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| Subtheme | Code | Original phrase | Study |
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| Main theme 1: Strengthen the commitment to patient education |
| Enhancing motivation for patient education | Developing factors that motivate nurses | “To overcome the obstacles of patient education, total commitment is necessary. Nurses must be fully willing to devote the necessary time and energy to patient education and believe in it. Thus, administrators should strengthen institutional commitment by developing motivational factors and facilitating change by every impetus to achieve this milestone.” p.4 | Fereidouni et al. 2019 |
| Motivating nurses | “Regarding motivation, the most important factor from the viewpoint of head nurses was forming motivation to follow the policy and teaching methods to the patient.” p.166 | Ghorbani et al. 2019 |
| Improving nurses’ motivation | “Regarding motivation, the most important factor from the viewpoint of supervisors was Improving the mentality and motivation of nurses.” p.166 | Ghorbani et al. 2019 |
| Appreciating nurses’ efforts in patient education | “In another case, a participant stated that ignoring the nurses who enroll eagerly in patient education is not reasonable. Managers should appreciate their efforts, even with a smile or other acknowledgment.” p.4 | Fereidouni et al. 2019 |
| Improving patient education motivation and performance | “Nurses indicated they did not receive feedback on advice appropriateness and that feedback on caller outcomes would be more helpful than the monitored service indicators.” p.220 | Valanis et al. 2003 |
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| Prioritizing patient education | Considering patient education an important factor | “12.2% of the nurses agreed with the viewpoint that if the managers did not consider patient education to be an important factor they should also not be so concerned about it.” p.234 | Vafaee-Najar et al. 2012 |
| Considering patient education a priority | “The participants stated that all stakeholders should consider patient education a priority and take measures toward improving education. One participant mentioned: “A lasting change requires a general determination. All people in the organization from the top of pyramid to its base should actively participate”.” p.4 | Fereidouni et al. 2019 |
| Focusing on patient education | “The observations also revealed that these supervisors did not pay attention to patient education in their rounds and did not consider this domain to be a priority. The following field note showed that practical involvement of the supervisors was not sufficient.” p.4 | Fereidouni et al. 2019 |
| Dedicating special staff to patient education | “71.4% believed that due to the nurses’ workload in each division, patient training would only be possible if special staff were dedicated to it.” p.234 | Vafaee-Najar et al. 2012 |
| Paying more attention to helping young nurses | “It’s important that managers have an opportunity to help young nurses instead of being overwhelmed by administrative tasks—we’re the ones who should help them. Patient teaching takes time, thus it’s a question of where we’re going to find the time.” p.194 | Bergh et al. 2015 |
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| Supporting patient education | Leveraging nurses suggestions for patient education | “Using nurses’ constructive and effective suggestions for patient education, from the viewpoint of supervisors” p.166 | Ghorbani et al. 2019 |
| Supporting the nursing profession | “Nursing personnel complained about their authority and decision making in hospitals. “Favoritism is corrosive. Desecration, discrimination, lack of authority, and professionalism are disappointing in our hospital. First of all, we should strengthen our profession and define our territory by choosing a qualified matron, supervisors, and nursing personnel”.’’ p.4 | Fereidouni et al. 2019 |
| Getting interested and involved in supporting patient education | “A total of 214 nurses responded to the supplementary open-ended item regarding perceptions of managerial support in nurses’ PE. Five categories emerged: offer of professional competence development, allocated time, available room for teaching, available working tools and interested and involved managers.” p.761 | Bergh et al. 2012 |
| Providing consulting options for nurses executing patient education | “One nurse observed that “I am not trained to deal with suicidal patients and yet, after hours, I am the only one available in the system to deal with this member.” Although she did have access to the on-call physician or could refer the patient to outside services, she still felt unsupported. In the medical offices, nurses could consult with an on-site physician, pharmacist, or supervisor.” p.220 | Valanis et al. 2003 |
| Valuing and supporting the nursing advice role | “Nurses expressed varying perceptions of the extent to which the healthcare system valued and supported the nursing advice role. One medical office nurse stated: “I wonder how much advice nurses are actually valued. If there is a staff shortage in the clinic, we are always the first ones pulled”.” p.221 | Valanis et al. 2003 |
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| Main theme 2: Ensure the necessary resources for patient education |
| Creating facilities for patient education | Ensuring adequate working conditions | “Managers regarded themselves as responsible for creating the necessary conditions for nurses to conduct their daily work.” p.194 | Bergh et al. 2015 |
| Creating room and facilities | “The importance of barriers to patients’ education, the most important factor from the perspective of head nurses was the creation of facilities and classes for patient education (video-internet-lag).” p.166 | Ghorbani et al. 2019 |
| Facilitating patient education work | “There was a desire for external parties to study the managers’ work situation to help them facilitate nurses’ patient education work: “We’re running around and an outsider would surely ask: Why are you doing that?”.” p.196 | Bergh et al. 2015 |
| Providing room to conduct patient education | “We need a quiet room in our wards for patient education to enhance its effectiveness. Concentration in a noisy environment is impossible for patients.” p.5 | Fereidouni et al. 2019 |
