CHAPTER ONE

BACKGROUND OF THE STUDY

1.0 INTRODUCTION
The well known lesson “if you give a man a fish, you feed him for a day, but if you teach him
to fish you feed him for a life time”, is suitable for the illustration of the importance of patient
teaching or education. Patient teaching or education involves helping patients become better
informed about their condition, medical procedure and choices they have regarding treatment
(Martin, 2012).
Behavioral chance communication comprise of set of actions that essentially change
behaviors through improving knowledge and changing individuals attitude ( Lisa, 2019).
Patient teaching is as old as Nursing profession. This can be seen from the achievements of
Florence Nightingale, founder of modern Nursing in improving the standard for the care of
war casualties in the Crimean war. Also in the Nightingales vision of nursing which
includes public health promotion, roles of nurses which was only partially addressed in the
early days of Nursing (Berman, Snyder, Kozier, and Erb, 2012).
Though other health professionals like physicians, pharmacists, registered dietician etc
participates in patient teaching, Nurses as Educators play a key role in improving health of
the patients. This is because Nurses are closer to the patients than any other health
professionals. ( Kelliher, 2011)
Nurses assess the patient’s level of understanding about treatment methods and correct any
knowledge deficits. The Nurse is often a physician interpreter to the patient/client explaining
in easily understood terms, clarifying and referring. Patient teaching supports behavior
change that leads to positive adaptation. Thus patient teaching involves decreasing the fear of
change, reducing anxiety and anticipatory stress. Patient teaching is an essential function of
every professional Nurse in every practice setting - Schools, communities, worksites,
healthcare delivery sites and homes. Never has the demand for quality patient teaching
(education) been greater than now. The current trend toward shorter hospital stay and
decreased time for healthcare professional patient interactions have increased the need
for effective patient teaching. Also more of the chronically ill patients are at home in need of
nursing assistance from their families, friends and volunteers. Such patient’s families and

1
friends should possess a moderate degree of understanding of the illness and its management.
Nurses often find it difficult to provide effective patient teaching in the current healthcare
climate. According to Fran, a Nurse, patient-education expert, noted, “Teaching patients isn't
rocket science, but it is a sophisticated skill that takes practice and commitment. Without
patient education, there's very little effective healthcare with improved long-term outcomes”
(Fran, 2009).
Nurses assume the role of teacher when clients have identifiable learning needs. The teacher
learner relationship is enhanced by the continuance of the helping relationship in which
mutual respect and trust have been established. The Nurse builds on this trust by sharing
information the Nurse and client have mutually identified as important. The Nurse
care giver as a skilled teacher can expect to effect the following outcomes: High level
wellness and related self-care practices, disease prevention and early detection, quick
recovery from trauma illness with minimal to no complications, enhanced ability to adjust
to developmental life changes in acute, chronic and terminal illness, family acceptance of
the life style changes necessitated by the illness or disability of a family member, patients
satisfaction. When Nurses incorporate patient education into the patient's plan of care, they
can improve their teaching effectiveness and increase the likelihood of optimal patient
outcomes (Jackie & Helen, 2013).
Smeltzer, Bare, Hinkle & Cheever (2011) stated that teaching as a function of Nursing is
included in all nurse practice acts and in the standards of clinical Nursing practice of
the American Nurses Association. Patient teaching/client teaching is also mandated by
several accrediting bodies, such as the Joint Commission on Accreditation of Health care
organizations (JCAHO, 2002).
The American Hospital Association patient bills of right calls for the clients
understanding of health status and treatment approaches. Informed consent for treatment
procedure can be given only by clients who are well informed (Daniels, 2004). The
United Kingdom Central Council for Nursing (UKCC) guidelines for professional practice
offer a number of helpful points that can be applied to the teaching of patients and their
family including: The importance of giving clear information on which the patient/client
can make informed choices, the need to recognize patients/clients as equal partners, the
importance of using language that is familiar to them, the need to ensure that

2
patients/clients understand the information they are given and so on (Quinn, 2010). In
Nigeria also, patient teaching is included in the curriculum for General Nursing and
Midwifery by the Nursing and Midwifery Council of Nigeria, (N&MCN, 2006).
The challenges in today’s health care environment necessitate the need for patient
teaching in an organized way. Also demands from consumer for comprehensive
information about their health issues throughout the life cycle accentuate teaching to
occur in every patient-Nurse encounter (Smeltzer et.al, 2011). Patients come to the
hospital with diverse disease conditions which can be acute or chronic. When patients
are provided with a solid knowledge base about their disease process and treatment,
outcome is more favorable. For them to be taught, Nurses are required to teach them,
Nurses are exposed through training and if they do not have this knowledge, they will
not be motivated to teach patients, and patients will not understand their problems and
how to manage them (Ward, 2012).
Nurses need to have right attitude towards patient teaching for the patients to learn.
They should look for opportunities to teach the patients no matter how tight their
schedules appears to be. There is also need for Nurses to practice patient teaching
routinely, in order to impact on the patients positively and perfect their expertise in it.
If they do not practice patient teaching, patients will not be satisfied with Nursing care
given to them. However, this integral role of Nursing profession, patient teaching has
been compromised in the Nurses attempt to deal with disease and its effects on patients.
Patient teaching is a parameter for professionalism in Nursing and should be treated with
equal importance as other Nursing actions. The foregoing promoted the interest of the
researcher for the present study. As such effective BCC helps to alleviate negative emotional
status of health care users, to solve problems and initiate plan of actions that contribute to
improved health conditions.

1.1 Statement of Problem:

Patient teaching involves identification of patients learning needs/teaching opportunities,
application of teaching strategies, evaluation and documentation. The report documented by
patient safety experts CRICO Strategies, discussed how miscommunication/teaching affects

3
healthcare delivery.
CRICO (2019) stated that, over 23,000 medical malpractice lawsuits and claims where
patients suffered some form of harm. Out of all these cases, it identified over 7,000 where the
problem was directly caused by miscommunication of certain facts, figures and findings.
According to the report, communication/teaching errors don’t just happen because someone
doesn’t fully understand what a Doctor or Nurse is saying. Errors “occur because information
is unrecorded, misdirected, never received, never retrieved or ignored.”
In all, CRICO estimated these errors cost the healthcare system $1.7 billion, including the
price tag of hefty malpractice payouts for serious injury or death.
The errors occurred in the inpatient setting, the outpatient setting and the emergency
department. Injuries to the patient caused by these errors were mostly of high and medium
severity. Out of all the high-severity injury cases reviewed, 37% involved some sort of
communication failure.
Over a quarter of malpractice cases involving surgery, and 32% of all nursing cases, were
caused by a lack of thorough communication in some aspect of patient care..
The University of Nigerian Teaching Hospital Enugu (UNTH) management and the
Nursing services department in collaboration with school of Nursing University of
Nigeria Teaching Hospital Alumni Association based in USA (SONUNTHAAUSA) have
equipped the Nursing services department library in the continuing education unit with
current textbooks, teaching aids such as models and software (demonstration techniques),
in 2011 and 2013 respectively. This is aimed at improving the knowledge base of the
Nursing staff in order to carry out patient teaching efficiently. Despite these efforts made
by the above mentioned bodies, the researcher observed that most Nurses do not fully
utilize these aids in assessment and in teaching patients. Majority of the patients do not
have sufficient knowledge about their diseases and treatment regimen as evidenced by
the twenty (20) patients, whose opinions were sampled in the outpatient unit of Sir
Yahaya Memorial hospital Birnin Kebbi . it was observed that teaching id the major challenge
for Nurses working in sir Yahaya memorial hospital as most of the Nurses does not
participate in patient teaching which predisposes some patients to be readmitted in no
distance time creating problems for the Nurses and patients like long term hospital stay and
abscondment which can all be prevented via patient teaching. The researcher finds it

4
necessary to carry out a research in order to assess the Knowledge, attitude and practice of
BCC among Nurses in Sir Yahaya Memorial Hospital Birnin Kebbi, Kebbi State.
1.2 Objectives of the Study/ Purpose:
The purpose of this study is to determine the attitude and practice of patient teaching
among nurses in Sir Yahaya Memorial Hospital Birnin Kebbi, Kebbi State.
The study will specifically achieve the following:
 To determine nurses attitude towards behavioral change communication in sir yahaya
memorial hospital.
 To Identify strategies and types of patient teaching adopted by nurses in sir
yahaya memorial hospital.
 To determine challenges nurses encounter in patient teaching in sir yahaya memorial
hospital.
1.3 Research Questions:
1. What are the attitudes of Nurses towards patient teaching?
2. What are the strategies and types of patient teaching do Nurses adopt?
3. What are the challenges Nurses encounter in patient teaching?
1.3 Significance of the Study:
Findings from this study if published would generate data to determine the types of BCC
provided and what is lacking. The findings would show areas of gabs in attitude and practice
of patients teaching among Nurses and this would help Nursing educators to know areas
to emphasize on during training of students Nurses. It would be of beneficial to Nurses,
When Nurses have sufficient knowledge about patient teaching and teaches patients, it
improves professionalism in Nursing through maintaining its standard and effects. Hence
improved patients knowledge about their disease conditions and treatment regimen and
take good care of themselves and be useful to themselves, relations, communities and the
nation as health promotion and healing process is achieved.
Furthermore, Nursing services department of institutions of study will utilize the findings of
this study to organize continuing education program for their Nurses.
Nursing and midwifery council of Nigeria may be stimulated by the findings of this study
by reviewing the various Nursing schools curricular in order to enrich them in the area of
patient teaching.

