Beliefs and Self Management In Nursing In health care and nursing, patient education plays a critical role in improving health outcomes by empowering patients with knowledge, fostering belief systems that encourage healthy behaviors, and equipping them with the skills necessary for effective self-management. This approach, which aims to enhance patients’ autonomy and ability to manage their conditions, can be measured through a variety of instruments that assess knowledge, beliefs, self-management, and other relevant metrics. These measurements are integral in evaluating the effectiveness of educational interventions and ensuring that patients are adequately supported in managing their health.
Knowledge or Need for Information in Health Care and Nursing
The knowledge or assessment of a patient’s or family’s need for information is central to patient education. Health care professionals must assess what patients know about their conditions, treatments, and self-management, as well as what additional information they require. While knowledge alone may not be sufficient to change behavior, it is a necessary component of empowering patients to take control of their health.
Patients often feel that they do not receive enough information from the health care system, and research has shown that patients value the information they receive, not only because it helps them make informed decisions but also because it provides them with a sense of control over their health. For example, patients with chronic conditions such as diabetes, cancer, rheumatoid arthritis, asthma, and cardiac diseases require specific knowledge to manage their health effectively. Redman (2003) provides a comprehensive review of instruments used to measure knowledge in these and other conditions, such as Crohn’s disease, osteoporosis, HIV/AIDS, and mental health conditions.
For instance, in cancer care, patients’ need for information is particularly high. Research by Misters et al. (2001) shows that cancer patients with higher levels of state anxiety and psychological complaints also have greater information needs. As the course of an illness progresses, a patient’s need for information changes, necessitating ongoing education and support from health care providers.
Knowledge assessment tools are essential in ensuring that the information provided is relevant and up to date. For example, in the field of diabetes care, treatment patterns have changed significantly since the findings of the Diabetes Control and Complications Trial and the United Kingdom Prospective Diabetes Study. Health care providers must regularly update educational materials and knowledge assessment instruments to reflect current medical practices.
Moreover, instruments that assess knowledge are often designed to be specific to particular patient education programs, meaning they are not universal. While these tools can assess essential knowledge for self-management, there is still ambiguity about how much knowledge is enough for effective self-care. Even when patients possess the necessary knowledge, they may not be able to act on it, suggesting that knowledge alone is insufficient to guarantee behavior change.
Beliefs of Patients in Health Care and Nursing
Patient beliefs play a critical role in how individuals perceive their health, manage their conditions, and engage in health-promoting behaviors. These beliefs can either facilitate or hinder effective health management. In nursing, understanding and addressing patient beliefs is essential for developing interventions that support positive health outcomes.
Beliefs are measured for two primary reasons:
- They represent theoretical models that explain health behaviors, such as the Health Belief Model.
- They describe lay models, which are the common beliefs patients hold about their health conditions.
One example is the Pain Stages of Change Questionnaire (PSOCQ), which is based on the Transtheoretical Model. This model posits that individuals move through discrete stages of motivation when considering changes in their health behaviors, such as managing chronic pain. These stages include precontemplation, contemplation, preparation for change, taking action, and maintenance of change. The PSOCQ identifies where a patient is in this process, allowing health care providers to tailor interventions accordingly (Kerns et al., 1997).
Another instrument, the Pain Beliefs and Perceptions Inventory, measures common beliefs about pain, such as whether pain is an inevitable part of life or whether patients blame themselves for their pain (Williams et al., 1994). These beliefs can significantly influence how patients cope with chronic pain and whether they seek treatment.
In the context of chronic conditions like osteoporosis, the Osteoporosis Health Belief Scale assesses beliefs related to preventive actions such as exercise and calcium intake. Based on the Health Belief Model, this scale evaluates how susceptible patients feel to osteoporosis, the seriousness they attribute to the condition, the benefits of taking preventive actions, and the barriers to doing so (Kim et al., 1991).
