patient education in nursing—polish literature condition

Patient Education and Counseling 53 (2004) 31–40

Patient education in nursing—Polish literature condition

BarbaraSlusarska∗, Danuta Zarzycka, Mariusz Wysokinski, Agnieszka SadurskaIndependent Laboratory of Nursing Skills, Faculty of Nursing and Health Sciences, Medical University, Aleje Racławickie 1, 20-095 Lublin, Poland

Received 5 August 2002; received in revised form 22 February 2003; accepted 4 March 2003

Abstract

The aim of the review is to present the results of an analysis and evaluation of the state of research on patient education based on thePolish nursing literature. A review and analysis of 139 research works was carried out, which during the years of 1990–2001 appearedin Polish nursing journals as well as in post-conference and convention proceedings and reports. The collected material was evaluatedaccording to the following criteria: defining the research problem, defining and operationalising the variables studied, the research toolapplied, the research method used, the size and selection of the research sample, the results achieved. The analysis of research workscarried out in the area of patient education became the basis of the objective knowledge of the current state of research and its relation tothe nursing practice in this area.© 2003 Elsevier Ireland Ltd. All rights reserved.

Keywords:Patient education; Polish nursing; Literature review

1. Introduction

Patient education is an important element of nursing care.The scope of patient education should comprise elementsof health education and elements of preparing the patientfor co-operation in the process of nursing, curing and re-habilitation, as well as self-control, self-care and renderingnon-professional care. In care practice, patient education isoriented towards measures directed at the subject of the care.The aim of such measures is to impart the necessary knowl-edge about health and its maintenance, about disease pre-vention, and in the event of a disease—knowledge about itand about the ways of dealing with its consequences. Thegoals further include assisting patients in taking decisionsabout health maintenance, developing skills and positive at-titudes towards health, as well as initiating, motivating andsupporting desirable health behaviours. Patient education in-volves initiatives resulting from the process of teaching andeducation, whose executors in the area of nursing are nurses.Considering the conditions of the above processes, the fol-lowing points should be borne in mind:

• Patient education transcends simple information transfer,emphasising attitudes and behaviours.

∗ Corresponding author. Tel.:+48-81-532-29-24;fax: +48-81-532-72-21.E-mail address:[email protected] (B.Slusarska).

• The basis of effective education is the voluntary and activeco-operation of the patient.

• In order to continue patient education, it is necessary tounderstand and apply the principles of proper communi-cation and the laws governing the process of learning andteaching, as well as behavioural motivation and change[1].

Patient education in the Polish nursing literature is definedas a process comprising educational influence and teaching,directed at the patient and/or his environment, whose aim itis to influence the shaping (change or consolidation) of mo-tives, attitudes and convictions concerning health[2]. Patienteducation is part of a larger issue of health education, un-derstood as a process in which people learn how to take careof their own health and that of their community[3]. Healtheducation involves influencing people of different age andhealth, i.e. healthy, ill and disabled ones. A common featureof all initiatives in health education is that they are alwaysdirected towards the strengthening, reinforcing or reclaim-ing health resources.

The above-presented understanding of the issue of patienteducation in the Polish literature is consistent with the po-sition non-Polish authors[4–8]. Luker and Caress[9] pointout that “patient education is taken to mean the impartingof information, skills or knowledge by the nurse, with theaim of bringing about demonstrable behavioural or attitudi-nal change in patients.”

0738-3991/$ – see front matter © 2003 Elsevier Ireland Ltd. All rights reserved.doi:10.1016/S0738-3991(03)00112-5

32 B. Slusarska et al. / Patient Education and Counseling 53 (2004) 31–40

2. Aim of the study

In consideration of the difficulty of readers’ access toPolish nursing literature, a critical review of source materialsavailable was conducted.

The objective of the study is to present to the reader theresults of analysis and evaluation of research in the area ofpatient education from the aspect of their scope and charac-ter.

The subject basis for the analysis were the followingsource materials:

• Nursing periodicals appearing during 1990–2001, suchas: Pielegniarstwo Polskie [Polish Nursing], Prob-lemy Pielegniarstwa [Nursing Problems], Piel˛egniarkai Połozna [Nurse and Midwife], Piel˛egniarstwo 2000[Nursing 2000], Magazyn Piel˛egniarki i Połoznej [Nurseand Midwife Magazine] and the interdisciplinary peri-odical Promocja Zdrowia. Nauki Społeczne i Medycyna[Health Promotion. Social Sciences and Medicine].

• Conference proceedings and convention memoirs, pub-lished during 1990–2001.

3. Materials and methods

The study uses the method of a literature review. The re-search material was analysed and evaluated by means of theConcept Analysis Worksheet for Empirical Studies researchtool, worked out on the basis of the assumptions of the lit-erature review suggested by Benton and Cormack[10] andPolit and Hungler[11] and prepared for the purposes of theinternational NDEC project[12]. The material analysis wascarried out according to the evaluation criteria adopted inthe research tool used, i.e. defining the research problem,defining and operationalising the variables studied, the re-search method used, the size and selection of the researchsample, the research tools applied, the results achieved. Thereview of the literature has been conducted with respectto the following evaluation criteria: problem statement,variables (conceptual and operational definitions), method,sample, instruments (include validity and reliability sum-mary), findings. In all, 139 research reports were gatheredand analysed, relating to the issue of patient education innursing and published in Polish nursing periodicals andconference proceedings.