5
It will provide empirical evidence for patient teaching as there is of Nursing literature of
this area in Nigeria.
It will serve as a reference point for other researchers that would want to work in
this area.
1.5 Scope of Study:
This study was conducted among nurses in Sir Yahaya Memorial Hospital Birnin Kebbi,
Kebbi State. It focused on the attitude of Nurses towards patients teaching, to find out the
strategies and types of patients teaching adopted by Nurses and challenges Nurses encounter
in patients teaching in Sir Yahaya Memorial Hospital under study.
1.6 Operational definition of Terms
1.6.1. Knowledge of patient teaching: In this study implies nurse’s ability to indicate
correctly meaning of patient teaching, approaches, strategies, types and methods of patient
teaching. The nurses should have from 50% and above responses in the indices of knowledge
to be adjudged knowledgeable of patient teaching. Categories of knowledge:
90 – 100% = Excellent knowledge
70 – 89% = Good knowledge
50 – 60% = Moderate knowledge
49 and below = poor knowledge.
1.6.2. Attitude toward patient teaching: In this study implies nurses’ willingness to see
patient teaching as their responsibility, eager to teach patients, steps she takes to establish a
trusting relationship with the patient that will pave the way for patient teaching. For example;
introducing him/her self to the patient, assessment of the patient on admission using nursing
process format to identify learning needs of the patient, reading patients folders, engaging in
extensive reading of different disease conditions of the patients to increase ones knowledge.

6
1.6.3. Practice of patient teaching: Implies nurses adoption or use of any of the strategies of
patient teaching and types of patient teaching as listed in the questionnaire namely: planned
and unplanned, use of the different teaching methods e.g. discussion, demonstration, printed
materials, audio-visual aids, and tools for teaching children e.g. story books, health fair, dolls,
puppet play etc in patient teaching and evaluation and documentation of patient teaching.
Categories of practice of patient teaching:
90 – 100% = Excellent practice
70 – 89% = Good practice
50 – 60% = moderate practice
49 and below = poor practice
1.6.4. Patient teaching/client teaching/patient education: Implies planned (structured) and
unplanned (unstructured) health instructions/teaching given to patients by trained nurses
which makes positive impact or leads to positive changes in health behavior.
1.6.5. Content of patient teaching: Implies the teaching process and everything, patient
requires to know about his/her health and well being for example; health promotion,
prevention of illness, restoration of health, and rehabilitation.
1.6.6. Context of patient teaching: Implies the environment nurses used for patient teaching
e.g. ward rounds, bedside, clinics etc.
1.6.7. Patient/client: interchangeably used in this study as recipients of nursing care, sick or
well.
1.6.8. Challenges encountered by nurses in patient teaching: implies those difficulties that
prevent nurses from teaching patients e.g. lack of time, shortage of staff, lack of knowledge
and skill and lack of teaching aids etc.

7
 CHAPTER TWO
2.0 LITERATURE REVIEW
This chapter reviews the relevant and related literature from text books, journals, and as well
as internet under the following identified headings:
1. Conceptual review
2. Theoretical review
3. Empirical review
2.01 Conceptual review
2.02 Knowledge, attitude and practice of behavioral change communication
Behavioral change communication is also called patient teaching or health education which is
the process of educating, persuading and disseminating information to people, to positively
influence their behavioral patterns about particular health issues.
According to WHO defined BCC as an art and science of giving simple accurate and
scientific information in a way that it will be understood, accepted, believed and put into
practice.
BCC encompasses social and community mobilization ad well as health communication
approaches, being a procedure of information, education and communication. (IEC). It is
beyond the mere dissemination of perceived necessary health information ( Adeweyi and
Adefemi, 2016). It is rather a two ways process that involved three cylindrical stages that
nurses used in dissemination health information to the clients. The stages include listening,
dialoging and auctioning in which listening enables them to lean about their target audience,
dialoguing aims at developing cultural approach and easy understanding strategies and
auctioning on the other hand deals with the implementing and monitoring changes often in
partnership with other health professionals.
According to kerina (2017) health providers particularly Nurses used BCC as widely
recognized health promoting strategies which helps individuals and community to develop
positive behaviors and create a supportive environment to enable patients to adapt and sustain
positive behaviors.
However, according to her health care providers practice BCC in the care of their patients,
some of the examples use in health setting includes interpersonal communication (IPC), mass

8
media campaign, intense messaging and many more. Interpersonal communication is the
commonly accepted method in health setting.
Furthermore she emphases that BCC has examples and focus on specific condition in
different parts of the world where Egypt BCC focus on maternal and child health, Bangladesh
is to improve maternal, neonatal and child survival ( IMNCS) programs, in Thailand on
family planning, Philippines health promotion and communication and in Nigeria, Kenya and
Senegal male involvement in family planning. Other countries include Niger and Yemen
which it focuses on child health (Kerina, 2017).
According to Sara Health (2017), the practice of informing patients about their health,
wellness, and treatment plans, potential outcome, and other information critical to the patient
experience is what health care providers do day and nights to ensure optimum level of
wellness of their clients. Therefore, patient teaching involve the process by which health
professionals impart information to the patients that will alter their health behaviors or
improve their health status.
In developed countries health providers carries out BCC effectively under the following
criteria: research centered, clients centered, benefit of learning, scientific and evidence based
and to promote health and health related issues (Adhikarin, 2019).
2.02 Types and strategies of behavioral change communication
Strategies to BCC: Strategies to patient teaching/BCC involves those activities that the nurse
teacher must put in place in order to achieve a good teaching/learning outcome. Mangal
(2017) documented these strategies as follows: Arranging a favorable and positive climate
for learning An environment can detract from or assist learning, for example, noise or
interruptions usually interfere with concentration, whereas a comfortable environment
promotes learning. Berman, Snyder, Kozier and Erb (2012) stated that placing the patient in a
position and location associated with activity or learning may influence the amount of
learning that takes place, Helping the learners (patients) to have clear cut objectives and
purpose of his/her learning. According to Pramila (2010), the chief goal of any education
process (patient teaching) is to bring about change in human behavior. She further stated that
for any educational programmed to be effective, the purposes and objectives must be clearly
stated so that it is easy to select the right subject matter, the clinical experience and the right
method to evaluate the teaching process. She defined objectives as the desirable outcomes of

9
intended actions through the mode of education (patient teaching), that is the result sought by
the patient (learner) at the end of a teaching program.
Organizing the learning resources and making them available to the learners: learning
resources are those sources that the teacher employs to bring about learning. These resources
are identified as messages, people, materials, devices, techniques and setting. Resources can
be used by the learner in isolation or in combination usually in an informal manner to
facilitate learning. According to (Iwu, Ike &Chimezie, 2006) these resources are of two types:
Resources by design: those resources which have been specifically developed as
instructional systems components in order to facilitate purposive, formal learning.
Resources by utilization: those resources which have not specifically been designed for
instruction but which can be discovered, applied, and used for learning purposes. To ensure
the transfer of learning, the nurse should use the equipment that the patient will use before the
teaching session, the nurse needs to assemble all resources (equipment and visual aids) and
ensure that they are functioning effectively.
Balancing intellectual and emotional components of learning: Mental level of the patients
and emotional readiness of the patients must be balanced. Patient Teaching should be
adjusted to suit the mental level of the client. Readiness to learn is equally important. Clients
who are ready to learn behave differently from those who are not. A client who is ready to
learn may search for information; ask questions, reading books or articles. They should assess
for these readiness characteristics: Physical readiness is the client ability to focus on things
and not distracted by pain, fatigue etc? Emotional readiness is the client emotionally ready to
learn self-care activities? Clients, who are anxious, depressed or grieving hardly learns.
Cognitive readiness can the client think clearly at this point? (Berman et. al, 2012). Sharing
feelings and thoughts with learners (patients) in a democratic way during patient teaching, the
nurse should assess patients feeling and their thoughts and encourage them to share their
feelings with the Nurse teacher. The learning environment should be such that allow the
patients to express themselves freely.
2.1.8 Types and Teaching Methods Adopted in behavioral changes
When teaching patients and their families, the teaching types can be either planned (formal or
structured) in advance, or spontaneous (informal or unplanned, depending upon the context.
Advance planning is always preferred since it helps to eliminate errors and omissions.

10
However, even spontaneous teaching can incorporate an element of advance planning (Quinn,
2010). According to Pramilla (2010) the common teaching methods and techniques that are
used in adult patient teaching are:
Lecture: is a verbal presentation made by the Nurse to a group of patients or family
members. Lecture is the method most often used by Nurses when instructing or transmitting
information to patients. It is a very effective method of teaching cognitive behaviors and is
more effective when used with discussion. Lecture can be improved by using visual aids.
Material presented in lecture should be prepared according to the patient’s level of
understanding and they should have an opportunity to clarify their doubts. Lengthy lectures
may cause loss of attention if the patient becomes bored, distracted or anxious about the
material presented. Lectures can be highly effective for influencing cognitive behaviors but
will not be effective in achieving affective or psychomotor learning objectives.
Small Group Work; is a group of two or five patients and of family members. This method
is used to discuss issues brought up in larger class, to share experience and to work on joint
projects related to self-care. Groups provide peer support, free expression, reinforcement of
teaching and sharing of ideas. They are useful for changing attitudes and exploring new
patterns of behavior. The nurse should prepare in advance the activities of the group before
the time the group meets. Berman, (2012) advocated that all members involved in a group
must have a common need and social cultural factors be considered in the formation of a
group.
Discussion: is an earnest conversation by a group of patients, families and health care
providers. Discussion can be enhanced by the following actions to be observed by the leader:
Encourage full participation by questioning the participants who are not getting involved.
Keep the discussion on target when the group gets into irrelevance, the leader should get
them into the stream of the topic focused discussion. Do not let one or two participants to
dominate the discussion. Though, their input can be appreciated but direct attention to others
by asking them to comment. Reinforce contributions by making positive remarks about their
comments. Summarize the points made by the group as discussion draws to an end
Demonstration and Return

