Short Communication
Effectiveness of a patient education intervention in enhancing the self-efficacy of hospitalized patients to recognize and report acute deteriorating conditions

https://doi.org/10.1016/j.pec.2014.07.003Get rights and content

Highlights

  • We developed a single session one-on-one patient education intervention.

  • Safety strategies promoted patient engagement in symptom recognition and reporting.

  • Patients’ self-efficacy to recognize and report acute deterioration improved.

  • We consider including the intervention into the current rapid response system.

  • We aim to reduce hospital mortality and cardiac arrest rates in the general wards.

Abstract

Objective

To develop and pilot test the effectiveness of a patient education intervention in enhancing the self-efficacy of hospitalized patients to recognize and report symptoms of acute deteriorating conditions.

Method

Using cluster randomization, acute care general wards were randomized to the experimental and control groups. 34 patients in the experimental group received a 30-minute patient education intervention on Alert Worsening conditions And Report Early (AWARE) while 33 patients in the control group received the routine care only. Levels of self-efficacy to recognize and report symptoms were measured before and after the intervention.

Results

The level of self-efficacy reported by the experimental group was significantly higher than the control group (p < 0.0001).

Conclusion

The AWARE intervention was effective in enhancing the self-efficacy of hospitalized patients to recognize and report acute deteriorating conditions.

Practical implications

Patient engagement through patient education could be included in the rapid response system which aims to reduce hospital mortality and cardiac arrest rates in the general wards.

Introduction

Early detection of physiological deterioration has been recognized as essential to prevent adverse events including unexpected admissions to the intensive care units, cardiac arrests and deaths [1]. As part of an integrated system of care known as the rapid response system (RRS), strategies such as the early warning scores, critical care outreach teams and educational programs for medical doctors and ward nurses have been implemented in many acute hospitals with the aim to improve the care of patients with deteriorating conditions [2], [3]. To enhance the effectiveness of the RRS, interventions that promote the engagement of patients in the early recognition and reporting of symptoms of acute deteriorating conditions have been proposed [4], [5].

There has been substantial evidence to support our study that patients may experience early symptoms of deterioration even before the medical team is able to detect the evolving signs of their deterioration [6], [7]. By speaking up about their changes in physiological states, these patients can quickly alert the medical team to their deterioration and lead to earlier initiation of treatments. However, a qualitative study has revealed that many patients were unlikely to verbalize their changes in conditions [4]. The inability to recognize physiological changes in clinical conditions, uncertainty of the significance of symptoms presented and assumption of a passive role in self-monitoring were identified as barriers that prevented the patients from speaking up about their deteriorating conditions in hospitals [4].

We developed a patient education intervention entitled Alert Worsening conditions And Report Early (AWARE) for the hospitalized adult patients. Self-efficacy, which refers to how much confidence individuals have in their abilities to deal with particular situations [8], has been identified as an important predictor of numerous health behaviors [9]. This study aimed to evaluate the effectiveness of the AWARE intervention in enhancing patients’ self-efficacy to recognize and report symptoms of acute deteriorating conditions.

Section snippets

Sample and setting

A cluster randomized controlled trial with pretest–posttest design was conducted between October to December 2012 after ethical approval was obtained from an institutional review board. The study was conducted in two general medical–surgical wards at an acute tertiary hospital in Singapore. The two wards were randomized, using coin tossing method, to experimental and control groups and the patients recruited in each ward were considered as clusters. The patients admitted to these two wards were

Patient characteristics

A substantial proportion of participants (30%) were within the age group of 51–60 years, males (67.2%) and Chinese (n = 23, 34.3%). Only 42% had their highest educational qualifications at the secondary level. There were more surgical patients (65.7%) than medical ones (34.3%). About 78% reported having a past medical history. There were no significant differences between the two groups for their demographic and clinical characteristics (Table 1).

Comparison of self-efficacy scores

There were no statistical significant differences

Discussion

In view of the global phenomenon of aging populations and the advancement in medicine, hospitals worldwide are challenged to meet the needs of an increasing number of patients who are afflicted with multiple chronic conditions and require high acuity care in the acute care settings. The coexistence of an acute illness with comorbid conditions often expose the patients to complex health problems and consequently, to a higher risk of unexpected clinical deterioration [15]. To date, the literature

Acknowledgements

The research team would like to thank all the patients who contributed to the research.

References (23)

  • M. Odell et al.

    Call 4 concern: patient and relative activated critical care outreach

    Br J Nurs

    (2010)
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