4. Results

4.1. The state of research in view of its types

In 1999, Lenartowicz reported that ‘the greatest researchdynamics in Polish nursing can be found in the realm ofbroadly-conceived patient education, health promotion andmodel construction of pro-health behaviours’[13]. The

analysis of the state of the art in the research area of patienteducation and health promotion shows that during the 1990–2001 period 139 research reports were published in nursingperiodicals, available memoirs and conference proceedings.

The analysis of the research material in patient educa-tion, carried out with regard to the type of research, showsa decisive domination of diagnostic research (120 works,or 86.3%) over verification research (19 works, or 13.7%).Diagnostic studies determine features, properties, and char-acteristics of the nursing reality, and ascertain certain prin-ciples of its functioning. Thanks to these studies, the vastmajority of information concerning the state of affairs asso-ciated with the research area examined have been collectedand arranged. The studies describing fragments of the stateof nursing practice in patient education and the part of nursesin health education, as well as presenting the views, opin-ions and judgements of receivers and professional providersof care with regard to health, coping in disease, and pro-and anti-health behaviours largely fill the research area ofpatient education in nursing.

Only towards the end of 1990s did verification researchof health education start to appear in Polish nursing. Verifi-cation studies are aimed at checking statements concerningcause–effect relationship between certain classes of phe-nomena and at explaining what conditions are necessary fora certain effect to appear. In case of nursing studies suchresearch is biased towards grasping the correlation betweennursing procedures and measurable parameters. In the re-search material analysed, the above-mentioned studies con-stituted only 13.7% of the literature reviewed. Some of themexamine the effectiveness of the educational programmescarried out, considered in respect of selected groups ofpatients. Other studies aim at capturing the relations be-tween the realisation of educational programmes by nursesand the measurable features evaluated in particular areasof life quality depending on health condition. A relation ofthe development of verification research to two additionalphenomena present at that time can be perceived, namely:

1. A deepening of the essence and understanding of healtheducation (including patient/client education) in nursingas successive stages of learning, rather than single, inter-ventional or occasional instructional–informational mea-sures of educational character. Acknowledgement thatthe results of teaching and education for health are ex-pressed in changes of human behaviour, as well as inthe development of the possibilities of active and cre-ative solutions to various health-related problems. Suchan understanding of health education has its particularapplication in nursing practice and is consistent with theviews of Charonska[3] and Grueningen et al.[1].

2. A dynamic development in Poland of research qualityof life in patients with somatic and psychic illnesses.Evaluation of life quality dependent on health conditionjoined the efforts of numerous professionals, includingresearchers from the area of nursing, who were among

B. Slusarska et al. / Patient Education and Counseling 53 (2004) 31–40 33

the first to perceive the recipients of their services holis-tically. The perception of the patient in the context oflife quality dependent on the nurse’s efforts consisted inrecognising the importance of the patient’s readiness forself-control and self-care in disease.

4.2. The subject of the research analysis

Analysing the state of research in patient education withregard to the subject, one should indicate a wide scope ofstudies and a considerable differentiation of the researchers’interests. However, two groups of studies can be distin-guished, considering the criterion of:

• the group examined: the studies directed at service recipi-ents, i.e. patients/clients or at care providers, professionalor potential, i.e. nurses/student-nurses, or at comparingthe problem in both groups;

• the method applied in examining the problem of pa-tient health education: studies conducted by means of adiagnostic poll in the form a questionnaire an inquiryor an interview, and studies conducted by means ofknowledge-testing and evaluating the health-maintainingskills.

In the group of studies directed at service recipients therewas a domination of research based on the diagnostic poll,compared to the testing method, in the ratio of 6:1. In thisgroup the prevalent tendency of interest focused around thefollowing problems:

• demand for counselling and information serving the sup-port of health and health behaviours (Table 1A);

• evaluation and self-evaluation of the patients’ knowledgeand ability to cope with disease problems in everyday life(Table 1B);

• evaluation and self-evaluation of health behaviours andchanges in lifestyle introduced by the patients in view ofan illness (Table 1C);

• objective evaluation of the patient’s knowledge and eval-uation of his ability (Table 1D);

• patients’ opinions and judgements about the nurses’ real-isation of educational measures (Table 1E).

Among the studies oriented at professional or potentialcare providers a decidedly more frequently dominant groupwere inquiry studies of opinions, judgements and convic-tions, as well as the ways of realising education, over studiesof the nurses’ and students’ objective preparation for edu-cation/health promotion realisation. The difference scale inthe application of the above methods was 10:1. The issuesaddressed by the above studies could be classified for thegroup of professional care providers as:

• the nurse’s educational role, the scope of educational tasks(Table 1F);

• the nurses’ opinions and beliefs about the education re-alised, examination of the nurses’ preparation for patienteducation (Table 1G).

On the other hand, among the potential care providers, i.e.students preparing for the profession or M.A. students, theissues taken up revolved around their preparation for therealisation of patient education (Table 1H).