11
Demonstration: is used to teach psychomotor skills to the patients. Nurse demonstrates to
the patient/family how to implement a procedure and observes them in return. The ideal
demonstration involves the patients performing the real procedure with real equipment. Other
teaching methods used for adults in patient teaching are:
Computer Assisted Instruction (CAI) is popular. Initially, the primary use of computer
education methods was cognitive learning of facts. Nowadays however, computers can be
used to teach the following: Application of information, psychomotor skills, and complex
problem solving skills. Some computer programs feature simulated situations that allow
learners to manipulate objects on the screen to learn psychomotor skills. When used to teach
such skills, CAI must be followed up with practice on actual equipment supervised by the
teacher. (Berman, 2012)
Discovery/Problem Solving in this method of learning the nurse presents some initial
information and then asks the learners a question or presents a situation related to the
information. The learners then apply the new information to the situation and decide what to
do. (Berman et.al, 2012).
Mass Approach: Pramilla (2010), posited that, no health team can mount an effective health
teaching except through mass media of communication. Mass media is a “one way”
communication. It is useful in transmitting messages to people even in the remotest places.
Though mass media alone cannot cause change in human behavior, it should be combined
with other methods. The power of mass media that is in favors of health, raising the health
consciousness of the people, settling norms, delivering technical messages, popularizing
health knowledge and fostering community involvement are well recognized. Approaches to
mass media can be accessed through television, radio, internet, newspapers, printed material,
direct mailing, posters, bill boards and signs, health museum and exhibitions and folk media.
One-to-one: as documented by Quinn (2010), one- to –one teaching method is the most
common form of teaching with patients and families in the hospital. Its success depends to a
large extent on the interpersonal skills of the teacher. One to one method of patient teaching
is used when sensitive or private topics are discussed but it is time consuming. Some of the
benefits of one-to-one method of teaching are:
Patients get the undivided attention of the Nurse teacher, Rapport can be established more
quickly. Progress can be quicker with just one patient Teacher can check learning easily with

12
just one patient. For one-to-one teaching to be effective, the pace of the teaching has to be
judged carefully to ensure that the patient is keeping up with the information. The
atmosphere needs to be informal and relaxed sessions should be kept short to avoid tiredness
that may be experienced by some patients with certain disease conditions.
Other teaching methods include: explanation or description, question and answers sessions,
printed and audio -visual materials.
2.1.9 Teaching Tools for Children; teaching tools for children is different from those of the
adults. These teaching tools are:
Story books: describes how the child feels, what will be done and what the place will be like.
Parents and guardians can read these stories to children several times before the experiences.
Doll: Nurses can practice procedures on dolls or teddy bears that the patients will later
experience. Children can also be allowed to practice on these dolls as this gives a sense of
mastery of the situation. Costume dolls are often available for inserting tubes and giving
injections (Berman et. al, 2012).
Puppet play: Pramilla (2010), defined puppet as an inanimate object or representational
figure animated or manipulated by a puppeteer. It is usually a depiction of a human character
and is used in puppetry (a play). Puppets can be used to role play situations to provide
information and show the child what the experience will be like, puppets can offer comfort
and safety; they can be used to help children understand what they will experience as a
patient and by doing so, they can calm the child fears and enhance their recovery.
Health Fairs: This is used to teach children about their bodies and ways to stay healthy.
Children that are well cared for by their parents receive prizes that will stimulate others who
did not win prizes to aspire to remain healthy. Fairs can focus on high risk problems children
face such as accident prevention, poison control and other topics identified as concern.
2.1.10 Evaluation
Evaluation is an essential component of patient teaching. It can be ongoing or summative.
The purposes of evaluation as documented by Pramilla (2010), are to:
Measure the extent to which the patient has met his/her learning objectives. Identify the
positive factors which promoted behavior change or learning. Identify the negative factors
which prevented change in behavior or learning. Reinforce the patients’ learning Provide
basis for change in learning objectives and teaching strategies.

13
She further stated that evaluation has four steps namely:
Patient’s participation during interventions. Patients performance immediately following
learning experience. Patient’s performance at home and Patients overall self-care and health
management
Quinn (2010) stated that, the most common method of assessing patients learning is by the
use of oral questionnaire and this can usually provide sufficient feedback on their
understanding. He outlined the types of questions as follows:
Open questions: These questions are phrased so as to allow the patients to respond in any
way they like and are used to ascertain patient’s feelings.
Probing questions: This is used to follow up a previous response by the patient and allow
the teacher to explore the response in more depth.
Factual questions: These are used to check whether the patient has understood the teacher’s
points and consist of asking the patient to repeat certain items of information.
2.1.11 Documentation of Patient Teaching
Berman etal, (2012) stated that, documentation of the patient teaching is essential because it
provides a legal record that the teaching took place and communicates the teaching to other
health professionals. She said that if teaching is not documented, legally it did not occur.
Pramilla (2010), in her own contribution said that patient teaching can be documented in the
patient’s medical record, patients care plan and or education file. Berman, (2012) added that
it is also important to document the responses of the client and support people to teaching
activities.
While the written teaching plan that the nurse uses as a resource to guide future teaching
sessions might also include these elements.
Actual information and skills taught. Teaching strategies used Time framework and content
for each class. Teaching outcomes and Methods of evaluation they are also of the opinion that
both the nurse and the patient should sign the copy of the teaching form.
2.04 challenges of nurses towards behavioral change
As documented by Berman et al, (2012) many factors combine to constrain patient teaching
by Nurses. Such factors can be from the patients and the Nurses. Factors from the patients
include nature of the patient, physical and emotional state, age, social and cultural
background, his education, experience and so on. Patients present to the hospital with various

14
health problems requiring cure or palliation. Some of the patients do not see themselves as
learners.
Physical and emotional state of the patients may constrain patient teaching. When
patients are not physically and emotionally stable, they will not be able to concentrate for
patient teaching. Patients in the two extremes of age that is the elderly and the very young
patients are difficult to be taught. The elderly patients may be faced with some memory loss,
sensory deficit acquiring psychomotor skills. The very young patients cannot make decisions
themselves. Parents of the very young patients may object to patient teaching.
Social economic factors can constrain patient teaching: patient teaching from low income
group find it difficult to comply with some treatment regimen. For example if a patient is
taught by the Nurse to use a new sterile syringe for each injection of insulin, when patient
cannot afford it. Many cultural groups have their own folk beliefs and practices with many of
them related to diet, health, illness and lifestyle. The cultural practices and values held by
patients will affect patient teaching (Berman et. al, 2012). Level of education and experience
of a patient is important in patient teaching. Patients with little or no education have less
information about health and management of disease process. Therefore, such patients pose a
challenge for the nurse to teach.
Factors from the nurses include the nature of nursing, lack of knowledge of what to teach by
the Nurse, lack of competence and confidence with teaching skills, lack of time and lack of
conducive environment for teaching and so on. The nature of nursing is such that nursing care
has priority over patient teaching and little or no attention is given to patient teaching.
Equally important is the lack of knowledge of what to teach by some nurses. The busy nature
of nursing do not allow some of them to update their knowledge with the disease conditions
patients present with in order to teach patients well about their conditions. At times where the
nurses have the knowledge, they may lack competence and confidence to handle patient
teaching very well.
Lack of time: which may be as a result of workload may constrain patient teaching for
example Nurses role in providing patient care, supervision of non-nursing staff, responsibility
to the physician for carrying out medical orders and assisting the doctors with special
procedures.

15
The environment where patient teaching takes place may constrain patient teaching, lack of
conducive environment, lack of space, lack of privacy, noise and frequent interruptions due to
patient treatment routines militate against Nurses’ ability to concentrate and effectively
interact with patients.
2.1 Empirical review
2.1.1 Knowledge, Attitude and Practice of behavioral change
Knowledge of behavioral change communication alone is not enough to motivate Nurses to
change their behavior towards patient teaching. Nurses require knowing what needs to be
done to achieve effective behavioral change communication. Knowledge and attitude will
only affect practice when the information is relevant and a positive attitude is shown toward
imparting the knowledge (Badrans, 2015).
There is a scarce of literature on knowledge, attitude and practice of patient teaching among
Nurses working in the sir Yahaya Memorial Hospital. However, some of the studies carried
out in related area were reviewed. Oyetunde and Akinmeye (2015) conducted a study on
factors influencing practice of patient education among Nurses at the University College
Hospital (UCH) Ibadan Nigeria published in the open journal of Nursing. A cross-sectional
descriptive survey design was employed, using 200 Nurses. These Nurses were selected
through stratified and simple random sampling techniques. The researchers used a self-
designed questionnaire in their method and data was analyze using statistical package for
social sciences version 15 (SPSS 15). The study revealed that the knowledge and practice of
patient education among the Nurses in UCH Ibadan was high and the knowledge was found
to be significantly associated with its practice (x2=7.89, p=0.017). The working experience of
Nurses does not determine whether they practice patient education or not. Almost all the
respondents (70% - 90%) in their study affirmed that the Nurses’ experience, cultural barriers,
workplace, insufficient staffing, and the complexity of patient’s condition were important
factors that influenced the practice of patient education. The researchers concluded that
Nurses at the University College Hospital have good knowledge and positive attitudes
towards patient education but could not practice effectively. The researchers advocated a
more critical approach in addressing heavy workload insufficient staffing, among others
needed to improve patient education. Further studies should be carried out on developing
Nurses’ roles as patient educators.