| Providing facilities to conduct patient education | “We need some facilities (such as video, TV, video software, and so on) to show various educational films on patient diets and medications while patients are in beds in their own rooms.” p.5 | Fereidouni et al. 2019 |
| Budgeting | “The managers were powerless as professionals in relation to their superiors when budgeting was discussed: “‘We’re virtually up against the wall when we have to explain our deficits”.” p.196 | Bergh et al. 2015 |
| Implementing standardized patient education forms | “From the viewpoint of head nurses, included introducing standard forms of education to the patient provided by health Ministry (3.88 ± 0.97), while it was being aware of the actual and potential capabilities of nurses (3.91 ± 0.79).” p. 166 | Ghorbani et al. 2019 |
| Designing forms for patient education | “The participants stated that having a specific form for patient education was necessary. They mostly mentioned that the current forms that were used in the hospital were obligatory for patients and quite time-consuming to complete. Thus, they recommended designing appropriate forms to improve patient education.” p.4 | Fereidouni et al. 2019 |
| Developing patient education leaflets | “In Dutch hospitals on the program level of patient education, there are specialized nurses with important roles in patient education for several patient groups. Dutch hospitals have a large number of patient leaflets on treatments that are developed within the hospital.” p.6 | Albada et al. 2001 |
| Managing patient education materials | “Most Flemish hospitals have little organization of patient education on the organizational level. The editing of patient information leaflet is an important activity on the organizational level. This task is generally among the responsibilities of a general communications officer.” p.7 | Albada et al. 2001 |
| Developing patient education leaflets | “The hospital developed patient education leaflets for diabetes and cataract patients. Policy on when to give face-to-face information and leaflets is present for education with diabetes patients.” p.7 | Albada et al. 2001 |
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| Managing human resources | Managing resources and environmental conditions | “Altogether 50 respondents described problems related to patient education on their wards. First, patients’ poor condition in terms of lack of insight and poor motivation was perceived most frequently (n = 33) to hinder the patient education. Second, a lack of staff resources (n = 25) meant that there was not sufficient staff on the wards and they were not motivated or competent to carry out patient education. Third, the discrepancy in the procedures (n = 17) concerned the unplanned and short treatment periods and lack of patient education instructions. Fourth, poor operational conditions (n = 9) were described.” p.337 | Hätönen et al. 2010 |
| Coping with tight nursing schedules | “A typical description of the connection between available resources and nurses’ patient education work is provided in the following quotation: “It mustn’t cost anything. We struggle with the tight nursing turnarounds where everything has to be done incredibly quickly. We might have to discharge 6-7 patients every day and it’s almost like a conveyor belt, but what kind of information do they get? There used to be a discharge meeting, at which the patient could ask the physician and the nurse questions but that rarely happens today. When the patient asks questions in connection with discharge, the nurse often says—yes but you saw the physician” [in the nurse’s opinion the patient should have asked the physician at the discharge meeting].” p.196 | Bergh et al. 2015 |
| Requesting nurses to provide patient education | “17.6% of the managers also believed that “Due to the high volume of responsibilities expected from nurses, requesting them to provide a patient education service is unrealistic”.” p.234 | Vafaee-Najar et al. 2012 |
| Managing shifts | “Considering the position of participatory management, the most important factor from the perspective of head nurses was the coordination in relationship and coordination of trainers in different shifts.” p.166 | Ghorbani et al. 2019 |
| Managing available resources | “Other obstacles to the development of patient education were that nurses often changed workplaces and that available healthcare resources were reallocated and used for training.” p.196 | Bergh et al. 2015 |
| Coping with a shortage of nurses | “I think that patient education falls through the cracks due to the high workload in the hospital. The nursing shortage is really a crisis. When I have seven patients in each shift, there is no chance left for patient education.” p.5 | Fereidouni et al. 2019 |
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| Educating and training | Educating and training new nurses | “Participants stated that newly graduated students were novices and that they started working in hospitals without experience. Thus, these new nurses needed to understand the importance of patient education and be thoroughly trained in this regard. One participant stated, “Frequent in-service education is recommended for nurses to improve their knowledge to educate patients efficiently”.” p.5 | Fereidouni et al. 2019 |
| Improving training for staff | “Less than half of the (45%) respondents reported that the nurses had sufficient professional education to deliver patient education interventions, whereas sufficient on-the-job training for staff had been poorly realized.” p 337 | Hätönen et al. 2010 |
| Providing opportunities for professional growth | “Previously, nurse educators participated in students’ caring activities. Caring conversations created conditions for nurses to reflect over their own care and patient education, thus helping them grow in their profession. The managers stated that it was necessary for nurses to have time for reflection: “to advance from novice to expert” (FG, 2), something that was missing today.” p.196 | Bergh et al. 2015 |
| Offering professional competence development in patient education | “Primary care managers offered professional competence development in PE significantly more frequently than in MC/HC.” p. 761 | Bergh et al. 2012 |
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| Main theme 3: Enhance patient education policies |
| Monitoring and supervising patient education | Giving positive and negative reinforcement | “A head nurse said, “Managers should use carrots and sticks at the same times. Frequent punishment will not work”.” p.4 | Fereidouni et al. 2019 |