The analysis of 139 research reports on patient educationpermits to observe that researchers usually chose for theirstudies samples of between 50 and 150 people. Single at-tempts addressed a population of over 500 (Table 1I). Themost frequently used type of sampling was non-random.Only in a few studies analysed, in order to achieve their re-search purpose and verify their hypotheses, did the authorschoose the populations by means of stratified random sam-pling, obtaining a representative random group (Table 1J).What is also remarkable is the fact that only in a few stud-ies, in order to find differences within a particular patternof procedure concerning health education, was the popula-tion sampling done with the application of a control group(Table 1K).

The research tools in the empirical studies reviewed wereusually not standardised. Only a few authors used standard-ised tools in their research (Table 1L). In numerous worksresearchers, in order to verify their hypotheses, did not usestatistical methods that might confirm or negate their cor-rectness. Taking into consideration the above circumstances,resulting from the analysis of works from the list, it can besaid that the results achieved by the authors can very of-ten only be said to refer to the group under study, withoutthe possibility of extrapolating the phenomena researchedto the whole population. The frequent lack of verificationof the statistical results of the study in question, as wellas proving their repeatability, does not allow to relate themto the general problem area of patient education. Thus, theresults published in the literature may differ from the real-ity of nursing practice. In the studies analysed no instanceswere found of repeated hypotheses testing by alternative re-searchers, which would have produced greater confidencein the results obtained. Unfortunately, single studies cannotconstitute a plausible basis for introducing changes in nurs-ing practice.

A detailed analysis of the scope of problems undertakenby researchers in Polish literature concerning patient edu-cation allowed us to distinguish the following groups of re-search problems:

• Studies of the level of knowledge and attitudes of patientswith chronic diseases and/or their families: e.g. patientswith diabetes, ischemic heart disease, bronchial asthma,discopathy in the lumbar region, gastric and duodenal ul-cer, renal failure, cancer or other chronic diseases—thesestudies constituted 52.05% of all the studies analysed.

• Studies of the preparation of nurses for the realisation ofeducation of patients with chronic diseases—20.05%.


Table 1A list of the review of literature (the arrangement according to the criteria)

References

A. Demand for counselling and information serving the support of health and health behaviours1 Janus B, Charonska E, Gorska U, Garwacka E, Szczepska M. The needs in the scope of the anti-smoking project among teenagers and some

of its results. Polish Nurs 1992;3:57–64.2 Zielinska JB, Kubiak D. The preparation of secondary school pupils towards family life. Polish Nurs 1992;3:87–92.3 Bednarek A, Bernat K. The knowledge about the promotion of health and the indications of healthy life style among the pupils of secondary

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4 Cisek M. The conditioning of the secondary school pupils’ life style. Nursing and the health of the society—new perspectives. In: Proceedingsof the 20th Anniversary of the Nursing Department at Collegium Medicum of the Jagiellonian University. Cracow; 1995. p. 329–34.

5 Sen M, Taranowicz I. The influence of the educational forms upon the health—oriented behaviour of primary school pupils. Nursing and thehealth of the society—new perspectives. In: Proceedings of the 20th Anniversary of the Nursing Department at Collegium Medicum of theJagiellonian University. Cracow; 1995. p. 315–20.

6 Zak M, Charonska E, Janus B. The pro-health message in mass media. The advancement of nursing and health promotion, vol. IX a. 1996.p. 231–7.

7 Gałeziowska E, Jabłonska-Chmielewska A. The need for the knowledge of health among soldiers on the basis of the survey research. Theadvancement of nursing and health promotion, vol. XI. 1997. p. 198–205.

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professional improvement of nurses and midwives. The standards of care in nursing, the implementation of health promoting schemes. Theconference materials. Poznan; 1999. p. 58–62.

14 Skotnicka U, Ciesielski M. The issues of pro-family sexual education in the evaluation of adolescent youths. Annales Academiae MedicaeSilesiensis. 2000 (Suppl 30). p. 113–22.

15 Trzcinska H. The pro-health attitudes of pupils, teachers and parents. Nurs Issues 2000;2:135–49.16 Huk-Wieliczuk E, Wieliczuk M. The opinion of village youth, aged 15–17, about HIV/AIDS. The summary. XXI century—new challenges

for nursing. The 2nd Podlaska International Scientific-Training Conference. Bialystok; 2001. p. 113.17 Klapa W, Osk˛edra I, Zych B. The Health education in the opinion of first form secondary school pupils. The summary. XXI century—new

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century—new challenges for nursing. The 2nd Podlaska International Scientific-Training Conference, Bialystok. 2001. p. 135.20 Qarmuz A, Anuszewska-Mastalerz K. The eating habits of the in-school youths. The summary. XXI century—new challenges for nursing.

The 2nd Podlaska International Scientific-Training Conference. Bialystok; 2001. p. 134.21 Warmuz A, Goj K. The cigarette smoking addiction among the Poles of the Silesian and coal-basin region. The summary. XXI

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B. Evaluation and self-evaluation of the patients’ knowledge and ability to cope with disease problems in everyday life1 Mroz A, Wierzbicka A. The preparation of heart attack patients to self-care. Polish Nurs 1994;5–6:35–41.2 Kowalewska M. The preparation of vasectomy patients to self-care. Nursing and the health of the society—new perspectives. In: Proceedings

of the 20th Anniversary of the Nursing Department at Collegium Medicum of the Jagiellonian University. Cracow; 1995. p. 223–6.3 Kozka M, Jozwiak E. Hospitalisation as a stage of preparing the stoma patients to self-care. Nursing and the health of the society—new

perspectives. In: Proceedings of the 20th Anniversary of the Nursing Department at Collegium Medicum of the Jagiellonian University.Cracow; 1995. p. 217–22.