16
In another study by Aghakhani, SharifNia, Ranjbar, Rahbar&Beheshti (2012) on Nurses
attitude to patient education barriers in educational hospitals of Urmia University of Medical
Sciences in Iran, The study was conducted using a cross-sectional design. The sample
consisted of 240 Nurses affiliated in the educational hospital. The data were gathered by a
questionnaire. Demographic variables and three domains were studied. Twenty questions
were about their working situation, 4 questions about hospital educating facilities, and 12
questions were about patients’ situation in hospital. The type and frequency of education
barriers were evaluated, and variables associated with reporting an obstacle were analyzed.
Findings revealed that the educational condition in their hospital used for study was not good
and most of the Nurses believed that patient education is not their duties, facilities in
hospitals are not sufficient and shortness of time is the most important of insufficiency of
patient education. In yet another study conducted by Whitehead, Wang, Wang, Zhang, Sun
&Xie (2012) on health promotion and health education practice: Nurses’ perceptions in
Clumbia. The study was conducted using phenomenological approach with a sample of eight
(8) students and eight senior Nurses. The interviews were audio recorded and transcribed
from Mandarin to English. Data analysis adhered to the framework developed by Giorgi.
Result showed that health education and health promotion related practices showed similar
results to those reported in Europe and North America. Hospital based Nurses were often
aware of what health promotion is, but did not have the scope or opportunity to implement it
in practice. Instead, they were likely to conduct more limited forms of health education.
Actual understanding of health promotion and health education constructs was high with
most participants, underpinned by active clinical-based educational support. Some
participants were able to conduct broader health promotion activities on voluntary basis in
their own communities. The researchers concluded that health education and health
promotion are universal health-related constructs. Thus, there is an expectation that all nurses
will implement these in a similar fashion where possible, hospital based nurses should strive
to improve their health education practices and further embrace wider perspectives of health
promotion practice. In another study by Kemppainen, Tossavainen and Turunen (2013) on
Nurses roles in Health promotion practice; an integrative review. The paper presented an
integrative review aimed at examining the findings of existing research studies (1998-2011)
of health promotion practice by Nurses. Systemic computer searches were conducted of the

17
Cochrane data bases, cinahl, pubed, web of science, PSYCLNFO and Scopus databases,
covering the period January 1998 to December 2011). Data were analyzed and the results
were presented using the concept map method of Novak and Gowin. The review found
information on the theoretical basis of health promotion practice by Nurses, the range of
expertise, health promotion competencies and the organizational culture associated with
health promotion practice. The researcher concluded that nurses consider health promotion
which is an aspect of patient teaching) important but a number of obstacles associated with
organizational culture prevent effective delivery.
In yet another study by Lin Chang, Chang and Lou (2011) on critical care nurses, knowledge,
attitudes and practice of oral care for patients with oral and endotracheal intubation published
in the journal of clinical nursing, Twelve (12) adult intensive care units in northern Taiwan
were purposively chosen. Two hundred and five Nurses (205) were recruited for the study.
Data were collected by structured questionnaire. Findings showed the average percentage
indicating the intensive care unit nurses oral care knowledge, attitude and practices were
58.8%, 79.4% and 49.8% respectively. Researchers discovered that higher scores on oral care
knowledge were associated with Nurses performing oral care more frequently. The Nurse’s
age and the type of intensive care unit they work in were significant factors related to the
frequency of performing oral care. The researchers concluded that Nurses who have
more .resources for learning about oral care have greater knowledge about it and provide oral
care to intubate patients more frequently. In a study conducted by Kotronoulas etal (2009) on
‘‘Nurses knowledge, attitudes and practice regarding provision of sexual health care in
patients with cancer: critical review of the evidence”. This study was aimed at gathering
evidence regarding knowledge, attitude and behavior (practices) of oncology nurses toward
sexual health issues and to identify salient and latent key factors which influence provision of
sexual health care in the context of cancer. A critical review of the literature was conducted
over a period of thirty (30) years and 18 original research articles were retrieved and
analyzed. Findings revealed that although oncology Nurses hold relatively liberal attitudes
and recognize provision of sexual health care as an important Nursing role, they possess
limited sexual knowledge and communication skills, while often avoid or fail to effectively
respond to patient’s sexual concerns. The researchers concluded that there is an evident need
of dispelling the myths about sexual health in cancer care. Besides, continuing education

18
activities and availability of education materials could assist Nurses to adequately address
sexual concerns while caring for patient with cancer. In another study conducted by Asian
pacific journal of cancer prevention (2014) on summary of “Cervical cancer screening):
knowledge, Attitudes and practices among Nursing staff in a Tertiary level Teaching
Institution of Rural India”. A cross sectional, descriptive interview based survey was
conducted with a pretested questionnaire among 262 staff Nurses. Findings revealed that 77%
of the respondents knew that Pap smear is used for detection of cervical cancer, but less than
half knew that pap smear can detect even precancerous lesions of cervix. Resources for
learning about oral care have greater knowledge about it and provide oral care to intubated
patients more frequently.
In a study conducted by Kotronoulas, Papadopoulou and Patiraki (2009) on ‘‘Nurses
knowledge, attitudes and practice regarding provision of sexual health care in patients with
cancer: critical review of the evidence”. This study was aimed at gathering evidence
regarding knowledge, attitude and behavior (practices) of oncology Nurses toward sexual
health issues and to identify salient and latent key factors which influence provision of sexual
health care in the context of cancer. A critical review of the literature was conducted over a
period of thirty (30) years and 18 original research articles were retrieved and analyzed.
Findings revealed that although oncology Nurses hold relatively liberal attitudes and
recognize provision of sexual health care as an important nursing role, they possess limited
sexual knowledge and communication skills, while often avoid or fail to effectively respond
to patient’s sexual concerns.
The researchers concluded that there is an evident need of dispelling the myths about sexual
health in cancer care. Besides, continuing education activities and availability of education
materials could assist Nurses to adequately address sexual concerns while caring for patient
with cancer.
In another study conducted by Asian pacific journal of cancer prevention (2014) on summary
of “Cervical cancer screening): knowledge, Attitudes and practices among Nursing staff in a
Tertiary level Teaching Institution of Rural India”. A cross sectional, descriptive interview
based survey was conducted with a pretested questionnaire among 262 staff Nurses. Findings
revealed that 77% of the respondents knew that pap smear is used for detection of cervical
cancer, but less than half knew that pap smear can detect even precancerous lesions of cervix.

19
Only 23.4% knew human papiloma virus infection as a risk factor. Only 26.7% of the
respondents were judged as having adequate knowledge base on scores allotted for questions
evaluating knowledge about cervical cancer and screening. Only 17(7%) of the staff Nurses
had themselves been screened by Pap smear, while 85% had never taken a pap smear of a
patient. Adequate knowledge of cervical cancer and screening, higher parity and age>30
years were significantly associated with self-screening for cervical cancer. Most nurses were
of the view that pap test is a doctor’s procedure, and nearly 90% of Nurses had never referred
a patient for pap testing. The researchers concluded that majority of Nursing staff in rural
India may have inadequate knowledge about cervical cancer screening and attitudes and
practices towards cervical screening could not be termed positive.
In yet another study by Alok, Gunvant, Anjani, Ragini and Anjali (2013) on the knowledge,
attitude and practices (KAP) of the Nurses on cervical cancer and screening among Nurses in
a Teaching Hospital at Surat carried out on 200 female Nurses. A self-administered
structured, open ended questionnaire was used. Information obtained was analyzed in Epi
info and Microsoft Excel software. Findings showed that majority of the respondents (88%)
were married, most common age of marriage being 21-25 years. Nurses linked multiple
sexual partners (61%), Human papiloma virus infection (38.6%) and heredity (31%) to
cervical cancer. Approximately 70% believed that cancer of the cervix is preventable,
detectable and curable if detected early. Pap smear was recognized as major screening
technique by 74% nurses. Major (84%) source of information was health professional. Eighty
percent (80%) of nurses had never had cervical/screening while 87.5% did not recommend it
to others. The researchers concluded that for a successful implementation of cervical
screening program, the nurses should be targeted first by education and sensitization so that
they can play pivotal role in developing the compliance of women.
In a study on knowledge, Attitude and practice of family planning among Nursing staff by
Lal (2012). 199 Nurses working in the J.L.N group of Hospitals, Ajmer, India were
interviewed. 59.3% were trained Nurses between 16-30 years of age. 71% of the in service
Nurses were in age group of 26-35. 59.4% of the nurses were married. 51.1% had 1-3
children, 20.6% did not have any children.
Only 77% of the Nurses could explain what they understood by the term family planning.
About 71.8% of the married S had knowledge of family planning, 34.6% had acquired

20
information about family planning by working as family planning staff, 29.6% from mass
media, 24.3% through classroom teaching, 11.3% from their husband and 10.3% from friends
and relatives. Out of 78 married Nurses, 48.7% were using some form of contraception.
33.3% of the Nurses who had children were using contraceptives and 81.8% of them had
been sterilized. 64.1% of the married nurses considered sterilization of either partner as the
most effective method of family planning, 17.9% preferred oral contraceptives and 10.3% felt
that conventional contraceptive were most effective. 1 Nurse preferred the use of IUD. 97%
of the Nurses were in favor of family planning. 83.9% advocated audio-visual methods as the
most effective method by 34.6% and family planning clinics were preferred by 12%. 6.1% of
the Nurses agreed that Nurses themselves could refer couples to family planning clinics. 51%
of the total interviewed stated that Nurses could undertake the task of educating patients and
motivating them for family planning when they are in the hospital or are attending the
hospital. 49.7% of the respondents who were interviewed suggested that family planning
programme should be strengthened, 26.5% stressed the importance of educational measures,
and 13.3% the co-operation between family planning staff and the people. The researchers
concluded that the coverage of the family planning subject in the training of all Nursing staff
should be adopted. In a study conducted by Spear (2010) on Nurses’ Attitudes knowledge
and belief related to the promotion of breast feeding among women who bear children during
adolescence. 151 Nurses employed by three nonprofit hospitals and city and country public
Health departments located in the south eastern part of the United States were surveyed.
Findings revealed that participants were generally knowledgeable about and supportive of
breast feeding by adolescent mothers. However, some of the Nurses did not know that there
are nutritional differences between breast milk and infant formula continued the practice of
imposing time limits for feedings at the breast, and indicated that they were skeptical about
young mothers’ potential for success with breast feeding because of immaturity and lack of
commitment. Significant differences were noted in mean attitude and knowledge scores based
on the participant’s specialty, knowledge and attitude were positively correlated with the
Nurse’s level of education.
In a study conducted by Muttappallymahl, Sreedharan, Venkatramana and Thomas (2010) on
Attitude and practice of Nurses in imparting Breast self-Examination to women in Ajzmer
United Arab Emirate (UAE), among 154 Nurses from different hospitals in UAE. Findings