Similarly, the Menopause Representations Questionnaire (MRQ), based on Leventhal’s self-regulation model, measures patients’ beliefs about menopause, including their perceptions of identity, consequences, time frames, control, and treatment (Hunter & O’Dea, 2001). Understanding these beliefs allows health care providers to address misconceptions and foster healthier behaviors.
In the management of specific conditions, instruments like the Back Beliefs Questionnaire identify patients’ inappropriate beliefs about back pain, such as the misconception that they should avoid activity during episodes of back pain. Interventions that address these beliefs have been successful in promoting early return to normal activities (Symonds et al., 1996).
These belief-based instruments are crucial in identifying and addressing misconceptions that could interfere with health outcomes. By measuring and modifying these beliefs, health care providers can tailor their interventions to support patient recovery and self-management.
Self-Management in Health Care and Nursing
Self-management refers to patients’ ability to manage their chronic conditions and health-related behaviors. In recent years, there has been a growing emphasis on promoting self-management, particularly for chronic illnesses like diabetes, heart failure, epilepsy, and chronic pain. Measuring self-management behaviors is critical for evaluating the effectiveness of patient education and determining whether patients are adequately equipped to take care of their health.
Many self-management instruments rely on self-reporting of behaviors, asking patients how frequently they engage in recommended actions. For example, the Self-Care of Heart Failure Questionnaire asks patients how often they limit sodium intake, adjust medications, or seek help when experiencing symptoms of heart failure (Carlson et al., 2001). These self-reported behaviors provide insight into how well patients are managing their condition and adhering to their treatment plans.
Similarly, the Epilepsy Self-Management Scale measures patients’ adherence to safety precautions, such as avoiding swimming alone or using seizure precautions in risky situations (Dilorio & Henry, 1995). These behaviors are essential in preventing complications and improving quality of life.
Other instruments assess problem-solving skills in managing chronic conditions. The Diabetes Problem-Solving Measure for Adolescents evaluates how well young people with diabetes can solve critical problems related to their disease management (Cook et al., 2001). Adolescents often struggle with glycemic control during this period, making problem-solving skills crucial for maintaining health.
The Diabetes Self-Management Profile provides a comprehensive assessment of patients’ adherence to various components of their diabetes regimen, such as exercise, diet, glucose monitoring, and insulin administration (Harris et al., 2000). By evaluating these self-management behaviors, health care providers can identify areas where patients need additional support or education.
Other Measures in Health Care and Nursing
In addition to self-management and beliefs, other measures relevant to patient education focus on the decision-making process, including the conflict patients experience when making health decisions and their regret after making a choice. For example, some patients may experience difficulty in deciding whether to undergo certain treatments, leading to feelings of uncertainty and regret later on. Tools designed to assess this conflict and regret are important in ensuring that patients are fully informed and confident in their decisions.
However, a lack of culturally competent instruments for measuring relevant predictors and outcomes in non-English-speaking populations presents a barrier to addressing health disparities. For example, in the Mexican American population, where literacy rates may be low, health care providers must adapt instruments to reflect the culture and language of the community they serve (Brown et al., 2002). Developing these culturally sensitive tools requires a significant investment of time and skill but is essential for ensuring that all patients receive appropriate education and care.
In some cases, innovative methods such as objective structured clinical exams (OSCEs) have been adapted from professional education to assess the competencies of lay caregivers and patients. These exams use simulated scenarios to evaluate skills such as dressing changes, line flushing, and identifying complications. Learners receive immediate feedback on their performance, ensuring they are adequately prepared for caregiving responsibilities (Heermann et al., 2001).
Conclusion
In summary, the measurement of patient knowledge, beliefs, self-management, and other outcomes is crucial for evaluating the effectiveness of patient education in health care and nursing. A variety of instruments are available to assess these dimensions, each tailored to specific conditions and behaviors. Understanding and measuring these factors allows health care providers to address patients’ needs more effectively, promote healthier behaviors, and improve long-term health outcomes. By continuing to develop and refine these measurement tools, the health care system can better support patients in managing their health and achieving optimal outcomes.