4 Kropornicka B, Dziedzicka A, Wierzbicka A, K˛epa M, Wasowska J. The influence of physical activity upon the occurrence of the heartattack. Nursing—new areas and new issues. The scientific conference materials, Lublin. p. 40–7.

5 Paluch H. The factors that influence the preparation of the stroke patients to self-care after hospitalization. Nursing and the health of thesociety—new perspectives. In: Proceedings of the 20th Anniversary of the Nursing Department at Collegium Medicum of the JagiellonianUniversity. Cracow; 1995. P. 227–34.

6 Soniak B, Wierzbicka A, Falkowska E, Brukwicka I. The stress factor in patients hospitalized because of the coronary artery disease.Nursing—new areas and new issues. The scientific conference materials. Lublin. p. 48–53.

7 Wyrzykiewicz T. The promotion of health in menopausal women. The advancement of nursing and health promotion, vol. IX a. 1996. p. 218–22.8 Płotka A, Kownacka S. Mental disorders in students and the psycho-prophylactics and promotion of mental health. Nurs Issues

1997;1–2:107–21.9 Prazmowska B, Paluch H, Kozka M. The preparation of patients towards self-care by the community nurses. The advancement of nursing

and health promotion, vol. XI. 1997. p. 206–12.


Table 1 (Continued)

References

10 Trubaluk-Liskiewicz G. Education as an element in the therapy of patients with the diabetic foot condition. Nursing at the turn of the 21stcentury. The programme and materials of the scientific conference. Wroclaw; 1998. p. 339–46.

11 Wierzbicka A, Kostrzewa E. The educational issues in diabetic patients. Nursing at the turn of the 21st century. The programme andmaterials of the scientific conference. Wroclaw; 1998. p. 347–53.

12 Kocka K. The need of women for community obstetric care. The obstetrics at the turn of the 21st century. The scientific conferencematerials. Lublin; 1999. p. 239–43.

13 Lorencowicz R, Chomicka R. The preparation of discopathy surgery patients to dealing with the illness. The promotion of mental health.The materials form the nation-wide scientific conference. Zamosc; 1999. p. 69–72.

14 Salamon J. The promotion of health and prophylactics in the early diagnosis of breast cancer in women. The education and professionalimprovement of nurses and midwives. The standards of care in nursing, the implementation of health promoting schemes. The conferencematerials. Poznan; 1999. p. 220–3.

15 Slusarska B. The preparation to self-care or the pro-health education during chronic diseases. The education and professional improvement ofnurses and midwives. The standards of care in nursing, the implementation of health promoting schemes. The conference materials. Poznan;1999. p. 111–4.

16 Wasilewski TP. The nursing-educational activities in relation to the urinal lithiasis patients. The advancement of nursing and healthpromotion, vol. XV. 1996. p. 83–6.

17 Ksiazek J. The knowledge of youth about the negative effects of cigarette smoking and the influence of the addiction upon the developmentof lung cancer diseases. The summary. XXI century—new challenges for nursing. The 2nd Podlaska International Scientific-TrainingConference. Bialystok; 2001. p. 104.

C. Evaluation and self-evaluation of health behaviours and changes in lifestyle introduced by the patients in view of an illness1 Brodalko B, Wdowiak L, Rzepecka B. The promotion of health and the health-oriented behaviour of Polish Rail Company workers with

ulcer. Soc Med Iss 1993;25:159–62.2 Pieniazek M, Dzik M. The pro-health behaviour of higher education students. The conference materials. Warsaw: CEM; 1994. p. 94–8.3 Bak E. The health-oriented behaviour among doctors and nurses in relation to the health promotion issues. Nursing and the health of the

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4 Slusarska B, Kropornicka B. The knowledge and health-oriented behaviour of patients with stomach and duodenum ulcer. Nursing and thehealth of the society—new perspectives. In: Proceedings of the 20th Anniversary of the Nursing Department at Collegium Medicum of theJagiellonian University. Cracow; 1995. p. 343–50.

5 Swiecka M, Niedbalska G. The educational and caring role of the nurse and the expectations of surgical ward patients. Nursing—new areasand new issues. The scientific conference materials. Lublin. p. 166–71.

6 Dzieza J. The pro-health behaviour of teachers in the health promoting school. The advancement of nursing and health promotion, vol. XI.1997. p. 222–6.

7 Gozdek N. From the research on the attitudes of a selected group of women towards the self-examination of breasts. Nurs Issues1997;1–2:79–84.

8 Dubowska A, Franek G, Gorak B. The health-oriented behaviour of children and adolescents connected with nourishment. The advancementof nursing and health promotion, vol. XIV. 1998. p. 140–4.

9 Łepecka-Klusek C, Prusak E, Fiuk B. The life style of women in the menopause period. The advancement of nursing and health promotion,vol. XIV. 1998. p. 211–216.