21
showed that majority of the Nurses (90.3%) had a positive attitude in providing knowledge
regarding risk factors of breast cancer and about the purpose of performing breast self
examination. Eighty-eight point three percent (88.3%) of the Nurses were with a positive
attitude towards providing information about breast self examination to all females who come
to the hospital irrespective of their demand. Also majority of the Nurses (83.8%) were found
to be teaching method of breast self examination.
2.2 Theoretical frame work
A number of theories have been propounded to explain knowledge, attitude and practice of
patient teaching by Nurses. These theories try to explain the inter-relationship between
knowledge, attitude and practice. They form part of what come to be known as knowledge,
attitude and practice (KAP) model and the learning theories. Two of such theories which
underlie this study are discussed below:
Ibrahim Badrans knowledge, Attitude and practice theory and Carl Ransom Rogers Learning
theory.
Badran (1995) stated that knowledge, Attitude and practice constitute a triad of interactive
factors characterized by dynamism and unique interdependence. According to Badran,
Knowledge is the capacity to acquire, retain and use information and education is prerequisite
for knowledge. He defined attitude as the inclinations to react in a certain way to certain
situations to see and interpret events according to certain disposition or to organize opinions
to inherent and interrelated structures. By practice, he meant the application of knowledge
that leads to action. Good practice is an art that is linked to the progress of knowledge and
technology and is executed in an ethical manner. He also identified several important factors
that could influence or control the course of practice which include conglomerate of
information, education, communication and human resources development, modern
technologies, environmental factors etc. Badran stated that triad of knowledge; attitude and
practice in combination govern all aspects of life in human societies and all the three pillars
that make up the dynamic system of life.
2.5 Application of Theory to the Study
Nurses acquire knowledge about patient conditions; physical, emotional, physiological,
cultural as well principles of teaching during Nursing, Midwifery, Post Basic Nursing training
as well as master’s program in Nursing. To retain the knowledge acquired, Nurses engage in

22
personal readings, workshops and conferences in order to refresh their memory.
Attitude: The knowledge that Nurses acquired and retained on patient teaching will incline
them to react in a certain way positive or negative way towards patient teaching.
Practice: When nurses apply the rules and knowledge of patient teaching, they will be moved
to action of teaching patients no matter how tight their schedules may appear to be. As Nurses
continue to increase their knowledge and their techniques of patient teaching, they will
become perfect in teaching patients and invariably enhance their practice of patient teaching.
This in turn will directly or indirectly affect their attitude towards patient teaching. If patient
teaching by the nurses positively influence the patients, the tendency for the nurses to be
positively motivated to retain and improve their knowledge. On the other hand, if patient
teaching by the Nurses had a negative outcome, there is also the likelihood of the Nurse to
seek for more knowledge so that he/she can be competent enough to teach patients
effectively.
As stated by Badran that knowledge precedes attitude and that both knowledge and attitude
will predict and precede practice. In essence, if the Nurses are not knowledgeable of what to
teach the clients, their attitude will not be influenced; neither wills their practice of patient
teaching be efficient. Hence according to Badran, (1995) knowledge, attitude and practice are
interactive factors characterized by dynamism and unique inter-dependence.
However, extraneous variables like finance, time factor, materials, belief and education can
indirectly affect knowledge, attitude and practice of patient teaching.

23
 DEPENDENT VARIABLE
INDEPENDENDENTVARIABLE
BEHAVIORAL CHANGE

PRACTICE ATTITUDE

EXTRANEOUS
VARIABLES

FINANCE

TIME

MATERIALS

BELIEF

EDUCATION

Figure 2.1; Adopted model from IbrahmBadrans model of knowledge, attitude, and practice
(2014)
Carl Ransom Rogers Experiential Learning Theory
Carl Ransom Rogers experiential learning theory (1983) is a teaching-learning theory. Carl
Ransom Rogers was an American psychologist. This theory has its origin in his views about
psychotherapy and humanistic approach to psychology. Rogers distinguished two types of
learning namely: cognitive and experiential. He termed cognitive as meaningless in itself
unless it is subjected to some use. He stated that cognitive learning is knowledge based.
According to Carl Ransom Rogers, the experiential learning on the other hand, is quite vital

24
to ones progress and welfare. It is associated with the application of the acquired knowledge.
2.3 Application of the Theory to Study/ Appropriate link to study
Nurses in their various training schools acquire knowledge of what to teach, how to teach and
how to evaluate patient teaching. According to Carl Ransom Rogers, this knowledge is
meaningless if it is not subjected to some use which is patient teaching. Experiential learning
is the application of acquired knowledge and it is vital to ones progress and welfare. This
implies that when Nurses apply their knowledge of patient teaching by practicing patient
teaching, the Nurses knowledge will increase, patient will benefit and there will be progress
and welfare of the individual nurses and the Nursing profession. This is because every time a
nurse empowers a client toward autonomy and self-care some autonomy and power is
reflected to the nurses and the profession.
2.4 Summary of Literature Review
There is a shortage of literature on knowledge, attitude and practice of behavioral change
communication among Nurses. Studies carried in related areas include: factors influencing
practice of patient education among Nurses at UCH, Nurses attitude to patient education
barriers in educational hospital of Urmia University of Medical Sciences, health promotion
and health education practice: Nurse’s perception in China, assessment of attitude and
practice associated factors towards palliative care among Nurses, Nurses roles in health
promotion practice, critical care Nurses knowledge, attitudes and practices of oral care for
patients with oral intubation, Nurses knowledge, attitude and practice regarding provision of
sexual health care to cancer patients, knowledge Attitudes and practices of Nurses toward
cervical screening, knowledge, attitude and practice of family planning among Nurses. The
reviewed literature shows that patient teaching is an integral part of Nursing job. Two theories
of knowledge, attitude and practice (KAP) by Ibrahim Badran and learning Theory by Carl
Ransom Rogers were reviewed to provide a framework for this study. Badran’s theory shows
that knowledge, attitude and practice constitute a triad of interactive factors characterized by
dynamism and unique interdependence. Carl Ransom Rogers theory of learning showed that
cognitive knowledge that is not applied into use is useless and meaningless. The empirical
literature reviewed, revealed that there is paucity of literature on knowledge, attitude and
practice of patient teaching by Nurses in Nigeria.

25
 CHAPTER THREE
METHODOLOGY
3.0 INTRODUCTION This chapter presents the research design, area of study, population
of the study, sample and sampling technique, instrument for data collection, validity of
instrument, reliability of the instrument, ethical consideration, and procedure for data
collection, method of data collection and method of data analysis.
3.1 Design of the study A descriptive survey design was used for this study. The descriptive
survey approach design is based on on-going event. This design was successfully used by
Osuala, Anarado, Nwazuruoke, Okpala and Okafor(2013) in a study of knowledge, attitude
and barriers to Nursing entrepreneurship among Nurses in South East of Nigeria. The
descriptive design is considered most appropriate for this study because the purpose of the
study is to observe, describe and document the characteristics of phenomena of study in their
natural setting at the time of study.
3.2 Research setting
The setting for the study is sir Yahaya memorial hospital, was carried out to understand the
attitude and practice of patient teaching among Nurses in Sir Yahaya memorial Hospital
Birnin Kebbi, Kebbi State.
Sir Yahaya memorial Hospital was located in the centre of Birnin Kebbi town opposite to Eco
bank, near malaria control centre, and all roads leading to the hospital are motor able, this
make it very accessible. The hospital was established in 1952. It was commissioned in
December 1952 as a general hospital with three ward (3) maternity unit, males and females
ward.
The hospital is over 290 capacity bedded facility and it's headed by chief medical doctor
(CMD), Majority of the doctors, nurses and orderlies are indigenes of the state At the time of
commissioned the hospital had only one medical officer and few staff Nurses, since then it
has continue increasing in size, complexity and undergone series of administration reforms
via various edicts. The hospital was established to provide secondary health care services to
the public in and around of the town.
Birnin Kebbi today as mainly civil service based with few industries, although some
inhabitants still perform the traditional occupation of the peoples, which include farming,
fishing, poultry and blacksmithing.

