group is presented by 4-14 evaluation
targets
3
2
1
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28.
Huhtik.
02
Summary Form
ward specific profiles
Conclusions and Development Plan
Maalisk.
04
Results: New empowering patient education practices
Leena Liimatainen 19.5.2005
• Shelving with empowering material and model to support quitting
smoking and treatment for nicotine addiction
• information desk (Health corner) at the internal medicine policlinic
to support self care and self assessment (Diabetes prevention, Type
2 Diabetes Risk Test)
• group counseling models for patients suffering from ischemic
attack in the brain, rheumatoid arthritis, and for those needing
dialysis treatment
• new counseling material, 40 electronic instruction for patients, and
an instructional video film for children suffering from asthma
• quality criteria for patient education to be included in the care plan
• PBL-based diabetes education programme for nursing staff
Results: changes in working units
Leena Liimatainen 19.5.2005
• sharing tacit knowledge in the reflective learning of the
working communities
• implementing change in working units by means of
change agents and a co-operational model
• experience of professional growth and empowerment
• linking patient education development work with the
operational plans of the working units, and with
strategic planning in the internal nursing area of
operation
Measuring outcomes of the counseling from
the empowerment approach
Leena Liimatainen 19.5.2005
• Empowering speech practices scale questionnaire was piloted in
the PEDE-project
• ESPS describes the realization of empowerment directing
attention to patient participation and was constructed on the basis
of empowerment theory and foregoing conversation analytic
research
• 127 counseling sessions were assessed, and we got some evidence
about the realization of empowerment.
• According to the results, the nurses succeeded mostly in building
a positive emotional climate and in giving information.
• Nurses need to improve the active mutuality of the counseling
relationship by asking patients’ opinions and views, by facilitating
their own assessment of personal health, and participation in
decision making and innovation of their individual care decisions
Recommendations
Leena Liimatainen 19.5.2005
• The experiential learning model is a convenient adult education
model, which will work on the levels of individual and
organisational learning taking the experiences, feelings, thinking
and behaviour of the participants into account
• An experiential learning and reflective videotape based training
programme is a useful tool teaching lifestyle counselling skills
and integrating theoretical models of behaviour (Stages of
change) into models of education
• Virtual learning possibilities!
• Empowering speech practices scale questionnaire needs further
study
* It can be used as a tool in quality assessment, and in
empowering patient education programs
Leena Liimatainen 19.5.2005
“You cannot teach a man
anything. You can only help him
discover it within himself”.
(Galileo Galilei)