10 Kowal A, Gaweł G. The life style and behaviours risky for the nurse’s health. The advancement of nursing and health promotion, vol. XV.1999. p. 192–200.

11 Olszewska R. The cytological examination in the population of women from the local health clinic of the Kosakow Lacki region. Theobstetrics at the turn of the 21st century. The scientific conference materials. Lublin; 1999. p. 151–2.

12 Gozdek N. The health-oriented behaviour of women after mastectomy and its dynamism. The nursing care in contemporary medicine. The1st Podlaska Scientific-Training Conference. Bialystok; 2000. p. 203–18.

13 Łepecka-Klusek C, Trz˛esowska A. The self-control of breasts in a group of women under treatment for marital childlessness, vol. LV (SupplVII). Annales Universitatis Mariae Curie-Sklodowska, Sectio D, Medicina, Lublin; 2000. p. 140–5.

14 Wierzbicka A. The eating habits among the stomach and duodenum ulcer patients in the pre-disease period. Annales Academiae MedicaeSilesiensis. 2000 (Suppl 30). p. 317–23.

15 Zych B, Orzeł A, Osk˛edra I. The level of the need for health education and the pro and anti-health behaviour of the pulmonological wardpatients. The nursing care in contemporary medicine. The 1st Podlaska Scientific-Training Conference. Bialystok; 2000. p. 179–97.

16 Kowalska A, Drygas W. The behaviour patterns of smokers in relation to inhaling the tobacco smoke after 2 years since joining theinternational scheme “Give up Smoking And Win”. The summary. XXI century—new challenges for nursing. The 2nd Podlaska InternationalScientific-Training Conference. Bialystok; 2001. p. 100.

17 Puchalski K. The anti-smoking activities in Polish work places—the conditioning and development prospects. The summary. XXIcentury—new challenges for nursing. The 2nd Podlaska International Scientific-Training Conference. Bialystok; 2001. p. 93.

D. Objective evaluation of the patients’ knowledge and evaluation of his/her ability1 Bernat K, Bednarek A, Frelek-Karska M, Bachanek L. The scope of mothers’ knowledge concerning the prophylactics of diarrhoea in

infants. Soc Med Iss 1993;25:176–9.2 Wilczewska L. The knowledge about epilepsy in the community of the city of Poznan and in the professional group of teachers in Poznan

schools. Polish Nurs 1994;5–6:43–9.


Table 1 (Continued)

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9 Radecka K. The role of the nurse in the process of health promotion. Nursing and the health of the society—new perspectives. In: Proceedingsof the 20th Anniversary of the Nursing Department at Collegium Medicum of the Jagiellonian University. Cracow; 1995. p. 279–82.

10 Sendecka A, Bassara-Nowak D, Domka K, Kuzdro T, Milewska G, Sadłocha M, Saracen A.Ł, Turos U, Wojciechowska G. Theimplementation of the breast feeding programme in selected Polish hospitals. Nursing—new areas and new issues. The scientific conferencematerials. Lublin; 1995. p. 141–8.

11 Szymanska G, Kondratowicz W. The pedagogical aspects of health promotion. The 15th Anniversary of the Nursing Faculty—ScientificConference Materials. Wroclaw; 1995. p. 109–13.

12 Swiecka M, Niedbalska G. The educational and caring role of the nurse and the expectations of the surgical ward patients. Nursing—newareas and new issues. The scientific conference materials. Lublin; 1995. p. 166–71.


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14 Swiecka M. The health education realized by nurses in a hospital ward. Nursing and the health of the society—new perspectives. In:Proceedings of the 20th Anniversary of the Nursing Department at Collegium Medicum of the Jagiellonian University. Cracow; 1995, p. 283–6.

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16 Zawadzka B, Tomczyk B. The promotion of health in the school—the role of the nurse. Nursing and the health of the society—newperspectives. In: Proceedings of the 20th Anniversary of the Nursing Department at Collegium Medicum of the Jagiellonian University.Cracow; 1995. p. 293–8.

17 Zak M, Charonska E, Janus B. The pro-health message in mass media. The advancement of nursing and health promotion, vol. IX a. 1996.p. 231–7.

18 Abramczyk A. The role of community/family nurses in diabetic care. Nursing at the turn of the 21st century. The programme and materialsof the scientific conference. Wroclaw; 1998. p. 278–83.

19 Bartczuk A, Czesak W, Łoboz-Grudzien K. The role of the nurse in health promotion in the hospital. Nursing at the turn of the 21st century.The programme and materials of the scientific conference. Wroclaw; 1998. p. 7–15.

20 Kozka M, Płaszewska-Zywko L. The communication between the nurse and the patient in the intensive therapy ward. Nursing at the turn ofthe 21st century. The programme and materials of the scientific conference. Wroclaw; 1998. p. 17–21.

21 Rucinska J. The promotion of health and contemporary nursing. Nursing at the turn of the 21st century. The programme and materials of thescientific conference. Wroclaw; 1998. p. 273–8.

22 Gałeziowska E. The role of the community midwife in the preparation for birth and infant care—the opinions of pregnant women from ruralcommunities. The obstetrics at the turn of the 21st century. The scientific conference materials. Lublin; 1999. p. 233–8.