26
The hospital today is improving receives many cases of various conditions because of
development and advancements, now Sir Yahaya Memorial Hospital have the following units
Accident and emergency unit, SOPD, MOPD, male surgical Ward, male medical ward,
pediatric surgical ward, pediatric medical ward, females ward, dental unit, dialysis unit,
medical records unit, theatre department, laboratory department, physiotherapy unit, males
and females amenity ward, and maternity unit.
On a monthly basis the Hospital Record over 5700 cases, admit 160 patients, 91 surgeries and
200 deliveries. Mortality rate is 4 percent; It has 34 resident doctors, 29 visiting doctors and
210 nurses. The vision is declining due to its old building. Hope rises for the hospital late last
year when the commissioner for health, Alhaji Umar Usman Kambaza after the state
executive councils meeting announced that government has decided to spend 2 billion to
renovated and expand 13 of its general hospitals.
Sir Yahayya memorial hospital is the only tertiary health institution owned by kebbi state
government which covered referred cases from all general hospitals in the state. It also served
as training health facility for students from College of Nursing Science Birnin Kebbi, School
of health technology Jega and Waziri Umar Polytechnic Birnin Kebbi.
3.3 Target Population The target population for the study consisted of all the nurses
working in Sir Yahaya Memorial Hospital. They were chosen because they are directly
involved in patient care. It comprises both males and females nurses. The total number is two
hundred and Ten (210) but eighty four Nurses (84) were used for the study.
3.4 Sample calculation: The sample size for this study comprised eighty four (84) nurses.
This sample was drawn from SirYahaya Memorial Hospital randomly selected from various
unit of sir yahaya memorial Hospital. The sample was determined using Nwana (1981) in
Akpabio and Ebong (2010) suggestion. Nwana suggested that if the population is a few
hundred, a 40% or more sample will do; if many hundreds a 20% sample will do; if a few
thousands a 10% sample will do and if several thousand a 5% or less sample will do. In this
study, 40% of the total population was used in order to get a representative of the entire
population.
There for 40% of 210 is 40 x 210/100=84

27
3.5 Sampling technique Simple random sampling procedure was employed to select the
some of the nurses from various hospital units in Sir Yahaya Memorial hospital Birnin Kebbi.
In order to select the 84nurses, stratified, random sampling procedure was used to select the
nurses from the various units in the hospital for the study. The Nurses from the hospital were
first of all stratified into cadre. Then, they were proportionately selected according to their
numbers and cadres. Inclusion Criteria include: willingness to participate in the study, nurses
must be working in the clinical area (i.e wards and clinics).
3.6 Instrument for Data Collection Data were collected using questionnaire tagged
Attitude and Practice of Patient Teaching among Nurses in Health Institutions,
questionnaire (KAPPTQ) developed by the researcher. Questions were generated from
reviewed literature guided by the objectives set for the study. The instrument has two sections
A and B. Section A comprised questions on social demographic data of the respondent.
Section B comprise data on what is the attitude of nurses towards patient teaching, do nurses
practice patient teaching, which strategies and type of patient teaching do nurses adopt, what
are the challenges do nurses encounter in patient teaching? Items covering Nurse’s attitude
and practice of patient teaching. Both open and closed ended questions and four point
modified liker-type scale ranging from “strongly disagree” (1) to strongly agree (4) on
one subscale. These items were generated from reviewed literature based on the objectives
of the study.
3.7 Validity of the instrument: The face and content validity were carried out by the project
supervisor and two senior lecturers in the Department of Nursing, Kebbi state college of
nursing sciences. They examined the generated items in line with the stated objectives and
modifications were made on the items. All modifications were effected as suggested in the
items to structure the final copy used for data collection.
3.8 Reliability of the instrument: In order to establish the reliability of the instrument,
after effecting corrections and modifications suggested by the supervisor in the
department, a testing of the questionnaire was carried out. Copies of the questionnaire
were administered once to 43 Nurses working in Kebbi Medical Center Kalgo representing
10% of the sample, the data will be retrieve within 24 or 48 hours, hopping that the feedback
that will be certain, will be the same with that of the questionnaire that will be distributed to

28
the target population when retrieved back in order to ensure it reliability.
3.9 Method for Data Collection: Three research assistants were trained on the purpose
and objectives of the study and how to collect data using the instrument. With the help of the
three research assistants, the researcher then administered the questionnaire to nurses who
met the inclusion criteria. The three shifts were covered and Nurses who gave their consent
were given an explanation on the study, advised on their rights including confidentiality of
personal data and assured that their participation would not affect their promotion. The
consenting Nurses were each given a copy of the questionnaire to fill in their wards. Some of
the questionnaires were collected same day while others were collected later through
the chief nursing officers of each ward after successfully filling them. Data collection
lasted for a period of ten weeks partly because two hospitals were involved in the study and
partly because respondents who misplaced their questionnaire were given another copy to
respond to. This prolonged data collection period.
3.10 Methods of data analysis: the data analysis to be used for this research work will be
basic statistical method of simple frequency stable, simple bar chart, figures, percentage and
tables which Will be used to present information based on the responses that would be
received from the respondents. The data on attitude and practice of patient teaching were
analyzed descriptively using frequencies and their percentages. Attitude and practice were
categorized into: 90-100% (excellent), 70-89% (good), 50-60% (moderate), 49 and below
(poor). The data collected on attitude of nurses to patient teaching was based on 4-point
modified liker type scale ranging from “strongly disagree” (1) “disagree”(2) “Agree” (3)
to “strongly Agree” (4) and analyzed item by item using means and standard deviations.
3.11 Ethical considerations: The study was conducted after ethical clearances were obtained
from the Health Research Ethics committee of Sir Yahaya Memorial Hospital. A written
administrative permit to carry out the study in the Nursing services department of the hospital
were also obtained. All the study participants were fully informed of the study, assured of
anonymity and confidentiality of their information and informed verbal consent was obtained.

29
 CHAPTER FOUR
RESULTS
4.0 INTRODUCTION
This chapter present and analyze data collected through questionnaire conducted in the course
of the research study.
The data presentation is done with the use of statistical approach this chapter gives an
interpretation of data collected from the respondents which involved nurses working in sir
yahya memorial hospital birninkebbi. The total number of 84 questionnaires was distributed
to the respondents of which 79 were retrieved. Therefore, the analysis will be based on these
respondents.
The information given from section of the questionnaire is interpreted using simple bar chart
and pie chart while section b interpreted using frequency table and percentage.
SECTION A
Figure 4.1 Showing Information On The Age Of The Respondent

100
90
80
70
60
50 Frequency
percentage
40
30
20
10
0
20-30 31-40 41-50 51 and above

The above figure shows that about 70 (88.6%) of the respondents aged between 20-30years,
8(10.1%) aged between 31-50years and 1(1.3%) aged between 41-50 while 51years and
above their is no participants.

Figure 4.2: showing the information on unit/ward of the respondent

30
 30

25

20

15 Frequency
Percentage
10

0
MSW MMW FAW MAW Maternity Paediatric Female A&E
Ward ward unit

the above figure shows the various unit/ward of the respondent where by male surgical ward
(msw) having a frequency of 17 (21.5%), male medical ward (mmw) having frequency of 6
(7.6%), female amenity (fmw) having a frequency of 8 (10.1%), male amenity ward (maw)
having frequency of 7 (8.9%), maternity unit having frequency of 7 (8.9%), pediatric ward
having frequency of 10 (12.7%), female ward having frequency of 20 (25.3%), a&e unit
having frequency of 4 (5.1%), which gives a total number of 79(100%) respondents.

Figure 4.3: showing information on gender of the respondent

31
 80

70

60

50

40 Frequency
Percentage
30

20

10

0
Male Female

The above figure shows the gender of the respondent whereby female having the highest
frequency of 54 (67.1%) and men having the lowest frequency of 26 (32.9%)
Figure 4.4: Showing Information on Marital Status of the Respondent

Percentage
Single Married Divorce

38%

62%

The above figure shows that the marital status of the respondent whereby single having the
highest frequency of 49 (62.0%), married having frequency of 30 (37.9%) while the divorce

32
having zero frequency.

Figure 4.5: Showing Information on Qualification of the Respondent

70

60

50

40

Frequences
30
Percentage

20

10

0
RN

g
g

r
he
in
in

in
/R

rs
rs
rs

Ot
RN

Nu
Nu

Nu
D

SC
C
BS
PH

33
the above figure shows the qualification of the respondent whereby Rn having the highest
frequency of 47 (59.5%), Rn/m having frequency of 21 (26.6%), Phd nursing having
frequency of 3 (3.8%), Bsc nursing having frequency of 8 (10.1%), Msc nursing having zero
frequency and also others having zero frequency.

Figure 4.6: Figure Showing Information on Cadre in Nursing

35

30

25

20
Frequency
15 Percentage

10

0
DDNS ADNS CNO ACNO PNO NO1 NO2

The above figure shows information on cadre of the respondent whereby no2 (staff nurse)
having the highest frequency of 26 (32.9%), no1 (nursing sister) having frequency of 19
(24.1), Pno having frequency of 13 (16.5%), Cno having frequency of 16 (20.3%), and
having frequency of 1 (1.3%) and Ddns having frequency of 4 (5.1%).