| Monitoring nursing tasks | “After repeated prompts to provide a more detailed description of the prerequisites for patient education, the managers quickly moved to general descriptions of nursing tasks that have to be monitored, such as documentation and liaison.” p.197 | Bergh et al. 2015 |
| Supervising the process of patient education | “On the other hand, they are the line managers in hospitals who directly supervise the processes; therefore, they know and can judge the process of patient education in their wards.” p.2 | Seyedin et al. 2015 |
| Ensuring quality | “The managers have control over routine matters as well as the power to decide the content, which implies quality assurance.” p.197 | Bergh et al. 2015 |
| Documenting | “The juridical discourse contained several controlling factors that restricted the nurses’ time available for patient education. By referring to the public regulations in health care, the managers expressed that nurses must exercise control and be controlled. The regulations require documentation. “I’m not exactly terrified but “I have to document everything to cover my back” is frequently heard”.” p.197 | Bergh et al. 2015 |
| Monitoring the implementation of patient education | “The participants acknowledged that including the implementation of patient education in annual personnel evaluations would be effective. Another participant also mentioned that “annual supervision at a specific time is not effective. Supervision should be intrusive and frequent”.” p.4 | Fereidouni et al. 2019 |
| Paying attention to how patient education is monitored | “Nurses reported aspects of the practice environment that limited their professional practice, impaired their optimal functioning, and contributed to low morale. These included the extent to which they were required to adhere to protocols, supervisor emphasis on time targets (eg, call time, talk time, and documentation time), and monitoring to ascertain that required questions were asked of all callers.” p.221 | Valanis et al. 2003 |
| Managing operations | “Hence, they expressed a desire to have power to manage operations.” p.196 | Bergh et al. 2015 |
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| Revising job description | Reducing the number of tasks of managers | “Constant changes constituted an obstacle to the development of the patient education provided by nurses, and all professional categories had tasks that were beyond their professional competence. The managers had no time. Only the most important administrative tasks were performed, and the rest were ignored: “It depends on how you sell it and your own opinions. I really resist any change. we’re fire fighters, we only have time to man the ward. We can’t reorganise things and think afresh. We have done that; now we have to reduce the number of tasks”.” p.196 | Bergh et al. 2015 |
| Updating the description of head nurses’ tasks and responsibilities | “All of the head nurses mentioned that their job description needed to be revised by their hospitals based on new accreditation criteria. They stated that they were currently busy with the new accreditation criteria and standards, which led to their unintentional neglect of nursing care obligations such as patient education.” p.4-5 | Fereidouni et al. 2019 |
| Clarifying nurses’ job descriptions | “Managers commented that patient criticism about not receiving or understanding information would decrease if nurses devoted more time to patient teaching: “They do a whole lot of the physicians” tasks these days. Many physicians don’t prescribe tests—the nurse has to do it in our computer system and decides which tests should be performed. A lot of time is spent changing prescriptions for medications that are completely off the wall. if the nurse didn’t have to do these medical tasks she’d have more time for patient education”.” p.197 | Bergh et al. 2015 |
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| Developing and implementing policies and procedures | Providing legal and professional information on patient education | “Informing nursing staff on legal and professional issues regarding avoiding education to patients from the viewpoint of supervisors.” p.166 | Ghorbani et al. 2019 |
| Developing education policies | “Policy on face-to-face education is present in Dutch hospitals for some patient groups and is developed in multidisciplinary projects supported by a patient communications officer.” p.6 | Albada et al. 2001 |
| Coordinating projects | “Some hospitals have quality projects in patient education. The communications officer is a central person within this network. The coordination of the network, editing patient leaflets, and coordinating quality projects in patient education are among the responsibilities of the communications officer. Until recently these were the tasks of a patient education coordinator, but this function no longer exists.” p.7 | Albada et al. 2001 |
| Implementing ombuds services in hospitals | “In 2002, the Law on Patient’s Rights stipulated that every hospital should have an ombuds service [17]. The ombuds services have now been implemented in hospitals. The law also set out guidelines for patient education but these guidelines do not greatly influence practice.” p.7 | Albada et al. 2001 |
| Implementing programs | “Medical Treatment Contract Act (WGBO) has made it the duty of healthcare workers to provide their patients with information [11–13]. This law greatly stimulated the policy and practice of patient education in hospitals and heralded the start of a broad implementation program that focused on informed consent.” p.6 | Albada et al. 2001 |
| Lobbying | “This patient organization has a stimulating influence on the organization of patient education through lobbying and quality projects in health care.” p.6 | Albada et al. 2001 |
| Promoting patient education through international organizations | “The World Health Organization (WHO) promotes patient education through the Health Promoting Hospitals project.”
“The European Association for Communication in Healthcare (EACH) aims to stimulate research and education on communication in healthcare.”
“The European Association for the Study of Diabetes (DESG) provides advice and best practices on patient education in diabetes.” p.8 | Albada et al. 2001 |
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