23 Garwacka-Czachor E, Borkowska J. The self-examination of breast—the educational programme for women in the city of Wroclaw. Theeducation and professional improvement of nurses and midwives. The standards of care in nursing, the implementation of health promotingschemes. The conference materials. Poznan; 1999. p. 12–21.

24 Lisowska R. The role of the midwife in preparing the pregnant woman for self-observation towards the monitoring the well-being of thefetus. The obstetrics at the turn of the 21st century. The scientific conference materials. Lublin; 1999. p. 244–7.

25 Solarz A, Talarska D. The influence of D. Orem model on the planning of the care of the diabetic patient. The education and professionalimprovement of nurses and midwives. The standards of care in nursing, the implementation of health promoting schemes. The conferencematerials. Poznan; 1999. p. 190–2.

26 Swiecka M. The health education realized by the medical personnel in the obstetrics—gynecological wards. The obstetrics at the turn of the21st century. The scientific conference materials. Lublin; 1999. p. 227–9.

27 Swiecka M. The educational role of the nurse in changing the attitudes of family members towards the dying. The education andprofessional improvement of nurses and midwives. The standards of care in nursing, the implementation of health promoting schemes. Theconference materials. Poznan; 1999. p. 186–9.

28 Abramczyk A. The quality of nursing care of the diabetic patient at the level of Basic Medical Care. Annales Academiae MedicaeSilesiensis. 2000 (Suppl 30). p. 193–201.

29 Swiecka M. The health education realized by the nurse in the pediatrics ward. Nurs Issues 2000;2:220–8.30 Ciechaniewicz W, Kozakiewicz H. The education of the patient hospitalized by the multi-professional care team. The summary. XXI

century—new challenges for nursing. The 2nd Podlaska International Scientific-Training Conference. Bialystok; 2001. p. 95.31 Ciechaniewicz W, Michalak I. The activities of the community—family nurse for the promotion of health. The summary. XXI century—new

challenges for nursing. The 2nd Podlaska International Scientific-Training Conference. Bialystok; 2001. p. 96.32 Fidali W. The health education in the treatment of family obesity. The summary. XXI century—new challenges for nursing. The 2nd

Podlaska International Scientific-Training Conference. Bialystok; 2001. p. 137.33 Korzeniowska E. The promotion of health in the work place—new scopes of activities for occupational medicine nurses. The summary. XXI

century—new challenges for nursing. The 2nd Podlaska International Scientific-Training Conference. Bialystok; 2001. p. 110.34 Korzeniowska E. The promotion of health as an element of the nurse’s professional role. The summary. XXI century—new challenges for

nursing. The 2nd Podlaska International Scientific-Training Conference. Bialystok; 2001. p. 111.35 Ostrega W. The school nursing as an issue of prophylactic health care of pupils in the 21st century. The summary. XXI century—new

challenges for nursing. The 2nd Podlaska International Scientific-Training Conference. Bialystok; 2001. p. 92.36 Smietało K. The effectiveness of prophylactic programmes among children and youth conducted by the school nurses. The summary. XXI

century—new challenges for nursing. The 2nd Podlaska International Scientific-Training Conference. Bialystok; 2001. p. 117.37 Zych B, Osk˛edra I, Klapa W. The programmes of health-oriented education in the nurse’s work. The summary. XXI century—new

challenges for nursing. The 2nd Podlaska International Scientific-Training Conference. Bialystok; 2001. p. 97.

G. The nurses’ opinions and beliefs about the education realised, examination of the nurses’ preparation for patient education1 Kepska T,Swiecka M, Zołnierowicz M. The influence of the knowledge of nurses on the reduction of hepatitis cases. The Soc Med Iss

1993;25:146–58.2 Sztembis B. The community nursing against the strategy of fighting the blood circulation illnesses. The Soc Med Iss 1993;25:79–89.3 Gozdek N, Kruk G. The programme of the prophylactics of bedsore as an issue of occupational nurses improvement. Nursing—new areas

and new issues. The scientific conference materials. Lublin; 1995. p. 227–31.4 Kozka M, Maczko M, Gołebiowska A. The role of the nurse in the education of hemophiliac children. Nursing and the health of the



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5 Kozka M, Maczko M, Gołebiowska A. The role of the nurse in preparing the cancer children to self-care. Nursing and the health of thesociety—new perspectives. In: Proceedings of the 20th Anniversary of the Nursing Department at Collegium Medicum of the JagiellonianUniversity. Cracow; 1995. p. 165–72.

6 Motyka M, Motyka H, Wsołek R. The self-evaluation of the preparation of the nurse for providing the mental support in illness. Nursing(2000) 1996;1:18–9.

7 Walkowiak A, Charonska E, Janus B. The opinions of nurses about the tasks of the health promoting school. The advancement of nursingand health promotion, vol. IX. 1996. p. 203–10.

8 Chojnowska E. The factors determining the promotion of health in the opinion of community nurses. The advancement of nursing and healthpromotion, vol. XI. 1996. p. 188–191.

9 Kozka M, Maczko A, Odrzywolska R. The knowledge of intensive therapy ward nurses about the extra-intestinal feeding. Nursing at the turnof the 21st century. The programme and materials of the scientific conference. Wroclaw; 1998. p. 23–9.