34
Figure 4.7: showing information on years of working experience

Year of working experience

1-5 years 6-10 years 11-15 years 16 years and above

18% 0%

19%

63%

the above figure shows the year of working experience of the respondent whereby 1-5years
having the highest frequency of 43 (54.4%), 6-10years having frequency of 13 (16.5%), 11-
15years having frequency of 12 (15.2%) and 16year and above having frequency of 11
(13.9%).
SECTION B
Table 4.8; showing information on nurse’s attitude to patient teaching

35
S/N Items UD DA A
N(%) N(%) N(%)
1. As a nurse I view patient teaching as a core 5(6.3%) 4(5.1%) 70(88.6%)
responsibility for nurses
2. I value my teaching role as a nurse 3(3.8%) 4(5.1%) 72(91.1%)
3. I like teaching patient 8(10.1%) 4(5.1%) 67(89.8%)
4. I see patient teaching a waste of time 9(11.4%) 69(84.8%) 3(3.8%)
5. I do not allow any nursing duty to prevent 12(15.2%) 13(16.5%) 54(68.4%)
me from teaching patient
6. To make way for teaching patient, I try to be 6(7.6%) 2(2.5%) 71(89.9%)
friendly to my patient by introducing myself
to them on admission
7. I usually assess patient on admission to 9(11.4%) 7(8.9%) 66(79.7%)
assess their learning need
8. As a habit, I read patient folder to assess area 4(5.1%) 10(12.7%) 65(82.3%)
where teaching is required
9. I always engage in extensive reading of my 8(10.1%) 8(10.1%) 63(79.7%)
patients different condition to increase my
knowledge as to give first hand information
to the patients

The above present information on attitude of nurses towards patient teaching whereby most
of the nurses have positive attitude to patient teaching, the majority of the respondents agreed
with above listed items except for the item showing information about seeing patient teaching
as waste of time where most of the respondent disagreed.
Table4.9: Showing information on practice of patient teaching
Items Frequency Percentage
Engaging in patient teaching
Yes 65 82.3%
No 14 17.7%
Frequency of engaging in patient teaching
Once weekly 9 11.4%
Twice weekly 5 6.3%
Daily 20 25.3%

36
 Monthly 5 6.3%
PRN 40 50.6%
Special time allocated to patient teaching
Yes 24 30.4%
No 55 69.6%
Results on the above table show responses on practice of patient teaching. as regards practice
of patient teaching, majority 65 (82.3%) of respondents indicated that they engage in patient
teaching, while 14 (17.7%) indicated that they do not practice patient teaching. however, this
implies that nurses regard patient teaching as core nursing responsibility and hence there is
good practice of patient teaching by nurses within the institution.

Table 4.10: showing information on strategy and method of patient teaching Adopted by
Nurses.
Items Frequency Percentage
Method of patient teaching used often
Planned (formal/structured method) 3 3.8%
open method 66 83.5%
Unplanned (informal) method 10 12.6%
Approach to patient teaching
Nurse initiated approach 56 70.9%
Patient initiated approach 23 29.1%
Family initiated approach 0 0%
Strategy for patient teaching
The nurse must arrange for a favorable and 13 16.5%
positive climate for learning
The nurse mustset clear cut objectives and 47 59.5%
purposed for patient learning
the nurse must organize the learning 3 3.8%
resources and make it available for patient
learning
the nurse must balanced intellectual and 16 20.3%

37
 emotional component of learning, share
feeling and thought with learners in a
democratic way
Environment for teaching patient
Bedside 45 56.9%
During ward round 26 32.9%
In the clinic 8 10.1%
Method of patient teaching
Planned method 45 56.7%
Unplanned method 34 43.0%
the above table show on how often nurses used various method of patient teaching, open
method present about 66 (83.5%) while 17 nurses used planned and unplanned method of
patient teaching,, on approach to patient teaching about 56 (70.9%) nurses used nurses
initiated approach, and majority of nurses set cut objectives for learners, most of the nurses
teaches patient at the bedside and the majority used planned method for teaching patient.

Table 4.11 showing information on method used in teaching adult and children
Items Frequency Percentage
Method used in teaching adult
patients
Discussion method 50 63.3%
Printed and audiovisual material 10 12.3%
Computer assisted planning program 3 3.79%
Modeling and role play 5 6.3%
Demonstration/stimulation 1 1.26%
Lecture method 4 5.1%
Questions and answer session 6 7.59%
Tools used for teaching children
Story books 10 12.7%
Dolls 3 3.8%
Puppet play 8 10.1%
Health fair 13 16.7%

38
 Closed method 45 56.9%
Documentation of patient teaching
Yes 26 32.9%
No 53 67%
Evaluation of patient teaching
Yes 30 37.9%
No 49 62%
Special chart for patient teaching
Yes 7 8.9%
No 72 91.1%

Document their evaluation of patient teaching, 26(32.9%) said that they do so always;
53(67%) of them said didn't document patient teaching.sometimes; 38(25.7%) of them said
rarely.
Finding of the study revealed that majority of the nurses use the following teaching methods
when teaching patients in this rank order: “discussion method” (one-to-one/group
discussion) ranked highest in the teaching methods used by nurses. Discussion method is an
earnest conversation on one-on-one basis, a group of patient’s familiar and health care
providers. The nurse’s preference for this teaching method may be traced to the nature of the
patient that they care for. when a patient requires particular information that is pertinent to
him, the best option for the nurse is to special chart for patient teaching about 72 (91.14) of
the respondents said no while 7 (8.86%) of the respondents said yes, most of the respondent
used discussion method for teaching adult patient and storybooks for children.

39
CHAPTER FIVE
DISCUSSION OF FINDINGS
5.0 INTRODUCTION
This chapter discusses the major findings of the research work with regard to the set
objectives and hypothesis. Included here also are conclusion, limitation of the study,
recommendations, suggestion for further studies and summary of this research work.

5.1 Nurses attitude towards patient teaching

The study revealed that nurses from the institutions of study have positive attitude towards
patient teaching. The reason for the above finding may be attributed to the fact these nurses
regard patient teaching as their core duty. This findings is in agreement with the report of
Oyetundeet. al, (2015) who reported that nurses used in their study had positive attitude
towards patient education. However, this finding of this study on attitude towards patient
education contrasted with the findings of Aghakhaniet. al, (2012) on a similar study who
reported that most nurses used for the study believed that patient education was not their
duties. Also, Muttappallmalet. al, (2010) in his study on attitude and practice of nurses in
imparting breast self examination to women reported that majority (90.3%) of the nurses had

40
positive attitude in providing knowledge regarding risk factors of breast cancer and the
purpose of performing breast self examination.
Choose to dose on one-one basis in order to maintain confidentiality and privacy of that
particular patient. But where the nurse wants the full participation of the patients and change
in attitude, group discussion is the best option. Demonstration is next on the rank of the
teaching methods used by nurses. This is not a surprise because most of the procedures
carried out on patients that required that the patient should be conversant with are usually
demonstrated to the patient. Nurses demonstrate to these patients that demonstrated to the
patient. Nurses demonstrate to these patients that have chronic illness and that need to
maintain maximum health at home and reduce frequent hospitalization. Teaching method
which is next on the rank is usually employed by nurses to assess whether the patients can
return the demonstrations which the nurses have demonstrated to them. Nurses use
demonstration/simulation teaching methods when teaching psychomotor skills to the patients
and their families. Lecture method is another teaching method which majority of the nurses
use. Nurses used this method often when teaching cognitive behaviors to patients especially
in the clinics and wards. Findings of the study also revealed that printed and audio-visual
materials were teaching method used by nurses in teaching patients. The reason for using this
method may be due to the fact that what is read, heard and seen is not easily forgotten. The
finding of the study showed that question and answer method were employed by majority of
the nurses in patient teaching. The reason for the use of this teaching method may be for the
nurses to find out the knowledge of patient, evaluate their patient teaching and to correct
misconceptions.

5.2 Strategies and types of patient teaching adopted by nurses

Findings from the study showed that majority of the nurses arrange for a favorable and
positive climate. The reason for this action of nurses may be able to be adduced to the fact
that no meaningful learning can take place in an environment that is noisy and uncondusive
ward or clinic. Findings of the study also revealed that the nurses set clear cut objectives and
purpose when teaching their patients. The reason may be adduced to the fact that setting clear
cut objectives help in selection of right subject matter, clinical experience and right method of
evaluation of the learning process. The study also showed that the nurses balance the

41
intellectual and emotional components of learning and share feelings and thoughts in a
democratic way with patient learner. The reason for adopting this strategy by nurses is that
the patient must be able to focus on things, have stable emotion and be able to think clearer
for learning to take place. This reason is in agreement with the view of Berman et al, (2012)
that physical readiness, emotional and cognitive readiness must exist for effective teaching
and learning to take place. The findings of the study revealed that the majority of the nurses
adopt the unplanned (informal) spontaneous or on the spot method of patient teaching. The
reason for adopting this method is that majority of the nurses does not have time to plan their
patient teaching. Due to work overload, most patient learning needs are detected when nurses
are carrying out one procedure or the other and utilize the opportunity to teach the patient on
the spot. Though it is reasonable to adopt this method instead of not engaging in patient
teaching at all. However, unplanned (informal) spontaneous or on the spot method is fraught
with some mistakes like misinformation. This finding is in agreement with what Quinn
(2010) documented that advance planning is always preferred since it helps to eliminate
errors and omissions.

5.3 Challenges Nurses Encounter in Patient Teaching

Findings of the study revealed that nurses encounter challenges with patient teaching. Most of
the nurses identified stress as the major challenge that they encounter in patient teaching.
They said that patient care is stressful and when patient teaching is added, the whole process
becomes more stressful. Others identified cultural and religious beliefs as a challenge to
patient teaching. This is not a surprise because certain cultures and religious beliefs impinge
on patient teaching. Lack of teaching aids was also indicated by the nurses as a challenge to
patient teaching. The reason adduced to this may be that teaching aids make patient teaching
easy and interesting. The result of study also revealed that lack of time constrains patient
teaching. This may be attributed to the fact that nurses run shifts and patient care takes time
because nurses carryout many procedures on patients in order to complete the patients care
for the shift and as such may not find the time to teach patients. The above findings on the
challenges encountered by nurses used for the study are in agreement with the findings of
Oyetundeet. al, (2015), Aghakhani et. at, (2012) and whitehead et. al, (2012) who reported
that nurses experience, cultural barriers, workplace, insufficient staffing and complexity of

42
patients’ condition were important factors that influence the practice of patient education.
However, no matter the challenges that nurses encounter in patient teaching, nurses should as
a matter of fact make patient teaching a priority care.