10 Kozka M, Maczko A. The evaluation of the preparation of nurses to educating the hemophiliac children. The advancement of nursing andhealth promotion, vol. XIII. 1998. p. 148–52.

11 Lipowczyk J, Szymanska-Pomorska G, Rynkowska M. The knowledge about education in the process of preparing nurses and midwives tothe educational activities in health promotion. Nursing at the turn of the 21st century. The programme and materials of the scientificconference. Wroclaw; 1998. p. 355–65.

12 Płaszewska-Zywko L, Gabrys T. The knowledge of the principles of the measurement of blood pressure among nurses. Nursing at the turn ofthe 21st century. The programme and materials of the scientific conference. Wroclaw; 1998. p. 137–44.

13 Salomon M, Sendecka A. The level of knowledge of the medical personnel in the scope of natural feeding. The obstetrics at the turn of the21st century. The scientific conference materials. Lublin; 1999. p. 248–51.

14 Lorencowicz R. The activities of the nurses towards solving the constipation problems in hospitalized patients. Annales Academiae MedicaeSilesiensis. 2000 (Suppl 30). p. 239–46.

15 Paluch H, Kozka M, Wozniak A. The deficits of self-care in patients after the implantation of vascular prothesis and the preparation of nurses toeducational activities. The nursing care in contemporary medicine. The 1st Podlaska Scientific-Training Conference. Bialystok; 2000. p. 225–36.

16 Zych B, Osk˛edra I, Ogarek M. The health education of patients and their families in the opinion of nurses. Annales Academiae MedicaeSilesiensis. 2000 (Suppl 30). P. 99–111.

H. Students preparation for the realisation of patient education1 Skommer J, Solarska B. The conditions for the health promotion in the opinion of Medical University students. Soc Med Iss 1993;25:35–45.2 Zielinska J.B, Gudełajtis M. The promotion of health among the nursing schools students. Nurse and Midwife 1993;8–10.3 Irzmanska A, Deluga A. The issues of the natural planning of family in the preparation of nursing faculty students for health promotion.

Nursing—new areas and new issues. The scientific conference materials. Lublin; 1995. p. 149–52.4 Irzmanska A. The participation of the nursing faculty students in health promotion. The role of the nurse and the doctor in medical care. The

15th Anniversary of the Nursing Faculty—Scientific Conference Materials. Wroclaw; 1995. p. 105–7.5 Miedzobrodzka A, Piorecka B. The level of knowledge of the nursing faculty students about the issues of human nutrition. Nursing (2000)

1999;3:54–60.6 Buławska K, Palarczyk-Dec U. The shaping of the educational and health-oriented skills of the nursing school students in the view of the

changes in education. Nurs Issues 2000;2:121–34.7 Gozdek N. Breast cancer in the educational and health-oriented programmes of the nursing faculty students. The nursing care in

contemporary medicine. The 1st Podlaska Scientific-Training Conference. Bialystok; 2000. p. 219–26.8 Kanadys K, Pilewska A, Łepecka-Klusek C, Bucholc M. Eating habits among students—health warrant or danger, vol. LV (Suppl VII).

Annales Universitatis Mariae Curie-Sklodowska, Sectio D, Medicina, Lublin; 2000. p. 69–73.9 Wrezlewicz E, Klapa W. The role of M nurses in the education of patients—the preparation during the M nursing courses for patient

education. The nursing care in contemporary medicine. The 1st Podlaska Scientific-Training Conference. Bialystok; 2000. p. 156–61.

I. Analysis of research studies addressing a population of over 500 people1 Wilczewska L. The knowledge about epilepsy in the community of the city of Poznan and in the professional group of teachers in Poznan

schools. Polish Nurs 1994;5–6:43–9.2 Miros E, Maj E, Rasmus A, Markiewicz A. The evaluation of the Polish society’s knowledge concerning the first aid life saving actions.

Nursing (2000) 1998;5:39–41.3 Gromadecka-Sutkiewicz M, Skommer J. Health-oriented behaviour of junior and senior secondary school pupils in the city of Poznan. The

advancement of nursing and health promotion, vol. XV. 1999. p. 212–9.4 Gromadecka-Sutkiewicz M, Skommer J. The health-oriented behaviour of local communities on the basis of the survey results. The

advancement of nursing and health promotion, vol. XV. 1999. p. 202–10.5 Olszewska R. The cytological examination in the population of women from the local health clinic of the Kosakow Lacki region. The

obstetrics at the turn of the 21st century. The scientific conference materials. Lublin; 1999. p. 151–2.

J. Analysis of populations by means of stratified random sampling1 Wilczewska L. The knowledge about epilepsy in the community of the city of Poznan and in the professional group of teachers in Poznan

schools. Polish Nurs 1994;5–6:43–9.2 Miros E, Maj E, Rasmus A, Markiewicz A. The evaluation of the Polish society’s knowledge concerning the first aid life saving actions.

Nursing (2000) 1998;5:39–41.3 Gromadecka-Sutkiewicz M, Skommer J. Health-oriented behaviour of junior and senior secondary school pupils in the city of Poznan. The

advancement of nursing and health promotion, vol. XV. 1999. p. 212–19.


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References

4 Olszewska R. The cytological examination in the population of women from the local health clinic of the Kosakow Lacki region. Theobstetrics at the turn of the 21st century. The scientific conference materials. Lublin; 1999. p. 151–2.