5.4 Implication of Findings to Nursing

- Knowledge of Patient Is Important For Nurses
- Reasons for the Knowledge of Patient Teaching Is Also Important
- None Payment of Teaching Allowance to Nurses Affected Their Attitude and Practice of
Patient Teaching
- Most Nurses Do Not Document Patient Teaching
- Most Nurses Do Not Also Know What to Document in the Chart for Patient Teaching
- Nurse’s years of work experience affected patient teaching positively.
- Educational qualification also affected patient teaching positively.

5.5 Limitations of the study

There was great dearth of literature in this area of study. The paucity of literature was
compensated by some relevant literatures from related studies. The researcher encountered
some difficulty among the nurses. Some of the nurses were reluctant to fill the questionnaire
because they claim they do not have time for it. The researcher also encountered huge
financial expenses in carrying out this research.

5.6 Summary of the study:

This study was conducted to determine the attitude and practice of patient teaching among
nurses working in Sir Yahaya Memorial hospital Birninkebbi, kebbi state.
Chapter one (1) deals with introduction which include background of the study, statement of
problem, objectives of the study, significant of the study and operational definition of terms.
chapter two (2) deals with review of literature on attitude and practice of patient teaching as
well as theoretical framework. Chapter three (3) entails with research methodology,
comprises of the research design, study stetting, target population, sampling technique,
instrument for data collection, method of data collection and ethical consideration. Chapter

43
four (4) includes analysis and presentation of data, answering of research questions. Chapter
five (5) entails discussion of finding in relation to other literature, implications to nursing,
summary, recommendations and suggestion for further study.

5.7 Conclusion
Based on the findings of this study, the following conclusions were made:
- Majority of the nurses have good knowledge of patient teaching, on the attitude of nurses
toward patient teaching, there was positive attitude on practice of patient teaching, and
the nurses adopted better method of patient teaching within the institution, there is
significant difference in the practice of patient teaching among nurses with different years
of work experience. The higher the work experience, the better their practice of patient
teaching. However, from the findings of this study the researcher conclude that there is
fair practice of patient teaching among nurses used for the study because majority of them
do not document their patient teaching.

5.8 Recommendations:
The following recommendations were made based on the findings of the study;
• The continuing education unit of both institutions of study should imbibe patient education
• The management of both institutions of study should pay all cadres of nurses teaching
allowance in order to motivate them to teach patients.
• employ more nurses to enable nurses have time to teach patients
• Written standardized patient teaching plan should be introduced in both institutions to
enable nurses teach patients easily
• Management of the two health institution should provide special chart for documenting
patient teaching.

5.9 Suggestions for further studies

44
Based on the findings of the study, the researcher suggests that studies be carried out to:
- Determine “the constraining factors to effective patient teaching.
- Knowledge, attitude and practice of patient teaching among nurses in tertiary health
institutions in Nigeria.
- Knowledge, attitude and practice of patient teaching among nurses working in private
hospitals and primary health care within the state.

REFERENCES,
Aghakhani, N., SharifNia, H., Ranjbar, H., Rahbar, N., &Beheshti, Z. (2012). Nurses attitude
to patient education, barriers in educational hospital of Urmia University of Medical
Sciences. Retrieved on 17th October, 2015 from
http://www.ncbi.nih.gov/pmc/articles/PMC3590688/

Alok, G. Gunvant, V., Anjani, S. Ragini, V. and Anjal, M. (2013). Knowledge, Attitude and
Practice about Cervical Cancer and Screening among Nursing Staff in Teaching Hospital.
International Journal Med. Science Public Health, 2(2): 249-253.

Altschul, B., Sinclair, R. (2005). Psychology for Nurses London: ELBS. Asian Pacific
Journal of Cancer Prevention (2014).

Badran, G. (2012) Konwledge, Attitude and Practice Theory. Retrieved 3rd November, 2014
from http://www.com.ng/G8de=utf-88:oe=utf-88aQ=+8rls=org.

Bestable, S.B., Grambert, P., Jacobs, K. &Sopczy, K. (2011) Health Professionals as

Educators: principles of teaching and learning. Sudbury, MA: Jones &Barlet learning, LLC.

45
Berman, A., Snyder, S.J., Kozier, B., &Erb, G. (2012). Fundamentals of Nursing, Concepts,
Process and Practice. 9th Edition New Jersey: Pearson Prentice Hall.

Brandt, M.J. &Wetherell, G.A. (2012). What attitude are moral attitudes? The case of attitude
heritability. Social psychological and personality science, 3(2) 172-179. Retrieved 10th
November, 2014 from http://journals2.scholarsportal.info.myacess.library.utoron.ca/tmp/
1076631605416514 6404.pdf

Burt, C.U., McGraig, L.F. &Simmon, A.E. (2008). Emergency Department Visits by Persons
Recently Discharged from U.S. Hospitals. National Health Statistics Reports No.6
Hyattsville, M.D.: NationalCenter for Health Statistics.

Akpabio, I.I., Ebong, F.S., (2010). Research Methodology and Statistics in Health and
Behavioral Sciences. Calabar: ECLAT b/2 Services.

Craven, R.F., Hirnle, C.J. (2007). Fundamentals of Nursing. Philadelphia: Lippincott

.
Daniels, R. (2004). Client Education Nursing Fundamental Clearing and Clinical Decision.
Oregon: Delmar Learning.

Ford, S. (2012). Ward rounds should not be neglected. Retrieved 3rd November, 2014 from
www.nursingtimes.net/nursingpractice/specialization/management/ward-rounds-should-not-
be-neglected

Kalliher, F. (2012). Nurses and Patient Education. Retrieved on 17th October, 2015 from
http://www.afdet.net

Kemppainen, V., Tossavainen, K. &Turunen, H. (2013). Nurses role in Health Promotion

Practice: An Integrative Review. Retrieved 5th October, 2014from

46
http://heapro.oxfordjournals.org/content/early/2012/08/10/ heapro.daso.

Kotronoulas, G.,Papadopoulou, C. & Patrick, E. (2009). Nurses Knowledge, Attitudes and

Practice Regarding Provision of Sexual Health Care in Patients withCancer: Critical Review
of the Evidence. Retrieved 5th November, 2014 from
http://www.ncbi.nlm.nih.gov/pubmed/19139928.

Lin, Y.S., Chang, J.C., Chang, T.H., & Lou, M.F. (2011). Critical Care Nurses Knowledge,
Attitudes and Practices of Oral Care for Patients with Endoteracheal Intubation: a
Questionnaire Survey. Retrieved 5thNovember, 2014 from
http://www.ncbi.nlm.nih.gov/pubmed/21812852.

Lal, U.M. (2012). Knowledge, Attitude and Practice of Family Planning Among Nursing
staff. Retrieved 5th October, 2014 from
http://www.popline.org/node/487176#sthash.fexsqvyv.duf.

MAHEC (2009). Teaching at the bed side. Retrieved 3rd November, 2014 from
http://www.oucom.ohiou.edu/fd/monographics/bedside.htm

Martin, J.C. (2012). Patient education. Retrieved 10th Nov, 2013 from
http:www.patienteducationstandford.

MuttappallyMalil J., Sreadharan, J., Venkatramana, M. &Thoma, M. (2010). Attitude and

Practice of Nurses in Imparting Knowledge on Breast Self Examination to Women in Ajman,
United Arab Emirates. Iran J. Cancer Prev. 3(139-44).

New International Webster’s Comprehensive Dictionary of English Language (2013).

Columbia: Trident Press International. Nursing and Midwifery Council of Nigeria
Curriculum Nigeria: NMCN.

Okolie, U. (2012). Problems Encountered by Breastfeeding Mothers in Their Practice of

47
Exclusive Breastfeeding in Tertiary Hospitals in EnuguState South East Nigeria. International
Journal of Nutrition and Metabolism 4(8), 107 – 113, August, 2012.

Osuala, E.O., Anarado, A.N., Nwazuruoke, J.C., Chikodi, I., Okpala, P., &Okafor, C.N.
(2013). Knowledge, Attitude and Barriers of Nursing Entrepreneurship: A Study of Selected
Nurses in South East of Nigeria. West African Journal of Nursing 24(2) 1 – 15 November,
2013.

Oyetunde, M.O. &Akinmeye, A.J. (2015). Factors Influencing Practice of Patient Education
among Nurses at the UniversityCollegeHospital, Ibadan. Open Journal of Nursing. (5) 500-
507 Retrieved on 17th October, 2015 from http://www.scirp.org/journal/ojn

Pramilla, T. (2010). Nursing Communication and Education Technology. New Delhi: Jaypee
Brothers Medical Publishers (P) Ltd.

Quinn, F.M. (2010). The Principles and Practice of Nurse Education. 6th Edition Slovenia:
Karton Ljubljana.

Spear, H.J. (2014). Nurses Attitudes, Knowledge and Beliefs Related to the Promotion of
Breastfeeding among Women Who Bear Children during Adolescent. Retrieved 5 th October,
2014. From http://www.paediatricnursing.org/article/50882-5963(04)00007-7/abstract.

Smeltzer, S.C., Brenda, B.G., Hinkle, J.L. & Cheever, K.H. (2010). Brunner and Suddarth
Textbook of Medical-Surgical Nursing 12th Edition. Philadelphia: Lippincott, William and
Williams Press.

Ward, J. (2012). A guide to patient Teaching and Education in Nursing. Retrieved on 17th
October 2015 from http://www.nursetogather.com/guide-patient- teaching-and-education-
nursing#sthash.wOaVac14.dpuf

Whitehead, D., Wang, V., Wang, J., Zhang, J., Sun, Z., &Xie, C. (2012). Health promotion

48
and health education practice: nurses’ perceptions. Retrieved on 17th October, 2015 from
www.ncbi.nim.nih.gov

49