K. Population sampling done with the application of a control group1 Płaszewska-Zywko L, Gabrys T. The knowledge of the principles of the measurement of blood pressure among nurses. Nursing at the turn of

the 21st century. The programme and materials of the scientific conference. Wroclaw; 1998. p. 137–44.2 Gromadecka-Sutkiewicz M, Sommer J. Health-oriented behaviour of junior and senior secondary school pupils in the city of Poznan. The

advancement of nursing and health promotion, vol. XV. 1999. p. 212–9.

L. Research using standardised tools1 Janus B, Charonska E, Gorska U, Garwacka E, Szczepska M. The needs in the scope of the anti-smoking project among teenagers and some

of its results. Polish Nurs 1992;3:57–64.2 Sek H, Woronkiewicz K, Pasikowski T. The significance of the nurse’s educational role in the patients’ assessment. Polish Nurs

1994;5–6:95–103.

• Demand for educational activities among patients threat-ened by disease and those with chronic disease—7.6%.

• Realisation of patient educational programmes (standards,procedures)—6.6%.

• Shaping health attitudes—8.5%.• Effect of education on the level of knowledge and

behaviour—5.2%.

5. Discussion and conclusion

The quantitative analysis conducted in the field of pa-tient education in Polish nursing shows a high dynamics ofdevelopment with respect to other research areas, such as:psycho-social care, management, economics, education ofnurses, ethical issues and historical development. Accord-ing to Lenartowicz[13] the research trend discussed cur-rently remains on the highest level and further dynamics ofits development is anticipated. Numerous studies pertainingto patient education conducted in Poland indicate an impor-tant aspect of the nursing practice, namely, the monitoringof the realisation of educational programmes with respect tovarious groups of patients/clients.

In the nursing practice in Poland, patient education hasa rather short history—slightly over 10 years, compared toother countries, e.g. USA, UK, Sweden, France, Italy orBelgium, where the traditions have existed for 20–30 years[14–19]. Theoretical analysis of patient education issueswhich covered the defining, conditioning and role of nursesin education, was originated on a large scale in the 1980sby, among others, Redman[20], Bille [21], and Close[4],and exerted a decisive effect on the development of nursingpractice in this respect. Ten-year review of Polish literatureconcerning patient education clearly shows a gradual devel-opment of the nursing practice in association with theoreti-cal essentials of the education process. There exists a clearcomparability with respect to groups of patients covered byeducational programmes in Poland and in other countries. Ingeneral, it may be stated that these are patients with chronicdiseases who must be covered by educational activities inorder to maintain a high quality of life with illness. The high-

est percentage of reports concern educational programmesand their realisation among patients with diabetes. This phe-nomenon occurs both in Poland and in other countries, suchas, e.g. Sweden[17], Germany[22], Italy [16], and manyother European countries[23,24]. Other groups of patientscovered by educational programmes undertaken by nursesare those with cardiovascular and respiratory diseases, aswell as people especially exposed to the development ofcancer. The reports concerning the realisation of educationalprogrammes in the Polish practice among various groups ofpatients increasingly more often oscillate around the prob-lem of strengthening behaviours supporting and maintaininghealth. The problem, however, is very complex, as goes be-yond the area of nurses’ and doctors’ activities. There mustadditionally arise the mechanisms of the health policy of theState, which should be concerned with the health of its citi-zens. Reports from the UK[19], France[15], Belgium[14],and Finland[25] also focus on the health policy of the Stateas an important element of patient education which condi-tions its efficiency.

The analysis of the state of research conducted in the areaof patient education in Poland revealed numerous deficien-cies and shortages. These deficiencies mainly concernedthe numbers of the group examined, statistical verifications,or the research methods applied. Meta-analysis conductedby Cooper et al.[26] pertaining to the education of pa-tients with chronic diseases presents similar problems withrespect to the designing of the research, random selectionof patients for the studies, and evaluation of distant effectsof the educational programmes realised. The stipulationsfrom the analysis performed should become a guidelinefor the future practice of investigating patient educationproblems.

5.1. Conclusions

Intensive development of research in the area of broadlyunderstood patient education is the basis for collecting andordering data about the current state of nursing practice inthis respect. It also provides information which constitutes afoundation for further development of verification research.


The review and analysis of research results within healtheducation in nursing permits to postulate greater care inselecting research groups, with particular attention due tostratified random sampling, and in studies with non-randomsampling—consideration of control groups.

In the nearest future it seems advisable to carry out a re-view and analysis of the scope and character of unpublishedstudies, including Ph.D. and M.A. ones, in the academiccentres conducting research into nursing.

The review of nursing periodicals carried out entitles oneto observe that they are a rich source of educational contentof various subjects, which can be used by nurses active inpatient education in order to verify their professional practiceon the basis of research experience.

5.2. Practice implication

The review and analysis of research achievements in thefield of patient education allows us to presume that in Pol-ish nursing practice there is a need for further developmentof the scope of problems undertaken in the present article.This brings along benefit not only for all recipients of ed-ucational activities, but also for the occupational group ofnurses on the way to making their occupation more profes-sional. In addition, the analysis showed the weak points ofthe studies being carried out, which should be an inspirationfor subsequent researchers for their verification.

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